Back in 2017, the Royal College of Paediatrics and Child Health (RCPCH) published a “landmark” report, providing the first snapshot of children and young people’s health across the UK.

Now, two years on, it’s published a new report that reveals exactly how all four nations — Scotland, England, Wales, and Northern Ireland — are getting on in terms of delivering on child health and safety. 

The State of Child Health: Two Years On report, published on Wednesday, is essentially a scorecard for each nation — and it shows that some great progress has been made. 

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But it also contains some stark warnings of the “significant risks on the horizon” that have the potential to reverse progress, including: child poverty, cuts to public health services, the political stalemate in Northern Ireland, and Brexit. 

“We are witnessing a hugely welcome shift towards the prioritisation of child health, which is exciting not just for us as paediatricians, but for the health prospects of children today and generations to come,” said Professor Russell Viner, president of the RCPCH, in a statement.

But, according to Viner, the uncertainty around Brexit is “raising legitimate concerns about recruiting enough children’s doctors and nurses, and access to medicines and to EU funding for vital health research.”

Two years on from our inaugural “State of Child Health” report, we are looking at the progress that has been made against the recommendations put forward to show why #ChildHealthMatters. Check out the “Two Years On” report here: https://t.co/BetnBbsayapic.twitter.com/KJNVBArxO5

— RCPCH (@RCPCHtweets) January 23, 2019

“Government must act now to ensure a focus on the children's workforce and investment in child health research are prioritised to mitigate the potentially damaging impact of Brexit,” he added. 

Meanwhile, on child poverty and inequality, he said these could “undo much of the progress we are seeing.” 

Poverty and deprivation can have a hugely negative impact on children’s health, according to the report — it can lead to poor mental health, increased alcohol or substance misuse, obesity, and death. 

Babies from families living in poverty are also more likely to be born premature or a low weight, and so are more susceptible to getting ill. 

So how is your nation getting on with delivering on the recommendations made by the RCPCH two years ago? 

Scotland

The Scottish government has been praised for publishing “bold plans” for tackling three of the major barriers to good child health in Scotland — child poverty, obesity, and mental health — throughout 2018, its “Year of Young People.” 

But, according to the RCPCH, for the efforts to be a true success, these policies “must now translate into actual improvements in child health.” 

“Scotland currently has some of the worst outcomes for child health in Europe, but as our scorecard shows, the government is working hard to turn this around,” said Professor Steve Turner, officer for Scotland for RCPCH, in the report. “However, the government strategy now needs to turn to action.”

He said: “Without timely and effective change, many more of Scotland’s youngsters will join the 230,000 children already living in poverty and their health will undoubtedly suffer as a result.”

What progress has been made? 

Poverty: 

• The Scottish Government has outlined exactly how it plans to reduce relative child poverty to less that 10%, through its Every Child, Every Chance: Tackling Child Poverty delivery plan. 
• A plan to make sure children get the best start in life was implemented in Dec. 2018, to provide lower-income families with financial support for their children.
• The Scottish government has also committed to bringing in Best Start Foods by the summer of 2019 — they’re essentially digital smart card vouchers aiming to encourage lower-income families to eat healthy and nutrition foods. 

Obesity: 

• The Scottish government has committed to halving childhood obesity by 2030, and has published consultations and plans outlining ways to achieve the goal. 
• It’s pledged to recruit 500 more health visitors, for example, to help offer healthy eating and exercise advice to more families. 

Mental health: 

• As part of its goal of delivering better mental health in Scotland, the Scottish government has committed an extra £250 million a year to improving mental health services, particularly in schools, colleges, and universities. 

What still needs progress? 

Child mortality — an estimated 100 children will die in Scotland this year from preventable causes. Unlike England and Wales, Scotland doesn’t currently have a system to learn lessons from these deaths. The report calls for the implementation of a Child Death Review Process asap. 

Child health training for GPs — most GPs have no formal post-graduate child health training, despite the fact around 25% of their patients are under 19. 

Smoking bans — there’s not been any movement on extending bans on smoking in public places to include school grounds and all sports fields and playgrounds. 

Health education in schools — the report said the Scottish government should introduce a requirement for all schools to have sex and relationships education across primary and secondary. 

Wales

Apparently 2019 could be a “transformative year for child health in Wales, but only if the policies made are delivered and enforced.” 

“The Welsh government has laid firm foundations for a healthier environment for all children growing up in Wales,” said Dr. David Tuthill, officer for Wales for the RCPCH. “I am particularly pleased with the progress made to improve public health with laws being passed to protect children from second-hand smoke in playgrounds, hospitals, and on school premises, and on minimum unit pricing for alcohol.” 

