Neena Modi: A bigger vision for child health

The benefits of health in fetal life, infancy, and childhood extend well beyond these periods, influencing adult wellbeing, population health, and national prosperity


There appears to be insufficient appreciation of the extent to which health and wellbeing in childhood are prime determinants of adult health, and thus a major contributor to national economic prosperity. For example the 2018 UNICEF report “Every Child Alive: The Urgent Need to End Newborn Deaths” rightly calls for millions of young lives to be saved every year, but does not point out that good newborn care not only reduces deaths, but can also have a powerful impact on life-long health. As a policy intervention, newborn healthcare thus makes both moral and economic sense.

Many chronic non-communicable physical and mental diseases of adult life have their origins in early development. For example, over half of all pregnant women in the UK are now overweight or obese. This is fuelling a rise in gestational diabetes. The children of mothers with gestational diabetes are six times more likely to develop diabetes themselves. Adverse childhood experiences increase the later likelihood of mental health problems. Then, throughout life, diverse economic, societal, and environmental conditions can exacerbate or attenuate progression to poor health offering opportunity for policy interventions at multiple time-points. Obesity will persist in four out of five children, leading them to lose 15-20 years of healthy adult life. Teenagers, even if only at the upper end of normal body weight, will have a substantially increased risk of premature adult death.

A life-course approach involves creating early developmental and subsequent wider societal conditions that preserve and promote health. It is often argued that interventions are not justified because the links between early developmental and wider societal determinants with later health are mere associations. However, the evidence for causal relationships is growing which justifies attention in national and international policy. For example, children growing up in conditions of poverty, deprivation, and displacement are more likely to be exposed to environmental toxins, nutritional deficiencies, and psychological stressors leading to suboptimal cognitive development, poorer educational attainment, and reduced economic productivity in adult life. Science is also unravelling the biological mechanisms that lead to later poor health, through the initiation of aberrant health trajectories by exposures that alter the way genes are read. This is the science of epigenetics.

National policy, especially in relation to prevention, has yet to build sufficiently on growing scientific understanding. For example, the UK Government is being sued for a third time over illegal levels of air pollution although smoke and air pollution experienced in fetal life, infancy, and early childhood scars lungs permanently, increasing the likelihood of chronic respiratory conditions in old age. Folic acid fortification of flour has yet to be implemented in the UK although the evidence that this will reduce neural tube defects is now overwhelming. And child poverty is at its highest since 2010. Approaches that build upon insights from science can break vicious trans-generational cycles that lead to progressively poorer health. Thus targeting infants and children so that young people approach parenthood with a healthy weight and lifestyle will initiate healthy development in fetal life. Science offers opportunity to seize the benefits of a bigger vision for child health.

Neena Modi is a professor of neonatal medicine, Imperial College London. She is also past president of the Royal College of Paediatrics and Child Health.

Competing interests: None declared.