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Growing pains across the UK

'We've got shelf-loads of policies on how to make things better for child health. There's been much less focus on delivery.'

It would be nice to think that the children of our nation are well-cared for, loved and healthy. Surely poverty, hunger and ill-health are problems to be worried about in developing countries, not here in the UK?

Sadly the figures show a different story. More than one in four (27 per cent) of children in the UK are growing up poor. Shockingly, one third of 11 to 16-year-olds do not even own a book, a study published in 'The Lancet' last year says.

Austerity measures disproportionately affect families, so at this time of recession and cuts it makes perfect sense for the BMA to publish a major report into childhood in the UK. Growing Up in the UK: Ensuring a Healthy Future for our Children examines the progress since a previous BMA report on the issue in 1999.

Since then, one would hope for a reduction in health inequalities but unfortunately the opposite is true. The UK still ranks low internationally for children's health and well-being and those who are socially and economically disadvantaged are the most affected.

BMA Board of Science Chair Averil Mansfield says: 'It is distressing that in the 21st century, the future health and well-being of a child born in the UK remains dependent on their social position. The UK is also lagging behind many other European countries on a range of health outcomes for children and young people without good reason.'

 

UK lagging behind

A UNICEF study, published in March, placed the UK sixteenth out of 29 countries for child well-being in rich nations based on health and safety, family relationships, behaviours and risks, subjective well-being and material well-being.

More children and young people are dying in this country than in others in northern and western Europe, according to the 2012 'Report of the Children and Young People's Health Outcomes Forum'. If the UK had the same death rate as Sweden, 1,500 children's lives could be saved each year.

Worryingly, indicators show that the gap between the rich and the poor has widened over the past 14 years. London child public health research fellow Ingrid Wolfe, one of the authors of the BMA report, says: 'There's been progress but not enough progress. Child mortality has gone down considerably but if we look at it more closely our relative position has worsened.'

You may ask how this can be the case in a developed country such as the UK. There have been numerous policies and much political rhetoric aimed at improving life for families. The Children's Act 2004 or the government paper 'Every Child Matters' spring to mind.

But policies alone are not the answer, according to Dr Wolfe.

'We've got shelf-loads of policies on how to make things better for child health. There's been much less focus on delivery. What we need is a meaningful system of accountability.'

 

Boost vital roles

In 1999 the BMA called for a children's commissioner, a role that has since been created by all four UK administrations.

Dr Wolfe argues, however, that the role does not go far enough: 'Having a children's commissioner, a strong advocate for children, is an excellent start to this process [of accountability], but to be even better this role could be underpinned by resources to evaluate health and policy, with a budget to match, and then there should be a system of reporting to a minister who is accountable, and who has the power to change things for the better for children.'

 

Avoidable deaths

One of the most shocking findings of the new report is that many child deaths in the UK are preventable. It quotes the Confidential Enquiry into Maternal and Child Health research 'Why Children Die', which found there were identifiable failures in more than a quarter of child deaths and potentially avoidable factors in a further 43 per cent of deaths. Deaths from pneumonia, asthma and meningococcal disease are higher in the UK than in comparable European countries.

Errors were particularly common among staff without paediatric training or supervision.

Dr Wolfe attributes this failure of health services partially to a lack of integration. She says: 'Many countries that we compare ourselves with have achieved progress in finding ways of bridging the gaps between primary and secondary care for children.

'There are lessons we can learn from looking at how other countries have tried to find solutions to common problems such as fragmented services for children with chronic conditions such as asthma or diabetes.

'Looking at other EU countries, one of the most striking differences is how we organise first contact care. The NHS is rightly commended for providing universal access to primary care but we need to look more closely at the gap between primary and secondary care.'

 

Common conditions

Chronic diseases and other long-term conditions have replaced acute infectious disease as the most common cause of illness and suffering among children and young people in recent years. Three-quarters of childhood diseases are attributable to long-term conditions according to the 'Family Resources Survey' 2011. Many diseases are preventable and can be linked to socioeconomic disadvantage.

'The most vulnerable children are likely to have the most health, behavioural and mental health problems. There are ways we can ensure better economic and material well-being for the most vulnerable children, and so boost their chances of improved outcomes. We could do more, through social protection policy, to look after these children and give them a better start in life,' says Dr Wolfe.

Current coalition government austerity policies to welfare benefits and social care, coupled with changes to the NHS, make it more vital that action is taken now to protect children's well-being. Dr Wolfe says: 'I think this report is important now because we're at such a pivotal moment in the economy and the NHS. With the Health and Social Care Act there's a real risk of further fragmentation of the health service which will make it more difficult to achieve the integration called for.

'Ultimately the issues come down to values and the significance placed on childhood as a society. 'I think we need to have a much more open debate. It's a political question about where the position of children should be in our society. In tough economic times we need to think where do we want to spend our money and what are our priorities as a society? At the moment we seem to have plenty of money to bail out banks but not enough to offer universal benefits for children. Austerity economics is harming children,' argues Dr Wolfe.

Read the full report