In comparison with its predecessors, the NHS Long Term Plan, which sets out the way care in this country should be delivered given the new NHS financial settlement, is striking for its emphasis on improving the health of children.
This is welcome, and speaks directly to the report on health in early childhood published last year by the Nuffield Trust and the Royal College of Paediatrics and Child Health (RCPCH), which showed that health outcomes for young children in the UK are now worse than those in many similar countries. Despite overall child mortality rates being reduced, our progress in reducing infant mortality seemed to have stalled, and a subsequent report by the RCPCH showed that infant mortality had begun to rise after over more than 100 years of continuous improvement. We were (and still are) lagging behind other high-income countries in many areas.
So, what of adolescents and young adults, who make up approximately a fifth of the UK population? As the World Economic Forum recently noted, adolescence is a time in which we take huge bounds, psychologically, biologically and socially. The forces shaping young people’s lives today continue into adulthood and have a huge impact on the society we all live in.
And today’s adolescents and young adults are not the same people as those of previous generations: on the whole, in recent years there has been a decline in underage drinking, fewer young people smoke, and illicit drug use among teenagers is decreasing.
Causes for concern
It is therefore worrying, as today’s report by the Nuffield Trust and the Association for Young People’s Health (AYPH) shows, that young people aged between 10 and 24 in the UK now experience worse health and wellbeing outcomes than those in many other similar countries.
The UK has one of the highest rates of young people living with a long-term condition in the countries studied – and the burden that such illnesses are placing on young lives in this country is amongst the highest in the developed world. Young people in the UK are more likely to die from asthma than in any other European country studied, and gradual improvements on this front over the last decade have seemingly ground to a halt. Obesity is more prevalent among older adolescents in this country than in almost any other high-income nation, and the differences between the richest and poorest in this respect are stark.
Too often, it is assumed that if we can just get provision during the vital early years of life right, health and healthy behaviours will simply flourish into adolescence, and on seamlessly into adulthood.
This seems dangerously complacent. Yet the muted response to reductions in the funding of local authority services over the past five years, disproportionately affecting young people, suggests it may be a widespread view. A recent World Health Organization report on adolescent health in Europe noted with concern that the UK as a whole continues to lack a clear policy mandate that provides guidance on funding and policy priorities to meet the health needs of adolescents and early adults.
Best laid plans?
As the RCPCH, AYPH and others have acknowledged, the Long Term Plan and other recent policy developments show that steps are being made in the right direction: by 2028, the NHS in England will move to a 0–25 years service and towards service models for young people that offer person-centred and age-appropriate care. School-age adolescents will receive statutory health education from 2020, and measures to combat obesity have been prioritised.
These are important shifts of emphasis: in a survey by the AYPH and other organisations consulting young people on how the Long Term Plan should improve health services, the loudest call was for youth-friendly services that understand the specific needs of young people.
But inequality remains a stubborn impediment to progress on all these fronts. The UK has amongst the highest levels of income inequality in the developed world. Social and economic circumstances have a profound impact on health, and young people are bearing the brunt of this: the New Policy Institute calculates that the poverty rate among young people is now higher than in any other age group. A decade earlier, children aged under 14 were more likely to be in poverty than young people, but this is no longer the case.
Our services are not up to the task
International comparisons are fraught with difficulty and should be read with a strong dose of realism: the countries chosen for study are always up for debate and direct comparisons should be avoided.
Nevertheless, they do provide us with an opportunity to make an assessment of how we’re performing in relation to countries very like ours. And at the moment, we aren’t serious players among this group, and young people are losing out as a result. 10- to 24-year-olds in the UK today are making better choices regarding their health than ever, but the services we are providing to support them are failing to deliver at the standards found in similar countries.
This should sound the alarm for UK policy-makers. The renewed focus on young people signalled earlier this year in the Long Term Plan appears more necessary than ever: our collective futures may depend upon it.
Edwards N, Rigby E and Viner R (2019), “Sound the alarm: we must improve our young people’s health services”, Nuffield Trust comment, https://www.nuffieldtrust.org.uk/news-item/sound-the-alarm-we-must-improve-our-young-people-s-health-services