Poverty kills: why child health in Wales is being threatened by deprivation

Regaled as the ‘best healthcare system in the world’ by international experts, the NHS boasts some of the best doctors and delivers some of the most innovative practices available. And yet the health of our children and young people is far from the best. In fact, on many measures of child health, the UK lags behind its Western European counterparts.

A sobering picture

The data reveals a sobering picture:

• The UK ranks 15 out of 19 Western European countries on infant (under one year of age) mortality and has one of the highest rates for children and young people in Western Europe.
• The prevalence of smoking during pregnancy in the UK is higher than in many European countries (for example 5% in Lithuania and Sweden, compared with 19% in Scotland, 16% in Wales and 15% in Northern Ireland).
• At 6 months, only 34% of babies in the UK are wholly or partially breastfed, compared to 71% in Norway
• Across England, Scotland and Wales more than one in five children in the first year of primary school are overweight or obese.

Of particular concern in Wales are smoking and drinking rates among young people. 7% of 15 year old boys and 9% of 15 year old girls in Wales report to be regular smokers.  And 13% of year olds admit to drinking alcohol weekly

Why does this matter?  

The health and wellbeing of children has a direct impact on the health of future generations; health children make healthy adults. Equally, many of the health problems that occur in adulthood have their roots in childhood.

For example, smoking in pregnancy increases the likelihood of death, disability, and disease such as stillbirth, cot death and the risk of respiratory disease across the life-course.  Obesity leads to substantially increased risk of serious life-long health problems, including type 2 diabetes, heart disease, and cancer.   And half of all mental health problems are established by the age of 14.

Poverty

At the heart of the problem is the alarming gap between rich and poor; a gap that is widening and that directly results in health for the most deprived.  

An estimated 200,000 children live in poverty in Wales – and poverty has a major effect on the health of children and young people.  Mothers from deprived communities are more likely to smoke, drink and have a poor diet during pregnancy, which can lead to low birth weights and risks to child health.  And young people themselves from poorer backgrounds are more likely to smoke or drink, causing both short and long term health problems. 

At the more extreme end of the spectrum, children from the most deprived fifth of the population have a rate of child death 70% higher than those in the least deprived fifth.

Political action

Welsh Government has done much to support families in need, in particular through the Flying Start project which provides free quality childcare, enhance health visiting services and access to parenting programmes. But there are clear gaps. The fact that where a child is born so starkly affects their chances of leading a healthy life is a trend that must be reversed.

In a landmark report published last week, the Royal College of Paediatrics and Child Health brought together data for the first time on 25 measures ranging from specific child health conditions such as asthma, diabetes and epilepsy, through to risk factors including obesity, low breastfeeding rates, and mortality.  It also made a series of recommendations which have the potential to have a major impact on improving child health across Wales.

At the heart of this is the call for Welsh Government to adopt a ‘child health in all policies’ approach; whatever policies are made, from whatever Government department, they must consider the impact on child health.

Other recommendations include:

• The expansion of the Flying Start project so all children living in poverty have access to the enhanced services and support it provides
• An extension of the ban on smoking in public places to all school grounds, sports fields and playgrounds
• Compulsory evidence-based health and wellbeing programmes embedded in all primary and secondary schools across Wales
• The extension of national programmes to measure height and weight of children after birth, before school and in adolescence
• Welsh Government to pursue responsibility to implement minimum unit pricing on alcohol

Early investment

Many of the illnesses that appear in adults have their roots in childhood, so by investing and intervening early, we’re much more likely to create a healthier population. It’s not always a message that goes down well with politicians, who are compelled to act on the ‘here and now’ and often fall victim to political short-termism.  But the positive response from Welsh Government to this latest report, and the strong case to act now to reduce poverty and its effect on children, I hope will mean that children in Wales will soon be amongst the healthiest in the world.