Evidence
Data and research
Dedicated to discussion on how we can make regions great places for all children and young people to stay healthy, develop, and thrive, this page is created by health practitioners for health practitioners, recognising health services can only ever be truly effective when coordinated with the wider determining structures within a child’s life.
Useful terms
Health Inequalities
Health inequalities refer to the avoidable, systematic and unfair differences in health situation between groups of people or communities.
Child in Poverty
“A child who experiences deprivation of the material, spiritual and emotional resources needed to survive, develop and thrive, left unable to enjoy rights, achieve full potential or participate as a full and equal member of society” – UNICEF.
Healthy Life Expectancy (HLE)
This refers to a health outcome measure which denotes the years spent in good health.
Deprivation Deciles
These are used to examine the experience of individuals, families or communities in terms of the level of deprivation of the area in which they live.
The current state of play
We are all acutely aware of the changing scenery within the UK household with the recent rise in the cost of living. This is no doubt going to push more children across the child poverty threshold.
In England and Wales in 2020, 30% of live births occurred in women who themselves were born outside the UK. 49% of all live births in 2020 occurred in women who are in lower paid jobs or unemployed.
With this information to hand, we can see a picture emerging; one in which there is a bleak prediction of rising persistent child poverty. The three devolved nations of the UK reported on their HLE during the 2017-2019 time period. The proportion of their life expectancy spent in poor health in those living the the most and least deprived areas (classified according to the national deprivation deciles) is shown in the graph below.
Without the right tools and support system, there will be an ever-increasing proportion of infants born into deprivation who become adolescents with poor educational attainment, who become adults with financial difficulties, left struggling to live in our world and culminating in poor health outcome. This cycle will repeat with the following generation.
Between April 2020 and April 2021
27% of all children in the UK were living in poverty 3.9 million children or 8 in a classroom of 30
Understanding the divide
In 2014, the Coventry Study reported on a link between living in areas of high deprivation and the risk of a child requiring state intervention to protect their welfare. In a recent report ‘The Economic Cost of Child Maltreatment in the UK’ by the Institute of Fiscal Studies, they estimate the average lifetime cost of non-fatal child maltreatment by a primary care-giver to be at £89,390 (95% uncertainty interval £44,896 to £145,508). We cannot achieve progress without addressing inequality and each community must have the means of creating health and wealth opportunities for all.
In February 2022, the UK government published the white paper on ‘Levelling up of the United Kingdom’. In this document, they set out the following agenda:
- boost productivity, pay, jobs and living standards by growing the private sector, especially in those places where they are lagging
- spread opportunities and improve public services, especially in those places where they are weakest
- restore a sense of community, local pride and belonging, especially in those places where they have been lost
- empower local leaders and communities, especially in those places lacking local agency.
The ambition for the government is to allow the UK economy to grow by incentivising the upskilling of the whole population regardless of the geographic area. They have set the timeline of 2030 to achieve their goals.
Index of multiple deprivation
Index of multiple deprivation is a relative measure of deprivation between small areas or neighbourhoods used throughout the UK. It utilises a number of different markers across seven (eight in Wales) domains to provide an overall measure of the problems experienced by a community living in a certain area.
The domains used differ slightly across the UK as the individual Governments collect and measure their data differently, therefore it cannot be used to compare between devolved nations. However, they are broadly:
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- income
- employment
- health
- education
- crime
- access to housing and services
- the living environment
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Each area is scored in each domain and the results are added up providing data to help compare small areas as well as local authority/council areas. This can help to target policies, funding and resources to the most deprived areas.
It does have some limitations. As it uses relative data, it cannot quantitatively say how much more deprived one area is compared to another. It is not a measure of individual deprivation as there can be deprived individuals living in non-deprived areas. It is also not as effective in rural areas due to the large geographical area needed to provide the same population data.
