Are young children healthier than they were two decades ago?

Future health and well-being have their origins in young children’s health. In recent years, there has been increasing recognition of the importance of early childhood in providing a strong foundation for later life and as a crucial opportunity for reducing inequalities. This recognition comprises an understanding that health inequalities are a consequence of social inequalities, that negative impacts on the health of young children are difficult to reverse and much poor health in young children is preventable.

This review, the fifth in our series, draws on research funded by the Nuffield Foundation and a collaboration with the Nuffield Trust. We focus on seven key indicators of young children’s health:

Progress in improving the health of young children is stalling

Overall, young children are healthier than they were 20 years ago and more children are receiving a better start in life. Infant mortality rates have fallen. Vaccination uptake rates have increased. Breastfeeding has increased. Tooth decay has declined.

But this progress has stalled in the last five years and we are now seeing a reversal of some of these long-term improvements. Infant mortality rates increased three years in a row in England and Wales between 2015 and 2017. Vaccination uptake rates have started to decline, with only Scotland and Wales meeting the 95% coverage recommended by the World Health Organisation for herd immunity (for the 6-in-1 vaccine for one-year-olds). Obesity rates have soared during the pandemic, with over one quarter of four and five-year-olds now overweight or obese.

Health inequalities between disadvantaged and advantaged children have increased and inequalities are also evident between children from different geographical areas and different ethnic groups. Poverty is a significant driver of poorer health outcomes across all seven indicators reviewed and has been rising particularly steeply for families with a child under five since 2013/14. In 2018 the infant mortality rate in the most deprived areas of England was almost twice the rate of those from the least deprived areas.

While data has not historically been collected on young children’s mental health, parental mental health has worsened over time, which in some cases can negatively affect young children, including their own mental health. Perinatal mental health problems affect up to 20% of mothers, only about half of whom are identified and even fewer receive adequate treatment. In England, an estimated 11.5% of children under five live in a household with a parent suffering from a severe mental health problem.

Inequalities are not inevitable, and some policies and interventions have led to improvements in young children’s health. The Scottish national infant feeding strategy has led to increased rates of breastfeeding. Sure Start led to major health benefits for children from poorer neighbourhoods. National oral health programmes in Scotland and Wales have accelerated rates of improvement in children’s oral health. The success of these interventions demonstrates that improvements in young children’s health are possible with sustained policy effort.

Impact of COVID-19

The health of young children is being affected by the COVID-19 pandemic, with negative effects felt disproportionately by disadvantaged children. While we still do not know all of the impacts of COVID-19 on young children’s health, three interrelated factors are having effects.

• The pandemic and associated lockdowns have had negative effects on young children’s health, including insufficient physical activity and worsening mental health.
• Reduced health services for young children, prompted by the National Health Service (NHS) undergoing unprecedented demands – in particular, reduced health visiting services.
• The economic disruption, which creates conditions for poor health to proliferate among young children, including worsening parental mental health and increasing child poverty.

What needs to change?

This review concludes tat the UK is at a critical moment in securing the future of young children’s health and recommends action on four fronts:

• A reassessment of whether young children are receiving adequate universal healthcare services.
• Further development of integrated services that meet both the health and non-health needs of young children and their families.
• Action to address child poverty. This would help to address health inequalities between ethnic groups as these inequalities are, in part, a consequence of conditions such as some ethnic minority groups disproportionately living in deprived areas, with these conditions themselves the result of longstanding inequalities and structural racism.
• Research to address the key data and evidence gaps, particularly in relation to young children’s mental health and emotional well-being and their respiratory health. Another important gap is research that explores how the associations between poor health and place, ethnicity, and level of deprivation intersect, compound and accumulate.