Closing the divide

Why Children Die, was the subject of a new report launched by the Royal College of Paediatrics and Child Health in the Scottish Parliament earlier this month.

Between 350-450 children die in Scotland every year, it showed, the majority of whom are under the age of one.

The death of any child – preventable or otherwise – is a tragedy, says Dr Donald Macgregor, paediatrician and spokesperson for RCPCH Scotland.

“To me it doesn’t really matter if it is preventable or not, it is terrible. But parents of children who have died are devastated and they really want us to learn so that no one else goes through the same thing. But you can’t always identify why did this child die of this illness? Sometimes you can get answers but sometimes you can’t. But you can look at all the deaths and say what the factors in there are. And maybe just by changing some of the common factors we might have an impact.”

For example, the report tells us that between 2005 and 2009, an average of 34 young drivers aged between 17 and 25 years were killed each year on Scotland’s roads, and so RCPCH Scotland propose greater use of 20mph speed limits in built-up areas and the introduction of graduated licensing schemes to reduce deaths due to injuries.

It also details that between 2009-12, 131 children and young people died due to probable suicide, with suicide rates more than three times higher in deprived areas. Therefore, RCPCH Scotland calls for a greater focus on improving training of health professional to identify, and also service provision for, those children most at risk of mental health difficulties.

“One of the parts of the report says we should be better at spotting and picking up people with mental health issues earlier. But we then need to be able to deliver something for them, and we are already struggling with huge waiting lists. It is quite demoralising if you want to start training people in spotting mental illness but they have nowhere to refer on to. That is not going to be a winner,” says Macgregor, who has also been leading an unscheduled care telemedicine project to enable consultant paediatricians to assess sick children in rural areas of Scotland by video conferencing, in a bid to identify them at an earlier stage.

If you were going to change one thing quickly, however, Macgregor says it would be to keep working on smoking rates.

Each year over 11,000 babies in Scotland are affected by – and 20 infant deaths are directly attributable to – smoking during pregnancy, the report states.

Macgregor backs “anything that reduces smoking”, calling proposals to introduce plain packaging “a no brainer”. However, he warns against viewing e-cigarettes – the regulation of which is currently the topic of a Scottish Government consultation – as a panacea.

“Although moving to e-cigarettes is good for the elderly population, e-cigarettes are still filled with nicotine and nicotine will still reduce the blood flow to the baby. So don’t think that is a simple solution.”

More comprehensive sex and relationship education is also recommended by the report.

While Macgregor says they don’t know for sure if that will work, he adds that we can’t stand by and do nothing. Dundee, where Macgregor is currently a consultant and lecturer, has struggled in the past with high rates of teenage pregnancy and so was one of the first locations selected for the Scottish pilot of the Family Nurse Partnership model – a preventative programme for first-time teenage mothers and their babies.

It has had successes, but also thrown up challenges, he explains.

“One of the problems with the Family Nurse Partnership is families have to say, yes, I’ll buy into that. And there are families who are anxious about that kind of involvement. It is almost like a stigma, or, ‘It is it is none of your business, hen.’ But I think you have to keep chipping away at that. If not every family buys into it but three or four do then it is still probably a winner.”
Another issue it has highlighted is a shortage of experienced health visitors.

“One thing that has happened as a result of that is we robbed Peter to pay Paul. We said we are going to have these super-duper health visitors and we will pay them a bit more, so guess who got all the jobs? All the health visitors. And then what happened? There were no health visitors. So now we are trying to train hundreds and hundreds of health visitors, which is great. But there are always consequences to doing something like that. You lose a lot of that experience in one.”

Recurrent through much of this is the role poverty and inequality plays in the relatively high levels of mortality in Scotland, and so the report concludes that more must be done to bridge the gap between rich and poor if we are to improve child health.

“Equity saves lives. Poverty kills,” Macgregor summarises.

“But you can deliver a better health service by changing some of that inequity, without a doubt.”