Dr Mair Parry calls for children’s health to be prioritised in the run up to the 2016 elections.
There’s a lot we can be proud of in Wales. We have world class sportsmen and women and world class entertainers who are great role models for our children. We also have one of the most advanced health systems in the world with fantastic clinicians delivering care that’s free at the point of access, enabling children and their families to receive support at any time, day or night.
Despite having a world class National Health Service, health outcomes across the UK are among the poorest in Western Europe, and children’s health in Wales is falling short of where it should be.
Wales continues to have the worst rates of childhood obesity and smoking during pregnancy in the UK. And child death rates in the most deprived parts of Wales are much higher than in the least deprived. Healthcare services are under severe pressure and demand for children’s specialist mental health support is under particular strain, with referrals doubling over the past four years.
For far too long, children’s health has been slipping down the political priority list with dealing with the challenges of an ageing population being the focus for most of the main parties. We need politicians of all party colours to commit to making child health an equal priority, and with the 2016 elections just over six months away, it is an opportune time for such commitment.
As a children’s doctor of course you would expect me to call for child health to be a priority but there is much wider support for this. According to a recent poll commissioned by the RCPCH, prioritising child health is something that the Welsh public also support; with over three quarters (78%) of Welsh adults saying that children’s healthcare should be a very important priority for NHS Wales.
‘The catalyst’
Poverty is the catalyst for many of our poor child health outcomes. We know that children living in poverty are more likely to die prematurely, are more likely to be overweight or obese and are more likely to suffer with mental health problems. And with one in three children in Wales living below the poverty line, it is clear that politicians must tackle inequalities if they are really improve the health of our children and the health of generations to come.
We know that healthy children are much more likely to grow into healthy adults so it’s crucial that any policies aimed at reducing health inequalities are centred on prevention and early intervention.
Tackling childhood obesity and improving mental health
It is unacceptable that just over a quarter of children in Wales are overweight or obese. This means Wales has a higher rate of obesity than Scotland, England and Northern Ireland. Childhood obesity is the biggest public health threat to our country and with devolved powers, Welsh politicians have a real opportunity to make policy changes quickly that will make a big difference.
One such change is a tax on food and drink high in sugar, salt and fat. The RCPCH proposed this along with a number of other preventative measures in its newly launched ‘Child Health Matters: A vision for 2016’ report. It’s a proposal that the British Medical Association also backs and is supported by around half of the Welsh public.
Other policies that must be considered include the introduction of a 20mph speed limit in built up areas. Not only will this encourage children to walk, scoot, cycle and play but evidence suggests it will also reduce road traffic deaths – a major cause of preventable death in Wales. This is a policy which 77% of the Welsh public support and one that is also backed by charities Sustrans Cymru and Living Streets.
When it comes to mental health, prevention is vitally important. We know that three children in every school class suffer with a mental health problem, and if not dealt with appropriately, poor mental health can lead to drug and alcohol misuse and in extreme cases, suicide, which is another leading cause of death in young people.
‘Stronger direction is needed’
Despite early successes on children and young people’s rights in Wales, the past few years have seen a reduced voice for children. Currently, children and young people are invisible in many of the debates about the services that affect their health and wellbeing.
We want to see political parties of all colours commit to appointing a Welsh Minister for Children to lead on policies affecting children and young people – this is something that 7 in 10 Welsh adults (71%) support and is something also acknowledged by Barnardo’s . The reinstatement of a children’s committee in Welsh Government Cabinet, supported by 68% of Welsh adults, would also send a strong signal that child health is being taken seriously by politicians.
With high profile organisations championing change along with high levels of public support, I urge the next Welsh government to make child health a priority. Only with political will can we make child health outcomes in Wales something to be proud of and comparable to the best in the world.
