From today's Guardian
Audit Commission report shows that the inequalities gap between under-5s from rich and poor families has barely changed over the last decade
Children who have a healthy start in life, especially the early years, grow up to be healthier adults. However, an Audit Commission report, Giving Children a Healthy Start, says that the health outcomes for under-5s have improved only marginally since 1999. The inequalities gap between under-5s from rich and poor families has barely changed over the last decade, and despite the government investing £10.9bn, some indicators – such as obesity and dental health – have worsened.
The first thing we need is a cultural change that makes children in our society a priority. Of 188 performance indicators available to local authorities, only six relate to under-5s'health, and none feature in the top 20.
The Audit Commission report makes a plea for integrated child health services, with seamless working between primary and secondary care – something the Royal College of Paediatrics and Child Health (RCPCH) has long been in favour of.
However, joined-up, complex services for children do not sit easily with the development of autonomous foundation trusts and payment by results. We need more "smart" targeted interventions, using IT and electronic records to identify children who would benefit most from help or who are missing out on available services. We need to identify what is spent on children, evaluate what works rather than follow gimmicks, and disinvest in what doesn't work.
Many things that are good for society will also be good for young children – for example, higher levels of education, healthy environments, reduced pollution. However, some interventions have early and direct benefits for young children.
Child poverty must be eliminated. Children cannot be healthy if they are living in poverty. Where child poverty is tackled through increased parental employment, accompanying policies need to recognise and resolve possible child health consequences. For example, returning to work before six months makes it more difficult to follow breastfeeding recommendations, yet many women need to return to work to maintain their family's financial viability. So women need financial protection to be able to breastfeed for at least six months.
Above a certain threshold, relative poverty is important, as well as absolute poverty. The Unicef index of child wellbeing in rich countries is strongly related to income inequality, and not at all related to average income per head. Children in countries with more unequal wealth distribution fare worse. Similarly, infant mortality is related to inequality in rich countries. The UK has a worse infant mortality rate than Greece, despite having almost double the income per person.
Children should be protected from the advertising of harmful products, such as low nutrient value foods, since voluntary codes appear to have been insufficient, and from second-hand smoke, which is a major risk factor for "cot death". Parents and prospective parents – especially pregnant women – who smoke need support to help them quit. Most want to, but are heavily addicted.
The critical role of parents must also be recognised. People who find parenting challenging should be supported, including through the provision of effective, evidence-based parenting programmes.
Although there has been much investment, many of the services reviewed by the Audit Commission report have not been in continuous operation since 1999. We should not expect results too early, so there must be sustained investment for the early years. The benefits are not instant. Some, such as increased educational attainment, cannot be measured in the early years, and some will take a generation to be achieved.
- Terence Stephenson is president of the Royal College of Paediatrics and Child Health and is Nuffield professor of child health, Institute of Child Health, University College London
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