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International Comparisons of Health and Wellbeing – a 2018 report for the Royal College of Paediatrics and Child Health (RCPCH) and the Nuffield Trust – assessed 14 OECD countries, including the UK. It found UK outcomes had improved across nine of 16 child health areas in the past decade, including reductions in the rate of infant deaths.
Are we doing well overall internationally?
There are things we do pretty well, but there are not many areas in which we are world-leaders. There are some areas we do extremely poorly in. Despite all the issues with the MMR vaccine in the 1990s, immunisation rates had been steadily improving, but have started slipping in the past couple of years.
Our breastfeeding rates are among the lowest in the world and we have considerably more overweight or obese children than the average for developed countries.
What has gone wrong?
The timing is not coincidental. There was welcome recognition five to ten years ago that investment in early years health was really important. In 2010, there was a big fanfare about increasing the numbers of health visitors and strengthening midwifery services, but now very quietly they have just been cut and cut away. The loss of public health services, starting about five years ago, has correlated directly with things getting worse. So, things are not too rosy.
Which issue is of most concern at the moment?
Our child mortality rates used to be among the best in Europe, but they rose in the past two years for the first time since at least the mid-1980s. Rises in infant mortality rates simply do not happen in developed countries, so this is a huge alarm bell for our society.
What does it mean?
Infant mortality tells us about the health of babies but is also inextricably linked to the health of mothers. It asks us what we are doing for their nutritional status and how we are supporting them to look after themselves both physically and mentally, pre-, peri- and post-natally.
This is dependent on strong public health provision, and this is where health literacy and education are so important. We have to ensure women giving birth can afford to get proper nutrition and access healthy lifestyles.
How can we do that?
It all comes down to societal issues of austerity and poverty. Take any health issue and the gap between rich and poor is tangible. Ten years ago, a baby born to a mother in the lowest socio-economic class was 60 per cent more likely to die in its first year than one born to a mother in the highest. Now it is 100 per cent. The problem is getting worse as society gets more unequal.
Will children’s services improve under the Government’s Long Term Plan for the NHS?
It’s great there is a special section on children. I think the Five Year Forward Viewin 2014 only mentioned the word ‘children’ about five times. Young people were not on the agenda at all. So, this is a huge step in the right direction. In general, the message is a good one; recognising mental health as a big area to focus on and improving early years investment in maternal care and post-natal health, reducing premature births and low birth weight and improving mental and physical health at delivery.
It is very good on immediate care and good to have a focus on issues such as asthma and diabetes, which affect a number of children.
So, will it be a success?
There is not quite as much clarity on how the funding will be divvied up. Children’s services often just get what is left behind, while the big beasts such as cancer and cardiovascular services gobble up all the resources.
Furthermore, the plans require a workforce that just isn’t there. We don’t have the staff for specialist nursing and neonatal intensive care. We don’t have child psychologists just waiting around ready to walk into post. We have to recruit and retain staff, and with the best will in the world this will take time.
Those are my key caveats. Plus, so much of children’s health is not just about healthcare but investment in green spaces, education and tackling poverty, and all these fall outside the NHS Plan. We can’t lose focus on them; they are actually more important than a healthcare plan.
Are we facing a crisis in children’s mental health?
It’s difficult to say whether there has been a true increase or whether we’re just better at picking it up. The truth is probably somewhere in between. We have always known mental health problems affect young people, with 25 per cent of them starting before the age of 14. The real crisis doesn’t come down to prevalence but a reduction in services.
Lower-level issues such as mild anxiety could be helped by talking sessions with a psychologist in clinics. I have people referred to me for a second opinion on things like mood disorders because they need support to be able to access any onward services. Five or ten years ago they would have gone into available mental health services, but now they are spilling out into my medical clinics and A&E.
More serious problems require admission to an inpatient unit, but we are losing these units and young people are having to travel sometimes hundreds of miles to access them because there simply aren’t enough beds.
So, are you pessimistic about child health overall?
The bigger picture is about poverty and inequality. Some public health cuts have affected young people disproportionately. But there are things we can do. We need investment and a broader lens on the causes of ill-health. It is all amenable to change if we choose to try.
How can the situation be changed?
Two things: a greater political focus on the underlying causes of poor health – poverty and inequality; and undoing the disinvestment in early years public health. In the Netherlands, in the past ten years, there has been a comprehensive plan put in place targeting infant mortality. Their rates were already better than ours, but they wanted to put it top of the political agenda.
They succeeded, and their breastfeeding rates increased as well. So, it is possible. Yes, it needed investment, but they didn’t shy away from that. There is a moral imperative to get this right, and the economic benefit will come later.
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