Healthy children make healthy adults, prevention pays, early intervention saves lives – the message from healthcare professionals is loud and clear. ‘If you get it right for children, you’ll get it right for adults,’ is perhaps most obviously true for health.
Yet still, in the UK we’re struggling to give our children the healthiest start in life and the statistics make for bleak reading. The UK is 20th out of 21 countries in the Western European league table when it comes to child mortality rates of under-five year olds. Our death rate around 25% higher than the Western European average. There are an estimated 2,000 excess deaths a year in children aged 0 to 14 years in the UK compared to the best performing country (Sweden). Although our overall child mortality rates are declining, the rate of improvement is worryingly slow, slower than the rest.
All this, against the backdrop of what is one of the most advanced health systems in the world. So what’s going wrong?
Earlier this month, Royal College of Paediatrics and Child Health and the National Children’s Bureau launched a report – Why Children Die – that delves into what children die from and which of these deaths could be prevented.
Find out more - Click here to view our infographic on the RCPCH's child deaths report
We found that child death disproportionally affects poorer families. This has been known for a long time, so why haven’t we done something about it? Other countries have found solutions that we could learn from. Where countries spend more on social protection, they have lower child mortality rates. Where countries have a smaller gap between rich and poor, fewer children die.
The question then becomes, what can practically be done to bring the rates down? At a basic level, we have to ensure children born to poorer families have decent housing and healthy food, something affected by both local and national government policy. We need to face up to the fact that children’s lives are at risk when the rich get richer and the poor get poorer, and again this is where national government policy could help. It’s also about promoting health in pregnancy. Living smoke-free, eating a healthy diet, and ensuring sufficient income and strong social support are important for protecting unborn lives, and for keeping babies alive once they are born.
Chronic illnesses starting earlier in life
We’re not just talking about babies when looking at potentially avoidable deaths. The other spike in child deaths is the 15-19 year old category. These deaths are mostly down to accidents, injuries, suicide and self-harm. So we need better policies focused on improving the mental health of young people, with proper funding to ensure safe levels of high quality mental health care for example. We need to reduce the number of traffic accidents through measures such as 20mph zones in built up areas and graduated licensing schemes for new drivers who are most at risk. We need to ensure children and young people can walk safely to and from school, avoiding injuries and improving their physical health through activity at the same time.
We’re also worried about chronic illnesses which are starting earlier in life. We have to prevent illnesses starting, and this means serious action on improving diets and making physical activity much more part of daily life. Let’s make healthy choices the easy ones to make. That means healthy food would be cheaper and more easily available than foods with high sugar and high fat. It means safe easy routes to cycle or walk to school. It means playgrounds and healthy green spaces. It means physical activity as a core part of the school day, for the sake of health.
Of course there’s a major role to be played by health professionals too. All healthcare professionals who look after babies, children, and young people must be better trained to spot early when a child may become seriously ill and act quickly.
In many ways, and thankfully, child mortality is just the tip of the iceberg. It’s important to remember that there are many other children who are unwell who might not need to be, or who get inadequate care. These children don’t make the headlines in quite the same way as avoidable deaths, but they are every bit as important. The same goes for children whose lifestyles or circumstances just won’t help them have a healthy life later on. These are preventable tragedies, and we have to do better than we do now.
Saving lives and improving health in the earliest years will pay the greatest dividends all the way through adulthood into older years.
So if we really want people to live well for longer, we need to be as committed to improving the health of our children at the beginning life as we are to adults towards the end of life.
Dr Ingrid Wolfe is a Member of the Royal College of Paediatrics and Child Health and Co-Chair of the British Association for Child and Adolescent Public Health and is one of the authors of Why Children Die.