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Child health in England in 2030: comparisons with other wealthy countries

Health Policy team
The health of today’s children and young people (CYP) will be one of the key factors in determining whether England is healthy and prosperous over the next 50 years. In our reports, published October 2018, we used long term historical data on key CYP health outcomes and various projection modelling methods to estimate CYP outcomes in 2030 in England compared with other wealthy European and western countries, and we outline recommendations.

Key findings

England has poorer health outcomes than the average across the EU15+ (the 15 EU countries in 2004 plus Canada, Australia and Norway) in most areas studied, and the rate of improvement in England for many outcomes is lower than across the EU15+. This means that unless current trends improve, England is likely to fall further behind other wealthy countries over the next decade.

The marked inequalities observed in most key outcomes are likely to widen over the next decade as problems in areas such as infant mortality and obesity are worsening more quickly amongst the most deprived section of the population.

Other findings include:

  • Mortality
    • If infant mortality begins to decline again at its previous rate, rates will be 80% higher than the EU15+ in 2030. If UK mortality continues the current ‘stall’ then it will be 140% higher in 2030.
    • England and Wales had notably high mortality for one to 19-year-olds for chronic respiratory conditions (e.g. asthma) and epilepsy (2001-2015) - mortality in both conditions is likely to remain substantially higher than the EU15+ average if current trends continue.
    • Key risk factors for infant mortality are higher in England than in comparable countries – it has higher proportions of young mothers and higher proportions of smoking during pregnancy than most EU15+ countries. Rates of breastfeeding are also concerningly low.
  • Mental health
    • Reported mental health problems in England are set to increase by 63% in 2030 if recent trends continue.
    • Around 30% of 11–15-year-olds in England reported being bullied one or more times in the previous two months - if current trends continue, bullying in England will continue close to or above the average across the EU15+ to 2030.
  • Obesity - Nearly one-third of England’s most deprived boys will be obese in 2030 if the Government’s Childhood Obesity Plan is not implemented.
  • Accident and emergency attendances - A&E attendances among children and young people are set to increase by 50% in 2030.
  • Outpatient attendance - If current trends continue, there will be a further increase of 48% (16.5 million) in outpatient visits by 2030. This is considerably higher than expected from the population increase projected for the same period (5.1%).

Recommendations

This report’s overarching recommendation calls for NHS England to develop a Children and Young People’s Health Strategy for England, to be delivered by a funded transformation programme led by a dedicated programme board. The term ‘health’ encompasses physical health, mental health and wellbeing. This strategy should set out a governance and accountability framework for the commissioning, implementation and delivery of interventions to improve CYP health outcomes. 

Other recommendations include:

  • NHS system - Sustainability and Transformation Partnerships (STP) and Integrated Care Systems (ICS) offer a real opportunity to have a joined-up collaborative approach to health care planning. We recommend that each organisation appoints a lead for children and that plans are developed and implemented by working with children, young people and families and by working with social care, education, youth justice and the voluntary sector.
  • Funding - NHS England should ensure that funding designated for expanding children’s services, eg for Child and Adolescent Mental Health Services, reaches frontline services in Clinical Commissioning Groups.
  • Obesity
    • There should be opportunistic recording of weight and Body Mass Index (BMI) for all children (2-18) once a year.
    • NHS England must increase capacity and access to specialist weight management services for children and young people.
    • There should be tailored health promotion advice and support for women who smoke, are overweight or misuse substances.
  • Mental health
    • NHS England must work with Public Health England and local authorities to ensure all maternity professionals and health visitors are trained to identify maternal mental health problems.
    • Local child and adolescent mental health systems should be commissioned to cover population need using ‘local offers’ so that they are structured around the child or young person, delivered as close as possible to their home and supported by a family-centred approach to care planning and information sharing.
  • Healthy start - Investment in health visiting and school nursing services must be increased and protected.