A decade of austerity combined with other factors, including the pandemic, has contributed to a worsening public health picture for the UK. The National Health Service across the four nations is not equipped to cope with current levels of demand, with mental health services under particular strain. The burden of chronic disease keeps increasing. The UK has the third-highest level of obesity in Europe.
The outline of this increasingly dire situation is widely accepted. On Monday, Rishi Sunak admitted that his government has not succeeded in cutting waiting lists, as he pledged to. About how to tackle this vast backlog, however, there is less agreement. While health and care services urgently need new funding, there are also calls to address problems caused by poor housing, nutrition and air quality.
A new report from the Academy of Medical Sciences shows how the general downturn in the nation’s health has affected one section of the population in particular – the under-fives. While themes such as obesity, tooth decay and the effects of poverty are not new, it draws them together to make a powerful case for change. Among the shocking details it highlights are the rise in infant mortality between 2014 and 2017, particularly in the poorest areas.
As the architects of New Labour’s Sure Start programme knew, the effects of economic deprivation on children’s health begin to be felt before birth. Household income is a robust predictor of antenatal maternal mental health, which is in turn closely associated with later difficulties. Children born into the poorest fifth of families in the UK are 12 times more likely than affluent peers to experience health and educational problems. More than 34% of children in the most deprived areas have tooth cavities, compared with 14% in the least deprived ones.
Evidence shows that these patterns can be long-lasting. Obese children are five times more likely to be obese in adulthood than others. But on the other hand, and as this report points out, children respond more readily than adults to environmental changes. Because this developmental plasticity reduces with time, they can also be regarded as among the easiest people to help.
Ingrained problems with housing supply and inadequate benefits will not be fixed easily – even if a future Labour government proved more willing to invest than seems likely. But doing too little will prove costly. From promoting breastfeeding to tackling air quality, the precise effects of different interventions will vary. But there is no doubt that the early years are crucial and deficits can be hard to make up. With that in mind, rebuilding the health visitor workforce would be sensible, and consistent with the expansion of the family hubs that were set up in place of Sure Start. Home visits, of the kind health visitors make, offer invaluable support.
Beyond that, and as other reports have argued, there is an overwhelming case for a more joined-up and cross-government approach to young lives. Given what we know about the way in which a child’s progress is shaped by their overall situation, it makes sense to take a holistic approach. But such rearrangements are no substitute for resources. With the re-establishment of family centres, ministers have recognised the need that exists. But much more will be needed to reverse the harm caused by a decade of cuts.
