Editorial: Should the Wealth of Nations be Invested in the Health of their Children?

Introduction

Preserving and improving child health in the second decade of the 3rd millennium is proving to be challenging for many western and developing countries. Nations respond in differing ways, and in England the 2nd annual report of the English Children and Young People’s Health Outcomes Forum for 2014/15 was published in March 2015 (https://www.gov.uk/government/publications/children-and-young-peoples-health-outcomes-forum-2014-to-2015).

The Children and Young People’s Health Outcomes Forum (CYPHOF) was established in January 2012 and convened as an expert reference group made up of key informants from across child sector agencies in England. The primary objective of this initiative like many others in western nations was to evaluate and report on the contemporary evidence which underpins best child health practice. The challenge for many governments is how best to meet the quest of improving the health of children and young people in society. This English initiative seeks to promote optimum care delivery to children and young people and aspires to investigate the steps the government should take to purposefully address and make significant improvements to child health.

Theme groups were convened to address the key challenges which had been identified in the Forum’s first annual report, and they have subsequently undertaken a significant portion of the work. Hence, this second annual report reflects a number of specific theme group reports that pose specific questions and challenges that are pertinent to the health of children and young people in society. Furthermore these individual reports give tangible examples of good practice.

Background

The links between child health and the prosperity of nations has long been recognized. Even the recruiting sergeants seeking to enlist young men for the British Boer war in South Africa at the dawn of the 20th century recognized that because of poor nutrition many of the volunteers were simply not fit enough to serve. Improving services for children and young people is a highly complex and multifaceted issue that attracts significant professional interest and an increasing volume of public and media attention. The English CYPHOF was convened after it was recognized that child health in England was falling behind that of similar international counterparts. Wolfe et al. (2011) believe that the care provided by children’s health services in England is inferior in many regards to the care available in comparable European countries. Although there have been some improvements in measurable outcomes for English children and young people over the last few years, the evidence is still showing that these improvements are occurring at a slower rate than other countries in northern and western Europe. For example, Sweden has the lowest mortality rate for children and young people, and when controlled for other variables such as population size, five children die each day in the United Kingdom that would not die in Sweden.

The status of mental health among English children is also suboptimum and Patel et al. (2007) have shown correlations between poor mental health and other health and development concerns, but specifically lower educational achievement and substance abuse. Of particular concern are the problems associated with transition between pediatric and adult care services where young people with chronic illnesses or disabilities may fall through the net of care provision that is not seamless. In these situations the care provision for this group of vulnerable children might be badly managed, with the risk of adverse health outcomes for specific children (Crowley et al., 2011).

In light of this second report, NHS England which is an executive non-departmental public body of the English Department of Health has signed the “English Children and Young People’s Pledge: Better Health Outcomes for Children and Young People,” and committed itself to a series of actions that address issues raised in this report. It will come as no surprise to readers of Issues in Comprehensive Pediatric Nursing that the problems currently experienced in England are similar to those in other countries.

The Status of Child Health in England

The report shows that of the 15 million citizens under 20 years of age in England, which makes up nearly 25% of the population:

• 6% have a disability;

• 14% have a long-standing illness;

• over 10% have asthma;

• 66,000 have autism;

• 60,000 have epilepsy;

• 23,000 have diabetes;

• 68,840 are looked-after children (at 31 March 2014)

• 48,300 are children subject to child protection plans (at 31 March 2014)

• (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/410482/CYPHOF_Report_2014-15.pdf)

The objective of the Children and Young People’s Health Outcomes Forum seeks to ensure that each child in England is afforded the best opportunities in life to ensure optimum health. Furthermore, the forum seeks to reduce inequalities in health in English society similar to that of the aspirations of President Barack Obama in the United States who has striven for health care reform over the past 7 years.

It is received wisdom that the foundation stones for almost every aspect of human development encompassing physical, intellectual, social, and emotional maturity are laid during the years of early childhood. Consequentially, the CYPHOF has a steadfast ambition of ensuring that every child in England is afforded the very best start in life by reducing and alleviating some of the burdens of health inequality. This aspiration is grounded on known facts of what can occur in childhood from conception through birth and beyond and includes among others obesity, heart disease and mental health, through to educational attainment and economic status (http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review).

