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UK born children are often worse off than those in other rich countries, report finds

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m849 (Published 04 March 2020) Cite this as: BMJ 2020;368:m849

Linked Opinion

Poverty is having an increasingly detrimental effect on children’s health and wellbeing in the UK

Rapid Response:

Child Health in the UK: we need to help them survive and thrive.

Dear Editor

The Royal College of Paediatrics and Child Health’s (RCPCH) latest report - State of Child health - continues to paint a bleak picture of child health in the UK.(1,2) Health outcomes are particularly poor for children who live in deprived areas. Mental health, breastfeeding, obesity and youth violence are just some of the diverse public health issues that require urgent action.(2)

The fact that the UK is fifth from the bottom among 27 European countries for infant mortality is certainly an area for significant concern.(1) However, it should also be seen as a sign for optimism, improvements are possible, there are effective interventions available. They just need to be prioritized and funded.

In relation to accident prevention for example, there is now a considerable evidence base and effective interventions are available.(3-10) That is why the RCPCH fully supports the recommendations for children and young people outlined by the Royal Society for the Prevention of Accidents (RoSPA) within their national strategy.(7) If the interventions were funded then the strategy could have a significant impact on preventable causes of ill health, early deaths, and on our overstretched health service.(7)

There has been some progress, from 2020 it is compulsory for all schools to teach the health and relationships aspects of Personal, Social and Health Education (PSHE).(11) Of concern however, is that so far teachers have not been given sufficient training and support to implement this policy. In addition, there are profound workforce issues in this sector including recruitment and retention.(12) Schools in disadvantaged areas are struggling to recruit, and their teachers are more likely to be inexperienced, unqualified and sick or absent.(12) Health promoting schools should be promoted too not only for the health of pupils but also for the teachers and other staff.(11)

The health workforce needs attention including school nurses, health visitors, mental health professionals and paediatricians.(2) Numbers need to be increased to meet demands and skills need to be addressed in some areas.

We fully agree with the RCPCH that the Government should prioritise public health, prevention and early intervention and central to this is adequate funding for public health departments in local authorities.(13-16) A multi-year funding settlement is required so that that directors of public health and their teams can address urgent child health priorities as well as adequately planning for the future.(16)

Our moral obligation to promote children’s health is clear within the UN Convention on the Rights of the Child and in UK law.(17) However, there still seems to be an under appreciation of the benefits of child health. There are of course advantages for children but it is also a prime determinant of adult health and thus national prosperity.(18)

The UK urgently needs a new focus on child health and the development of a cross-departmental National Child Health and Wellbeing Strategy would achieve this. A radical agenda for child public health is required whereby we not only provide children with information and life skills but also create health promoting environments to ensure that they survive and thrive.

References
1) Mahase E. UK born children are often worse off than those in other rich countries, report finds. BMJ 2020;368:m849
https://www.bmj.com/content/368/bmj.m849

2) Royal College of Paediatrics and Child Health. State of child health 2020. March 2020. www.rcpch.ac.uk/state-of-child-health.

3) National Institute for Health and Clinical Excellence. Preventing Unintentional Injuries in the Home among Children and Young People Aged under 15: Home Safety Assessments and Providing Safety Equipment. NICE Public Health Guidance 30. London: NICE, 2010.

4) National Institute for Health and Clinical Excellence. Strategies to Preventing Unintentional Injuries in under 15s. NICE Public Health Guidance 29. London: NICE, 2010.

5) National Institute for Health and Clinical Excellence. Strategies to Prevent Unintentional Injuries among Children and Young People Aged under 15: Evidence Update February 2013. London: NICE, 2013.

6) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health.2016; 26(5), 194-199
https://www.paediatricsandchildhealthjournal.co.uk/article/S1751-7222(15)00255-3/fulltext

7) RoSPA. Safe and active at all ages: a national strategy to prevent serious accidental injuries in England. Birmingham: RoSPA, 2018.
https://www.rospa.com/national-strategy/

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

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

10) Watson M C and Lloyd J. IHPE Position Statement: Unintentional Home Injuries to Children (Under 5s) (June 2019). Lichfield, Institute of Health Promotion and Education, 2019.
https://ihpe.org.uk/wp-content/uploads/2019/12/Position-statement-Child-...

11) Lloyd J and Watson M C. IHPE Position Statement: PSHE (October 2019). Lichfield, Institute of Health Promotion and Education, 2019.
https://ihpe.org.uk/wp-content/uploads/2019/12/PSHE-Position-Paper-Octob...

12) Sibieta L. Teacher shortages in England. London: The Education Policy Institute, 2020.
https://epi.org.uk/publications-and-research/teacher-shortages-in-englan...

13) Watson M C and Lloyd J. Raiding the public health budget. Action is needed to tackle current public health threats BMJ 2014;348:g2721
https://www.bmj.com/content/348/bmj.g2274/rr/692406

14) Watson M C and Lloyd J, 2016. Need for increased investment in public health BMJ 2016;352:i761.
https://www.bmj.com/content/352/bmj.i761

15) Watson M C and Thompson S, 2018. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279

16) Watson M C and Owen P. Inequalities in 2020: time for a health strategy that unites the country BMJ 2020;368:m544
https://www.bmj.com/content/368/bmj.m544

17) Viner R. NHS must prioritise health of children and young people. BMJ 2018;360:k1116
https://www.bmj.com/content/360/bmj.k1116

18) Modi N. A bigger vision for child health. The BMJ Opinion, 2018.
https://blogs.bmj.com/bmj/2018/03/20/neena-modi-a-bigger-vision-for-chil...

Competing interests: No competing interests

09 March 2020
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK. http://ihpe.org.uk/