Growing up in poverty can impact all aspects of a child’s life, including their health. Child poverty is measured in a number of ways, but regardless of the measurement approach taken, the numbers affected are shocking. Using relative poverty as a measure, it was estimated that in 2022/23 just under a third of children (30%) in the UK were living in poverty, which equates to 4.3 million children. 1 Over the last year, the Trussell Trust provided 1.1 million emergency food parcels to children in the UK – a sobering indication of the impact of child poverty. Understanding the scale of the challenge to address health inequalities affecting children and young people is critical to enable the NHS to meet children’s needs for health care.
The NHS England Core20PLUS5 approach
Addressing child health inequalities is a target of the 2022 NHS England Core20PLUS5 approach. The aim is to focus interventions on children and young people most at risk, based on being part of the ‘Core20’ or a ‘PLUS’ group. The ‘Core20’ includes those in the most deprived 20% of the population as measured by Index of Multiple Deprivation (IMD). ‘PLUS’ groups are those who may be at increased risk of inequalities but can’t necessarily be identified by deprivation status. For instance, young people with learning disabilities or those from ethnic minority communities.
The Core20PLUS5 approach includes targets that aim to improve health outcomes and access to care for children with asthma, diabetes and epilepsy, as well as those with oral health and mental health needs. One target is to reduce the number of asthma attacks. Improving asthma care for children is important because asthma is the most common long-term health condition affecting children, and asthma attacks can be prevented. It is estimated that over 1 million 0-15-year-olds in the UK have asthma. Core20PLUS5 also highlights the importance of reducing reliance on reliever medication. A survey conducted by Asthma + Lung UK found that one in five people with asthma were overusing reliever medication, suggesting poorly controlled asthma.
Another objective of Core20PLUS5 is to improve access to supportive technology, such as insulin pumps and real time continuous glucose monitors for children from minority ethnic backgrounds living with diabetes. While use of diabetes technology has increased over time, there is a widening inequalities gap. In 2021/22, there was an 9% gap between white and black children with diabetes in England and Wales using real time continuous glucose monitors, but by 2022/23 this had increased to 14%. In 2022/23, 50% of white children with diabetes were using this technology, compared with just 36% of black children.
In the chart below (which has two parts), we review children’s hospital inpatient care in 2023/24 for the five clinical areas that the Core20PLUS5 approach focuses on in England. In the first part of the chart, we look at absolute differences in the rate of emergency admissions for these conditions per 100,000 by IMD decile to highlight variation across the population. In the second part of the chart, we look at the relative differences between deprivation deciles (compared with the least deprived group), to highlight for which conditions there are most variation across the deprivation gradient.
Aside from rates of mental health emergency hospital admissions, which were fairly similar across all groups, rates were higher across all other areas for young people in the more deprived deciles. Asthma admission rates are the highest of the five measures, and the rate in the most deprived 10% of the population was 2.7 times higher than in the least deprived 10% of the population (232 per 100,000 compared to 87 per 100,000).
There are also clear differences for epilepsy, diabetes and tooth decay. For epilepsy, emergency admissions were 1.7 times higher in the most deprived 10% (100 per 100,000 compared to 59.6 per 100,000), and for diabetes just under two times higher (64.6 per 100,000 compared to 34.7 per 100,000). Although the number of emergency admissions as a result of tooth decay are the lowest of the five measures, there is a four-fold difference between the rate of hospital admissions with a primary diagnosis of tooth decay between the most and least deprived deciles (11.3 per 100,000 compared to 2.66 per 100,000).
What is within the power of the NHS to influence?
This data provides clear evidence of the degree to which health inequalities impact children and young people, but this is not new or unexpected. In 2017 (prior to the introduction of the Core20PLUS5 approach), the Nuffield Trust published a briefing highlighting inequalities in emergency hospital admissions by children and young people, summarising some of the same points we still see today – chiefly that there is a health gap between those who have most and those who have least.
Efforts to improve care quality for young people with epilepsy is a good example of how the inequalities gap can be narrowed. Although there is still a clear gap, rates of emergency admissions for epilepsy have declined over time for children and young people in the most deprived areas. This could be attributed to wider efforts such as the Epilepsy12 audit, which have improved understanding of variation in care and service provision at a local level. Tracking of asthma prescribing is another example of how data can be used to support the NHS to understand local variation in care.
The NHS can also play a part in tackling some of the upstream causes of poor health, with a key example being childhood obesity. Childhood obesity is a risk factor for poor health both as a child and moving into adulthood, and there are therefore potentially longer-term health benefits of providing tailored weight loss support for children and young people.
Addressing child health inequality is vital. If the human cost is not imperative enough, there are clear financial costs. For dental care alone, costs were estimated at £40.7 million for tooth extractions for 0-19-year-olds due to tooth decay in 2022/23 in England. The Labour government has announced a new ministerial taskforce to work on the child poverty strategy. Health inequalities affecting children and young people are another stark consequence of living in poverty. It is important that this is acknowledged, while also considering and acting on what is within the power of the NHS to influence and change.
Data notes
Activity reflects primary admitting diagnosis. Raw scores are rounded to the nearest 10 prior to rates being calculated. International Statistical Classification of Disease and Related Health Problems (ICD-10) codes were used to identify specific diagnosis to reflect the Core20PLUS5 clinical areas: Asthma (“J45” & “J46”), Epilepsy (“G40” & “G41”), Diabetes (“E10-E14”), Mental health = (“F” chapter – Mental and Behavioural Disorders) and Dental caries (tooth decay) (“K02”). ONS population estimates by sex, single year of age (0-17 years old) and IMD decile for England (2020) were used to calculate the crude rate per 100,000. Hospital Episode Statistics (HES) data (2023/24) Copyright © 2024, NHS England. Re-used with the permission of NHS England. All rights reserved. A data-sharing agreement with NHS England (DARS-NIC-226261-M2T0Q-v6) governed access to and use of HES data for this project.
Suggested citation
Davies M (2024) “What is the scale of the challenge to address health inequalities affecting children and young people?" QualityWatch: Nuffield Trust and Health Foundation.