As this article is published, the public will be preparing to cast their votes in an election where once again children’s health is low on the political agenda, despite soaring rates of obesity and a clear link between poverty and childhood ill-health.
The party manifestos brimmed with promises on mental health – and rightly so given the pitiful resourcing of services compared with the sharp rise in demand – but is the wider health of children, and the role of schools in protecting it, a blind spot in public policy?
The plight of school nurses is a case in point. Last month, a report by the Royal College of Nursing estimated that the number of full-time school nurses has dropped by 16 per cent between 2010 and 2017, despite the number of school-age pupils increasing by more than 450,000 during that time.
School nurses bring essential expertise into schools, playing a vital part in promoting physical and mental health, supporting pupils with long-term health needs, and safeguarding vulnerable children. Importantly, they are able to reach out to those children who often suffer the worst health outcomes: from disadvantaged backgrounds, for example, or those in local authority care.
Since becoming the responsibility of local authorities funding for school nurses has been cut. The school nurses who remain are faced with increasing workloads and having to work across more schools. When the National Children’s Bureau surveyed school nurses in 2016 these pressures were shown to undermine their confidence to do the job well.
There is a public health crisis in this country. The gap in health outcomes between rich and poor children is stark. A report by the Royal College of Paediatrics and Child Health and the Child Poverty Action Group reaffirms that poverty significantly contributes to children’s ill-health (State of Child Health 2017: www.rcpch.ac.uk/state-of-child-health).
Many children from the poorest and most deprived homes are falling far behind their more privileged peers across multiple health outcomes.
Childhood obesity is an area in which the gap between affluent children and those from disadvantaged backgrounds is especially profound.
By age five the poorest 20 per cent of children are almost twice as likely to be obese as the richest fifth; at age 11, obesity among this group is three times as likely. A recent NCB report on approaches to reducing obesity shows that while some local areas are tackling the issue effectively, resource constraints are a major barrier (Working Together to Reduce Childhood Obesity: http://bit.ly/2qAu1Zs).
And the rising obesity rate is just one consequence of childhood poverty. Tooth decay and admission to A&E following injury are also common aspects of poverty-related ill-health in children.
These health factors, as well as readiness for school, were shown to be closely linked to poverty among under-5s in NCB’s report Poor Beginnings. But the report also showed that there were significant local variations in outcomes among the poorest areas.
Partnership working between local authorities, schools and health bodies can be effective in helping the poorest families improve children’s health. Lambeth’s Early Action Partnership (www.leaplambeth.org.uk) is an example of a local programme taking a holistic approach to improving children’s health and development.
Of course, education settings make an important contribution to this collective action. This must start with free childcare delivering high-quality early learning, and continue throughout school with education on health issues, support from well-resourced school nurse services and giving children healthy and affordable eating options in the school canteen.
But beyond the school gates, if we are really serious about tackling health inequality, the next government must take a holistic approach to improving support for children and families. With cuts to councils’ public health budgets, and schools under similar financial strain, this wider network of targeted support for child health is increasingly difficult for local services to provide.
We urgently need joined-up action on child health, but we also need the resources so that health professionals, schools and local authorities can work together to put these plans into action.
- Anna Feuchtwang is chief executive of the National Children’s Bureau. Visit www.ncb.org.uk