The greatest challenge to public health in Britain is the wellbeing of children and young people...
DAME SALLY DAVIES, the Chief Medical Officer, published her latest annual report last year, entitled Our Children Deserve Better. It makes demanding reading. As the title suggests, the CMO argues that the greatest challenge to public health in Britain is the decline in the physical and mental wellbeing of children and young people.
Britain's mortality rate for children up to 14 years is among the worst in Europe.
Beyond doubt it is in decline both relatively and absolutely. Fewer under-25s in England and Wales with Type 1 diabetes achieve good control of the disease than in broadly similar European countries. Here the figure is 16 per cent, while in Germany and Austria for example it is 34 per cent. The increase in vitamin deficiency here, leading to the inevitable return of diseases like rickets, is avoidable and preventable. It should not be allowed in a country that did so much to discover the role of vitamins in the body’s metabolism.
International comparisons are usually invoked to demean us. Health and education league tables in particular often conceal more than they reveal. For example young South Koreans do remarkably well in science and maths tests, but at the price of a shockingly high and growing suicide rate resulting from a culture of 12 or more hours a day cramming. But neither can comparisons be ignored. Our mortality rate for children aged up to 14 years was among the best in Europe in the 1980s; now it is among the worst.
Inequality at home is even more telling. In England the under-17 mortality rate is 8 deaths in 100,000 for the five best performing local authority areas; it is 21 deaths in 100,000 for the five worst. The highest death rates are unsurprisingly in deprived areas of the North West, northern cities and some of the poorer London boroughs.
Affluence is the factor that bears most strongly on wellbeing in health as with education. It is also true that the moribund economic and political system which prevails in Britain accentuates the poverty that leads to ill-health. We do not have the luxury of waiting until we have a fairer society – children are dying today. If we are to have a working class healthy enough to work and to fight for the better pay that brings health we must act now. Davies’s report confronts the government with a checklist of concerns and makes a series of 24 recommendations for action now.
One recommendation has hit the headlines, namely that all under-5s should receive free supplements for vitamins A, C and D. Such an early intervention has attracted criticism, for example questioning whether the body metabolises synthetic vitamins as well as those in their natural state in food. Try telling that to a family for whom poverty comes in the form of an inadequate diet.
There is a debate to be had about the form of intervention, but there is a great deal of evidence to support the idea it should take place at an early stage. As the report states, “...to try to impact on the diseases of adult life that make up the greatest burden of disease, it makes sense to intervene early”. It makes economic sense too. The long term costs of obesity in England are around £580 to £680 million a year. The long term costs associated with mental health disorders are estimated at £2.56 billion – for the under-15s alone. The CMO’s response to those who ask if we can afford to fund this, is that we can’t afford not to.
Alongside early intervention, another theme which runs through the report is “proportionate universalism”. That’s a clunky title for an important principle that identifies the combination of universal and targeted provision. The cervical cancer vaccination programme for all 15-year-old girls is universal, whereas flu jabs for at-risk groups is targeted. There is a place for both. The approach by both local and national authorities runs counter to that principle. Their aim is increasingly to fund services only for the poorest sections of society, usually sanctified with the label “protecting the most vulnerable”.
This report is a challenge to us all. Why do so many of us encourage our children to be idle when the natural condition of childhood is activity? Just 15 minutes of daily summer sunshine supplies all the vitamin D necessary. But improving health overall will need coordinated action, including the fight for better pay.
This report is awkward for the government because it seeks to replace disorder with planning. The CMO along with medical bodies and health organisations are snapping at the government’s heels with this report. The government should not be allowed to damn its recommendations with faint praise and then do nothing. ■
The full report is available at https://www.gov.uk/government/publications/chief-medical-officers-annual-report-2012-our-children-deserve-better-prevention-pays