Across most indicators, health outcomes are worse for children who live in deprived areas. Inequalities in some outcomes have widened since the last State of Child Health report in 2017. Progress has also been seriously affected by deep cuts to local authority budgets - used to finance public health initiatives and community services.
The authors highlight that, even where there have been notable improvements in children’s health, the UK is often lagging far behind other countries. For example, although there has been a fall in the number of emergency asthma admission rates across all four nations, the UK still has one of the highest mortality rates in Europe for children and young people with asthma.
Dr Ronny Cheung, Clinical Lead for RCPCH and co-author of the report, said:
Two weeks ago, the Marmot Review presented a stark picture about life expectancy in England. Now, our own report shows troubling signs for children and young people across the UK.
The harsh reality is that, in terms of health and wellbeing, children born in the UK are often worse off than those born in other comparably wealthy countries. This is especially true if the child is from a less well-off background.
Infant mortality is a globally-recognised sign of how well a country is looking after the health of its citizens. Throughout the world, the number of babies dying in their first year has been steadily falling for decades, as incomes rise and mothers and children receive better healthcare. Yet UK infant mortality rates have stalled, and in England they actually got worse between 2016 and 2017. For a high-income nation such as ours that should be a major wake up call.
State of Child Health 2020 brings together 28 measures of health outcomes, ranging from specific conditions – such as asthma, epilepsy, and mental health problems – to risk factors for poor health such as poverty, low rates of breastfeeding, and obesity.
Community paediatrician and co-author Dr Rakhee Shah, said:
Investment in preventative health services must now be prioritised by the new UK Government. England has seen a huge decline in spending on local services and I see the results of that every day of my working life especially for my most disadvantaged patients. The cuts to services also have an impact on our NHS – people have fewer places to go to get advice, support, and stay well.
The authors make a number of policy recommendations for each nation. For England, these include:
- Introduce a cross-departmental National Child Health and Wellbeing Strategy to address and monitor child poverty and health inequalities.
- Restore £1 billion of real-terms cuts to the public health grant for Local Authorities.
- Ensure future investment in public health provision increases at the same rate as NHS funding and is allocated based on population health needs.
- Implement in full commitments from the prevention green paper, Advancing our health: Prevention in the 2020s.
- Implement commitments to provide a Youth Investment Fund, with protection of the committed £500m funding.
- Provide health-based support for children throughout education, including funding for increased numbers of school nurses and school counsellors.
- Provide renewed investment in services for children and families, which support the child’s school readiness.
- Ensure that health visiting services are protected, supported and expanded with clear and secure funding.
President of the RCPCH, Professor Russell Viner, said:
We’ve got a lot of work ahead of us if we’re to get a grip on the state of child health in the UK. This report is the only one of its kind to zoom out and look at the full picture and it’s not a pretty sight. On many vital measures we risk lagging behind other European countries.
There some positive signs – teenage pregnancies have fallen hugely, Scotland is leading the way on reducing youth violence, and we’ve made huge strides in the treatment of conditions like diabetes. These outcomes are invariably the result of good policy, political commitment, and proper funding.
In many areas of healthcare, we’ve led the rest of the world. But we’re in danger of failing a generation if we don’t turn this situation around. The government has made welcome commitments on childhood obesity and young people’s mental health but we need to see delivery in these and other areas. We have the evidence, the experience and the expertise to make real progress in the life of this government. It’s now time to deliver for children and young people.
See below for some highlights of State of Child Health 2020.
- The UK is fifth from bottom among 27 European countries for infant (under one year of age) mortality. Infant mortality in England stalled between 2013 and 2018 at 3.9 per 1,000 livebirths, with a slight rise in 2017 to 4.0.
- In England and Wales infant mortality is more than twice as high in the most deprived areas compared with the least deprived areas.
- The prevalence of children aged 4-5 who are overweight or obese has not improved significantly in any of the four countries since 2006-7.
- Trends among 4-5 year olds are stable across the UK with around 25% of children overweight but this increases to around 34% for 10-11 year olds in England.
- Childhood obesity is more prevalent in deprived areas. In England, the prevalence of severe obesity among 4-5 year olds was almost four times as high in the most deprived areas (3.8%) than the least deprived areas (1.0%) in 2017/18.
Child poverty (new indicator)
- A total of 4.1 million children live in relative poverty in the UK (after considering housing costs) – an increase of 500,000 between 2011-12 and 2016-17. From 2016/17 to 2017/18, the numbers in England rose from 30% to 31% of children and in Wales from 28% to 29%
- Child poverty in Scotland plateaued at 24% and in NI decreased from 26% to 24%.
- Across the UK, rates of child poverty have increased for all types of working family. Lone parents working part time and households with only one working parent have seen the sharpest increases in poverty over the last three years.
- Nearly half of children (47%) in working lone parent families live in poverty.
- In 2018, all four UK nations fell short of the 95% WHO target for the second dose of MMR.
- In 2018, the uptake rates of two doses of MMR vaccine at 5 years ranged from 86.4% in England, 91.2% in Scotland to 91.8% in Northern Ireland and 92.2% in Wales.
Youth violence (new indicator)
- While rates of physical violence among young people are broadly similar across the four nations, England is the only country in which rates are increasing – most notably for 20-24 year olds. Between 2012 and 2017, the rate of physical violence among that age group increased from 297.7 to 315.49 per 100,000.
- In Wales, Scotland and Northern Ireland, physical violence among young people aged 10-24 shows an overall downward or stable trend from 2012-2017.
Long term conditions
- Emergency admission rates for asthma have fallen since 2003/4 across the UK. However, the UK has among the highest mortality rates in Europe for children and young people with the underlying cause of asthma.
- Epilepsy had until recently seen similar falling rates of emergency admissions. However, in 2017/18 rates rose slightly in England, Wales and Scotland. In Scotland, children with epilepsy from the most deprived areas were twice as likely to have an emergency admission to hospital than those from the least deprived.
- There has been continued improvement in blood glucose control among children and young people with Type 1 diabetes across all four nations, and it is encouraging that there have been increases in the completion of key health checks for those with diabetes.
- Mortality - Infant mortality; Child mortality (1-9 years); Young people’s mortality (10-19 years)
- Maternal and perinatal health - Smoking during pregnancy; Breastfeeding
- Prevention of ill health - Immunisations / vaccinations; Healthy weight; Oral health
- Injury prevention - Accidental injury; Road traffic accidents; Youth violence (new indicator)
- Healthy behaviours - Smoking in young people; Alcohol and drug use in young people; Conceptions in young people
- Mental health - Prevalence of mental health (new indicator); Mental health services (new indicator); Suicide
- Family and social environment - Child poverty; Education – not in education, employment or training (NEET) (new indicator); Young carers (new indicator); Children in the child protection system; Looked After Children (new indicator)
- Long term conditions – Asthma; Epilepsy; Diabetes; Cancer; Disability and additional learning needs
- Workforce - Child health workforce (new indicator)