Published by the Nuffield Foundation today (9 December) the evidence review explores how the lives of young children have changed over the last two decades. The review focuses on seven ‘key indicators’ – infant mortality, immunisations, breastfeeding, obesity and overweight, oral health, mental health and emotional wellbeing and respiratory health.
It reveals that while children under five are healthier today than 20 years ago, health inequalities between disadvantaged and advantaged children are increasing, with inequalities also evident between different regions and countries of the UK and different ethnic groups.
According to the review, poverty is a ‘significant’ driver of poorer health outcomes across all seven indicators and has been rising particularly steeply for families with young children.
These health inequalities are ‘being compounded’ by the pandemic, which has led to a spike in rates of childhood obesity, worsening parental and child mental health and reduced health services for children, including a ‘drastic drop’ in health visiting and community paediatric services.
The review highlights a number of ‘key trends’ including:
- Infant mortality - The last five years have seen small but unprecedented increases in rates of infant mortality, which increased three years in a row in England and Wales between 2015 and 2017 and in all four UK nations between 2018 and 2019. The UK’s infant mortality rate is 30 per cent higher than the median rate across EU countries.
- Obese and overweight children – Until the Covid-19 pandemic, rates of obesity and overweight in four- and five-year-olds had remained broadly static since 2005, but they have soared in the last year. In England, the proportion of four- and five-year-olds classified as obese increased from 9.9 per cent in 2019/20 to 14.4 per cent in 2020/21. Around 1 in 7 children are obese and 1 in 20 children are severely obese when they begin primary school.
- Vaccination uptake rates - have increased in the last 20 years but have been falling since 2014. With the 6-in-1 vaccine for one-year-olds, only Scotland and Wales meet the 95 per coverage recommended by the World Health Organisation for herd immunity.
- Breastfeeding – there have been improvements in the proportion of mothers who breastfeed immediately after birth, but rates for those who continue to exclusively breastfeed remain far below recommended levels and are among the lowest in high income countries.
- Dental decay – Over the last 20 years any improvement has slowed since 2014/15.
- Respiratory health – Evidence suggests this is worsening among children. Respiratory conditions are three of the top five reasons children are admitted to hospital.
The review concludes that the health of young children is at a ‘critical point’.
It recommends action on four fronts: a reassessment of whether young children are receiving adequate universal healthcare services; further development of integrated services that meet both the health and non-health needs of young children and their families; action to address child poverty; and research to explore the associations between poor health and place, ethnicity, and level of deprivation.
'The worsening picture on infant mortality, low birthweight and obesity is a major concern.'
Carey Oppenheim, early childhood lead at the Nuffield Foundation said, ‘It is very worrying that after two decades of improvement in young children’s health, progress on some key indicators has stalled or gone into reverse.
'Our evidence shows that targeted interventions and integrated services can make a positive difference in specific areas of children’s health but the worsening picture on infant mortality, low birthweight and obesity is a major concern, with long term consequences for health and wellbeing into adulthood.
'There is such a clear link to levels of poverty and deprivation that action to tackle child poverty also needs to be a policy priority if substantial progress is to be made.’
The Government has been approached for a comment.
