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It takes a community to raise a child

Early on in our existence as Public Health England, the four PHE centre directors for the Midlands and East of England region and I discussed where we particularly wanted to focus our efforts. Considering many of the challenges faced by our communities within the region, we looked at the wide variation in health inequalities we have. The region includes both some of the most advantaged areas in the country and some of the most disadvantaged. However, all of them had one common factor: the need for opportunities to be available to every child born in the region to have the best start in life. We didn’t take long to agree that the first few months and years of a child’s life is the most seminal time of our existence as a human being.

Importantly, this was something we were hearing time and again from our local authorities: that they want support from Public Health England and are keen to work with us. We know too that Sir Michael Marmot’s landmark report in 2010 on tackling the health inequalities divide in England, Fair Society, Healthy Lives, set out six policy objectives to achieve this, with the first of them being to give every child the best start in life.

There is now incontrovertible evidence for early years support and ensuring parents have the skills to positively influence their child’s early development. In particular, the first three years of a child’s life are crucial for setting the building blocks of physiological, social and emotional wellbeing. No matter where a child is born, every child needs their parents and carers to interact with them and support the child to develop skills that will be lasting into adulthood and will positively impact on that child’s achievement as an individual and as a member of society.

I see our role in PHE in part as being to advocate for focus on early years and working with and through local partners, including local authorities, the voluntary and community sector and the NHS to promote actions to ensure the positive start to life for all our children. There is no magic bullet here and we need a number of coordinated approaches that address:

  • the social and emotional development of children
  • parenting skills and support
  • smoking in pregnancy
  • teenage pregnancy and sexual health
  • supporting the work of health visitors, following their transfer to local authorities
  • supporting the immunisation programme
  • our workforce having the necessary skills.

So how have we engaged in the midlands and east? Each of the four centres are starting to develop bespoke discussions with their local partners, particularly local authorities and NHS England area teams, about how PHE can support and galvanise collective action. We also work with the national lead in PHE on the children and young people priority area. For example, the PHE East Midlands centre coordinated a very successful innovation and practice event which involved local authorities, academic partners, providers of services such as family nurse partnerships and the voluntary and community sector. Speakers included Graham Allen MP, Chair of the Early Intervention Foundation. There was unanimous support for the development of a network for PHE East Midlands to convene and support the local authorities, the NHS and the third sector in their role in giving every child the best start.

A most powerful message that I took from the event was the importance of the interaction between the child and the child’s parent, and the parent fully understanding the importance of that interaction, irrespective of how young the child is. This was powerfully illustrated by the example of a teenage mother who, when asked if she talked to her baby, asked why she would when the baby can’t talk back. This example demonstrated not only the limited understanding of the mother which was not surprisingly given her age but that there was no one else to help and teach the mother.

For me, the saying ‘it takes a community to raise a child’ is even more relevant now than before.

One early action we have identified is tackling the levels of smoking in pregnancy. This is vital when you consider both the impact on the unborn – leading to higher rates of stillbirth – and on young children more generally. The levels of smoking during pregnancy, despite such a focus on supporting people to stop smoking,  have been fairly static in many parts of the region, ranging from just under 1 in 4 women smoking during pregnancy to the ‘best’ areas still having levels of around 1 in 10!

We know that smoking in pregnancy is reflective of a range of factors that impact on that individual mother’s life that culminate in behaviours that are detrimental to both the mother and her unborn child’s health and wellbeing. We also know that where health care and other professionals are able to make the contact they have with their patient count in promoting health, this can lead to a potentially successfully outcome. Advocating the Making Every Contact Count programme and sharing evidence and best practice from elsewhere are some of the ways we are supporting local areas to reduce smoking in pregnancy.

Clearly we are only just starting to galvanise our focus and efforts on the first few years of a child’s life, starting with developing effective partnerships and sharing of best practice that is going on across the midlands and east region, as well as nationally.

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  1. Comment by Chm posted on

    Shame the contribution of school nurses is not recognised , in fact not even mentioned!! Children's health issues do not miraculously disappear one they start schools!! With the last HV contact and that too by an NNEB most of the time school nurses are the ones identifying and dealing with increasing numbers of raising 5's entering school!!!

  2. Comment by LW posted on

    I agree, with caseloads of 400 plus in my case 575 how can hv's address all these issues and support parents. It alright saying there is a need and promises of better staffing levels that don't happen and cutting the NNEB support. Even better off areas have significant needs, but no one seems to recognise this.

  3. Comment by Bren posted on

    Hello Rashmi,

    The focus on children is spot on and well done. As our future, the children (and family) have to be given the very best start in life, and particularly in early years. I also think we need to keep fathers in mind too as we develop support and interventions for children.

    Great blog and thank you Rashmi and I will watch with interest as you go forward with the relationships you have, and are clearly building.

    Best wishes,


    • Replies to Bren>

      Comment by Rashmi Shukla posted on

      Many thanks Bren. We are keen to make an impact to improve the health and wellbeing of our children, especially given the opportunity of close working with local authorities in their new statutory duty to improve health.