How family friendly is the UK?BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4823 (Published 04 August 2011) Cite this as: BMJ 2011;343:d4823
Before becoming prime minister, David Cameron promised voters he had a “long term vision of making Britain the most family friendly country in the world,” and now The Family Pressure Gauge, published in May 2011, is an attempt by the Relationships Foundation to measure Cameron’s annual progress in “helping families with the pressures they face.”1 This pressure gauge compares official data from the United Kingdom with other European countries. Overall, Britain is judged a bad place to be a child (table⇓).1
Policies that promote a secure family home, a safe school environment, parents’ escape from poverty, and inclusion in local social networks contribute towards maximising the potential wellbeing of every child.2 Unfortunately for population health and wellbeing, millions of British children do not experience such positive environments. In 2007, a Unicef report showed that life was miserable for more schoolchildren in the UK than in other “economically advanced” nations.3 It took a while for the Department of Health fully to grasp the implications of this widespread family misery, but a 2011 strategy prioritised the prevention of mental illness and early intervention for childhood problems.4 The strategy also committed the Department of Health to work alongside the Office for National Statistics in developing better measures of wellbeing and the Office for Civil Society in linking social policy more directly to wellbeing. These partners agreed that wellbeing included individual, family, and neighbourhood dimensions. At the level of primary healthcare, all these dimensions can arise simultaneously—for example, in developing a local children’s centre.5 This overlap is important for future collaborative clinical commissioning and the provision of new services (such as basing health visiting within local authority services).
The Relationships Foundation’s report aims to focus the attention of policy makers on various pressures now experienced by families in the United Kingdom by showing that the UK scores badly, compared with other European countries, on a composite measure. Across 27 countries with overall scores ranging from the best in Norway (pressure only 0.235) to the worst in Romania (pressure 0.524) the UK finishes 24th out of 27, with a score of 0.477. No units are given for the measures on this apparent continuum, which is based on a convenience sample of 25 indicators (“the closest proxies for the Conservative manifesto”), which are unweighted, arbitrarily grouped into four key domains, ranked within the domains, and then reconstituted within the “average” overall score. Although the gauge is based on a wide variety of data, it contains no statistical analysis, which implies that the authors aimed to impress politicians with an avalanche of data, rather than interpret those data to inform specific policies.
There are several difficulties in interpreting the validity of the score. For example, because the score comprises a composite of several unweighted indicators, it is impossible to tell whether the score represents a small proportion of the population with a large number of pressures or a more even spread. Unicef showed that the poorest 10% of UK children who have the least chances in life experience extreme inequalities in resources for education, such as no space at home where they can sit down to do their homework.6 Health inequalities reflect multiple pressures on some families—for example, births to women aged 15-19 is an indicator where the UK ranks 26th out of 27.1 Any realistic policies around teenage pregnancy have to account for deep inequalities; an example would be targeting public health outreach to girls in care.7
The Relationships Foundation’s report also shows that the UK has the highest proportion of children living in workless households in the EU, and highlights several areas that threaten family health, such as the burden of household debt on parents (rank 27/27) and adolescents who get drunk repeatedly (rank 25/27). The report cites five factors that lead to poverty: family breakdown, economic dependency and worklessness, educational failure, addiction, and personal indebtedness. Yet for some reason the public health community has failed to translate these concerns into effective action.8 These pathways are convergent, not independent, as politicians would discover if they listened to young people’s concerns about the social environments in which they now grow up.9 Often young people shrug off specific health risks from their excessive drinking but at the same time express their concern about the bleakness of their life chances.
What needs to happen to improve these rankings? Their publication alone is unlikely to be enough. Nonetheless, if enough health and social care commissioners are stimulated to think again about what makes families flourish,2 and the new collaborative health and wellbeing boards that link local health and social services can integrate input from many experienced professionals, family health might benefit from 2012 onwards.
The Relationships Foundation closes its report with a consultation, and it invites a “conversation” about family friendliness during 2011. There is a list of other measures that might be relevant, such as providing more green spaces. The United Nations Educational, Scientific and Cultural Organization presented a plan to parliament on new green landscapes for a civil society,10 and many parents would welcome more family friendly parks and gardens to enjoy with their children. The consultation ends by seeking some measurable outcome of family friendly policy. This could be a measure of shared resilience within a community. All children experience pressure, but resilience involves “knitting” individual stories into wider connections with people and communities.11 In relation to No Health Without Mental Health, 4 the crucial nature of these connections between individual children and their local social environment has been discussed with Lord Wei and other advisers on the government’s proposed “Big Society” initiative. The big society may have a very short life unless that resilience, rooted across generations and neighbours, promotes the solidarity and altruism needed for it to grow. The minister for decentralisation and cities views “the grace of undiluted altruism” as a vital strand of the big society (www.communities.gov.uk/speeches/corporate/growingbigsociety) but we have yet to see how the planned 5000 community organisers will sustain that strand, if times are hard.
What can the UK learn from other countries that score highly on family wellbeing? In the Netherlands, vulnerable families and communities are monitored over time, with the aim of making effective early interventions that can be coordinated locally. Unsurprisingly, the indices of teenage births and adolescent drunkenness are much lower in the Netherlands than in the UK.1 But this is part of a wider Dutch policy of supporting families. For example, compared with the UK, in the Netherlands more adults are able to adopt flexible working hours (34.9% v 21.4%) and far fewer children experience severe housing deprivation (0.4% v 4.8%).1
Cite this as: BMJ 2011;343:d4823
Competing interests: The author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; WC was active in the Department of Health steering group for No Health Without Mental Health, is a member of a special interest group for parenting, and supervises student research on intergenerational relationships; he has sought advice from fellow members of the statistics users forum (Royal Statistical Society) about the methods used in The Family Pressure Gauge.
Provenance and peer review: Commissioned; not externally peer reviewed.
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