Nursery World - Prevention really is better than cure

Early intervention is vital for improving the health of children
and young people, and practitioners have opportunities to make a real
difference, say Dr Claire Lemer and Leonora Weil.

Late last year the Chief Medical Officer (CMO) for England, Dame Sally Davies, published her second annual report (advocacy volume), which focused on children, young people and the current state of child health in the UK; it was entitled Our Children Deserve Better - Prevention Pays.

The report was written by experts in the field and looked at all children and young people (up to the age of 25), as well as focusing on those with mental health problems, those with neurodisability, those in the youth justice system and those being cared for by the state. Perhaps most importantly of all, the voices of children and young people were sought, through focus groups and a review of the literature.

WHY CHILDREN AND YOUNG PEOPLE?

The CMO chose to focus on children and young people for a number of reasons. Firstly, because we are increasingly able to show that what happens early in life, and indeed prenatally, has a profound effect on a child's future health. We know that, for example, 'under nutrition' in the womb can have an impact on the risk of heart disease as an adult.

The second reason was because of the variation in child health; in some parts of the country children may have a three times higher likelihood of death than in other parts of the country. This type of data tells us that if we could improve areas performing less well to the level of those doing well, we could really impact on children and young people's lives.

Finally, the CMO was able to show that investing early in child health not only benefits families and the child themselves, but also makes a great deal of economic sense. Prevention actually pays.

WHAT HAVE WE LEARNED?

The report identified many aspects, but four key themes are highlighted here. Firstly, that there is a great deal of evidence to support the importance of early action during times of rapid brain growth and remodelling, which includes both early years and adolescence. The old adage 'prevention is better than cure' really is true in this context. Dame Sally recommended that Public Health England continues to work closely with organisations such as the Early Intervention Foundation to try to deliver this promise.

The second key theme identified was that public health policy should adopt a 'proportionate universalistic approach': this means working to improve the lives of everyone, with proportionately greater resources targeted at the more disadvantaged.

The CMO commended those who work with children, including health visitors and school nurses, who try to achieve this through

programmes such as the Healthy Child Programme. She therefore recommended that the Healthy Child evidence be brought up to date, and the universal provision of free vitamins, including - crucially - vitamin D.

The third theme was about engaging children and young people. The CMO identified how important this was and encouraged the involvement of this group in designing services, for example through the You're Welcome teenage programme, which sets out quality criteria for young people-friendly health services, and to encourage increased involvement by children and young people in health research. Part of this was showing how important it is that staff working with children are trained to communicate and interact effectively with them and their families.

The fourth theme was the need to build resilience. To prevent infection, we immunise; to prevent complex health problems, we need to think of the equivalent to ensure that young people are able to mount appropriate responses against life's challenges.

Other aspects of the report relevant to those working with young people include the need for greater co-ordination, information sharing and integration of care between health professionals and those working with children. Children and young people have said that they want to be kept informed and to have a say in decisions about their care, to have personalised child-friendly care and to be treated with respect.

They also want to be supported through transitional periods of their lives, and to understand their rights and responsibilities, including their rights of privacy and confidentiality.

WHERE ARE WE NOW?

In the six months since the report has been published there has already been progress in a number of areas, including the need to assess the progress on early intervention and prevention and to disseminate the evidence for why this matters (recommendation two) and for the National Institute for Health Research to work towards an evidence base to improve health outcomes for long-term conditions in childhood (recommendation 22). Part of the progress of the report has been to remind us, as Dame Sally Davies said in her summary, of 'how much the health and well-being of children matters to us all'.

HOW CAN YOU HELP?

Those who work with and care for young children are the backbone of the Healthy Child Programme and its delivery. They ensure that children have the best start in life and this report has shown the importance of this not just for individuals but also for society.

Childminders, educators and healthcare staff have the potential to make a big difference to the lives of children and their families every day, whether this is through continued training in age-appropriate care, promoting a healthy life choice, focusing on the whole family, not just the young person in front of them, or through supporting a child to give them that bit more resilience for life.

The CMO's report has helped to encourage the child health community to act together to improve our poor health outcomes.

The report is clear that early intervention matters, and we have an evidence base to support this. The challenge for all of us now is to spread this message and follow it in our working lives.

Dr Claire Lemer is a consultant in general paediatrics at Evelina London Children's Hospital and was the editor of Annual Report of the Chief Medical Officer 2012: Our Children Deserve Better - Prevention Pays.