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Child health high on the agenda, but political uncertainty and public health cuts pose risk to progress, warns UK’s top paediatrician

The RCPCH has published State of Child Health: Two Years On, which highlights progress made against the policy recommendations in our landmark State of Child Health 2017 report.

Children’s doctors say they are “witnessing a hugely welcome shift towards the prioritisation of child health” but warn child poverty, cuts to public health services and uncertainties about Brexit pose substantial threats to progress.

In its State of Child health: Two years on scorecard, published today, the Royal College of Paediatrics and Child Health (RCPCH) congratulates the Government on its commitment to child health, commending them on bold pledges in areas such as obesity, mental health and the integration of children’s health services.

The scorecard, which describes progress against a series of recommendations made in the RCPCH’s landmark ‘State of Child Health report’ (2017), have been produced for each of the four UK nations and reveal a varied picture.

The Scottish Government has published bold plans aimed at tackling child poverty, obesity and mental health and in Wales, a series of measures have been outlined to reduce childhood obesity rates and to protect children from alcohol exposure. However, progress in Northern Ireland isn’t as encouraging, with the two-year political deadlock stalling any real progress in child health policy.

For England, the scorecard reveals progress in a number of areas including:

  • Child and adolescent mental health: A mental health prevalence survey is to be conducted every seven years and Government has announced substantial investment in community-based mental health services to ensure every child who needs specialist care can access it.
  • Tackling childhood obesity: The soft drinks industry levy has been introduced, the Government’s Childhood Obesity Plan proposes restrictions on junk food marketing, price promotions and food labelling, and NHS England has committed to a targeted support offer and access to weight management services in primary care for obese children.
  • Reducing child deaths: A Reduction of Avoidable Mortality in Children Programme has been established and a National Child Mortality Database created, allowing lessons to be learnt and avoidable deaths prevented.
  • Provision of statutory Relationships and Sex Education and Health Education in all schools: The introduction of statutory physical health and wellbeing education, alongside relationships and sex education, has been confirmed.
  • Strengthened tobacco control: Government published its Tobacco Control Delivery Plan and progress has been made in reducing marketing of e-cigarettes for non-medicinal use on television and radio.
  • A health system that meets the needs of children and young people: By 2028, the NHS will move to a 0-25 years service and towards service models for young people that offer person-centred and age appropriate care for both mental and physical health needs, rather than arbitrary transition to adult services that are based on age rather than need.

Professor Russell Viner, President of the Royal College of Paediatrics and Child Health (RCPCH) said:

“This scorecard reveals great progress for child health. We are particularly pleased to see children feature as an integral part in the recently published NHS Long Term Plan. We are witnessing a hugely welcome shift towards the prioritisation of child health, which is exciting not just for us as paediatricians, but for the health prospects of children today and generations to come.

“But there are significant risks on the horizon. The political uncertainty caused by Brexit looms large, raising legitimate concerns about recruiting enough children’s doctors and nurses and access to medicines and to EU funding for vital child health research. Government must act now to ensure a focus on the children’s workforce and investment in child health research are prioritised to mitigate the potentially damaging impact of Brexit.”

The scorecard also reveals that England continues to lag behind other Western European countries on a range of child health outcomes and notes areas for improvement, particularly in universal public health provision, including:

  • Reducing child poverty and inequality: Universal early years’ services continue to bear the brunt of cuts to public health services, with no targeted help provided for children and families experiencing poverty
  • Child deaths: Infant mortality reductions have stalled after a century of improvement, with recent projections suggesting a catastrophic picture by 2030 if this stall is not reversed
  • Tobacco and alcohol control: There has been no progress on extending smoking bans, nor on the introduction of a minimum unit price for alcohol, unlike in Wales or Scotland
  • Breastfeeding: There are no plans to reinstate this UK-wide infant feeding survey which provides robust monitoring and informs commissioning of strategies. This is particularly concerning given the UK has some of the lowest breastfeeding rates in the world.

Professor Viner concludes:

“Child poverty and inequality could undo much of the progress we are seeing. Deprivation is a major contributing factor to poor child health outcomes, and can lead to higher rates of poor mental health, increased alcohol or substance misuse, obesity, and death.  Babies from the most deprived families are also more likely to be born premature or a low weight which makes them more susceptible to illness.

“The gap between rich and poor continues to widen so without inequalities being addressed, England has little chance of catching up with its European neighbours. Cuts to public health budgets are a substantial threat to the good progress the government is making. Without health visitors for example, many families miss out on vital stop smoking and mental health support as well as advice around child development and feeding. Increased investment in public health is essential to ensure a healthier future for all children in England.”

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