As the NHS approaches its 70th birthday, it is right to reflect on the incredible achievements that we have made in improving child health outcomes. Before the NHS was set up in 1948, around one in 20 children died before their first birthday and illnesses like polio, tuberculosis and measles were commonplace.
70 years on and child health has been transformed. Overall child mortality rates have fallen to an all-time low, vaccination programmes have drastically reduced the numbers of children and young people contracting preventable illnesses like measles, rubella and tuberculosis, and some illnesses like polio have been eradicated.
But, despite these achievements, many children and young people in the UK now experience worse health outcomes than those in similar countries, as our new report today shows. Despite overall child mortality rates being reduced, our progress in reducing infant mortality has stalled and we are now lagging behind most other high-income countries. We are bottom of the pack when it comes to breastfeeding, and young girls in the UK are some of the most overweight in the developed world.
Inequality, which is proven to have a negative effect on child health, is rising and the impact on the poorest in society is being sorely felt. The Nuffield Trust’s recent briefing on health inequalities among children and young people found that the poorest school-aged children are now more likely to be admitted to hospital in an emergency for asthma than they were 10 years ago.
Children and young people living in poverty are also far more likely to have poor mental health. At the same time, some of the totemic diseases of the 1940s are on the rise again, with cases of scarlet fever reaching a 50-year high and measles outbreaks confirmed in five parts of the UK over the past few months.
So why the poor picture? In England, public sector austerity, cuts to health visiting services, and growing income inequality all play a role. And despite some specific initiatives like the soft drinks industry levy, the Childhood Obesity Plan, money allocated for improving child and adolescent mental health and some national service reviews, child health remains a low priority area.
A year ago, the Royal College of Paediatrics and Child Health’s State of child health report 2017 documented the absence of child health initiatives from the vast majority of the NHS’s 44 place-based plans to improve health care in local areas. It also highlighted several areas where government action is required – from developing a cross-departmental child health strategy to reducing child poverty and inequality.
In an update to the report published at the start of this year, the RCPCH criticised the absence of political focus on child health – pointing out that despite some bright spots, in many areas there had been no progress and in some the state of play had actually got worse. It’s clear that a fragmented approach to children and young people’s health will not lead to a healthy and prosperous nation.
Our report today, which compares health outcomes for children and young people across a range of countries, provides a snapshot of how the UK is performing in relation to comparable countries.
International comparisons are fraught with difficulty. Although we have tried to use comparable data where possible, it is sometimes difficult to make direct comparisons with other countries included in the report due to variable data quality and lack of standardised definitions. This should be taken into account when drawing any conclusions about the potential implications of the report’s findings.
Despite these limitations, however, reports such as this enable us to see how we are doing, but also where there is room for improvement.
Time to pick up the pace
So while it is absolutely right to celebrate the considerable achievements we have made in improving child health, internationally the UK is not faring as well as it should be. We are still running in the race to improve our children’s health – but we have been passed and left behind by runners from many other comparable countries. As well as a moral duty to preserve the health and wellbeing of our children and young people, there is a strong economic argument. Healthy children become healthy adults.
It’s time for policy makers to take child health seriously.
Edwards N and Viner R (2018) "Lagging behind: why we must do better on child health", Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/lagging-behind-why-we-must-do-better-on-child-health