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England falling behind on child health

Infant mortality on the rise, says report

Jo Carlowe

Monday, 15 October 2018

Infant mortality has started to rise following 100 years of continuous improvement.

A report, published today, from the Royal College of Paediatrics and Child Health (RCPCH) reveals that England is falling behind other European countries in the race to improve children’s health.

The report: “Child health in 2030 in England: comparison with other wealthy countries,” uses long-term historical data to project outcomes for children and young people’s health. It concludes that whilst England is middle of the pack for some outcomes, on the majority, it is likely to fall further behind other wealthy countries over the next decade.

As a result of the findings, the College is calling for a properly funded health strategy to transform the life chances of children and young people.

Infant mortality in England and Wales rose in 2015 and again in 2016, reversing the 100-year decline in one of the key indicators of population health. This report reveals that even if infant mortality begins to decline again at its previous rate, infant mortality rates could be 80% higher than the average across the EU15+ [those countries in the EU in 2004] in 2030. If mortality continues the current “stall” then it will be 140% higher in 2030.

Professor Russell Viner, report author and president of the RCPCH, said: “This report clearly identifies the danger on the horizon - but trends shown here are not inevitable. Each of them could be turned around if key actions are undertaken. We acknowledge that admirable action has been taken on some fronts, such as the government’s Childhood Obesity Plan, which we believe will help to reverse current obesity trends if fully implemented. In childhood diabetes, a focused national strategy has driven major improvements in diabetes control in English children and young people. However, there is more work to be done elsewhere. That’s why it’s hugely encouraging that child and maternal health have been included as a work stream in the NHS England Long-Term Plan. The forthcoming Plan provides a crucial opportunity for improving child health and my message to policy makers is to act now or the consequences are grave.”

The report found that England and Wales had notably high mortality for one to 19-year-olds for chronic respiratory conditions (such as asthma) and epilepsy (2001-2015). Mortality in both conditions is likely to remain substantially higher than the EU15+ average if current trends continue, the report stated.

Another area for concern, was around mental health, with a prediction that if recent trends continue for the next decade, reported mental health problems in England look set to increase by 63% in 2030.

In addition, A&E attendance amongst children and young people is on a trajectory to increase by 50% in 2030.

Poverty lies at the root of many risk factors for infant mortality notes the RCPCH, particularly with regards its impact on mental health and nutrition.

“Child poverty is predicted to increase over the next decade, which, if true, may make our predictions under-estimates. Children living in poverty are more likely to be obese, have mental health issues and die early,” said Professor Viner.

The report included a number of recommendations including calling on NHS England to develop and support the implementation of a Children and Young People’s Health Strategy for England, and investment in health visiting and school nursing services.

Professor Viner said: “We welcome the opportunity provided by NHS England to work with them on proposing how we can improve children and young people’s health in their Long-Term Plan. This Plan must set out a clear vision for delivering world class health and wellbeing outcomes for our next generation.”

Commenting, the British Medical Association’s consultants committee deputy chair and child and adolescent psychiatrist, Dr Gary Wannan, said: “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.”

Commenting on today’s report, Maria Trewern, chair of council at the Royal College of Nursing, said: “This report paints a bleak picture for children and young people if we do not act now to improve their health and wellbeing.

“RCPCH is right to highlight the important role of health visitors and school nurses in ensuring children have a healthy start to life. They are the frontline defence against childhood obesity and poor child mental health, but all too often nurses report they are understaffed, which means time with the children is rushed.

"They often feel the care they give is compromised. Significant cuts to public health funding has also reduced resources available to help vulnerable families and children in poverty.

“The government risks turning back the clock on children’s health if it doesn’t increase and protect investment in health visiting and school nursing services. Focusing on child and maternal health in the NHS 10-Year Plan is an opportunity that cannot be missed. If not, we are building problems for the future which can be avoided by interventions at an early stage.”

Responding, an NHS England spokesperson said: “This report provides useful context for the NHS Long-Term Plan to ensure the best outcomes for children in the future.”

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