Each Government has produced an interactive map, so you can look up areas by postcode and look at their deprivation rank:
An overview of life expectancy data and other useful sources of evidence on health inequalities that are available to access online are shared below:
Information collated as part of the RCPCH State of Child Health landmark report published in 2020, looking into the health and wellbeing of children and young people and providing evidence on child health outcomes and data trends across the UK.
Social determinants that impact on a child’s health outcomes, including poverty, education, the health of their family and whether they require targeted support from social services were analysed, with a specific indicator focused on child poverty featured.
An online hub providing support and assistance to the NHS and beyond, in promoting equality and tackling health inequalities for patients, communities and the NHS workforce.
The platform brings together equality and health inequalities resources, with useful reports and guidance for the sharing of good practice, including tailored ‘RightCare’ packs for individual local commissioning groups to support benchmarking and future delivery of services that reduce health inequalities.
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report on health inequalities published in April 2022. Based on NCEPOD reports over the last 15 years and data collections in progress, the report reviews data to identify themes relating to healthcare inequalities.
It identifies four areas of healthcare inequalities: protected characteristics – age and disability, socioeconomic deprivation, organisation of healthcare services and inclusion health groups. Key findings showed socioeconomic deprivation was visible in the care provided to children and young people, and highlighted hospital admissions as an opportunity to intervene in the general healthcare of vulnerable young people who may not be accessing primary care for their general health.
An online hub created by the Health Foundation with the latest data, insights and analysis exploring how the circumstances in which people live shape their health.
Information on the platform includes analysis on international comparisons of life expectancy, life expectancy and healthy life expectancy at birth by deprivation, inequalities in age-standardised mortality rates, and a map of healthy life expectancy at birth in the UK.
An extensive online library of King’s Fund resources focussed on health inequalities and access to care for different groups in society, including in-depth analysis and expert commentary on key topics, a programme of regular educational virtual events, opinion blogs, references for further reading and useful data visualisation tools.
The King’s Fund is an independent charitable organisation working to improve health and care in England, founded in 1897 by the Prince of Wales. It is not aligned with any political or professional interests.
The Joseph Rowntree Foundation is an independent social change organisation working to solve UK poverty. Through research, policy, collaboration and practical solutions, the Foundation aims to inspire action and change that will create a prosperous UK without poverty.
Online resources include data presented from their 2022 UK Poverty report, which sets out the trends and impacts of poverty across the UK, and the latest policy briefings, news articles and reports focused on child poverty.
Social determinants of children and young people’s health
For RCPCH Conference 2021, a breakout session on the social determinants of children and young people’s health was led by Born in Bradford (BiB) who shared their journey in tackling health inequalities in one of the most deprived cities in the UK. The BiB team were joined by a panel of child health professionals to discuss how we can all be agents for change and take a whole system approach to improving the health of the next generation.
There was science, and much more, including stories and personal reflections, insights and words of wisdom from the UK and around the world. In this section, you can explore recorded talks, vlogs, and resources all designed to ignite the conversation on social determinants of children and young people’s health. We share the challenges and successes of tackling the social determinants of health, and discuss how we can all work together to transform child health within the UK and across the world.
Vodcasts
The BiB longitudinal birth cohort study was established in 2007 to transform the poor health outcomes facing children growing up in deprivation. BiB’s expertise in coproduction, data integration and working in complex systems is helping to create new and practical ways of building a healthier and fairer future for communities in Bradford and beyond.
These seven vodcasts, created by the BiB team and each lasting about six minutes, provides an introduction to the science of social determinants of children and young people’s health to stimulate discussion and share learning.
Agency
Dr Mathew Mathai, Consultant Paediatrician at Bradford Teaching Hospitals NHS Foundation Trust asks: ‘Is it time for a new type of paediatrician?‘
Download the slide decks below and listen to the accompanying audio commentaries as you view in slideshow:
Download Dr Mathai's vodcasts
RCPCH Conference 2021 session orientation for delegates (0.0) Is it time for a new type of paediatrician? (0.0)Inequalities
Prof Kate Pickett FRSA FFPH, Deputy Director of the Centre for Future Health and Associate Director of the Leverhulme Centre for Anthropocene Biodiversity, at the University of York discusses: ‘Unequal-ities – the importance of micro and macro- perspectives’.
