Author : BACAPH team -editors : Ingrid Wolfe and Guddi Singh

What would you say if you were asked for policy recommendations to improve health for the early years?

Snapshot of Child Health
Britain’s children are growing up unhealthy, unhappy, and poorly prepared for adult life. Child survival in the UK is among the worst in Europe and the gap is widening. Key contributing factors include social inequality and a failure to address the social determinants of health. 

Headline figures:
The UK ranks 15 out of 19 Western European countries on infant mortality and has one of the highest death rates for children and young people in Western Europe.
There is a strong association between poverty, deprivation, and mortality, for example infant mortality is more than twice as high in the lowest compared with the highest socio-economic groups.
The UK is the fifth richest country in the world and yet more than one in four children is growing up in poverty today.
Child poverty is increasing; 600,000 more children will live in absolute poverty by 2020-21 compared with 2015-16.
The main drivers for the increase in child poverty are cuts in public expenditure.
The £3bn cut in local authority spending between 2010-11 and 2015-16 has led to the dismantling of universal services such as health visiting. Children’s social services are struggling to meet their legal duties.

National policy initiatives on early years for children and families
There has been little coordinated national policy to promote child health since the end of the Labour government in 2010. Important preceding policies include Every Child Matters (2003) coinciding with the Children Act (2004) and the National Service Framework for children and families (2004); Think Family: Improving the life chances of families at risk (2008) and Graham Allen’s 2010 report “Early Intervention: Smart Investment, Massive Savings” and the UK's First Cross-Party Children's Manifesto report “The 1001 Critical Days” which received widespread professional organisational support. Since then the economic and social policies for austerity have disproportionately and adversely affected children, increased child poverty, significantly reduced Local Authority budgets, and reduced important universal and targeted public health services, such as health visiting and children’s centres.

The Health and Social Care Act has promoted higher commissioning costs and fragmented service provision, rather than fostering the cooperation and collaboration in public services that young children and families need. The 5 Year Forward View goes some way towards promoting cooperation and collaboration through new models of care, but focuses on adult and elderly populations.  Nonetheless there are a few sites developing new models of care for children, designing services around the child’s needs, delivered by networks of collaborating providers. The UK is a signatory to the Council of Europe’s Guidelines for Child Friendly Health Care (2011), and BACAPH has published a Family Friendly Framework to support implementation.

What is needed now?
There is a strong and evidenced case for investment in child health and wellbeing. The UK’s problems are preventable The current predicament could be reversed with good policy, public health, and clinical practice. Britain could be the best place for children to grow up – but this requires an approach that tackles the economic and social determinants of health and improves health services for children. Long term gains in health and productivity will be the reward.

 Key recommendations for improving early years outcomes

Healthy Family & Home:
Health begins before conception. A life course approach understands that health and illness are determined by a combination of inherited factors and exposure to assets and hazards throughout life. The first 1001 days - when both mind and body are developing - is the most influential time to set a positive course for the rest of life, and reaps the long-lasting benefit of a healthier and more productive adult population.
Parents need support to be able to provide a healthy environment for children to flourish:

This will involve:

    • Promoting breast feeding through practical support and legislation
    • Investing in Sure Start Children’s Centres
    • Investing in support for the most vulnerable families
    • Improving the quality of housing, especially in the private rented sector
    • Increases to, and protection of, child benefit (‘a triple lock’ on child benefit)
    • An end the two-child benefit limit (responsible for around a third of the increase in child poverty)
    • Restoring  additional financial support in a baby’s first year (the ‘baby tax credit’)
    • Increasing the age for legal tobacco sales by one year every year for 10 years (Starting to smoke during adolescence increases the likelihood of being a life-long smoker;  smoking accounts for 25% of low birth weight babies who have more complications, and smoking continues to be the greatest single cause of avoidable mortality in the UK.)
    • Increase unit cost of alcohol (In 2013/2014, 13% of 15-year-olds surveyed in Wales, 11% in England and 13.5% in Scotland reported drinking alcohol at least once a week)

Healthy Community & Services:

Evidence-based programmes for health care delivery should be provided in an integrated way, delivered by competent professionals collaborating around the needs of the child. Networks and pathways that support equitable provision are feasible, and should be promoted by local and national decision makers.  Commissioning for value, using robust data, is a realistic vision but requires support and investment.

This will involve:

    • Increased investment 1% annually for 5 years for children’s Local Authority public health, social care, education and early intervention  services
    • Introduce an equalisation policy for local government funding, so that the poorest areas no longer suffer the most severe cuts in funding
    • Increased investment towards improved primary care training and access for paediatrics and child health in the community
    • A 5-year forward view for children and young people to focus on developing new models of care that meet the specific and evolving needs of the young

Healthy Environment:

Child poverty damages childhoods – but it is not inevitable. With the right policies every child can have the opportunity to fully enjoy their childhood and do well in life.

This will involve:

    • A renewed strategy to reduce child poverty (the 2010 Child Poverty Act and targets were abolished)
    • Introducing a Living Wage
    • Ending the freeze on working-age benefits
    • Reversing cuts to work allowances in Universal Credit

 

References

Children's National Service Framework. 2004.
Think Family: Improving the life chances of families at risk. Cabinet office. 2008.
Early Intervention: Smart Investment, Massive Savings The Second Independent Report to Her Majesty’s Government. 2011.
Hurt L, Paranjothy S, Lucas PJ, et al. Interventions that enhance health services for parents and infants to improve child development and social and emotional well-being in high-income countries: a systematic review. BMJ Open 2018;8:e014899. doi: 10.1136/bmjopen-2016-014899
The 1001 Critical Days. The Importance of the Conception to Age Two Period. A CROSS-PARTY MANIFESTO.
Guidelines of the Committee of Ministers of the Council of Europe on child-friendly health care
and their explanatory memorandum. 2011.
Chief Medical Officer annual report 2012: children and young people’s health. 2013.
Chief Medical Officer annual report 2012: the public's health. 2014.
BACAPH/BACCH Family Friendly Framework. 2014.
FPH Start Well, Live Better, A manifesto for the public’s health. FPH 2015
RCPCH. State of Child Health. 2017.
ESPN Country Profile, United Kingdom, 2018. European Commission. Bradshaw et al.

 
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