A nation's health is defined primarily by how a society is organised and how well it performs. Those measures that establish a nation's health include the average life span and how well vulnerable members of society—including babies, children and young people—are safeguarded from the things that can be detrimental to their health and wellbeing.
In 2019, the UK under-5 mortality rate was the second highest in Western Europe (National Child Mortality Database, 2021). This is a most odious reality that we should all own—not ‘they’, whoever ‘they’ may be, but ‘we’. In a rich society such as ours there should be no such thing as avoidable infant and child deaths. Infant mortality is a very reliable gauge of the outcomes of the social determinants of health. Those children who grow up in poverty will experience worse physical and mental health than their affluent friends. Deprivation is killing children in the UK.
The National Child Mortality Database team examined the records of 3347 children who died in England between 1 April 2019 and 31 March 2020, and found a clear association between the risk of death and level of deprivation, for all categories of death apart from malignancies. More than a fifth (23%) of all child deaths could be avoided if those children who were living in the most deprived areas had the same mortality risk as those who lived in the least deprived areas. The report showed that infant mortality had risen over the previous 4 years, especially among those families who live in more deprived areas. Deaths in the study were only counted up to 31 March 2020, so it did not examine the impact of the pandemic, which may have increased the rates of child poverty—there is already plenty to indicate the pandemic will increase the burden of inequity.
Where there was a mention in child death records of deprivation as a contributing factor, problems concerning family debt or financial difficulties, homelessness in pregnant mothers, poor maternal nutrition and mental health problems in either parent were the most commonly reported contributors. Problems with housing—for example, a lack of cleanliness, unsuitable accommodation (including overcrowding), or maintenance issues such as damp or mould, or homes being in poor repair—had been found in 123 of those deaths reviewed. Homelessness, related to either of the child's parents, or the child, was included in an additional 33 deaths. This was most commonly seen in pregnant mothers, who then gave birth to babies who later died, families with young children and young people who had left or were being driven out of their family home. Living in homes that are not fit for purpose puts children at risk of dying a sudden unexpected death.
Nurse, midwife or health visitor, we all have a role to play in addressing deprivation and those child deaths that are avoidable. We can learn from every child's death so as to inform policy and to enhance the life chances of future children. A promise for action in order to improve wellbeing through tackling the wider factors that have an impact on health, including social deprivation and inequalities, was made in the NHS Long Term Plan (NHS England/NHS Improvement, 2019). The Government is required to act now to address these shameful findings. It will require a cross-agency approach and also investment in the modifiable factors including family incomes (through child benefit and other support), homelessness, overcrowding in the home, accessible health and social care services, supporting maternal and infant wellbeing, a co-ordinated response to those who are vulnerable and the development of public services.
Policy makers and those commissioning public health services as well as health and social care professionals should use the data in the report to develop, implement and scrutinise the impact of any strategies, initiatives and policies to reduce social deprivation and inequalities.