As part of our 10 years of children's public health in local government interviews, Royal College of Paediatrics and Child Health President Professor Steve Turner shares why he believes there is so much more to come from local government in terms of improving child health.
In many ways the last 10 years has been a disappointing decade for child health, said Professor Stephen Turner. The practising paediatrician and Royal College of Paediatrics and Child Health President points to the worsening rates of child obesity, dental health and mental health as the reasons for concern.
“It’s really worrying – and children in the most deprived neighbourhoods have been the worst affected. If they are not healthy in mind and body as a child, they will not be healthy in body and mind as an adult. This will impact their ability to work – and should ring alarm bells across government.”
But he said children’s public health is in the right place. “It takes a village to raise a child. Health and wellbeing are determined by the environment children grow up in – the food they eat, the homes they live in, the neighbourhood they play in and the air they breathe.
“Most of that is outside the control of the NHS. It is usually only when it goes wrong the NHS can step in. But it is in the control of local government to influence those determinants. So local government has most of the levers which can make a meaningful improvement to child health and wellbeing.”
The child health myth
He said obesity is a perfect example of our environment harming our children. “It’s one of the biggest challenges in child health, and local government really can have a big influence. Local government can’t do everything, of course, the pathway towards obesity is complex, but is dominated by a child’s environment and lifestyle.
By being in local government, public health can tackle obesity, for example starting before children are even conceived by educating future parents and having health visitors available to work with young families.
“Through council planning strategy, local authorities can make sure healthy food is available and easily accessible, limit unhealthy food outlets like takeaways and help ensure there are places to exercise and good parks and public spaces. Schools can promote healthy lifestyles, provide healthy food and identify those at risk of becoming obese and connect them with local programmes that can support them.”
So, what has gone wrong? Professor Turner said we have failed to create a healthy world for children and young people to grow up in. “It’s everybody’s fault - local government, national government and wider society. If I was ruling the world my mantra would be prevention, prevention, prevention. Preventing ill-health costs much less than treating it.
“The problem is that there are many people who simply don’t see the need for good public health for children. They think babies are born healthy – and that children grow out of illnesses, so child health is not seen as the priority it should be. We are challenging that misbelief.
“There are some areas of the country where local politicians really get it and they have worked well to address determinants of poor child health. But not all areas demonstrate this insight. We need public health directors to champion child health at the senior leadership table to make a difference.”
Councils in difficult position
But Professor Turner has a lot of the sympathy for the position councils have found themselves in in recent years. “The public health budget has been cut and local government is being pulled in lots of different directions. Just look at what has happened with health visitor numbers – they are such an important workforce but the numbers have dropped by almost 50 per cent within a decade.”
However, he is insistent not everything can be blamed on funding – or the lack of it. He said he cannot understand, for example, why more is not done to join up information about children between schools, the NHS and social care.
“We have data on everything from obesity and school readiness to health conditions and education absence. But it is not joined up – there is no single unique identifier which allows all data for an individual child to be linked together. Health data is not joined up to school data and that is not joined up with social care data. That’s really holding us back. We have a beautiful jigsaw of information about children, but it’s all in separate pieces.
“It creates duplication and people working in silos. We should be able to solve this. It would help us to fulfil the glaring opportunity that is there - to use data to help children reach their full potential.”
But he also said there is much for local government to be proud of. “We’ve seen smoking rates fall and teenage pregnancies go down. There has also been an expansion of social prescribing – and local government has really helped drive that because they know their communities and work closely with a whole range of partners. The NHS has to find more ways to plug into that and utilise resources within communities.”
However, he is also hopeful for the future – despite the tight financial climate. “The Darzi report was the most powerful, positive thing I have seen in a long time. The government response was spot on – with the big three themes focusing on shifting from treatment to prevention, hospital to community and analogue to digital. Transforming in these three areas has the potential to have a huge impact on children’s health.
“This has to be the direction we are going in – we must see this through, and we have to make sure all those working with children are ready to grab the opportunity with both hands. We must shift the dial on children’s health. After all, children are 25 per cent of the population – and 100 per cent of the future.”
Please note this is an independent article. The content and views reflected within are those of the named contributor and not necessarily those of the LGA.
