Children and young people’s health, wellbeing and development can be affected in many ways and by many factors in the period between conception and adulthood. The Child Health Profile shows that the picture for child health in Plymouth is mixed.
Children in Plymouth are more likely to be exposed to smoking in pregnancy and thereafter, less likely to be breastfeed or achieve a good level of development at school entry than England. About a fifth of families with children aged under 5 are considered vulnerable due to multiple risk factors including parental mental health and substance misuse, dependence on benefits, social isolation, violence in the home and parents or children identified with special needs. Our obesity figures are mixed compared to England, but with nearly 1 in 5 children being obese by year 6, it is a significant health problem.
An estimated 10% of children aged 5-16 years have a clinically diagnosable mental health disorder and about 1 in 10 young people will self-harm. About half of adults with life-time mental health illness (excluding dementia) present by age 14 years. We have seen the impacts of the COVID-19 pandemic on children and young people manifest in many ways, including increasing levels of self-reported anxiety and isolation, a drop in school readiness and as yet an uncertain picture in terms of risk taking behaviours around substance misuse [drugs and alcohol].
There is an abundance of evidence that now describes the impact that adverse childhood experiences [ACE’s] can have on lifelong health and wellbeing outcomes. These experiences range from suffering verbal, mental, sexual and physical abuse, to being raised in a household where domestic violence, alcohol abuse, parental separation or drug abuse is present. Studies estimate that 47% of individuals (adults) experienced at least one ACE and 9% had experienced four or more.
The Public Health Nursing Service is commissioned by Public Health and provided by Livewell Southwest and consists of health visiting, family nurse partnership and school nursing. The service leads on the delivery of the Healthy Child Programme 0-19 to ensure a healthy start for every child (Office for Health Improvement & Disparities, Commissioning health visitors and school nurses for public health services for children aged 0 to 19, 2023). They provide care across four levels covering universal through to targeted and underpinned by their role in safeguarding: Health Visitors provide a range of services to support parents with pre-school aged children. Health visitors are trained nurses or midwives with specialist training in family and community health. They deliver 5 mandated checks (which means reach across the whole of the child population in the crucial first 1000 days) and deliver against 6 impact changes (transition to parenthood, maternal mental health, breastfeeding, healthy weight; managing minor illness / accidents; healthy 2 year old and school readiness. They also support families with additional needs through targeted interventions including support for breastfeeding and nutrition, maternal low mood, developmental problems and in partnership to families with higher levels of need including safeguarding.
The Family Nurse Partnership, is a specific intensive home visiting programme for first-time young mums and families because teenage parents and their children are at risk of a range of poor outcomes.
The School Nursing Service works to improve the health and wellbeing of school aged children and young people to reduce health inequalities and so also maximise learning and achievement. The six school aged years high impact areas are: resilience and emotional wellbeing; keeping safe: managing risk and reducing harm; improving lifestyles; maximising learning and achievement; supporting complex and additional health and wellbeing needs and seamless transition and preparation for adulthood. The school nursing service also delivers the mandated National Child Measurement Programme.
Current annual investment in these services is approximately £5.1 million. As with heath improvement interventions for adults, interventions can be very cost effective to the health and care system as well as beneficial to individual children, young people and families. The evidence shows that intervening early in the life is cost-effective across the life course. Social Return on Investment studies show returns of between £1.37 and £9.20 for every £1 invested in the early years (Health matters: giving every child the best start in life, 2016)..
Perinatal mental health problems are estimated to cost the UK £8.1bn each year anda single case of perinatal depression is estimated at around £74,000. The high prevalence of this condition means that, even when averaged over all births, the cost is still nearly £7,000 for every woman giving birth in any one year. Nearly three-quarters (72%) of this cost relates to adverse impacts on the child rather than the mother. The Health Visitor’s universal mandated checks identify women who may be experiencing mental health issues, providing early intervention and also mitigating this effect for children (The costs of perinatal mental health problems, 2014).
Mental health excess costs are estimated at between £11,030 and £59,130 annually per child. The annual costs of hospital self-harm admissions in England &Wales was £40 million (2014/15). Public Health Nursing supports the development of protective factors including secure attachment, developing communication skills, supportive parenting, positive school climate and whole school approaches. Early intervention avoids children and young people falling into crisis and avoids expensive and long-term interventions as adults (The mental health of children and young people in England, Public Health England, 2016). Investment in Public Health Nursing is demonstrated to provide immediate and lifelong benefits.
Preventing ACEs in future generations could reduce levels of:
- Early sex (before age 16) by 33%
- Unintended teen pregnancy by 38%
- Smoking (current) by 16%
- Binge drinking (current) by 15%
- Cannabis use (lifetime) by 33%
- Heroin/crack use (lifetime) by 59%
- Violence victimisation (past year) by 51%
- Violence perpetration (past year) by 52%
- Incarceration (lifetime) by 53%
- Poor diet (current; <2 fruit & veg portions daily) by 14%