But, he continued, the “urgent challenge now is in delivery and implementation… It is crucial these laws are enforced so the most vulnerable in our country are protected.” 

What progress has been made? 

Obesity — a strategy has been developed, including the introduction of clear front-of-pack labelling, and efforts to support overweight or obese women when pregnant to improve the nutrition of their child. 

Smoking bans — these have been extended to include school grounds, playgrounds, and NHS grounds. 

Breastfeeding — the minister for health and social services has accepted recommendations to increase breastfeeding rates to help improve child nutrition throughout the first 1,000 days of life. 

Mental health — a ministerial group has been established to improve mental health support for young people. 

What still needs progress?

Mental health — all schools should make mental health support available to their pupils, and professional bodies that represent those working with infants, children, and young people should provide mental health training for staff. 

Child health training for GPs — Health Education Wales should fund mandatory child health training for GPs. 

Breastfeeding — the Welsh government must establish specific targets to drive improvement in breastfeeding rates. 

Northern Ireland

A 2-year “political deadlock’ in Northern Ireland — following the collapse of the Northern Ireland Executiye — has unfortunately stalled any “real progress” in child health policy, according to the report. 

“Two years on… we remain in the same situation,” said Dr. Raymond Nethercott, Ireland executive committee member for RCPCH. “No Executive, no Assembly. And minimal progress in advancing integrated policies that positively impact meaningful child health outcomes.”

“With no end to Northern Ireland’s political turmoil in sight, and Brexit, with all its uncertainties just around the corner, we fear that child health and wellbeing in Northern Ireland is in real jeopardy,” he added. 

According to the RCPCH, “clear, decisive leadership” is needed to help protect children and, as a result, it is “calling for a commitment from all political parties to put an end to this damaging deadlock… to put child health at the top of the agenda before it is too late.” 

What progress has been made? 

Road safety — a new graduated driver licensing system is expected to be introduced in 2019/20. 

Safety in the home — “significant progress” has been made in delivering health visiting services and home safety schemes, to help educate and equip parents and carers to keep their children safe, including safe sleeping. 

Breastfeeding — a strategy is in place and the Department of Health is monitoring progress against it, and has published a mid-term review. 

What still needs progress? 

Mental health — for children in Northern Ireland, mental health is getting worse, and a strategy for suicide prevention doesn’t have enough of a focus on children, according to the report. 

Obesity — a quarter of children in Northern Ireland are obese or overweight, but no progress has yet been seen in preventing childhood obesity. There also don’t seem to be plans to prevent fast food outlets being near to schools, colleges, leisure centres, or other locations that attract children. 

Child mortality — the Northern Ireland Executive should fully implement a system for learning from the causes of child deaths, so that future deaths can be prevented. 

Health education — there also doesn’t seem to be progress on delivering high-quality health education to children in schools.  

England

Last year, according to the RCPCH, there was little evidence of progress in England towards the recommendations made in the 2017 report. 

However, in this scorecard, it noted a “much more positive picture for infants, children, and young people in England.” 

While good progress is being made, however, the report warns that cuts to public health budgets are a “substantial threat” to this progress and increased investment in public health is “essential to ensure a healthier future for all children in England.” 

What progress has been made? 

Mental health — a survey will be conducted every seven years to explore the prevalence of mental health issues among young people. The government has also announced “substantial investment” in mental health services in communities, and to help improve access to specialist care.

Obesity — a tax on the soft drinks industry has been introduced; restrictions on junk food marketing, price promotions, and food labelling have been proposed; and NHS England has committed to weight management services in primary care for obese children. 

Child mortality — a programme to reduce avoidable deaths in children has been established, and a database has been created to learn lessons from causes of death to help prevent deaths in the future. 

Health education — introducing physical health and wellbeing lessons in schools has been confirmed. 

What areas still need progress? 

Child poverty — with early years’ services “bearing the brunt” of cuts to public health services, the report highlights that children and families in poverty are getting “no targeted help provided.” 

Child mortality — reductions in infant mortality have stalled after a century of improvement and, according to the report, with recent projections “suggesting a catastrophic picture by 2030 if this stall is not reversed.” 

Tobacco and alcohol control — there’s been no progress on extending smoking bans, nor on the introduction of a minimum unit price for alcohol, unlike in Wales or Scotland. 

Breastfeeding — there are no plans to reinstate the UK-wide infant feeding survey, which provides robust monitoring and informs on strategies. The report said this was “particularly concerning” given that the UK has some of the lowest breastfeeding rates in the world.