Child health: a multisectoral and multidimensional betrayal

Child health is being betrayed, and the physical and mental health of children is in appalling decline. This verdict belongs not to a fortune hunting social media influencer but to a new report from the Academy of Medical Sciences (doi:10.1136/bmj.q313).1 The UK was recently ranked 30 out of 49 Organisation for Economic Cooperation and Development countries on infant mortality. The Joseph Rowntree Foundation estimates that the number of children experiencing destitution tripled to around one million over five years (jrf.org.uk/deep-poverty-and-destitution/destitution-in-the-uk-2023).2 The academy’s report calls for urgent action to tackle workforce issues and social determinants, to name but two factors that are damaging children’s long term health and life chances.

The benefits of investing in child health are well established, and the current crisis speaks of wilful neglect and short term policy making (doi:10.1136/bmj.q282).3 The crisis is a common theme in the “great” democracies of the UK, US, and India, each of which is in the throes of national elections. Yet, you won’t hear of the child health crisis. You will hear about stopping immigrant boats and rowing back on climate commitments. Or a prime minister’s diet and a king’s cancer (doi:10.1136/bmj.q278 doi:10.1136/bmj.q342).45

You will hear more outrage among the great powers about missiles fired into the Red Sea than you will about thousands of deaths of children in the world’s ongoing conflicts. Children are collateral damage from wars and the cost of living crisis. To prop up the banks and feed ideologies that seek to slim down the state we drive poor children into deeper poverty. To appease fossil fuel companies and their shareholders we deprive children of their future. The world’s moral compass, if ever there was one, is missing when it is most needed.

If we saw the world through the lens of child health we might better fund and prioritise primary care (doi:10.1136/bmj.q279 doi:10.1136/bmj.q295 doi:10.1136/bmj.q287),678 and we would ensure we didn’t leave a health system in limbo for two years, as happened in Northern Ireland (doi:10.1136/bmj.q270).9 We might tackle the root causes of an alarming decline in vaccination rates that predates the covid pandemic, leading to outbreaks of measles in many countries (doi:10.1136/bmj.q259).10 We might deal more urgently with deteriorating workforce crises (doi:10.1136/bmj.q8 doi:10.1136/bmj.q277).1112 We might also grapple more seriously with the responsibilities of social media platforms in disseminating health information (doi:10.1136/bmj.p2987).13

Prioritising child health might lead us to take a fresh view of attention deficit/hyperactivity disorder, where the pursuit of a diagnostic label—which at first glance seems a helpful step—may well be detrimental to child health, particularly in children and adolescents with borderline symptoms (doi:10.1136/bmj-2022-073448).14 It would certainly encourage us to support more robust studies on the benefits and harms of drug treatments and non-drug interventions, as well as the benefits and harms of an ADHD diagnosis itself.

Seeing people and problems in one dimension is generally easier for all of us. How do I best use the Glasgow coma scale (doi:10.1136/bmj-2023-077538)?15 What are the chances of success of cardiopulmonary resuscitation (doi:10.1136/bmj-2023-076019)?16 Has the National Institute for Health and Care Excellence really recommended sterile water injections for intrapartum care (doi:10.1136/bmj.p2885)?17 These are important but, largely, focused questions. Child health is multisectoral and multidimensional—as is society’s betrayal of children, their health, and our future.