In 2017, the Royal College of Paediatrics and Child Health published a landmark report looking at key indicators of infant, child and young people’s health. Uniquely, the State of Child Health report compared data from across all four UK nations.
The report found that child poverty was having an increasingly detrimental effect on children’s health and wellbeing and warned of an ever-widening gap between the health of rich and poor families.
Over the last twelve months, I’ve been involved in compiling the second edition of that report, The State of Child Health 2020. So, three years on, what’s changed?
Despite some improvements, we’ve found even more areas of concern. For some indicators, previous progress has stalled and in some cases the trends are worsening.
Several of the areas where we are performing badly are in child health outcomes which are influenced by the provision of universal health services and strong public health systems. Infant mortality, for example, is a globally recognised marker of a health system’s performance, yet the UK’s progress for this measure does not compare well with European counterparts. The rise in infant mortality in England between 2015 and 2017 is of great concern—and of course the rises are highest for those children living in the most deprived areas. Previous progress in reducing child and adolescent mortality has also stalled over recent years.
Alarmingly, across the UK, uptake of early vaccinations including MMR has declined since the last report. Progress made in reducing the rate of women that smoke during pregnancy has abruptly plateaued, and in Scotland the proportion of women who reported smoking at the first health visitor review has actually increased since the last report. Tackling child obesity continues to be a huge challenge.
The UK is the sixth largest economy in the world. Among similar high income countries, the United Kingdom is one of the few places to provide universal healthcare services free at the point of access.
So why are we failing our children and young people?
A key factor is that investment into child health and young people’s preventative health services is simply not being prioritised by the government. Over the past few years in England there has been a 39% decline in spending on non-statutory services.  Local authority spending on universal and targeted youth services fell by 35% between 2014 and 2017. 
But if we are to change the trajectory and improve health outcomes for children and young people in the UK we also need to look at policies outside the health sector that aim to address the wider determinants of health such as deprivation to reduce health inequalities and variation.
As a community paediatric doctor working in London, I see evidence of these inequalities every day of my working life. Rates of obesity, the proportion of children who are looked after and the numbers of those referred for child protection medicals are all higher for those of my patients living in the poorest parts of our catchment area.
It’s not all doom and gloom: care for children with long term conditions like diabetes and epilepsy is showing real improvement, as is oral health. Road traffic accidents, accidental injuries, and teenage pregnancy rates are all falling. What the good news stories in this report show is that properly resourced policies and services are crucial if we are to turn things round. The bad news stories show we still have a very long way to go.
Rakhee Shah is a community paediatrician at the Chelsea and Westminster. She is a co-author of the report “State of Child Health 2020″ Twitter: @shahrakhee
2] Department for Education. Expenditure by Local Authorities and Schools on Education, Children’s and Young People’s Services in England, 2017-18. 2018