Making the case for young people’s health

1. Making the case for young people’s health Janet Shucksmith Professor in Public Health University of Teesside j.shucksmith@tees.ac.uk

2. The case makes itself? • Making changes • Barriers and concerns • Opportunities and openings

3. The case makes itself? • Focusing on 3 recent policy documents that almost make the case on their own: • Innocenti report card 9 • Marmot – one year on • No health without mental health

4. Innocenti report card 9 • UNICEF November 2010 • Premise - true measure of nation’s standing is how well it attends to its children – health and safety; material security; education and socialisation; sense of being loved, valued, included • Protecting children during vital, vulnerable years of growth is mark of a civilised society and means of building a better future

6. Report Card 9: Children ‘Left Behind’ • Uses new method of measuring how far most disadvantaged children allowed to fall behind those at median level in health, educational and material well-being • Ranks all 24 countries according to the size of this gap • UK ranked alongside countries such as Hungary, Slovakia and the Czech Republic in the bottom two fifths of countries Today, ‘bottom-end inequality’ is no longer a concern only of the political left. In the United Kingdom, for example, a Conservative Prime Minister has argued that “We should focus on closing the gap between the bottom and the middle not because that is the easy thing to do, but because focusing on those who do not have the chance of a good life is the most important thing to do.” (p3)

7. Fair Society, Healthy Lives • Published February 2010 • Year long independent review into health inequalities in England by Professor Sir Michael Marmot • Proposes most effective evidence-based strategies for reducing health inequalities in England from 2010

8. One year on… • February 2011 - London Health Observatory examines key indicators for monitoring health inequalities for all ‘upper tier’ local authorities in England – those which will take over the responsibility for public health • Indicators at local authority level: • life expectancy at birth • children reaching a good level of development at age five • young people not in employment, education or training (NEET) • percentage of people in households receiving means tested benefits

9. Off to a poor start • Just under half (44%) of all five year olds in England not considered by their teachers to have good level of development in first year of school • Giving every child the best start in life was highlighted in Fair Society, Healthy Lives as the highest priority recommendation for reducing health inequalities - report called for ‘second revolution in early years’

10. Lost generation • Average of 7% of young people in England not in Employment, Education or Training (NEET) in the three months to January 2010 • Largest percentage in Redcar and Cleveland, nearly 14%

11. No health without mental health • DH, but cross government mental health outcomes strategy for people of all ages • Amongst the main thrusts of activity - promotion of positive mental health and prevention of mental disorder in childhood and adolescence

12. No brainer? Conduct disorder most common mental disorder in CYP 70 times more likely to go to jail Half go on to develop anti social behaviour disorder as adults

13. No brainer? • Annual cost of crime in England and Wales committed by adults who had conduct disorder as children and adolescents estimated at £22.5 billion • Good evidence that parenting interventions are effective and extend into adult life • Total gross savings over 25 years estimated at £9,288 per child and thus exceed average cost of the intervention by a factor of around eight to one

14. Schools can improve health • Reviews of social and emotional learning programmes show improvement in • social emotional skills • attitude about self and others • social behaviour and academic performance in children • reduced emotional distress and conduct problems • Economic estimates suggest cost savings over two years are more than twice the initial investment with cumulative net savings per child of £6,639 after five years and £10,032 after 10 years.

15. Building up trouble for the future? • Problems ahead for Coalition agenda of localism? • Swingeing cuts in local authorities’ budgets - loss of services for most vulnerable and needy? • Cost borne later by central government (in spades) • NEET - cuts in youth support likely to increase the £12 billion life-time cost of NEET very significantly • EMA - scrapping this will increase NEET numbers and create short term hardship for poor families who cannot afford post-16 education (Cole 2011)

16. The case makes itself? • Social and health inequalities are inextricably linked • We are a far from equal society – social justice and the need to maintain our position as an advanced industrial country means we cannot afford such inequalities • Saving on services for young people now may simply stack up costs and problems for the future • We have cost effective, evidence based interventions that we know are effective, e.g. family nurse interventions with teenage mothers to prevent the recycling of poor health and poverty

17. Making changes Structural aspects of health services • Age appropriate • No gaps between child and adult services • No assumption of homogeneity for services for young people between 6 months and 18 years • Integration with other children’s and young people’s services • Informed by young people’s views • Outreach and location may be critical

18. Making changes Professional aspects of services • Fewer service silos • Fully trained and better supported staff • Young people’s health and wellbeing everyone’s responsibility – a new ethic of service

19. Making changes Individual aspects • YP educated to be emotionally literate • Recognition that resilience comes from overcoming challenges, not from being mollycoddled • Overwhelming need for emotional stability means we have to tackle parenting

20. Barriers and concerns? • Ongoing paradox in policy YP seen both as ‘at risk’ and ‘risky’ – simultaneously vulnerable and vile! • Over emphasis on policing (and self policing) individual behaviours • Insufficient attention on tackling structural issues about supply of drink, tobacco smuggling, obesogenic modern life

21. Barriers and concerns? • (Legitimate?) concerns about ‘dangerous rise of therapeutic education’ • Poorly supported professional ‘extension’ • Lack of respect for children’s privacy • Medicalisation of normal problems • Focus on weakness and problem finding rather than resilience and problem solving

22. Opportunities and openings? • A time of great ‘churn’, but opportunities for YP health as public health moves away from NHS and back to LA? • More prospect of joined up services • More chance of YP voices being heard • Less emphasis on (medicalised) health and more on wellbeing – upstream approaches

23. Opportunities and openings? • Potential only likely to be realised if policymakers and legislators take on board the need to ‘spend to save’ where young people’s health is concerned • Current attempts to be tough and strong in order to reduce the nation’s debt may be perceived as weedy and misplaced ‘solutions’ in the long run.