If prevention is better than cure then we need to prioritise children’s health

It has long been known that a focus on early intervention and prevention in the early years can prevent ill health in the future. With the mental and physical health outcomes of children in England on a downward spiral, the new government’s commitment to raising ‘the healthiest generation of children ever’ has been warmly welcomed by the children’s sector. Will this sentiment be met with the action needed to address the scale of the challenge?  

The recently published Darzi report on the state of the NHS in England revealed the sheer scale of the challenge in relation to children and young people, referencing some disturbing statistics.

There has been a 250% increase in the prevalence of life-threatening and life-limiting conditions in children (between 2001 and 2018). 1.2 million children are living with obesity-related complications. There has been a significant rise in mental health needs, with an 82% increase in hospital admissions for eating disorders in the past five years, and many children and young people are unable to access the mental health support they need. The most common reason for children aged between 6–10 years being admitted to hospital is to have rotting teeth removed – something entirely preventable and which even the Prime Minister expressed being ‘genuinely shocked’ by when he spoke at The King’s Fund annual conference in September. The Darzi report found that the declining physical and mental health of children is closely related to wider social injustices, such as poor housing, lower incomes and insecure employment. This highlights part of the challenge – action is needed not only from the health sector but also local government, schools and communities. 

Considering the scale of the issue and the clear need for immediate action, The King’s Fund has been considering how we might contribute. We recently hosted a series of events to bring together thinking on prioritising and improving children’s health, and actions that can be taken to prevent ill health in future populations.

Conversations focused on the challenges of a rise in complex preventable illnesses among children, growing waits for treatment, gaps between demand and capacity, and wider social issues contributing to poor health. A point that came through strongly was how the health service tends not to consider children as a population group with a unique set of issues that affect their health and wellbeing; instead, children are often thought of more narrowly in terms of a clinical specialty and a set of services. Despite making up around a quarter of the population, babies, children and young people account for only 11% of NHS expenditure. The introduction of integrated care systems presented an opportunity for the health of babies, children and young people to be considered in a joined-up way across all four pillars of population health – that is, the wider determinants of health, health behaviours, communities, and health and care services – with a legal requirement for integrated care boards to set out how they intend to meet these needs. However, we heard that children are often an afterthought in meetings, plans and strategies – or worse, even ‘ignored’ and ‘invisible’ – a strongly ingrained issue that must be unpicked to ensure children and young people are prioritised alongside other urgent pressures.

As well as outlining the challenges, conversations also covered some of the things that could help. We heard about the need to focus on pre-birth and early years and how crucial this time is for future health outcomes – the first five years of a person’s life profoundly shape future health-related outcomes. There was consensus that early years hubs and centres such as Sure Start should be available everywhere and accessible to all. A focus on interventions such as educating children and parents on things like tooth brushing, food budgeting and cooking could also have a great impact and bring positive and lasting change, and more generally, schools have a big role in supporting health and wellbeing and health behaviours. There is evidence of positive change happening in this space – for example, through the new government’s commitment to introducing supervised tooth brushing in schools. The need to listen to children, young people and their families directly was also made clear – they are the ones with the insight and experiences, and their voices must be factored into policy-making and the changes that will impact them.

The publication of the Darzi report was an important assessment of the state of the health of children and how services that support and treat them are performing, and will hopefully be a catalyst for a shift to prioritisation of action on children’s health. Although successive governments have long known that action on early years and children is required to improve health outcomes, most of the focus tends to be around adult and older-age populations. Despite sector-wide enthusiasm around the new government’s stated commitment to improving children’s health, the scale of the challenge should not be underestimated – this issue needs sustained prioritisation from government, with a long-term focus from all sectors and services required to integrate and take action. The government has already taken positive steps in areas such as junk food advertising and the introduction of legislation to raise the age of sale on tobacco products so that the upcoming generation of children will never be able to legally buy cigarettes.

The next 12 months are crucial for enacting steps to make change. The sector has already made some strong calls and recommendations, including through the Health Policy Influencing Group’s ‘Roadmap for the healthiest generation of children ever’, which provides clear direction on how the government can begin to address the challenges facing children and young people. Government must take bold action to put children at the heart of its work on health and prevention, to ensure the needs of children and young people are prioritised and that we have a healthy nation for the future.