Warning Over Missed Opportunity to Improve Children's Health

Peter Russell

October 15, 2018

A properly-funded strategy for children and young people is urgently needed to stop child health in England continuing to fall behind other comparable countries, the UK's most senior paediatrician has told Medscape News UK.

A report published by the Royal College of Paediatrics and Child Health (RCPCH) predicted higher infant mortality rates, growing obesity and increasing mental health problems by 2030 unless issues were addressed and measures implemented.

'The Concern Is We Will Fall Further Behind'

Prof Russell Viner, report author and RCPH president, said: "We've known for some time that our outcomes are poorer than other comparable wealthy countries in key areas but if you look at recent historical trends – the last 5 to 10 years – and project those forward to 2030, the concern is that we will fall further behind."

The report, Child health in 2030 in England: comparisons with other wealthy countries , compared England and the rest of the UK with 15 similar countries in the European Union, plus Australia, Canada, and Norway – a group of nations known as the EU15+.

It found that children in England currently have poorer health outcomes than the average across those other countries in most areas studied. Crucially though, the rate of improvement in England was found to be lower. "Essentially, our outcomes are improving but they're improving at a lower rate than most other competitors," said Prof Viner.

Among the report's main findings:

  • The UK infant mortality decline has stalled and mortality has begun to rise after more than 100 years of continuous improvement. Assuming latest trends continue, infant mortality would be 140% higher in 2030 compared to today.

  • Key drivers for higher infant mortality, including higher smoking rates during pregnancy, more young mothers, and lower breastfeeding rates, are more common in the UK than in comparable countries.

  • There are higher rates of non-injury mortality among children and young people in England and the rest of the UK than seen in the EU15+, with high mortality for preventable causes of death including common infections and chronic respiratory conditions, such as asthma.If current obesity trends continue, around 23% of 11-year-old boys may be obese in 2030, an increase of 13% since 2016. The UK currently has higher obesity prevalence than other north-western European countries but may see smaller increases than those countries over the next decade.

  • Reported mental health problems have increased five-fold over the past 20 years and, although future trends were hard to predict, may increase by a further 63% by 2030.

  • Diabetes control amongst children and young people in England is poorer than in comparable wealthy countries, although improvements have been seen in the past 5 years.

  • Attendances by young people at Accident and Emergency (A&E) departments could increase 50% by 2030 if current trends were maintained.

The report charted some 'good news' aspects of child health, including a rapid decline in smoking rates amongst young people. It said that by 2030, smoking rates would be "negligible" across England, as well as in the group of comparable countries.

"I think it's important to say that all of these futures are only there if we do nothing," said Prof Viner, who highlighted a welcome government focus on childhood obesity and young people's mental health. "What we need to do is see those strategies beefed up and see them bite," he said.

Prof Viner told Medscape News UK: "What we particularly want is a broad children's health strategy, so that across the board we want a greater focus on children's physical and mental health."

Childhood Obesity

Figures published last week  showed that the rate of severe obesity among children aged 10 to 11 in England had increased by more than a third since 2006/7 to 4.2%, its highest rate ever. The statistics, drawn from the national child measurement programme (NCMP), showed that "stubborn inequalities" persisted between the richest and poorest areas, with obesity in the most deprived areas being more than double that found in the most affluent areas.

"What we need to see in future is a turn back, or a dial down, on obesity," said Prof Viner. "The Government has announced a really useful set of initiatives in chapter two of its childhood obesity plan. They're currently being consulted on. We urgently need to see those implemented."

'Worrying' Trends

Dr Gary Wannan, a child and adolescent psychiatrist and spokesman for the British Medical Association (BMA), commented: "After 100 years of decline, the rise in infant mortality in England in recent years is really concerning and a clear sign that urgent action must be taken now if we are to see improvements to children's health in the future.

"With this report predicting a significant rise in demand on child and adolescent health services, any future NHS planning must factor this in.

"As well as addressing the link between poverty and poorer health outcomes, such as obesity among children from more disadvantaged backgrounds, the BMA has long been calling for greater investment in child and adolescent mental health services which remain worryingly underfunded.

"We can no longer regard ourselves as one of the leading healthcare providers in Europe, and indeed across the world, if we lag behind so significantly in provision for young people. This report should be a serious call to action for the government who must begin working to avert these worrying predictions."

Children's Health 'A Priority': Government

A Department of Health and Social Care (DHSC) spokesperson said: "Improving children's mental and physical health is a key priority for this government and will be pivotal in our long term plan for the NHS, which we're backing with additional funding of an extra £20.5 billion a year by 2023/24."

The DHSC said it was on track to achieve a 20% reduction in stillbirths, neonatal deaths, maternal deaths and neonatal brain injuries by 2020. It said it had an "ambitious" childhood obesity plan that included helping children to exercise more and cutting sugar and calories in food.

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