- Email: [email protected]
Child mortality in the UK
Correspondence
Child mortality in the UK The UK did particularly poorly in terms of the mortality estimates for children younger than 5 years, produced by the Global Burden of Diseases team (Sept 13, p 957).1 At 4·9 deaths per 1000 in 2013, the UK has almost the highest rate in western Europe, double that of Sweden, a country with one of the lowest mortality estimates.2 Furthermore, high-income countries with a high proportion of children living in relative poverty, have a high rate of under-5 mortality (figure).1,2 Child poverty in high-income countries varies greatly, suggesting that the level of poverty might be a policy choice, amenable to change by national governments. Analyses consistently show that much of this variation is directly related to differences in tax and benefit systems.3 Unfortunately, signs of concern suggest that present policies in the UK might be making the situation worse.4 Absolute child poverty increased for the first time in 17 years in the UK, during changes to the tax and benefit system that are reducing the
adequacy, eligibility, and access to benefits, especially for some families with lowest incomes with children.4 Governmental cuts to spending for the public sector are affecting services relied on by families with low incomes who have children, with the largest spending cuts to budgets of local authorities in deprived areas.5 If we are to reduce the number of child deaths in the UK we need a welfare system that prioritises children, with a renewed focus on improving the circumstances in which children grow up, alongside systematic improvements in health services.6 We declare no competing interests.
*David Taylor-Robinson, Jonathan Bradshaw, Ben Barr, Margaret Whitehead [email protected] Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK (DT-R, BB, MW); Population, Policy and Practice, Institute for Child Health, University College London, London, UK (DT-R); and Department of Social Policy and Social Work, University of York, Heslington, UK (JB) 1
Wang H, Liddell CA, Coates MM, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 957–79.
Number of deaths (per 1000 livebirths)
10
Bulgaria
8 Malta Slovakia
USA Latvia
6
New Zealand
Canada
Hungary UK
Poland Ireland Lithuania Australia Switzerland Austria Greece Estonia Belgium Italy Denmark France Spain Portugal Germany Slovenia Czech Republic Finland Norway Japan Luxembourg Sweden Iceland Netherlands
4
Cyprus
2 0 0
5
10
15 Relative child poverty
20
Figure: Child poverty and mortality in 35 countries in the Organisation for Economic Co-operation and Development Child relative poverty rates (having equivalised household income of less than 50% of the national median) are from the 2013 UNICEF report.2 Mortality estimates are for children younger than 5 years for 2013 from the Global Burden of Diseases analysis by Wang and colleagues.1 Linear regression trend line; mortality in children younger than 5 years is calculated by 1·94 + 0·22 × relative child poverty; p<0·0001; R2=0·40.
www.thelancet.com Vol 384 November 29, 2014
2
3
4
5
6
UNICEF. Child well-being in rich countries: a comparative overview. 2011. http://www. unicef.org.uk/Images/Campaigns/FINAL_RC11ENG-LORES-fnl2.pdf (accessed May 10, 2014). Marx I, Nelson K. Minimum income protection in flux. Houndmills, Basingstoke, Hampshire, UK: Palgrave Macmillan, 2013. Taylor-Robinson D, Harrison D, Whitehead M, Barr B. Doctors need to take the lead on poverty’s effects on health. BMJ 2013; 347: f7540. Taylor-Robinson D, Gosling R. English north-south divide. Local authority budget cuts and health inequalities. BMJ 2011; 342: d1487. Wolfe I, Thompson M, Gill P, et al. Health services for children in western Europe. Lancet 2013; 381: 1224–34.
Haidong Wang and colleagues 1 emphasise the importance of global monitoring to identify countries most in need of improvement. Although we support this ambition, we recognise that every country has a responsibility to build infrastructure and assimilate data sources (old and new) to identify opportunities to improve the quality of health and provision of social care for children. A review2 suggested that more than 20% of child deaths in the UK in 2013 had so-called modifiable factors, whereby health care could have intervened to mitigate the risk of death. Analysis of routine data sources, such as data from incident reports for patient safety, could help to understand what common contributory, modifiable factors might be.3 A global registry for paediatric safety using a minimum dataset from every country, irrespective of economic setting, would allow the necessary surveillance to ensure harm was mitigated against and indeed solutions developed to prevent these avoidable deaths in children. This registry will need a combination of analytics with clinical expertise to generate action-orientated outputs with strong face validity in the health-care profession. AE, AC-S, SSP, and PR work on a project funded by the National Institute of Health Research (NIHR) Health Services and Delivery Research (HS&DR) to characterise patient safety incident reports in primary care. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR, NIHR, UK National Health Service, or the Department of Health (UK).
