International comparisons of health and wellbeing in early childhood

How do health outcomes for babies and young children in the UK compare with other similar countries on key measures such as immunisation, birth weight, mortality rates, breastfeeding and obesity?

This report presents data on health and wellbeing for early childhood in the UK and 14 comparable countries, recognising the particular influence that a child’s development in this period can have on his or her future health and quality of life. We consider the benefits and challenges of comparing child health indicators between countries, to inform local and national policy and practice that improves the health of children and families in this country.

UK lagging behind peers on child health, new research reveals 15/03/2018

Press release

The first ever international analysis looking at UK child health measures over time shows that the UK is now stalling in several key areas like infant mortality and immunisation levels.

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Key findings

Life expectancy

A boy born in the UK in 2015 can expect to live to just over 79 years; over a year longer than a boy born in Portugal, but more than a year less than one born in Sweden. The UK life expectancy for a boy is broadly similar to most European comparators. However, a girl born in the UK can expect to live to almost 83 years; three years less than a girl born in Spain, and the lowest of all European comparators. For both boys and girls, improvement in life expectancy has plateaued since 2011.

Size of the early childhood population

In 2015 there were just over 4 million children aged 0 to 4 years in the UK. This represents 6.2% of the total population. Among the 14 countries examined, only Ireland, New Zealand and Australia see 0-to-4-year-olds make up a higher percentage of their overall populations. 

Low birth weight

In 2014, 6.9% of live births in the UK weighed less than 2,500 grams; around average when compared with the other 14 comparator countries.

Breastfeeding

The UK has one of the lowest breastfeeding rates in the world: 34.0% of babies are receiving any breastmilk at six months, compared with 62.5% in Sweden.

Percentage of infants aged 0 to 5 months (inclusive) who are fed exclusively with breastmilk 15/03/2018

Chart

Note:  

Source data years: UK, 2010; Greece, 2009; Italy, 1999, Belgium, 2012; Sweden, 2011;
Ireland, 2006; Australia, 2010; New Zealand, 2012; Netherlands, 2010; US, 2011; Germany 2003-6; Canada, 2009-10; Spain, 2011-12; Portugal, 2003.

Source:  

WHO, Global Health Observatory data repository; Australian Institute of Health and
Welfare, 2011; Royal New Zealand Plunket Society, 2012.

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Obesity

The UK has considerably more overweight or obese children and young people than the average among high-income countries, for both boys and girls. In the UK in 2013, it is estimated that 6.1% of boys and 29.2% of girls aged 2 to 19 years were overweight or obese. In England in 2016/17, nearly a quarter (23.6%) of children in reception were obese or overweight.

Percentage of children classified as overweight and obese in 2013 using IOTF thresholds 15/03/2018

Chart

Note:  

IOTF stands for International Obesity Taskforce.

Source:  

Ng and others (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013, The Lancet.

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Vaccination and immunisation

Vaccine uptake in the UK generally compares well with other countries. However, data from 2016 show a slight reduction in uptake of all three major early childhood vaccines in the UK. Furthermore, MMR (measles, mumps and rubella) vaccine coverage is still below 95% for children receiving two doses by their fifth birthday, and around 50,000 children in England each year are at risk of measles, mumps and rubella because they have not been immunised against the diseases.

Uptake of diphtheria, tetanus and pertussis, and pneumococcal vaccines within the UK since 2006 15/03/2018

Chart

Note:  

In this chart DTP and HiB values are identical.

Source:  

WHO-UNICEF, 2016.

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Social determinants of health (poverty, education and employment)

  • When compared with the other 14 countries, the UK has a comparatively low rate of child income poverty, with approximately 10% of children living in income poverty (using the Organisation for Economic Co-operation and Development [OECD] definition). However, the proportion of children in relative income poverty (using UK government definitions) has risen back to the levels last seen in 2009/10.
  • Among the countries studied, only Canada and Ireland have more young people educated to the highest level of education.
  • When compared with the other 14 countries, the UK has the second highest proportion of children in households where no adult is working (15.4%).

Stillbirths and deaths in early childhood

  • Rates of stillbirths, neonatal, infant and child death have seen a decline over the past 20 years in the UK, as they have across developed countries in general. However, rates have declined more slowly than in other comparable countries and, in 2015, over 3,500 children died before their fifth birthday.
  • Improvements in infant and neonatal mortality rates have stalled since 2013.
  • In England and Wales, the most common cause of death in the 1 to 4-year-old age group is cancer. Among the countries studied, the UK has the lowest incidence of cancer in 0 to 4-year-olds. Five-year survival for all childhood cancers in the UK and Ireland rose from 74.4% in 1999–2001 to 77.8% in 2005–2007.
  • The number of deaths in children under five from injury and poisoning in the UK is similar to that in the other 14 countries.

Trends in infant and neonatal mortality rates per 1,000 live births in the UK 15/03/2018

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Source:  

Office for National Statistics, Vital Statistics: Population and Health Reference Tables.

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Trends in neonatal mortality rates 15/03/2018

Chart

Note:  

Neonatal mortality rates are a subset (and are included) within the infant mortality rate.

Source:  

Sweden – WHO, European Health for All family of databases; US – Kochanek and others, 2016; UK – WHO, European Health for All family of databases, except 2013–2015 data which uses ONS, Vital Statistics: Population and Health Reference tables.

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Trends in infant mortality rates 15/03/2018

Chart

Note:  

Infant mortality rates include neonatal mortality rates.

Source:  

Sweden and the UK – WHO, European Health for All family of databases (indicator
E070100.T); US – Kochanek and others, 2016.

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Conclusion

International comparisons of child health allow us to understand where the health and wider outcomes of children and families in the UK are similar to those in other countries. Where outcomes are better or improving, it is possible to consider how this might be sustained. Where outcomes are worse, this presents the opportunity to prioritise activity at a local and national level to achieve improvement. However, there are many challenges involved, reflected in the relatively limited number of indicators which it was possible to include in this report.

In none of these fields is there a convincing argument that the UK is among the best performing of any comparable country.

Country-level comparisons should be interpreted with a degree of caution, since there are significant societal, population and economic differences which may be impacting individual health outcome indicators far in excess of specific health or policy interventions.

With these limitations in mind, the findings in this report show that the UK is doing well in many areas relating to the health of young children. By and large, trends over the past decade show improvements in the majority of indicators, and broadly support the argument that this decade’s young children in the UK enjoy better health than the last.

But in none of these fields is there a convincing argument that the UK is among the best performing of any comparable country. Moreover, for certain indicators, such as the percentage of children who are overweight or obese, or breastfeeding, the UK lags far behind similarly developed countries. In others, notably in childhood mortality, we can see that, where once we led the field, our rate of improvement has slowed to the extent that we have among the worst outcomes in comparable countries.

Even those indicators which had previously shown encouraging progress have stalled or worsened over the past two to three years. Worryingly, these include life expectancy, mortality, immunisation rates and low birth weight – indicators that are most susceptible to public health interventions and therefore most at risk in the face of increasing threats to children’s (and particularly early years) services.

While international comparisons of health outcomes should be handled with care, this research has an unequivocal message: we must do much better for our children and young people. The recent changes to the UK’s trajectory on life expectancy, premature deaths and immunisation should set alarm bells ringing for policymakers about the effects of cuts to public health and early
years services.

Partners

Royal College of Paediatrics and Child Health

Suggested citation

Cheung R (2018) International comparisons of health and wellbeing in early childhood. Research report, Nuffield Trust and Royal College of Paediatrics and Child Health. www.nuffieldtrust.org.uk/research/international-comparisons-of-health-and-wellbeing-in-early-childhood