Child health: UK must regain “lost ground,” Kingdon urges next government

Dear Editor

Kingdon paints a bleak picture of child health in the UK(1,2) and this is supported by wide-ranging evidence including the recent stark report by the Academy of Medical Sciences.(3) However, change is possible as effective interventions exist. Moreover, improving child health, will bring short- and long-term benefits to individuals, community health and the economy, and reduce potential costs to the NHS.

Our children are our future and healthy children are more likely to become healthy productive adults. Every child should have the best start in life, and health and well-being are created and sustained in the settings where children live, play and study. This includes homes, outdoors and schools. We firmly believe that creating health promoting settings will enable children to flourish.(4-6) Safe, supportive and happy childhood environments are widely understood to be crucial for a child’s development, health and wellbeing.(7)

In homes and communities, health visitors are important in providing care and support to children and their families, from the antenatal period up until age five.(8) They provide a universal service for all and for vulnerable populations targeted according to need. Key public health areas they cover include accident prevention, immunisation, healthy eating, and child development. However, there is currently a shortage of health visitors in England – their numbers need to be greatly increased.

In schools, teachers and school nurses have crucial roles to play in protecting and improving the health of young people. School nurses provide a vital and unique link between school, home, and community. Promoting good mental health, safeguarding, positive relationships and maintaining a healthy weight are just a few vital topics that they can address.(9-11) They could also play key roles in creating health promoting schools. We recommend that there is a school nurse in each school.

The outdoors and particularly green space can have a tremendous effect on children’s health and so communities should be designed with their needs in mind.(12-17) Three important foci should be play, clean air and safe and active travel. We need to increase each of these with attention to reducing inequalities in each.

As well as producing health promoting settings for all, to be successful in promoting children’s health and reducing inequalities we need to provide extra support for those most in need including marginalised groups, such as youth offenders and refugees. In addition, we need to advocate on important but under highlighted and poorly resourced issues, such as accident prevention, access to the arts, female genital mutilation, homelessness, and physical activity.

The provision of training and support for Special Educational Needs and Disability (SEND) in schools is also vital to prevent widening inequalities, with inclusion policies and equal opportunities needed to enable progression to healthy, thriving adults. However, an alarming number of suspensions and exclusions across year groups involve SEND.(18) Resources for in-class support, working alongside school nurses and the wider school community are needed urgently.

The health of the whole school community could also be improved by reversing declining curriculum time for both arts and physical education in schools.(19,20) Although these subjects have intrinsic benefits, a well-rounded education can also produce significant positive impacts on academic and social development.

Every child has the right to a safe and healthy childhood,(21) and it is unacceptable that the UK, the sixth richest nation, is failing to provide this. A shift in focus must prioritise the health of children in a ‘child health in all policies’ approach. With appropriate ambition, the current decline in child health could be reversed, leading to a healthier future for all our children, and with enormous returns for society as a whole.

References
1) Iacobucci G. Child health: UK must regain “lost ground,” Kingdon urges next government BMJ 2024; 385 :q877 doi:10.1136/bmj.q877
https://www.bmj.com/content/385/bmj.q877

2) Iacobucci G. Paediatricians call for new cabinet level position of children’s minister BMJ 2024; 385 :q882 doi:10.1136/bmj.q882
https://www.bmj.com/content/385/bmj.q882

3) Academy of Medical Sciences. Prioritising early childhood to promote the nation’s health, wellbeing and prosperity. Feb 2024. London: Academy of Medical Sciences, 2024.

4) World Health Organisation. Health Promoting Schools. An Effective Approach to Early Action on Noncommunicable Disease Risk Factors. WHO/NMH/PND/17.3. 2017.
https://iris.who.int/bitstream/handle/10665/255625/WHO-NMH-PND-17.3-eng....

5) Watson M C, Lloyd J. Creating health promoting schools will improve population health and help reduce inequalities BMJ 2021; 373 :n1290 doi:10.1136/bmj.n1290
https://www.bmj.com/content/373/bmj.n1290

6) Baybutt M, Kokko S, eds. A handbook on settings-based health promotion. Cham: Springer, 2022.

7) British Medical Association. Supporting a healthy childhood. The need for greater investment in services in England. London: British Medical Association, 2020.

8) Institute of Health Visiting. What is a health visitor? (Accessed 20/04/24)
https://ihv.org.uk/for-health-visitors/what-is-a-health-visitor/

9) Watson M C, Lloyd J. Children’s mental health: the UK government needs to be far more ambitious BMJ 2021; 372 :n573 doi:10.1136/bmj.n573
https://www.bmj.com/content/372/bmj.n573.full

10) Local Government Association. School nursing: looking after the health and wellbeing of school children. 14 Jul 2022.
https://www.local.gov.uk/publications/school-nursing-looking-after-healt...

11) Sutton S and White S. The role of the school nurse in the UK: where are we now? Paediatrics and Child Health,2024; 34(3), 99 - 103
https://www.paediatricsandchildhealthjournal.co.uk/article/S1751-7222(23)00213-5/abstract#:~:text=The%20advancement%20of%20educational%20programmes,for%20children%20and%20young%20people.

12) Muñoz S-A. Children in the Outdoors A literature review. Forres: Sustainable Development Research Centre, 2009.

13) Brussoni M, Gibbons R, Gray C, Ishikawa T, Sandseter EBH, Bienenstock A, Chabot G, Fuselli P, Herrington S, Janssen I, et al. What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review. International Journal of Environmental Research and Public Health. 2015; 12(6):6423-6454. https://doi.org/10.3390/ijerph120606423
https://www.mdpi.com/1660-4601/12/6/6423

14) Lambert A, Vlaar J, Herrington S, Brussoni M. What Is the Relationship between the Neighbourhood Built Environment and Time Spent in Outdoor Play? A Systematic Review. International Journal of Environmental Research and Public Health. 2019; 16(20):3840. https://doi.org/10.3390/ijerph16203840
https://www.mdpi.com/1660-4601/16/20/3840

15) Watson M C, Neil K E. Prioritise health of children and young people by promoting both safe and active travel BMJ 2023; 380 :p49 doi:10.1136/bmj.p49
https://www.bmj.com/content/380/bmj.p49#:~:text=and%20active%20travel-,P...

16) House of Commons Health and Social Care Committee. Prevention in health and social care: healthy places. HC 484. London: House of Commons, 2024.
https://publications.parliament.uk/pa/cm5804/cmselect/cmhealth/484/repor...

17) House of Commons Levelling Up, Housing and Communities Committee. Children, young people and the built environment Inquiry. (Accessed 20/04/24)
https://committees.parliament.uk/work/7981/children-young-people-and-the...

18) Chance UK. Too young to leave behind. The long-term negative impact of exclusions and suspensions in primary school. Executive Summary | April 2024.
London: Chance UK, 2024.

19) Ofsted. Research and analysis. Research review series: art and design. Published 22 February 2023. (Accessed 20/04/24)
https://www.gov.uk/government/publications/research-review-series-art-an...

20) Youth Sport Trust. Fall in number of hours of PE delivered in schools poses threat to wellbeing. (Accessed 20/04/24)
https://www.youthsporttrust.org/news-listings/news/fall-in-number-of-hou...

21) United Nations. Convention on the rights of the child 1989. Treaty no. 27531. United Nations Treaty Series, New York: United Nations, 1989; 1577, pp. 3-178.
https://www.unicef.org.uk/what-we-do/un-convention-child-rights/