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
1923
Child mortality in the UK The UK did particularly poorly in terms of the mortality estimates for children younger than 5 years, produced by the Global Burden of Diseases team (Sept 13, p 957).1 At 4·9 deaths per 1000 in 2013, the UK has almost the highest rate in western Europe, double that of Sweden, a country with one of the lowest mortality estimates.2 Furthermore, high-income countries with a high proportion of children living in relative poverty, have a high rate of under-5 mortality (figure).1,2 Child poverty in high-income countries varies greatly, suggesting that the level of poverty might be a policy choice, amenable to change by national governments. Analyses consistently show that much of this variation is directly related to differences in tax and benefit systems.3 Unfortunately, signs of concern suggest that present policies in the UK might be making the situation worse.4 Absolute child poverty increased for the first time in 17 years in the UK, during changes to the tax and benefit system that are reducing the
adequacy, eligibility, and access to benefits, especially for some families with lowest incomes with children.4 Governmental cuts to spending for the public sector are affecting services relied on by families with low incomes who have children, with the largest spending cuts to budgets of local authorities in deprived areas.5 If we are to reduce the number of child deaths in the UK we need a welfare system that prioritises children, with a renewed focus on improving the circumstances in which children grow up, alongside systematic improvements in health services.6 We declare no competing interests.
*David Taylor-Robinson, Jonathan Bradshaw, Ben Barr, Margaret Whitehead [email protected] Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK (DT-R, BB, MW); Population, Policy and Practice, Institute for Child Health, University College London, London, UK (DT-R); and Department of Social Policy and Social Work, University of York, Heslington, UK (JB) 1
Wang H, Liddell CA, Coates MM, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 957–79.
Number of deaths (per 1000 livebirths)
10
Bulgaria
8 Malta Slovakia
USA Latvia
6
New Zealand
Canada
Hungary UK
Poland Ireland Lithuania Australia Switzerland Austria Greece Estonia Belgium Italy Denmark France Spain Portugal Germany Slovenia Czech Republic Finland Norway Japan Luxembourg Sweden Iceland Netherlands
4
Cyprus
2 0 0
5
10
15 Relative child poverty
20
Figure: Child poverty and mortality in 35 countries in the Organisation for Economic Co-operation and Development Child relative poverty rates (having equivalised household income of less than 50% of the national median) are from the 2013 UNICEF report.2 Mortality estimates are for children younger than 5 years for 2013 from the Global Burden of Diseases analysis by Wang and colleagues.1 Linear regression trend line; mortality in children younger than 5 years is calculated by 1·94 + 0·22 × relative child poverty; p<0·0001; R2=0·40.
www.thelancet.com Vol 384 November 29, 2014
2
3
4
5
6
UNICEF. Child well-being in rich countries: a comparative overview. 2011. http://www. unicef.org.uk/Images/Campaigns/FINAL_RC11ENG-LORES-fnl2.pdf (accessed May 10, 2014). Marx I, Nelson K. Minimum income protection in flux. Houndmills, Basingstoke, Hampshire, UK: Palgrave Macmillan, 2013. Taylor-Robinson D, Harrison D, Whitehead M, Barr B. Doctors need to take the lead on poverty’s effects on health. BMJ 2013; 347: f7540. Taylor-Robinson D, Gosling R. English north-south divide. Local authority budget cuts and health inequalities. BMJ 2011; 342: d1487. Wolfe I, Thompson M, Gill P, et al. Health services for children in western Europe. Lancet 2013; 381: 1224–34.
Haidong Wang and colleagues 1 emphasise the importance of global monitoring to identify countries most in need of improvement. Although we support this ambition, we recognise that every country has a responsibility to build infrastructure and assimilate data sources (old and new) to identify opportunities to improve the quality of health and provision of social care for children. A review2 suggested that more than 20% of child deaths in the UK in 2013 had so-called modifiable factors, whereby health care could have intervened to mitigate the risk of death. Analysis of routine data sources, such as data from incident reports for patient safety, could help to understand what common contributory, modifiable factors might be.3 A global registry for paediatric safety using a minimum dataset from every country, irrespective of economic setting, would allow the necessary surveillance to ensure harm was mitigated against and indeed solutions developed to prevent these avoidable deaths in children. This registry will need a combination of analytics with clinical expertise to generate action-orientated outputs with strong face validity in the health-care profession. AE, AC-S, SSP, and PR work on a project funded by the National Institute of Health Research (NIHR) Health Services and Delivery Research (HS&DR) to characterise patient safety incident reports in primary care. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR, NIHR, UK National Health Service, or the Department of Health (UK).
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
1923