What can I do about child health? A paediatrician’s view from the front line

After years of progress, in March we reported that health outcomes for babies and young children in the UK are stalling in several key areas. In a guest blog, paediatrician Dr Lizzie Wortley shares her frustrations about it. What can she and others do to improve matters?

Blog post

Published: 16/07/2018

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

The headlines are over. The news cycle has moved on. The UK is not performing as well as its European equivalents on child mortality and health. We have high rates of child obesity and we don’t breastfeed enough of our children. Our mothers are unhealthy, producing small and often preterm babies, which is impacting on neonatal death rates. 

For me, this means my patients are not as healthy as they could be, and we’re letting our young people down. I know this already. I’ve sat in clinic and A&E, starting to tell young people and parents about a service that no longer exists. I’ve read the recent reports, felt the shame, anger, frustration and looked somewhere for the hope of change. And I retweeted them, some with comments, to show my commitment to the cause of our young. But now I want to rethink, reflect and redirect – I want to know what I can do next. 

Let’s be clear, Public Health England, health think-tanks and the Government can help society make a shift towards a positive breastfeeding culture, a community where healthy choices are easier, and help support our young people’s wellbeing (invest $1 and reap $7 ring a bell?) That is a major part of improving these outcomes for us all.

We know the likelihood of the unhealthy young person becoming the unhealthy parent, and we know it doesn’t make sense to cut children’s services. If there is evidence they work, then they need to be available.

But beyond banging on the doors of Whitehall and the echo chamber of social media, what is my role?

Culture shift, not just service change

As a more junior doctor I didn’t want to have to address the daunting context beyond the immediate problem. But somewhere along the way, with the help of some marvellous mentors and colleagues, that attitude changed.

The more public health I become involved in, the more I realise the importance of my role as a clinician. I can make a change to my patients by making ‘lifestyle’ conversations important. And if I make a change to mine, and you make a change to yours, suddenly ‘public’ health is progressing and the headlines improve. 

But apart from my Twitter account, what can I do to salve my despondency? What can I tell my GP colleagues in our ‘learning together’ clinics?

Well I can tell them that it may not be easy, and there may not always be the extra service to deliver the best care, but I can initiate the conversation. I can make it ok for a mother to ask about what is normal, pointing her to the right source of information. 

Linking up with my some of my local GP colleagues and our local CAMHS (child and adolescent mental health) service, I have discovered there are little pockets of wonderful work. Be it the charity sector, the local children's centre, or the school scheme, somewhere someone just like us is whirring away on the wheel, trying to make an impact. With one other source to offer, one other option to help make that change (possibly leading to another change), we’re helping that child really reach their potential.

What I’ve learned

As my more enlightened colleagues tell me, it comes down to communication, local knowledge and commitment. If we – the health professionals seeing people – don’t think it’s important, and we don’t start to address the issues, our patients won’t think it’s important either. 

I would argue that, whether or not you intended it to, public health comes into our working lives in every interaction we have with a patient, whoever we are. It matters. ‘Public’ health may be a population-wide overview, but it is the accumulation of individuals that drives it. We drive it, as clinicians, every day. If we carry one small part of the load, and our colleagues in the think-tanks, Public Health England and Government do their part, together the jigsaw will be complete. 

We all have our part to play. This is where I think others can do their bit in this critical mission.

Forward action: we all have our part

Health professionals
  • Think about the wider picture for that one patient – place their health needs in context.
  • Don’t ignore the other issues (at least acknowledge them): smoking, diet, obesity.
  • Take an interest in the other aspects of the child’s life – brilliant tools such as HEEADSSS help.
  • Think about advocacy and how you could play a wider role in influencing decision-making and policy.
Commissioners/local decision-makers
  • Foster innovative partnerships outside the health sector. 
  • Have a thoughtful, holistic approach to children and young people’s needs.
  • Involve young people in service development – completely and wholeheartedly (‘nothing about me without me’ on a population level).
  • Get involved: keeping young people healthy helps keep us all healthy in the end (we’re all going to need someone to look after us one day).
  • Keep kids active: bring it into everyday life – it doesn’t have to be a separate event.
  • Normalise healthy behaviours. This includes stop talking about being on diets, or having to ‘exercise’ and labelling activities as ‘good’ or ‘bad’.
  • Acknowledge there is a balance to be struck for a happy, healthy life.
  • Look at your own behaviours. What behaviour do you model – is it what you would want your child to do? How much do you look at your phone in front of your child? How much television do you watch?
National policy-makers
  • Prevention really is better than cure – take it seriously.
  • Look at the bigger picture: reactive firefighting tends to be ‘short-termist’.
  • Aim for a longer-term collaborative cross-party perspective that looks to sustainability and a belief that investment in youth pays dividends, while acknowledging this is unlikely to show an immediate economic effect. 

The time is now

So, let’s get started. We’ll advocate for better services for all, we’ll hold the Government to account for the many and then we’ll see our patients, one at a time. 

To us they are the many; to them, we are the few. And what we do matters. Let’s make it matter for the best. One chat could impact for generations. 

Dr Lizzie Wortley is a paediatric registrar. She’s currently working at Northwick Park Hospital. 

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

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