Tackling health inequalities - consultation response

The RCPCH strongly supports any increased effort to reduce the current health inequalities. Our State of Child Health report (2017) shows that in all but one health indicator, children and young people (CYP) from deprived areas have worse health outcomes then those from more privileged areas. It is imperative that we tackle poverty and inequality to improve these outcomes for those children.

Our response

• The strongest determinants of child health across every indicator in the State of Child Health report are social, educational and economic factors. In particular, poverty is associated with poorer health, developmental, educational and long-term social outcomes and is undoubtedly the most important determinant of child health in high income countries like the UK. This is captured by the strong inverse relationship between socioeconomic status and child mortality.
• There is also a strong correlation between levels of household financial resources and children’s outcomes, meaning children living in low income households are more likely to have poor cognitive, social-behavioural and health outcomes. There is also evidence that living in poverty long term increases risk of adverse outcomes even more then shorter-term periods of poverty.
• Research shows that CYP in the most deprived households are up to three times more likely to develop mental health problems than their peers living in the least deprived households and data also shows that there is a strong association between growing up in deprivation and risk of suicide.
• Short term solutions for public health services are not going to be enough to deal with the current issue. They need to be universal, targeted and crucially need a long-term strategy that goes beyond extra funding from a one term government. Therefore, Government must be prepared to make additional investment over multiple terms to adequately deal with existing burden of health inequalities within acute service provision whilst concurrently investing in prevention and early intervention, allowing adequate time for a shift in health inequalities to be realised.
• Responsibility for improving child health and reducing mortality is held by several government departments, not just the Department of Health. To ensure that the health of infants, children and young people in the UK matches the best in Europe, coordinated Government action across several departments is required. Achieving the best child health outcomes must be a priority across Government. Therefore, the RCPCH has repeatedly campaigned for a cross-government child health strategy. Ring fencing of public health budgets for children could be considered.In doing so, however, we would not wish to see a reduction in funding for other areas such as the delivery of child protection and safeguarding services.

Our recommendations

• Ensure universal early years’ public health services are prioritised and supported, with targeted help for children and families experiencing poverty. Provide good quality, safe and effective prevention and care throughout the public health and healthcare services with a focus on primary care to mediate the adverse health effects of poverty.
• A preventative, multi-agency approach to mental health across all ages, incorporating attention to education for young people and families, social determinants, and health promotion – focusing on public mental health and early intervention for CYP, including minimising the need for admission and effective crisis services to ensure that CYP can be supported and their treatment managed in their homes as much as possible.
• UK Government and the Government in Wales, Scotland and Northern Ireland to commit to adequate resourcing to preserve universal health visiting services.
• Public Health England to develop a national strategy to increase initiation and continuation of breastfeeding, based on multidisciplinary approach, and sound evidence.
• Strong links between health, social care and education are vital. We recommend that all these areas be prioritised in the development of a child health strategy.
• Wider entry gates into health professional careers is essential which includes considering how to financially encourage mature students to enter a health service professional training. There needs to be opportunities for multi professional and modular training, so that staff can divert with relative flexibility into different career paths during their career, relatively easily.

We respond to a wide range of consultations to ensure that the College’s position, and ultimately children’s health, is represented. Members can get involved in current consultations by contacting the Health Policy team: health.policy@rcpch.ac.uk.