Yet another wake-up call on declining child health has been issued, with readers responding to a warning from the Royal College of Paediatrics and Child Health (RCPCH) on a 'national embarrassment'. The RCPCH study highlighted that UK children will be one of the unhealthiest generations in decades.
Health visitor workforce in crisis
Barbara Stilwell (President, International Collaboration on Community Nursing Research), Alison Morton (CEO, Institute of Health Visiting), Sally Kendall (Professor of community nursing, University of Kent), Gina Higginbotham (Emeritus professor, University of Nottingham), and Pam Smith (Professor of nursing, University of Edinburgh) expressed disappointment that the report did not mention the shrinking health visitor workforce. They noted that health visitors are described by Unicef UK as the 'backbone of the early years … the safety net around all families'. These specialist public health nurses provide the only universal service that sees babies and children in their own homes.
The experts stated that all big-ticket health concerns flagged in the report fall within the remit of health visitors, who can contribute significantly to improving birth outcomes, tackling falling immunisation rates, and supporting strong foundations for health and development. However, the profession is in crisis, with 45% fewer health visitors than in 2015. Preventive support for families has been eroded over years of underinvestment. Rebuilding the workforce must be a priority.
Poverty and inequality drive poor child health
Dr Louise Lawson (Lecturer in social policy, University of Glasgow) agreed that the RCPCH is right to describe the state of children's health as a 'national embarrassment'. While greater investment in health services is essential, the roots of poor child health lie beyond the NHS. The most striking finding is not worsening child health alone, but the deep inequalities that drive it. Children from poorer communities face higher rates of infant mortality, obesity, poor mental health, and other adverse outcomes.
Children's health is shaped by whether families can afford nutritious food, live in warm homes, access secure housing, enjoy green spaces, attend well-funded schools, and grow up free from the chronic stress of poverty. After years of austerity, local government cuts, reductions in preventive services, the cost of living crisis, and rising child poverty, it should surprise no one that health outcomes have stagnated. The consequences extend beyond childhood: as healthy life expectancy stalls, more people face lives shaped by ill health.
Political choices and the need for action
The widening gap between rich and poor children is the result of political choices. Tackling poverty, inequality, insecure housing, and the erosion of public services would do more to improve children's health than any number of new clinical targets. The healthiest societies are those that create conditions in which good health can flourish.
As Sarah Woolnough of the King's Fund said, this report is a wake-up call. The question is: how many wake-up calls do we need before governments act?
