Catalysing systemic change to tackle inequalities in children and young people's health and wellbeing
Chief Executive Officer
This year we’re doubling down to catalyse systemic change and tackle inequalities in three main areas. One Key strategic priority that we are committed to focusing on is to promote children’s and young people’s health and wellbeing, using our collective knowledge, skills, and resources to navigate and better understand the role of local partnerships in making the prevention of poor health outcomes a reality.
Physical and mental health is on the decline
As highlighted by the Nuffield Foundation, we know that whilst children and young people are healthier now than they were 20 years ago, there is still a worrying decline in health outcomes. Over the last five years, progress has stalled. We have seen widening inequalities; the cost-of-living crisis has resulted in many families now living in fuel poverty and on or below the breadline. These circumstances impact children and young people’s physical and mental health, with infant mortality rising, a childhood obesity crisis and many more referrals to child and adolescent mental health services.
Recent news headlines highlight how far the NHS is stretched, often to breaking point, with health needs rising and workforce capacity unable to keep up with the increased demand for care. As a result, CAMHS waiting lists are at an all-time high, A&E admissions and crisis responses are up, and spending on public health and prevention is down.
Whose responsibility is prevention?
Despite the clear scientific, moral, and economic arguments for prevention, it is concerning how little funds are reserved for prevention strategies, we often know very little about what is actually spent. Estimates suggest a figure of around 4-5% that has been reducing in real terms over the last decade.
A major factor in preventative spending being so low is the vicious cycle of rising demand for high-cost treatment services, sucking financial resources - hence the need for continued system reform. Across the UK, we have fragmented and siloed systems where competing goals, accountabilities, and incentives limit and frustrate preventative efforts. Reforms such as the formation of Integrated Care Systems in England and Health and social care partnerships in Scotland seek to mitigate some of these constraints – with varying degrees of success.
Our response
A core part of our work is local supporting partnerships to co-design strategies to reduce health inequalities for children and young people. We also work with system leaders to get a handle on the dynamics and spiralling costs of high-value treatment services, such as CAMHS or children’s social care
We bring together leaders of health, local authorities, and communities – alongside young people - to think about how to harness the collective public and community resources that already exist to strengthen the local preventative infrastructure. We ground this in four things:
Good data on needs and inequalities
Evidence on the social determinants of health and wellbeing
A mapping of existing systems and assets
A strong youth and community voice articulating and elevating what matters locally.
Why place and local context matter
We’ve learnt that the emphasis on ‘what matters, locally’ is critically important. So much evidence-informed policy and practice loses impact because it fails to design with local context in mind. Research has taught us a lot about the social determinants of health and wellbeing, including poverty, inequality of access to resources, chronic stress, unhealthy environments, and structural racism. Yet understanding how these determinants manifest in concrete ways for young people in local contexts is critical, as is co-designing responses with young people and communities to address these negative health outcomes.
In Kailo for example, we are working with local partners to design preventative mental health strategies for and with young people. We spoke directly to hundreds of young people, community members, practitioners and local system leaders in two very different places: rural Northern Devon, and inner-city Newham. As you’d expect there were some evidence-informed and cross-cutting themes, such as fragmented systems of support, a desire to build mental health literacy of young people and supporting adults in the community. There were also different areas of importance for the young people in both communities. In Northern Devon, geographical and social isolation is an important issue, as is equitable access to diverse employment or training opportunities. Whereas in Newham, what really matters is feeling safe in the community – from racism, discrimination, and violence – and having the opportunity to engage in positive activities. You can read more on this via the Kailo ‘latest’ page here. It is therefore crucial, to not only connect local leaders and decision-makers with the evidence to support promoting health and preventing ill-health, but also with what matters locally.
Working together and taking a systemic approach
Prevention requires a systemic approach: thinking about specific interventions and bolstering community assets to have the greatest impact. Then, designing portfolio-based approaches comprising mutually beneficial investments and resources.
This work involves carefully considering the system's different roles and collective resources, and stakeholders determining the best role they can play. This may involve stepping in, stepping back, or aligning and collaborating in pursuit of shared goals.
A great example of this is demonstrated through our partnership with leading Cancer Charities, Young Lives vs Cancer, Children’s Cancer and Leukaemia Group, Ellen MacArthur Cancer Trust and Teenage Cancer Trust. Together, we’ve co-designed research and worked on a nationwide survey to understand the psychosocial needs of young people experiencing cancer. The partners are now further connecting with the sector to design a series of strategically aligned and mutually reinforcing – but not duplicative – approaches. This joined-up way of thinking really has the potential to make a difference for children and young people.
Ways to get involved
Over the coming months, we’ll explore more ways for partnership work to contribute to improving children’s health and wellbeing. Our systems thinking training will equip you with the skills to put systems dynamics tools and approaches into practice. We are always keen to hear from Integrated Care Systems, Local Authorities and Health and Social Care Partnerships interested in putting exploring this work with us, so do get in touch. You can also connect with us on LinkedIn or sign up to our newsletter to keep up to date with our work, new training offers and ways we’re collaborating with community partners.
For more information on our strategic priorities this year, please contact Tim Hobbs.