Historically one of the greatest supports off child health has been the health visiting service. When I practised as a health visitor way back in the 60s and 70s we visited every baby within two weeks of birth (taking over from the midwife) until they started school at the age of five, when we handed over to the school nurse. We visited weekly until the baby was six weeks old , thereafter as often as necessary, based on a “contract” with the mother. We knew all our families and were able to provide all kinds of support and advice. When I came home to Swansea in 1997 I was shocked to find how poor the health visiting service was in Wales. On a Welsh Government commission I reviewed the health visiting services in Wales and was even more shocked by what I found. My report was quietly shelved, as were two later reports which had similar terms of reference and made similar recommendations. Nowadays it seems that the health visiting service is no more than a protocol-driven tickbox exercise of annual checks. What a great loss to child health!
Would a general tax on fat really help? Wouldn’t this lead to a battle, with places like MacDonalds trying to maintain their prices for their more than willing, and happy consumers? Biscuits are already quite expensive, and the cheaper, more affordable packs might not be any healthier than their fancier and pricier rivals. At times during my childhood, I existed on biscuits! This is a mildly exaggerated claim, but nonetheless, I certainly topped up on them. I think it’s a good thing to discourage the use of trans-fats in biscuits, and other food products, and perhaps it would be helpful to have a targetted fat tax – perhaps margarines and spreads containing hydrogenated, and trans-fat, could be taxed? Can that be done in Wales?
A children’s, and young people’s minister, with the power to make some good changes, would be desirable in Wales, and I’d support that proposal, especially since so many families have to juggle their time, and are subjected to so many demands on their resources.
Tackling childhood poverty, and childhood obesity, requires the making of significant changes to adult lives, and this means that society’s values, and lifestyles, must be affected, for the better. We have to work out how we can live sustainably, so that we can still make a living, while prioritising and protecting the well-being of adults and children.
Perhaps the fast food outlets, and the biscuit manufacturers, could begin again, with fresh, healthier ingredients, and ‘slower’ cooking, and eating practices, rather than continuing with the current emphasis on fast through-put.
Our roads and streets could do with broader speed restrictions, which also include country roads currently set at national speed limits. In rural parts of Wales, it is dodgy to take a walk along a lane or relatively quiet road, for fear of being sliced off the side of the verge by the next car going at 60mph. Only emergency vehicles really need priority – most other people can slow down! Everything needs to be done to make walking pleasant, comfortable and safe. It is the most basic of human instincts to walk, and we should, and could, make Wales a walking-friendly land, an everyday thing in rural areas and urban places. Bus companies, car manufacturers, and oil companies must gradually adapt to changing priorities – human health comes first, and we are responsible for organizing, and ensuring this.
Cycling investment needs to be priorised, firstly so that parents can feel confident that children and young people are safe to cycle to school, and to popular places, such as sports centres, parks, and local shops. Clearly devised, highly visible, protected and marked pathways also make it more likely that parents will cycle too…
Out-of-town retail parks need to be visibly, and well, linked by walking and cycling roadways to residential roads, and large businesses should accept some responsibility for helping to create the additional infrastructure. A scheme that enables this needs to be set up before many more retail, and housing spaces are developed without proper regard for these matters.
That’s all – I hope that politicians and policy makers in the Assembly read this.
Thank you Mair for submitting this article.
Alice’s point about the dangers of riding/walking along rural lanes is a very good one. A simple solution would be ‘if the road doesn’t have a white line down the middle then the speed limit is always 30’.
June – worth reading Halperns new book ‘Inside the Nudge Unit” http://www.amazon.co.uk/Inside-Nudge-Unit-changes-difference/dp/0753556537
There is a specific part discussing the efficacy of health visitors work. On close examination the evidence base actually pointed towards the fact that if you really want to get the parents doing parenting right then re-focus the majority of your resource on the mother for their first pregnancy/child and form the right habits from the outset which they will generally continue with. If you don’t do that they just carry on as they have previously done when number 2/3/4 comes along whether it is good or bad. Intervention by officialdom for these subsequent children is of marginal benefit if at all.