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NHS must prioritise health of children and young people

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1116 (Published 14 March 2018) Cite this as: BMJ 2018;360:k1116

Re: NHS must prioritise health of children and young people

Viner makes a very clear case for urgent action to improve the health of children.(1) Moral, scientific, and economic arguments are put forward. He quite rightly calls for decisive action and adequate resourcing for child health services. The case for action is of course strengthened by the fact that there are effective interventions available to improve child health.

Looking specifically at one topic – accident prevention, there are now evidence based approaches and interventions that can reduce injuries.(2,3) In the past there has been tremendous success in this area; injuries have been prevented and lives have been saved.(3,4) However, significant inequalities still exist. Much more could and should be done to support children and their families.(5,6)

Besides accident prevention there are other important public health areas that need decisive and increased action in infancy and childhood including those of alcohol abuse, breastfeeding, mental health, obesity, and smoking. However, we are not advocating a piecemeal approach. Linking topics together in a child health strategy will have synergistic effects.

In order to improve the health of all children action will be needed in many settings including schools, primary care, and hospitals.(7) In schools the introduction of mandatory relationships and sex education in England is welcome, but this on its own is not enough. A more comprehensive approach is needed. Personal, Social and Economic Education (PSHE) must be made a statutory subject so that all children are taught about all aspects of health. If teachers are to be effective at encouraging and promoting good health, they will need training and support in order to be confident and competent.

Many professionals could be involved in promoting the health of children but there are considerable capacity issues in different settings. Viner quite rightly draws our attention to workforce issues in the community and health services.(1) Similarly, the Social Mobility Commission noted that schools in deprived areas: often struggle to recruit teachers; often lack high-quality applicants; and, have high teacher turnover that can have negative effects on disadvantaged children’s attainment.(8) Problems about GP workforce recruitment have also been raised in relation to areas with high deprivation, where health care needs are greater.(9,10) Together these workforce issues are likely to increase the gap in health between rich and poor children.

In 2017 the State of Child Health report was published which highlighted alarming inequalities in the health across the UK.(11) Just over one year on and it appears that very little has altered.(1,12) Although some small steps have been taken to improve child health they are far from adequate: a bigger vision is required for child health.(12)

What is needed is a long term comprehensive child health strategy that is in line with the Ottawa Charter - a seminal public health document.(7,13) The Charter proposed a radical agenda for public health. In relation to children we should not only be providing them with information and life skills but we should also be creating health promoting environments so that it is easier for them to choose the healthier options.

References
1) Viner R. NHS must prioritise health of children and young people. BMJ 2018;360:k1116

2) Lloyd J et al. Safety Education: Priorities for children and young people – A Manifesto for Action. Welwyn: Institute of Health Promotion and Education, 2015. http://ihpe.org.uk/wp-content/uploads/2015/06/Safety-Education-A-Manifes...

3) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health.2016; 26(5), 194-199

4) Hemenway D. While We Were Sleeping. Success Stories in Injury and Violence, Berkeley: University of California Press, 2009.

5) Public Health England. Reducing unintentional injuries in and around the home among children under 5 years. London: Public Health England, 2018.

6) Public Health England. Reducing unintentional injuries on the roads among children and young people under 25 years. London: Public Health England, 2018.

7) Watson, M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185. https://pdfs.semanticscholar.org/c1b6/3555f6b033effdc0062235adb7bab3de43...

8) Social Mobility Commission. State of the Nation 2017: Social Mobility in Great Britain, November 2017. London: HMSO, 2017

9) Goddard M, Gravelle H, Hole A, Marini G. Where did all the GPs go? Increasing supply and geographical equity in England and Scotland. J Health Serv Res Po. 2010;15(1):28–35.

10) Esmail A, Panagioti M, Kontopantelis E. The potential impact of Brexit and Immigration policies on the GP workforce in England: a cross sectional observational study of GP qualification region and the characteristics of the areas and population they served in September 2016. BMC Medicine. 2017 Nov 16. Available from, DOI: 10.1186/s12916-017-0953-y

11) Royal College of Paediatrics and Child Health. State of child health. 2017. http://www.rcpch.ac.uk/state-of-child-health

12) Modi N. Neena Modi: A bigger vision for child health. thebmjopinion. March 2018. https://blogs.bmj.com/bmj/2018/03/20/neena-modi-a-bigger-vision-for-chil...

13) Thompson S R, Watson M C, and Tilford S. The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education. 2018,56(2), 73-84.

Competing interests: No competing interests

04 April 2018
Michael Craig Watson
Associate Professor in Public Health.
Dr John Lloyd (Past President Institute of Health Promotion and Education, Institute of Health Promotion and Education, http://ihpe.org.uk/).
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA