Similarly, children held in institutional care typically come disproportionately from the most socio-economically disadvantaged strata of society14 and, as such, are likely to suffer disproportionately from health conditions that are more common among disadvantaged groups. These health risks may be compounded by the reasons for the child being in institutional care: for example, where children are in institutional care in relation to experiences of physical, emotional or sexual abuse, the trauma associated with those experiences may increase the risk of mental health problems.15 Children who have been homeless or otherwise suffered neglect prior to entering institutional care may have had limited access to healthcare including vaccinations, and inadequate nutrition, potentially increasing the risk of both communicable and non-communicable disease.16 Children deprived of liberty for notionally therapeutic reasons (e.g., in relation to acute mental illness) by definition suffer from compromised health. However, given the tendency for health conditions to co-occur (e.g., poor mental health increases the risk of obesity),17 it is important to consider the overall health status of children deprived of liberty in these settings, not only the health condition that precipitated their deprivation of liberty. 1.1 The Impact of Deprivation of Liberty on Health The concentration of ill health in places where children are deprived of liberty underscores the salience of another important question: what is the impact of deprivation of liberty on health? In addition to the human rights implications, considered in other chapters of this Study, there are good reasons to suspect that deprivation of liberty might have an adverse impact on the health of children. First, deprivation of liberty is an inherently distressing, potentially traumatic experience and, as such, may have adverse impacts on mental 14 Fred Wulczyn, Robert Gibbons, Lonnie Snowden & Bridgette Lery, ‘Poverty, social disadvantage, and the black/white placement gap’, Children and Youth Services Review, Vol. 35(1), 2013, pp. 65-74; Richard Barth, Judy Wildfire & Rebecca L. Green, ‘Placement Into Foster Care and the Interplay of Urbanicity, Child Behavior Problems, and Poverty’, American Journal of Orthopsychiatry, Vol. 76(3), 2006, pp. 358-66; Lumos, ‘Children in Institutions: The Global Picture’, 1 January 2017, Available at https://www.wearelumos.org/resources/ children-institutions-global-picture/ (Accessed 1 August 2019). 15 Rosana E. Norman, Munkhtsetseg Byambaa M, Rumna De, Alexander Butchart, James Scott & Theo Vos, ‘The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis’, PLOS Medicine, Vol. 9(11), 2012, p.e.1001349. 16 Jennifer Edidin, Zoe Ganim, Scott J. Hunter & Niranjan S. Karnik, ‘The Mental and Physical Health of Homeless Youth: A Literature Review’, Child Psychiatry & Human Development, Vol. 43(3), 2012, pp. 354-375; Angela L. Hudson, Adeline Nyamathi, Barbara Greengold, Alexandra Slagle, Deborah Koniak-Griffin, Farimaz Khalilifard & Daniel Getzoff, ‘Health-seeking challenges among homeless youth’, Nursing research, Vol. 59(3), 2010, pp. 212-218. 17 Merrill Singer, Nicola Bulled, Bayla Ostrach & Emily Mendenhall, ‘Syndemics and the biosocial conception of health’, The Lancet. Vol. 389(10072), 2017, pp. 941-950; Floriana S. Luppino, Leonore M. de Wit, Paul F. Bouvy, Theo Stijnen, Pim Cuijpers, Brenda W. J. H. Penninx & Frans G. Zitman, ‘Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal studies’, Archives of General Psychiatry, Vol. 67(3), 2010, pp. 220-229; Genevieve Gariepy, D. Nitka & N. Schmitz, ‘The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis’ International Journal Of Obesity, Vol. 34, 2009, pp. 407-419. 119