Poor Beginnings

Huge gap in levels of obesity, tooth decay, injury and early childhood development for under-fives across the country

  • A five-year old in Leicester is five times more likely to have tooth decay than one in West Sussex.
  • If young children in the North West had the same health as those in the South East then over 15,000 cases of child ill-health could be prevented.
  • The link between growing up in a deprived area and poor health is not inevitable as several areas have better than average child health despite being less prosperous.
  • Report published as public health responsibility for under-fives is transferred to local authorities.

The health and development of children under five varies dramatically between different parts of England, with a child living in one area far more likely to be condemned to poor health than another living relatively close by, finds a report published today.

The analysis by the National Children's Bureau looks at important indicators of health and development in early childhood and reveals startling variations, with a child in reception class in Barking and Dagenham over two and a half times more likely to be obese than a child of the same age in Richmond upon Thames, only 18 miles down the road.

Similarly, a five-year old in Leicester is over five times more likely to have tooth decay than a child of the same age in West Sussex, and a young child on the Isle of Wight is over four times more likely to be admitted to hospital with an injury than one of their peers in Westminster.

At a regional level, if under-fives in the North West enjoyed the same health and development as those in the South East, over 15,000 case of ill-health could be prevented. Resulting in:

  • 43% fewer five-year-olds with tooth decay - equivalent to over 11,000 children per year.
  • 31% fewer under-fives admitted to hospital with an injury - equivalent to over 2,500 cases a year.
  • 19% fewer obese four to five-year-olds - equivalent to over 1,600 children a year.
  • 11% more children achieving a good level of development by the end of reception class - or around 5,500 children per year.

The report confirms that the health and development of children under five is closely linked to the affluence of the area they grow up in, with those living in deprived areas far more likely to suffer poor health.

Comparing the 30 most deprived local authorities with the 30 best-off, the report finds that children under five in poor areas are significantly more prone to obesity, tooth decay, accidental injuries and lower educational development. While only 18.4% of children living in the 30 richest areas suffer from tooth decay, this rises substantially to 31.6% of four to five-year-olds in the 30 most deprived areas.

However, the data shows that poor early health is not inevitable for children growing up in deprived areas. Several areas with high levels of deprivation buck the trend and achieve better than expected results, suggesting that more work is needed to understand how local strategies and programmes can make a difference. For example, children in three local authority areas - Hartlepool, South Tyneside and Islington - have lower rates of tooth decay despite high levels of deprivation.

Poor Beginnings is published as responsibility for public health services aimed at under-fives, including health visitors and family nurse partnerships, is transferred from central government to local authorities in October.

Anna Feuchtwang, Chief Executive of the National Children's Bureau said:

'It is shocking that two children growing up in neighbouring areas can expect such a wildly different quality of health.

'As these variations are closely linked to poverty, with those in areas with the highest levels of deprivation more likely to suffer from a range of health issues, we have to ask whether England is becoming a nation of two halves?

'The link between poverty and poor health is not inevitable. Work is urgently needed to understand how local health services can lessen the impact of living in a deprived area.

We need local and national government to make the same efforts to narrow the gap in health outcomes across the country for under-fives as has been made to narrow the gap in achievement between poor and rich pupils in school. Government must make it a national mission over the next five years to ensure that the heath and development of the first five years of a child's life is improved.'

Cheryll Adams, Chief Executive of the Institute of Health Visitors said: 

'Trends in inequalities in health can be complex as this report suggests, with poverty not always being associated with poor health outcomes.

'Local health professionals, such as health visitors, understand the social determinants off health in communities, and how these may most effectively be addressed upstream with the right local policies and interventions.

'Although the greatest need is often concentrated in many poor communities, the majority of need, whilst less concentrated, is in fact in the rest of the population which is so much larger in number.    

'Health services must continue to be commissioned to recognise risk and intervene early in the life cycle, in pregnancy and the very early years, as this can have the greatest impact on improving health and development.'

The report calls on the government to set out a renewed strategy to improve the health and development of children and families in the early years, and further investigate the variations uncovered in the report and how they relate to local health initiatives.

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