The report cites statistics that could have catastrophic implications for future health provision in England. For example, more than one in three 11–15 year olds in England are obese or overweight and worryingly only 14% of boys and 8% of girls aged 13–15 meet the recommended physical activity levels. Despite overt and well publicized and high profile public health campaigns, almost two-thirds of adult smokers begin experimenting with tobacco before the age of 18. In addition, 10% of English 5–16 year olds have a diagnosable mental health disorder with 50% of all adult mental health illnesses starting by the age of 14, and 75% by the age of 24.

This report also unearths some concerning negative trends about child health in England such as a 40% increase in children and young people attending emergency departments. Hospital admissions for common childhood illnesses such as bronchiolitis and self-harm have also risen significantly in England and although there have been some improvements, for example in reducing teen pregnancy and the number of young road traffic accidents, the data still shows that England lags behind other countries.

Making Government Pledges to Promote Child and Young Person Health

Influenced by the CYPHOF, the English Department of Health through the government have pledged to:

1. Ensure that children, young people, and their families will be at the heart of decision making.

2. Provide services that will be high quality, evidence-based and safe, and delivered at the right time, in the right place by a properly planned, educated and trained workforce.

3. Ensure that good mental and physical health and early intervention will be of equal importance to caring for those who become acutely unwell.

4. Integrate services and care, which will be coordinated around the individual child, with an optimal experience of transition.

5. Provide clear leadership, accountability and assurance and that organizations will work in partnership for the benefit of children and young people.

These pledges include a range of coordinated key themes, principally, reducing infant and perinatal mortality, improving cancer-in-childhood survival, improving transition for children with long-term conditions, promoting integration of child health services, enhancing childhood illness outcome data collection, ensuring that children and their families are listened to, and importantly improving child patient safety and safeguarding.

Discussion

Although it is beyond the scope of this editorial to consider the full range of international governmental initiatives to tackle child health, in the US for example, the Affordable Care Act (ACA) was designed to expand health insurance to millions of uninsured children and adults. The ACA’s dependent coverage provision allows young adults to remain on their parents’ insurance plans until they turn 26 years old. This took effect for plans renewing on or after September 23, 2010 (Sommers & Kronick, 2012).This will have a profound effect on improving child health during those vulnerable formative years of later childhood and adolescence. Similarly, the Irish Government’s commitment to child health and well-being is evident in a number of initiatives being led by the Department of Children and Youth Affairs whose primary mission is to lead efforts to improve health outcomes for children and young people in Ireland. For example, the Irish government has recently launched the first overarching national children’s policy framework in relation to child health “Better Outcomes Brighter Futures: The National Policy Framework for Children and Young People 2014–2020” (Department of Children and Youth Affairs, 2014). This government-led initiative adopts a whole government approach to address children and young people with the aim of establishing a shared set of outcomes for children and young people towards which all government departments and agencies, statutory services and the voluntary and community sectors will work, to ensure a coherent response for children and young people in Ireland. Transformational goals include earlier intervention and protection, supporting parents, listening to and involving young people, ensuring quality services, strengthening transitions and cross government and interagency collaboration and coordination.

Conclusion

It is clear that many governments are waking up to the reality that the wealth of their nations must be spent on the health of their children, for not to do so will ultimately lead to economic and social ruin. Only countries that are morally bankrupt will fail to see the sense in this and like others England through its forum believes that it occupies a strategic position where it can play a significant role in advising health agencies and the government in the foreseeable future about how to respond to the challenges which are impacting the health of the nation’s children with the specific aim of improving health care outcomes. Pivotal to these aspirations is developing a robust children’s health care workforce to ensure that children and young people are treated at the right time in the right place by professionals with the appropriate tool kit of skills. The reality is that the care children and young people receive when they are ill may only ever be as good as the children’s nurse who delivers it! To paraphrase Gandhi, the future of child health depends on what we as child health care professionals do now in the present.

Declaration of interest

The author reports no conflict of interest. The author alone is responsible for the content and writing of this article.