Readers have responded to a report by the Royal College of Paediatrics and Child Health warning that UK children will be among the unhealthiest generations in decades. While the report was described as a ‘national embarrassment’, several letters noted the absence of discussion on the shrinking health visitor workforce and its impact on child health.
Health visitors in crisis
Health visitors are specialist public health nurses who work with families to improve health and reduce inequalities. Unicef UK describes them as the ‘backbone of the early years … the safety net around all families’. They provide the only universal service that sees babies and children in their own homes.
The letter, signed by Barbara Stilwell, Alison Morton, Sally Kendall, Gina Higginbotham and Pam Smith, states that all the big-ticket health concerns flagged in the report fall within the remit of health visitors. These include improving birth outcomes, tackling falling immunisation rates, and supporting foundations for health across the life course, alongside safeguarding and parenting support.
However, the profession is in crisis, with 45% fewer health visitors than in 2015. Preventive support for families has been eroded over years of underinvestment. The signatories argue that rebuilding the workforce must be a priority.
Roots of poor health lie beyond the NHS
Dr Louise Lawson, a lecturer in social policy at the University of Glasgow, writes that while greater investment in health services is essential, the roots of poor child health lie far beyond the NHS. The most striking finding of the RCPCH study is not worsening child health alone, but the deep inequalities that drive it.
Children’s health is shaped by whether families can afford nutritious food, live in warm homes, access secure housing, enjoy green spaces, attend well-funded schools, and grow up free from the chronic stress of poverty. After years of austerity, local government cuts, reductions in preventive services, the cost of living crisis and rising child poverty, health outcomes have stagnated.
The consequences extend beyond childhood: as healthy life expectancy stalls, more people face lives shaped by ill health. The widening gap between rich and poor children is the result of political choices. Tackling poverty, inequality, insecure housing and the erosion of public services would do more to improve children’s health than any number of new clinical targets.
As Sarah Woolnough of the King’s Fund said, this report is a wake-up call. The question remains: how many wake-up calls do we need before governments act?
