What do child health indicators tell us?

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Previously I have written about how the government hasn’t yet clearly set out a long-term, cross-departmental strategy for child health and wellbeing, echoing others including Professor Sir Al Aynsley Green, and the Royal College of Paediatrics and Child Health. But what is our ‘ask’ of national and local leaders?

To inform this, first we need to understand what’s working well for children and families, and what’s not, and it’s here that the child health indicators can help us. 

The indicators cover many of the issues we would expect a child health and wellbeing strategy to address. These include understanding health outcomes and inequalities, and how they’re influenced by broader factors, such as early child development and poverty.

Here at the Fund, we’ve looked at change between around 2010 and the latest available data – which differs by indicator – for key indicators of child health status and wellbeing; health system quality (namely vaccinations); and the wider social and economic determinants that influence them. We’ve done this for three groups: the England average, and people living in the most and least deprived areas in England, so we can consider the difference in health between these groups, often referred to as the health inequality or health gap. 

Technicalities over. So, what’s happened? Let’s start with what’s going well. 

Since 2010, childhood obesity among 4–5-year-olds and child mortality have fallen slightly across England. And just over 3 per cent fewer children (1–17-year-olds) had decayed, missing or filled teeth. 

There’s been a drop in the rate of child deaths and serious injuries from road traffic accidents; stillbirths; and hospital admissions for injuries (0–14-year-olds) and mental health conditions (0–17-year-olds). There’s also been a narrowing of the health gap between children in the most and least deprived 10 per cent of areas. This is because health in the most deprived areas has improved faster than it has in the least. But inequalities remain. 

For example, the greatest improvement has been in the rate of hospital admissions for mental health conditions, where the health inequality gap between the least deprived and most deprived areas has fallen from 21.4 per 100,000 in 2010/11 to 15.5 per 100,000 in 2015/16 – a move in the right direction, but still a gap.  

Looking at the wider determinants of health that influence the above health outcomes, a smaller percentage of children (aged under 16) are living in low income families, and the teenage pregnancy rate has fallen. The health inequality gap has also narrowed between the least and most deprived areas. 

Where has the health inequality gap widened or remained static?

Between 2010/11 and 2014/15, 0.6 per cent more mums in England started to breastfeed their babies, and between 2010/11 and 2015/16, 2.8 per cent more 1–2-year-olds had MMR vaccinations. This would be good news, except that the health inequality gap between the least and most deprived areas widened: considerably so for MMR vaccinations (up from 0.2 per cent to 3 per cent over the same period), and the already large health inequality gap (14.1 per cent) for initiating breastfeeding in 2010/11, widened by a further 0.1 per cent.

There’s been virtually no change (0.1 per cent England average) in the proportion of babies born at term with low birth weight across all three groups, with no progress made on reducing the 1.3 per cent health gap between the least and most deprived areas. And although 2 per cent fewer mums smoked during pregnancy in both the least and most deprived areas, the health gap remains stubborn at 6.5 per cent. In 2015/16, women living in the most deprived areas were almost twice as likely to smoke during pregnancy as those living in the least deprived. 

And it’s also not only a matter of variation between deprivation deciles: the data highlights variation between local authority areas and between the north and south of England, with those living in the south generally healthier than their northern counterparts.
Finally, let’s look at what has got worse. 

In England, since around 2010, there’s been an increase in childhood obesity (10–11-year-olds), and in the rates of young people being admitted to hospital due to substance misuse (15–24-year-olds), and for self-harm (10–24-year-olds).

Three indicators – the proportion of 1–2-year-olds receiving the five-in-one vaccination (DTaP/IPV/Hib vaccination); hospital admissions for asthma (for under 19-year-olds); and family homelessness (a broader determinant of health outcomes) – got worse for all groups that we looked at, but particularly for people living in the least deprived areas, which suggests growing in-area inequalities. 

For two indicators status – hospital admissions for injuries (15–24-year-olds), and infant mortality (under 1 year) – health got better for England overall and in the most deprived areas, but outcomes got worse in the least deprived areas. Hospital admissions for tooth decay (in 0–4-year-olds), and the proportion of children (0–18 years) in care increased for England overall, and in the least deprived areas, but respectively improved and remained static in the most deprived areas. 

Counterintuitively, this has led to the disappearance of the health inequality gap for DTaP/IPV/Hib vaccinations, and a narrowing of the health inequality gap for the other indicators (although inequalities remain). But it clearly isn’t a positive trend as it doesn’t reflect an overall improvement in outcomes for children. 

So what next? The child health indicators – alongside other data sources and information – provide a useful starting point to help local and national leaders, and policy-makers, better understand what’s working well for infants, children, young people and families, and where changes and improvements need to be made. All of which would help support informed and evidence-based decision-making. 

The indicators also serve as a common language, with potential to encourage cross-sector working at all levels of government. They draw attention to health inequalities and the social gradient in health, both within and across areas, and the interrelation between indicators. They thus point to the need for focused work in the context of a wide-reaching, cross-sector approach to improving child health and wellbeing. 

But a cross-sector child health and wellbeing strategy also needs to be informed by an understanding of what’s behind the changes outlined above – why have some things got better or worse for everyone, and why are some groups doing better or worse than others? 

Leaders and policy-makers will need to speak with children and families, and experts from a broad range of disciplines, to understand the context of the indicators; learn from previous successes; and consider how to address the issues identified, to improve health and wellbeing outcomes for all infants, children, young people and families.


John Kapp

Comment date
10 October 2017
What about their mental health, where I have heard 1 in 10 are self harming? The best remedy I know is the www.mindfulnessinschools.org programmes.

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