Widening differences in UK child mortality are not inevitable

Every death of a child or young person is a unique tragedy. In coping with such events as healthcare professionals, we respond in personalised ways. A common question, though, is whether we did everything we could to prevent it. Did we examine thoroughly? Did we respond to results quickly? Did we listen to the story?

The factors influencing the survival of children and young people extend well beyond the hospital or clinic. To understand how to prevent deaths, we must look at a complex web of determinants—from individual behaviours, to healthcare systems, to political, socioeconomic and environmental factors.

Monitoring trends and describing differences in survival between children and young people according to socioeconomic background - and where they live in the UK - can provide useful insights into how to reduce deaths. Our State of Child Health 2020 report demonstrates that although overall mortality rates are slowly declining, improvements are stalling in some age groups.

Declines in infant mortality have recently slowed, and while mortality rates in 1 to 9-year-olds continue to improve, there is considerable variation between UK countries and within them. Beyond infancy, adolescence is the point at which children and young people are most likely to die, usually from preventable causes such as injuries. It is also the age group with the greatest geographic variation in UK outcomes, with mortality rates far higher in Scotland and Northern Ireland than England.

Variation in child deaths can be explained in part by the uneven distribution of determinants to mortality. Among infants, for example, social gradients in preterm delivery, breastfeeding and maternal health are all likely contributors to large differences in outcomes—infant mortality rates in our most deprived communities are more than double those in wealthier groups. Shamefully, these differences appear to be widening. Behind such statistics are tragedies that often could have been avoided.

Differences in UK mortality rates have not happened by chance—they are the result of decisions we have made as a society

So, what can be done? Our report highlights the crucial importance of macrolevel determinants of child health and survival and calls for renewed efforts to reduce child poverty and support parental mental health, employment and education. Beyond these broader proposals, the report also offers a set of focused recommendations targeting specific age groups.

These include measures to improve preconception maternal health, supporting midwifery and health visiting, and enhancing healthcare access for children and young people with long-term conditions. For adolescents, we also need to focus on the built environment, poor housing and infrastructure—the major determinants of death from injury—and provide appropriate child and adolescent mental health services (CAMHS).

Differences in UK mortality rates have not happened by chance—they are the result of decisions we have made as a society. They are also not inevitable. Our latest report offers clear policy recommendations that are likely to reduce inequalities, reverse worrying recent trends in mortality rates and improve outcomes for all children and young people living in the UK.