Last year, the NHS was applauded as the ‘best healthcare system in the world’, and few who have had been cared for in the heathcare system would disagree.
Yet despite its world-leading status, the pressures that the NHS is currently facing are unprecedented – huge demand, greater expectations and ever-tightening budgets.
And when it comes to prevention, child health is not as good as it should be. The latest figures show that nearly one in four British children under the age of five is overweight or obese and this rises to a third of 10-11 year olds.
One in10 children have a mental health problem and less than half are treated appropriately and on time. And there’s the shocking statistic that one in six children in the UK live in poverty, which of course has adverse effects on their health and wellbeing.
At the Royal College of Paediatrics and Child Health (RCPCH), our role is two-fold. Firstly, to ensure paediatricians and all other healthcare professionals dealing with children receive the best possible education and training so that they can provide expert care. And secondly, to advocate for child health, whether to reduce childhood obesity, tackle poor child and adolescent mental health or increase the amount of research to improve children’s wellbeing.
These aspects of our mission involve working closely with other professionals, because there are so many people involved who can influence child health.
The area I particularly want to focus on is the need to increase the amount of child health research that takes place. It’s a fundamental area that if we don’t get right, will risk stalling progress when it comes to improving the health of our children and their life in adulthood. This holds the key to addressing many of the child health challenges we face.
Why is child health research important? Research generates evidence and it’s only with good evidence that we know how best to care for children with health problems and how best to prevent ill health.
Forty years ago, a condition like childhood leukemia was a death sentence. But today, the majority of children with leukaemia are cured because treatment has improved as a result of evidence gained by the participation of children in clinical research as a matter of course. This model needs to extend to all aspects of care so that medical treatments continually improve.
Two years ago, the RCPCH published a major report Turning the Tide, which presented the current situation when it comes to child health research. The good news is that in the UK, we have had strong recognition from successive governments of the importance of medical research and a children’s research network to facilitate the delivery of clinical studies. The bad news is that there is an imbalance between research that targets adults and research that addresses the needs of children.
Children make up over 20 per cent of the population, but funding secured for child health research represents just five per cent of the annual UK public and charitable research expenditure – the equivalent of less than £10 per child each year compared to about £50 per adult.
Many of the medicines prescribed to children have not been evaluated in children to see if they work as we expect, or what dose to use. In fact, approximately 95 per cent of medicines used to treat new-born babies have not been properly evaluated in them.
But whose responsibility is it? As with many of the well-publicised challenges in child health, whether it’s obesity, asthma or diabetes, responsibility for overcoming the lack of good evidence that comes from carrying out research studies rests with a number of groups.
First is the industry – for diseases where two-thirds of the burden is carried by children, only 12 per cent of industry-funded research is aimed at them, so children have to rely on public and charitable funding.
Second, we have to work with research organisations that are in a position to support studies. Earlier this year, the RCPCH launched a UK ‘Children’s Research Collaboration’, bringing together a range of child health research organisations to optimise the use of funding for research and raise awareness of the need to strengthen children’s involvement. Working together, we will be in a much more powerful position to ensure that children benefit from the huge number of scientific and technological advances that have potential to improve their health.
Third, we have to ensure doctors are well trained in how to evaluate treatments so it becomes a core part of their work. Pediatricians must know how to communicate the value of research studies to young people and their parents so the mystery that surrounds them is removed.
And perhaps most importantly, parents and young people need to be aware of the opportunities for them to be involved in research. There is a particular challenge among the Asian community, with many either uncertain of what clinical studies involve or nervous about allowing their children to participate.
We have to change the culture of child health research in this country and around the world if we are to improve the health and wellbeing of the next generation. If you are interested in finding out more, or want to add your voice to the others who want to see child health research higher up the agenda, read our Turning the Tide report at http://www.rcpch.ac.uk/harnessing-the- power-of-child-health-research and join the debate on Twitter #ChildHealthResearch.
Professor Modi is the first president of the Royal College of Paediatrics and Child Health of Indian origin. She took up her post in April 2015 following election by the membership.