Child health declining: just one of the indicators – losing our first world status?

Just as overall life expectancy is set to fall, so child health is declining, and the life expectancy of ill children depends more and more on your post code, and your income group. We are losing our first world status.. Our main natural resource is our people and our children. With no significant underground resources we are in trouble if we don’t invest in education and our children more.

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Jacqui Wise reports in the BMJ: Child health crisis: calls for urgent action must be heeded (BMJ 2018;360:k1270 )

The data pointing to a reversal in the health of British children are mounting, reports Jacqui Wise

After years of progress the UK is stalling in areas such as infant mortality and immunisation levels and is lagging behind similar countries on mortality, breastfeeding, and the prevalence of obesity.

Several new reports detail the worrying state of the nation’s child health. Health professionals say that the latest figures are cause for alarm and are calling on the government to act urgently to develop a comprehensive child health strategy.

Rising infant mortality

Latest figures from the Office for National Statistics show that the number of babies dying in the first year of life is rising,1 a reversal of several decades of the NHS’s success in reducing infant mortality. In England and Wales the rate has increased to 3.8 deaths per 1000 live births, up from 3.7 in 2015. Neonatal death rates have also risen, from 2.6 per 1000 births in 2015 to 2.7 per 1000 in 2016.

Furthermore, the ONS figures show that the infant mortality rate in the most deprived areas of England was 5.9 per 1000 live births, more than double the 2.6 per 1000 in the least deprived areas.

The news comes after findings in a report from the Nuffield Trust and the Royal College of Paediatrics and Child Health that the UK is falling behind most other high income countries in many key areas of child health.2

The report’s author, the paediatrician Ronny Cheung, warned, “The recent changes to the UK’s trajectory on life expectancy, premature deaths, and immunisation should set alarm bells ringing for policy makers about the effects of cuts to public health and early years services.”

The analysis, which compared the UK with 14 other countries—10 in Europe and also the US, Canada, Australia, and New Zealand—found that in 2014 the UK had the fourth highest infant mortality rate. The UK also has the second highest prevalence of babies born with neural tube defects.

The UK’s rates of breastfeeding are among the lowest in the world: only 34% of UK babies receive any breast milk at six months, half the 62.5% in Sweden. The UK’s proportion of children and teenagers who are overweight or obese is considerably above the average among high income countries.

Diphtheria, tetanus and whooping cough, and pneumococcal vaccines have all seen their uptake fall in the past year, and the UK lags behind Sweden, Spain, Germany, and the Netherlands in the uptake of measles vaccine.

Poverty set to increase

The report said that inequality, which has been proved to have a negative effect on child health, is rising. Last year a report published by the Royal College of Paediatrics and Child Health showed that UK children from deprived backgrounds had much worse health on 24 of the 25 indicators measured, including higher rates of mortality, obesity, non-intentional injury, maternal and adolescent smoking, and emergency hospital admissions for asthma or poor diabetes control.34

The situation is likely to get worse, because child poverty rates look set to rise even further. Another new report, from the Equality and Human Rights Commission, looked at the effects of changes to taxes and social security between 2010 and 2018. It concluded that children will be among the hardest hit by the changes.5 One and a half million more people will be in poverty by 2022, it predicted, and the proportion of children in lone parent households who will be in poverty will rise from 37% to over 62%.

Russell Viner, president of the Royal College of Paediatrics and Child Health, argued in The BMJ last week that the problem was that NHS England didn’t prioritise children and teenagers.6 In contrast, Scotland and Wales have both recently announced new national strategies to improve the health of young people.

In a press release accompanying the college’s report Viner said, “We want to see the UK government develop a comprehensive, cross departmental child health strategy, which includes a ‘health in all policies’ approach to policy making. It’s also crucial that some of the biggest threats to child health are tackled boldly—for example, tighter restrictions on junk food advertising to tackle obesity, the reinstatement of child poverty reduction targets, and, crucially, the reversal of damaging public health cuts.”

Michael Marmot, director of University College London’s Institute of Health Equity and a leading expert on health inequalities, told The BMJ, “The worrying part is when a downward trend that has gone on for years stops. While the increase in infant mortality has been small, we should be doubly concerned. First, because one extra death that might have been avoidable is a tragedy for the family concerned. Second, because a rise in infant mortality is an indicator that things are perhaps not going well in society, as well as in the healthcare system.”

He added, “Child poverty rates are set to rise in the UK, and growth in funding for the NHS is way below historical trends. The Nuffield report shows that breastfeeding rates are low in Britain. The government needs to pay attention to all three of these with a good deal of urgency.”

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This entry was posted in A Personal View, Medical Education on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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