Complex systems
Prof Mark Mon Williams, Professor of Cognitive Psychology and Academic Lead at the University of Leeds explores: ‘Why we can’t change health outcomes in isolation and we need to work with schools’.
Co-production
Prof Rosie McEachan, Director of Born in Bradford, Bradford Teaching Hospitals NHS Foundation Trust and Honorary Professor at University of Bradford presents: ‘A people powered research programme: from pregnancy – through birth and childhood to transition and beyond!‘ and also explores co-production with a talk on: ‘Building a healthier, fairer future for children and communities, together’.
Download the slide decks below and listen to the accompanying audio commentaries as you view the slideshows:
Download Prof McEachan's vodcasts
Building a healthier, fairer future together (0.0) A people powered research programme (0.0)Ecology
Prof Neil Small, Professor of Health Research at University of Bradford and Academic Lead for BiB discusses: ‘The relationship of individuals to the whole – building alliances and sharing power’.
Policy
Prof John Wright, Director of the Bradford Institute for Health Research and Chief Investigator for BiB asks: ‘What difference does it make? From research to policy’.
Case examples
Made by NHS England with the Connecting Care for Children (CC4C) team, the video below describes a system approach to integrated care for children and young people, including primary care and the community:
The CC4C film below shows a very powerful form of community engagement, using a simulation of an asthma attack. It also shows the benefits of an integrated care system that includes members of the public as equal partners:
‘Fix Freddie’: this CC4C film below encourages us to think outside the box. It describes how puppet theatre can be used to share important information with the public:
The ‘Patient Academy’: this CC4C film below describes a place that parents can play in – teaching each other; teaching professionals; and learning from professionals. It illustrates coproduction to tackle high numbers of parents bringing their young children to A&E with minor illness:
‘How to Help Your Unwell Child’: this CC4C film below shows a very powerful form of community engagement, using a simulation of an acutely unwell infant. It also shows the benefits of an integrated care system that includes members of the public as equal partners:
Parkview Olympics was an award-winning intervention that used local resources to turn weight management into a thrilling community activity, at zero cost. Watch their film here, which describes an obesity project designed and delivered by local parents.
Meet the community
Further reading
- Beck AF, Anderson KL, Rich K, et al. Cooling The Hot Spots Where Child Hospitalization Rates Are High: A Neighborhood Approach To Population Health. Health Affairs 2019; 38, NO. 9: 1433–1441. DOI: 10.1377/hlthaff.2018.05496
- An ecological framework for improving child and adolescent health.
- , et al. Using a network organisational architecture to support the development of Learning Healthcare Systems.
- Fine-Goulden, M.R. Power and powerlessness in a pandemic. Pediatr Res (2021). DOI: 10.1038/s41390-021-01480-z
- , , , et al
- Klein MD, Beck AF, Henize AW, et al. Doctors and lawyers collaborating to HeLP children–outcomes from a successful partnership between professions. J Health Care Poor Underserved 2013 Aug;24(3):1063-73. DOI: 10.1353/hpu.2013.0147. PMID: 23974381
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Singh, G., Owens, J., & Cribb, A. (2018). Practising ‘social paediatrics’: what do the social determinants of child health mean for professionalism and practice? Paediatrics and Child Health (United Kingdom). DOI: 10.1016/j.paed.2017.12.003
References
ONS statistics on Birth by parents characteristics in England and Wales 2020:
Levelling up the united Kingdom – Policy paper:
https://www.gov.uk/government/publications/levelling-up-the-united-kingdom
Healthy life expectancy data 2017-2019: