The importance of prioritising health for children
31st December 2019
Children form a fifth of the population in Europe; and the whole of the future population – they will grow up to become the future workforce, parents, and informal carers; in due course they will progress to become the future older citizens. Therefore, child health should be everybody’s business – for altruistic, societal and economic reasons.
Many years ago, in my very first job I was part of a team setting up a well child screening service, using a computerised record system. Its success led to one of my first scientific papers. Soon after, with health service reorganisation in the UK, it contributed to setting up a national system run by each locality, seeking to raise service delivery and at the same time to learn from pooled data.
Through the subsequent years child health always remained one of my interests. It was also a frustration – children always seemed to be in a paradoxical position. As pressures on health systems increased, so hospital waiting times, high technology services, and the eternal search for new wonder cures for illnesses always pulled in resources. Primary care and preventive services for children struggle to compete. The failure of a preventive intervention is only seen later, when the damage is done, whether it is the failure to go the extra mile to ensure that a child is vaccinated, or the non-availability of early support for a distressed child with an early mental anxiety.
Looking wider, Europe gives us a chance to look at alternative approaches, and see how well each works. Countries prize their autonomy to run their own style of health service. Some have a publicly funded service, others an insurance-based one with different solutions as to how best to get cover for children. In primary care, some countries opt for a specialised community paediatrician model, others for family doctor generalist practitioners. And the training and role of nurses varies tremendously.
The European Commission sometimes refers to the European Union’s internal variety as providing a living laboratory, and they are right. Given the varied models of health system, the question naturally arises as to what works best, as so little is known about accessibility, acceptability, or outcomes. A Horizon 2020 call to research models of care gave opportunity to assess this, and the Models of Child Health Appraised (MOCHA) project was the result, funded to spend three years studying all 30 EU and EEA countries.
The main finding was that information systems on children’s health, and on their determinants of health, are so poorly developed that we cannot find out about outcomes linked to healthcare or other causes. We do not even know the number of children’s attendances in primary or secondary care, or the cost. Much more detail of what was discovered can be found on the MOCHA web site; And this month, Emerald publish an Open Access book with many key analyses from the rich MOCHA data. Both outline the further work that needs to be done.
We cannot say we have developed good enough health services for children – including preventive services and addressing the determinants of health – and we do not even know the size of the weaknesses or how best to address them. We do know we are not good at identifying the most vulnerable children, or at giving them the best support to overcome their problems. MOCHA, and in turn Emerald, have taken their steps to put this in the public domain. We can and must do more for our children’s health.
Michael Rigby is the co-author, with Mitch Blair and Denise Alexander, of Issues and Opportunities in Primary Health Care for Children in Europe. This is part of our Open Access books programme; you may also be interested in our Healthy Lives Open Gateway.
Visiting Professor in the Section of Paediatrics & Emeritus Professor of Health Information Strategy
Imperial College London & Keele University