The conundrum of children’s and young people’s health: time to address it

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In the past few years, our focus here at The King’s Fund - on integration, new models of care and, increasingly, place-based population health systems - has been concerned with the physical and mental health of adults, often older people. But we are increasingly aware of some of the trends, issues and conundrums when it comes to the health of children and young people.

Why do I say conundrums? Well for a start, some important trends in children’s and young people’s health have been moving in opposite directions. Take the trends in health risk behaviours. Over the past 10 years we have witnessed steady and consistent declines in key areas of health risk-taking among children and young people, with steep falls in levels of smoking, alcohol consumption and drug taking, and a reduction in behaviours and outcomes such as youth crime, suicide and teenage pregnancy. These deserve a lot more celebration and, more importantly, understanding than they are currently receiving. There has been very little focus on why these improvements are occurring, the policies (if any) that are driving them, which children and young people are benefiting and which are not, and the long-term implications of this change.

But all is not rosy. Child obesity is stubbornly high while the much-promised ‘Olympic effect’ on sports participation and physical activity seems not to have materialised at all; children in the UK are struggling at the bottom of the international league on a wide range of physical activity indicators. It is tempting to see the ‘rise of screen time’ as a key cause of these findings, but the evidence is only now emerging and is unsurprisingly much contested. Finally, risky health behaviours cluster in younger people just as they do in adults; this is an inequalities problem, with engagement in multiple risky behaviours more common in adolescents from deprived backgrounds.

Children’s and young people’s health is clearly not just about risk-taking behaviours. We have learnt much about the critical paths to health, wellbeing and social outcomes that experience in the early years (as disseminated by the Early Intervention Foundation and others) sets us on; and the added impact of adverse childhood events. And work by UNICEF has shown that the financial crisis – and how policy-makers have responded to it – has been a challenge to children and young people’s wellbeing, with the UK being one of the countries with the greatest increase in the numbers of children in severe material deprivation. Recent evidence also suggests that the self-reported health of teenagers in year 10 (aged 15 and 16) has fallen since 2005 (albeit from a high level) – particularly the mental wellbeing of girls. Depressingly – but perhaps not surprisingly – wellbeing is also socially skewed, with more reported problems in poorer groups.

The other conundrum is how the government has responded. On behaviours, the recent childhood obesity plan has been widely criticised for being only a partial response to the problem, and there seems to be little interest in learning from some of the really welcome behaviour changes referenced earlier, that have been happening for some time. The Prime Minister’s recent speech on mental health is very welcome, especially the planned Green Paper and its focus on the public mental health of children. But resources for mental health have not so far followed the rhetoric. Funding for early years services is also increasingly challenged, as local authorities (newly responsible for them in England) have to make tough choices on where to spend their ever-reducing public health budgets. Ultimately, children’s and young people’s services are among those paying the price for public health cuts.

So, while there have been some really welcome improvements when it comes to health risk-taking behaviours, other areas have not improved; and some trends in wellbeing, particularly for girls and for poorer children, have been going in the wrong direction. Why, when we are more aware than ever of the importance of early years to long-term health and other social outcomes, are these and other children’s services among those facing the biggest cuts? We welcome the Prime Minister’s focus on children’s mental health, but it’s time that the contradiction of resources and wider policies not aligning with what we know about the importance of children’s and young people’s health and wellbeing is addressed.

Comments

Julia Ross

Position
chief strategist care and health,
Organisation
pi Ltd
Comment date
27 January 2017
Excellent points and this neglect of childrens health and social care makes no send short or long term
The causes are no doubt complex and will be hard to tackle
However. Having recently spent some time looking at children's data, across health and social care and indeed education and housing, I am less than surprised. The hard data intelligence is sadly lacking and has lagged way behind the current progress in the adult world. Why ?

David Rogers

Position
Vice-Chair,
Organisation
Healthwatch Devon
Comment date
27 January 2017
Agree both with David's blog and Julia's comments above. Don Berwick's blog (also just read) offers some hope re children's activity levels, if such schemes implemented elsewhere. Earlier this week I attended the launch of Sugar Smart Exeter, where there was great enthusiasm for tackling childhood obesity and dental caries.

Richard Shircore

Position
Specialist in Communty and Public Health,
Organisation
www.healthpromotion.uk.com
Comment date
04 April 2017
We have a major problem with Child and Adolescent Mental Health. None of the speakers featured in this report, sought to define what they were talking about. Yet child mental health is a problematic and contested concept. It is plagued by differing organisations, health, education, social services and youth offending all having different methodologies and methods.

The greatest threat to young people's mental health is that there is no "early stage, evidence based assessment pathway" for the child, so as to identify exactly what are the issues to be addressed. Child behaviour as interpreted as "mental health" can be caused by organic brain issues, environmental stress e.g. failure to be able to engage with curriculum, biological stress (e.g. sleep deprivation), an undiagnosed learning difficulty, poor non-verbal communication skills etc... Unless an evidence based assessment is carried out - with no presumption as to cause - we shall continue to fail children in respect to their "mental health".

Sioban Boyce

Position
Communication/Behaviour Specialist,
Organisation
Not Just Talking
Comment date
17 May 2017
Thank you David Buck for again highlighting the poor development of children since the 1980s observed by me firstly as a Speech and Language Therapist then as someone determined to get non-verbal conversational skill development on the agenda.
It is not just screens that cause the problem with behaviour, poor emotional understanding, limited socialisation, not achieving educational potential and as a result falling into anti-social behaviour but other things that impact on the development of non-verbal conversational skills such as forward facing buggies, lack of the family meal table

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