The best start in life

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Part of Improving the public's health

Local authorities have specific statutory duties in relation to children and young people’s services (Citizens Advice Bureau 2013).

Here, we focus on broader interventions and national initiatives that local authorities can tap into to improve the health of local children and their families.

How can early years experiences affect health?

To get the best possible start in life, a baby’s mother needs to be healthy before and during pregnancy and childbirth. There is compelling evidence that a child’s experiences in the early years (0–4) has a major impact on their health and life chances, as children and adults.

  • Babies that are born below the low birth weight threshold are five times more likely to die as an infant than those of normal birth weight (The Poverty Site, no date).
  • A child’s early development score at 22 months is an accurate predictor of educational outcomes at age 26 (Feinstein 2003), which in turn is related to long-term health outcomes (see Healthy schools and pupils).
  • Experiences in early life are increasingly being recognised as having a lasting effect on adult health both directly and through influencing adult health behaviours. Roughly half of the gradient in socio-economic mortality in later life can be explained by early life experience, including its influence on adult smoking rates (Giesinger et al 2013).
  • Adverse experiences in the early years such as excess exposure to alcohol and cocaine use pre-birth, and neglect during the early years, lead to poor development, which affects later life chances. For example, a single reported experience increases the risk of attempted suicide between two and five times and the more poor experiences the higher the risk of lifetime depressive disorders (Middlebrooks and Audage 2008)
  • One in four children is overweight or obese when they start school (Rudolf et al 2011), which puts them at greater risk of cardiovascular disease and diabetes in later life.

What are the possible priority actions for local authorities?

Local authorities have an important role in commissioning and delivering early years services, and need to ensure that their actions are well targeted and evidence-based.

There are currently a number of national initiatives under way that should help local authorities better tailor their early years support to the needs of the most disadvantaged children and their families. These include the Early Intervention Grant (over which local authorities have control) and the expansion of the troubled families programme from 120,000 to 400,000 families (HM Treasury and Department for Communities and Local Government 2013; Department for Communities and Local Government 2013). Other initiatives include:

  • the provision of 10–15 hours a week of free early education, recently extended to around 130,000 of the most disadvantaged 2 year olds
  • from September 2014, the provision of free early education places for 2 year olds who live in households that meet the eligibility criteria for free school meals, along with children who are looked after by the local authority (Department for Education 2013)
  • the delivery of 15 hours a week of free early education for 3 and 4 year olds, 95 per
    cent of whom now access their free entitlement.

To provide effective early years support to improve health and reduce inequalities, local authorities can (Hallam 2008):

  • target the most disadvantaged children and their families with intensive support, supplementing specific interventions with mainstream universal family support services. Successful interventions tend to be behaviour-focused – for example, coaching parents during play sessions with children – rather than simply providing information. Staff should be adequately trained to provide specialist, intensive support
  • focus on vulnerable mothers, from pregnancy until the child reaches the age of two. Programmes that involve health visitors and specialist nurses undertaking home visits have had successful outcomes, including improvements in prenatal health, fewer childhood injuries, fewer subsequent unplanned pregnancies, and increases in maternal employment and children’s school readiness.

The business case for different interventions

The costs of caring for preterm birth and low birth weight babies, from birth to the age of 18, are substantial, at around £3 billion (for England and Wales) for each annual cohort (Mangham et al 2009). The business case establishing the ‘massive savings’ that can be made from smart investment in early interventions is strong (HM Government 2011a), with much of the evidence coming from robust studies in the United States.

The Family Nurse Partnership – a voluntary home visiting programme for vulnerable mothers from early in pregnancy until their child is 2 – for example, has generated savings of more than five times the programme costs. Other studies of targeted pre-school interventions have shown a wide range of positive returns on investment (HM Government 2011b).

The Greater London Authority (GLA Economics 2011) has translated the data from the major US studies and applied it to the UK context. Overall, half of pre-school programmes produced strong savings to the public purse, as did three out of eight child welfare and home visitation programmes. This reinforces the importance of sticking to programme designs; without this, it is easy to lose focus and reduce effectiveness and payback.

Finally, there is strong evidence that early intervention to support people experiencing mental health problems can produce significant cost savings and productivity improvements in the longer term, for the NHS, local authorities and others (Knapp et al 2011). For example, health visitors identifying and treating post-natal depression improves productivity and leads to cost savings in the medium to short term and targeted parenting programmes to prevent conduct disorder pay back £8 over six years for every £1 invested with savings to the NHS, education and criminal justice systems.

Further resources and case studies

  • Graham Allen MP’s second report to government, Early Intervention: Smart investment, massive savings (HM Government 2011a), includes an annex on the 25 best early intervention programmes in the United Kingdom.
  • The Children and Young People’s Health Outcomes Forum has produced two recent reports (2013a, 2013b) one on public health and prevention, the other on tackling inequalities in health outcomes.
  • The Greater London Authority has set out the economic case for early years interventions to reduce health inequalities in London (GLA Economics 2011).
  • The experience of the 10 pilot sites for the Family Nurse Partnership programme in England has been evaluated, detailing the health impacts and cost issues (Barnes et al 2008).
  • The National Foundation for Educational Research has published a guide that develops a business case for early interventions and considers their value for money (Durbin et al 2011).
  • The recently established Early Intervention Foundation (2013), whose mission is to champion and support early interventions to tackle the root causes of social problems among children and young people, will work with 20 local authorities initially. In the longer term it aims to become an enabler and knowledge hub for all local authorities to support their early years services.
  • The health impacts and cost-benefit case for early learning for 2 year olds in the United Kingdom (Department of Health 2013). The HighScope Perry PreSchool Programme in the United States examined the lives of 123 children born in poverty and at high risk of failing in school (Schweinhart et al 2005). The UK evaluation of the Effective Provision of Pre-school Education (EPPE) has shown good results (Sylvia
    et al 2004).
  • The Local Government Association (LGA) commissioned the National Foundation for Educational Research to conduct a review of early interventions to assess impact and value for money, which includes numerous case studies (Easton and Gee 2012).
  • The Social Care Institute for Excellence (SCIE) published a review of decision-making for early intervention in local authorities, which includes seven case studies covering innovative approaches (Anderson 2013).
  • The LGA’s report, Bright Futures: Local children, local approaches, shares good practice and learning on how local councils have worked with children’s centres, including four case studies of how councils have worked with health services to achieve successful early intervention (Local Government Association 2013).

For references please see Improving the public's health: references appendix

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