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CHILDREN AND YOUNG PEOPLE - THE CHALLENGES
9. 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.
10. 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 |
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 yrs have clinically diagnosed disorders of mental health that affect their daily life. 3 Young carers are twice as likely as their peers to have mental health issues 4 |
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 are affected by parental alcohol misuse 5 Some 11,000 children are looked after and accommodated by Local Authorities. Within this already disadvantaged group over 40% have emotional or mental health problems. 6 |
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. 7 Around one third of very low birth weight babies (<1000gm) will be disabled, about half of them severely. 8 |
Changing social pressures and cultural attitudes result in changing patterns of behaviour-dependent health issues
In the most recent Scottish Health Survey 5% of children reported having smoked in the previous week, increasing from 2% at age 12 to 29% at age 15. 9 30% of girls and almost 35% of boys between the ages of 2 and 15 are either overweight or obese 10. At 12 years of age just over 11% are classified as severely obese. 11 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. 12 |
Deprivation and social exclusion remain important determinants of health for children as well
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. 13 Although death in childhood is rare mortality rates for children are nearly twice as high in the most deprived sectors of the community compared to more affluent areas. 14 Teenage girls who live in areas of deprivation are three times more likely to become pregnant. Because terminations are less likely in poorer area they are ten times more likely to become teenage mothers. 15 Compared with children from more affluent areas, four times as many 5 year-olds from deprived communities have unrestorable tooth decay. In many children this leads to dental extractions, often under general anaesthetic. 16 |
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. 17 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. 18 Rural areas of Scotland often have few, if any, clinical staff specialising in the care of children. 19 |
11. These few examples testify to the range of problems which impact on the health and healthcare needs of children and young people in Scotland today. This Action Framework is intended to provide a way forward by which these challenges can be addressed consistently, effectively and equitably across the country.
12. The next section describes the basis for change including why children and young people are different, the policy context in Scotland, and the issues described in the review of the NHS in Scotland led by Professor David Kerr in health services fit for children and young people.
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