Health and wellbeing of children and young people
Almost a third (29%) of the population of England and Wales are children and young people, defined as those under the age of 25. Childhood and adolescence are generally considered to be healthy stages of life in comparison to adult and elderly periods, which are more likely to be dominated by ill health. Census data from 2021 reveal that self-reported health declines with age – those under the age of 25 report the highest levels of good health (while acknowledging that parent and carers report data on behalf of children). Reflecting this higher level of healthcare need in later life, healthcare expenditure is higher for older age groups.
However, it is important to focus on child health to prevent ill health during adulthood. Most long-term conditions are developed in childhood. In comparison to similar countries, the UK has one of the highest rates of 16-24 year olds living with a long-term condition. Approximately a quarter (23%) of 11-15 year olds in England reported that they lived with a long-term illness, disability or medical condition in 2020. It has been estimated that 1.7 million children and young people have either asthma, diabetes or epilepsy. Alongside physical health, we know that mental health conditions also develop early on – with 75% of mental health problems becoming established before the age of 24.
Childhood and adolescence are periods of development and change. This is a period when children and young people learn and adopt behaviours that can either benefit or worsen their health outcomes – such as, sleep patterns, diet, self-care (including dental care for example), rates of physical activity and use of alcohol, drugs, or other substances. Intervening during this period can enable young people to foster positive habits and self-management techniques that can be carried through into adulthood. There are lifelong implications for promoting good health in childhood.
Young people also find themselves transitioning into independence, from education to employment, and often experience changes in living circumstances. For young people with long-term conditions, self-management of their own health and wellbeing is vitally important, especially as their care needs are transferred from paediatric to adult settings.
Access to and experience of services will impact on how individuals re-engage with NHS services in the future. Yet, research has shown that a third of children struggle to understand information given to them from healthcare staff and over half of children do not feel like they are involved in decision-making around their health and care.
Health inequalities of children and young people
Health inequalities have their roots before birth, in socio-economic circumstances, sometimes passed between generations. For example, data show that women living in more deprived areas are more likely to smoke during pregnancy and are less likely to breastfeed their babies. Inequalities that are embedded in childhood can persist across the life course.
In 2021/22, there were 4.2 million children living in poverty in the UK – representing 29% of children under the age of 18. Children in lone parent families, in larger families and from minority ethnic groups are more likely to live in poverty. Given the links between deprivation and the social determinants of health, we know that children and young people living in poverty are at greater risk of experiencing poorer health outcomes. Children living in statutory care, ethnic minority young people, LGBTQ+ young people, disabled children and young people, people with mental health conditions, young carers and young people living in the criminal justice system are also more likely to experience health inequalities.
In England, the rate of infant mortality is 2.4 times higher in the most deprived areas compared to the least deprived areas. The social gradient in mortality rate extends into adolescence, contributing to variations in life expectancy by deprivation status. Deaths during this age group are largely preventable, such as accidents and suicide. Another clear measure of the growing inequalities faced by children is obesity rates. Year 6 children living in the most deprived areas of England were twice as likely to be classified as obese in comparison to children in the least deprived areas (31.3% compared to 13.5%) in 2021/22. This is a particular area of concern as children with obesity may go on to develop a number of health conditions later in life, such as diabetes, heart disease, cancer and mental illness.
There are also inequalities in how children and young people access healthcare services. Research has found that children under the age of five from more deprived areas are more likely to attend A&E services, compared to older ages and those from the least deprived areas. Data analysis reveals that Did Not Attend (DNA) (or 'Was Not Brought') rates are higher for children in areas of higher deprivation. Young people aged 16-24 from more deprived areas are less likely to report positive experiences of healthcare settings.
The Covid-19 pandemic disproportionately impacted the health and wellbeing of children and young people. There were particular concerns relating to school closures and limited socialising opportunities on the mental health of young people. There were also increased rates of poverty and safeguarding concerns for vulnerable children during the period. The long-term impact of Covid-19 on children's health will not be known for a long period of time. In the immediate term, NHS waiting lists for children have grown at a much faster rate than they have for adults – 64% compared to 43%. The Community Network – hosted by NHS Providers and NHS Confederation – recently surveyed community provider leaders and found that 72% of respondents were "extremely concerned" about the impact of long waits for children and young people's services on staff morale. Demand for children and young people's mental health services has also grown as a result of the pandemic, with an 81% increase in Child and Adolescent Mental Health Services (CAMHS) referrals between 2019 and 2021, compared to an 11% rise in referrals in adult mental health services.