Children's health

Summary

-Children's health must be made a priority now to avoid a chronic disease epidemic in 40-50 years.

- Coronary heart disease, high blood pressure and diabetes originate in childhood

- Children's lifestyles are increasingly unhealthy

- Foetal development is a vital part of the jigsaw

- The under 16s make up 1/5 of the population but health initiatives have focused on adults.

Rationale for a policy focus on children

As a signatory to the United Nations Convention on the Rights of the Child, the government has a responsibility to ensure that all children have the best possible start in life. Protecting children from avoidable disease is fundamental to fulfilling these responsibilities.

Unless we take action on current trends and inequalities in diet, physical activity, obesity and smoking, and make children's and young people's health a national priority, we will fail to prevent an epidemic of coronary heart disease, as well as stroke, cancer and diabetes, in 40-50 years' time. Stemming this epidemic was the goal of the National Heart Forum's 'young@heart' campaign.

Linking children's health and heart disease

Heart attacks and illness from coronary heart disease seem remote from children's lives, but the key risk factors for developing coronary heart disease - raised blood cholesterol, high blood pressure, and diabetes - all develop over the life course, and most originate during childhood.[1]

Studies show that the early signs of coronary heart disease are apparent in some children and adolescents. Atherosclerosis (fatty deposits in the walls of the arteries) has been found in a small minority of children as young as two years old. By the age of 20, it may be present in as many as one in three young people.[2]

Some people have a genetic disposition towards some of these risk factors, but for most people the risk of coronary heart disease is largely determined by physical inactivity,[3] diet,[4] and smoking.[5]

Research indicates that children and young people's lifestyles are increasingly unhealthy, resulting in a rising prevalence of overweight/obesity in this group[6]. There is also an increased risk of developing Type 2 diabetes in individuals who are overweight or obese, and cases of Type 2 diabetes are being diagnosed among teenagers for the first time.[7]

Foetal development and babies' consequent birthweight make up another very important piece of the risk factor jigsaw. Studies suggest that low birthweight (particularly when followed by rapid weight gain in infancy) is associated with a number of coronary heart disease risk factors.[8]

Birthweights show a clear socio-economic gradient: the average birthweight of babies from low-income families is lower than that of babies born into better off families. Closing this gap demands measures that ensure adequate infant feeding and nutrition in pregnancy as well as appropriate nutrition during adolescence to support the healthy physical development of future mothers.

Investing in child-centred strategies

If current knowledge about the causes and prevention of CHD are turned into effective policy action focusing on children and young people, death and disability from avoidable coronary heart disease among people under 65 could be virtually eliminated.

Children and young people under 16 make up one fifth of the population,[9] yet public health initiatives aimed at children have lacked both the priority and the resources given to adult interventions.

Investing in child-centred strategies has the potential to yield both immediate and long-term benefits - by protecting young hearts from the damaging effects of poor nutrition on early growth and development, and by fostering and sustaining positive health behaviours throughout life.

A policy focus on children is a natural step from the government-commissioned Independent inquiry into inequalities in health (published in 1998)[10] and builds on the Government's commitments to improve children's health,[11] [12] and to end child poverty in the next 20 years.

References

McCarron P, Davey-Smith G. 2003. Physiological measurements in children and young people, and risk of coronary heart disease in adults. In: National Heart Forum. 2003. A Lifecourse Approach to Coronary Heart Disease Prevention. Scientific and Policy Review. London: The Stationery Office.

Berensen GS, Srinivasan SR, Bao W et al. 1998. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. New England Journal of Medicine; 338; 23: 1650-56.

Cavill N, Biddle S. 2003. The determinants of young people's participation in physical activity, and investigation of tracking of physical activity from youth to adulthood. In: National Heart Forum. 2003. A Lifecourse Approach to Coronary Heart Disease Prevention. Scientific and Policy Review. London: The Stationery Office.

McColl K. 2003. The diets of children and young people: implications for coronary heart disease prevention. In: National Heart Forum. 2003. A Lifecourse Approach to Coronary Heart Disease Prevention. Scientific and Policy Review. London: The Stationery Office.

McNeill A, Charlton A. 2003. Policy implications for reducing smoking in young people. In: National Heart Forum. 2003. A Lifecourse Approach to Coronary Heart Disease Prevention. Scientific and Policy Review. London: The Stationery Office.

Bundred P, Kitchiner D, Buchan I. 2001. Prevalence of overweight and obese children between 1989 and 1998: Population based series of cross sectional studies. BMJ; 322: 326-28.

Drake AJ, Smith A, Betts PR et al. 2002. Type 2 diabetes in obese white children. Arch Dis Child; 86: 207-8.

Barker DJP. 2002. (In press.) The foetal and infant origins of coronary heart disease. In: National Heart Forum. Towards a Generation Free from Coronary Heart Disease(provisional title). London: The Stationery Office.

Government Actuary Department. Press release, 15 November 2001.

Acheson D. 1998. Independent inquiry into inequalities in health. London: The Stationery Office

Department of Health 1999 Saving Lives: Our Healthier Nation. London: The Stationery Office

Department of Health 2000 The NHS Plan: A plan for investment, a plan for reform. London: The Stationery Office