The Physical Health of Children and Young People

THE PHYSICAL HEALTH OF CHILDREN AND YOUNG PEOPLE
INTRODUCTION
The United Nation Convention on the Rights of the Child (UNCRC) says this:
• ‘I should be supported to live and grow.’ UNCRC, Article 6
• ‘I have the right to good quality health care, to clean water and good food.’ UNCRC, Article 24
The Covid-19 pandemic has brought to the forefront issues of children and young people’s physical health that have long lain dormant in policy discussions. Paediatricians, academics and those who care for and work with this demographic have always known that physical health is the foundation for health throughout the life course, but this understanding has not been “a truth universally acknowledged”. Government has appeared to cede responsibility for addressing matters such as food insecurity to the awareness-raising of individuals in the public eye, whilst at the same time allowing the short-term effects of the pandemic on children’s inactivity levels to be countered by programmes devised by popular celebrity profiles – with the long-term damage and potential impact on new behaviour patterns not known. We now have a unique opportunity to discard pre-Covid shibboleths and build a healthier course for the post-pandemic world. This is, and should remain, an entitlement for all children. What we already know is that healthy physical environment coupled with positive healthy behaviours established from birth, can forge a pathway of good health throughout life. For such a beneficent outcome, optimum physical health and respect of the body are paramount. Yet the pandemic has thrown into sharp relief the fact that some groups of children and young people will embark upon their life from less than a level playing field due to the family grouping, geographical or socio-economic circumstance in which they live. Growing up in poverty is now seen to be a major determinant of a pattern of ill health that establishes a grip in childhood and worsens throughout the life course. What is not so well known is the less than auspicious health prospects in store for BAME babies or in some respects the simple fact of being born female instead of male. A BAME girl born into a poor family might therefore be said to be facing the future with the health odds stacked against her. A lack of consistent direction and service provision from Government has exacerbated persistent inequalities and created the conditions for an imbalance in decision-making typified by the canard that at least “something is better than nothing”. Children are the foundation of our future society. They – and we – deserve better than this. In recent years, the childhood obesity crisis is one such area of physical health that has dominated policy conversation; invariably over-simplifying the issue and reducing wider messages around children’s physical health to simple weight measurement and physical activity levels. To an increasing extent we have seen a medicalisation of children’s physical outcomes denoted by activities such as: counting steps, measuring heart rate, calorie counting etc. and reducing physical activity to a series of orchestrated activities supposedly to preserve health. Policy that continues to use physical activity and nutrition as a means to “fix” poor health is a failing approach. Policy must start to realise the value in the promotion of good health. If we are committed to improving physical health outcomes, then an array of factors needs to be considered. As a minimum, this should include practical approaches that support families, build safer communities for children, and ensure everyone has access to nutrition. Meanwhile, an emergent policy vacuum is in danger of becoming a fixed template and wider topics of child health have been remaindered. A renewed focus is needed to establish physical health as a priority policy area for present and future government, based on an acceptance that:
• Good physical health is an entitlement for all children and young people
• Children and young people respect their bodies and embrace a lifetime of health, based on nutritional security and physical activity
• Health policy should not merely be about addressing poor health
In this report we aim to shift the direction of conversation about children’s physical health from one that has become crudely fixated on weight management, to one that champions positive health. We prioritise and invite discussion on crucial health matters concerning disability, illness, substance addiction, abuse, physical activity and nutrition. Starting with an explicit focus not on “the first 1000 days” alone or even the nine months of a pregnancy but upon pre-conception advice as a matter of routine and in all relevant settings as a necessity, we put forward a clear message. Instilling positive healthy behaviours as early as possible in a child’s life and that of their parents in preparation will provide that child with the best start in life. As we move away from a world of draconian measures, enforced by Government to protect our health (whilst at the same time damaging it), we have a renewed opportunity to look at what being physically healthy really means.