Delivering a Healthy Future: An Action Framework for Children and Young People's Health in Scotland

CHILDREN AND YOUNG PEOPLE - THE CHALLENGES

10. In a modern developed society, childhood and youth are stages of life which are associated with high expectations of health and natural fitness. Fortunately, many children will only suffer the minor ailments and injuries during the early years of life that can be considered to be "normal". This is a consequence of past investment in health initiatives to protect and promote the health and well-being of our children - well-structured public health and immunisation programmes; antibiotic treatment for bacterial infections; improved social and environmental circumstances; injury prevention measures and the wider benefits of advancing medical knowledge.

11. While these measures may have resulted in major improvements in many areas of child health over the past 50 years there is no room for complacency. Many challenges remain unresolved and other health issues have emerged in recent years, sometimes as a direct result of the complex interactions between health and society.

Some conditions have actually increased in prevalence in recent decades

The incidence of Type 1 (insulin dependent) diabetes in children has trebled in the last 30 years. Scotland now has one of the highest rates in the world for this condition. ¹

Although survival rates have also improved substantially during the same period the number of children in Scotland developing cancer each year has increased by over 20% between 1975-79 and 1995-99. ²

The vulnerability of children places their well-being at risk to the wider societal changes, challenges and inequalities that affect their parents and carers

Current estimates suggest that 40-60,000 children in Scotland have a drug abusing parent and up to 100,000 live in households where one or more parents has an alcohol problem. ³

Over 12,000 children and young people are looked after by Local Authorities ⁴. Within this already disadvantaged group over 40% have emotional or mental health problems. ⁵

Mental health is a key determinant of health, even in childhood

Surveys in the UK continue to show that as many as 10% of children aged 5-15 years have clinically diagnosed disorders of mental health that affect their daily life. ⁶

Young carers, of whom there are over 16,000 in Scotland, ⁷ are twice as likely as their peers to have mental health issues. ⁸

Medical advances bring their own challenges. Children who would previously have succumbed to extreme prematurity or serious chronic illness are enabled to survive through childhood and beyond

Around 7,000 children in Scotland have been designated as having "complex needs". With this figure growing there will be an additional requirement to provide multi-agency support for their health and personal needs. ⁹

Around one-third of very low birth weight babies (<1000gm) will be disabled, about half of them severely. ¹⁰

Deprivation and social exclusion remain important determinants of health for children and young people

Although overall life expectancy is improving, the gap between the most and least affluent is widening and in some areas life expectancy is actually falling. ¹¹

Death in childhood is rare but mortality rates for children are nearly twice as high in the most deprived sectors of the community compared to more affluent areas. ¹²

Teenage girls who live in areas of deprivation are three times more likely to become pregnant. Because terminations are less likely in poorer areas they are ten times more likely to become teenage mothers. ¹³

Compared with children from more affluent areas, four times as many five year-olds from deprived communities have unrestorable tooth decay. In many children this leads to dental extractions, often under general anaesthetic. ¹⁴

Changing social pressures and cultural attitudes result in changing patterns of behaviour-dependent health issues

By age 13, 6% of children describe themselves as regular smokers rising to 19% by age 15. ¹⁵

By Primary 7, 11% of schoolchildren are classified as "severely obese", a further 8% are clinically obese and in total 34% are overweight or obese. ¹⁶

Along with the rest of the UK, Scotland continues to have the highest rate of teenage pregnancy in Western Europe with over 40% of conceptions ending in medical termination. ¹⁷

35% of 15 year olds report at least occasional drug use with 4% using drugs most days. ¹⁸

None of the top ten leisure activities Scottish 11-16 year olds describe as "things they are most likely to do in a typical week" involves sport or physical activity. ¹⁹

Children and young people's health services face significant workforce challenges that affect the quality of care

Many child health teams have less than the recommended medical consultant numbers required to provide 24 hour/7 days a week cover with some specialist services having only one or two providing a service for Scotland or their local area. ²⁰

To meet estimated demand for children and adolescent mental health the CAMHS workforce at a NHS Board level would have to double in size over the next 10 years. ²¹

Rural areas of Scotland often have few, if any, clinical staff specialising in the care of children. ²²

12. The complexity of the problems and their causes testifies to the need for an approach that embraces all the agencies and systems that impact on the health and well-being of children and young people. The following section, "Working Together", describes the key elements of this overall approach to children and young people's health as it is currently being pursued in Scotland.

13. There are however specific challenges for those services, particularly within the NHS in Scotland, that are more particularly involved in the provision of healthcare to children and young people and the remaining sections of the Action Framework address these specific issues and the actions inherent in providing health services fit for our children and young people.