Scotland's public health priorities

Priority 2: A Scotland where we flourish in our early years

We want Scotland to be the best place for a child to grow up. Addressing the health and wellbeing issues of our children and young people and recognising, respecting and promoting their rights is essential to achieving this outcome. This priority places particular emphasis on our early years, recognising the impact that early childhood poverty, disability and adverse childhood experiences can have on health outcomes throughout a person’s life.

Why are the early years important?

Improving health and wellbeing and supporting parents, carers and families is critical to Scotland’s health and prosperity, both now and in the future. Evidence suggests that our childhood has a large influence on our health as adults, no matter what kind of life we lead in later years. Investing in getting it right in the early years is a highly cost-effective approach and can produce huge benefits across society. By taking a whole-systems approach to childhood in the earliest years, from pre-conception onwards, we maximise the impact on our nation’s future health. And we will ensure services continue to work with parents, carers and families as the most important people in a child's life. Investing early in our young peoples’ future is the best form of prevention.

How will we make a difference?

Creating healthy childhood experiences is a shared responsibility for all of Scottish society. Public services are working with partners in the third and private sectors to focus on the early years and Getting It Right for Every Child ( GIRFEC) continues to be our approach to improving outcomes and supporting the wellbeing of children and young people.

The Scottish Government, the NHS and local government all rightly focus much of their resource on the early years, through provision of funding for early learning and childcare, health visiting, early years services, and education and support for families. The GIRFEC approach has been developed and embedded across Scotland over a number of years. However, we now need to build on this and increase our ambition across the whole system by recognising that everyone has a role to play collectively in continuing to deliver improvement – not just early years professionals.

Pregnancy

We need to ensure that families are sufficiently supported financially, emotionally and in terms of employment and social security rights to have a healthy pregnancy and post-natal period. This includes being smoke-free, well-nourished and supported to breastfeed where possible. Despite clear evidence of the benefits to mother and child of breastfeeding, rates remain low in Scotland and are lowest in young mothers and the most deprived groups. We need to join up the whole system to ensure women and families get the right support, in the right place, at the right time.

Adverse Childhood Experiences

Adverse Childhood Experiences ( ACEs) describe stressful or traumatic events occurring during childhood, such as physical or verbal abuse or neglect; sexual abuse; parental separation; problem substance use; incarceration; mental ill health; or domestic violence. Such experiences can lead to an increased risk of ill health later in life. There is strong evidence that, without intervention, ACEs have long term impacts throughout the life-course on health, emotional wellbeing and other life outcomes.

The Scottish Government is working closely with NHS Scotland and other partners to raise awareness of ACEs and their impacts across various sectors, and councils are working with community planning partners at the local level to prevent ACEs from occurring and to mitigate the impact where they do. This includes working with the many organisations across Scotland who are already developing trauma-informed approaches to support children and young people who experience adverse and/or traumatic events. We will work to strengthen these national and local efforts as we continue to embed a system-wide ACE-informed approach within the wider GIRFEC approach.

Attainment Gap

Closing the poverty-related attainment gap in schools between those children from low-income and high-income households is a key priority at both national and local level. This is supported by £1bn of investment in the expansion of early learning and childcare which the Scottish Government and local government are jointly delivering from 2020 onwards. This will deliver quality early learning and childcare in an effort to reduce the poverty-related attainment gap and to provide additional support to families. In addition, £750m has been committed to the Attainment Scotland Fund ( ASF) over the lifetime of this Parliament. This includes £120m Pupil Equity Funding, which provides resources direct to schools intended to help tackle the attainment gap through targeted improvement activity in literacy, numeracy and health and wellbeing.

Local Level

Councils across Scotland are working with community planning partners to plan and deliver joined-up local children’s services which take a holistic approach to meeting the social, emotional and developmental needs of children. Working closely with families, communities and the third sector, local partnerships are acting to protect and improve the wellbeing of our children and young people to ensure they have the best start in life. Examples include providing opportunities for safe play, identifying and supporting young carers, providing additional support for learning and tackling violence against women and girls.

All that councils and their partners do to support families through providing community facilities, employment support, housing, education, parenting support and safe outdoor spaces helps to form a strong foundation for families and communities to ensure our children can flourish.

A child is born every 10 minutes in Scotland (54,488 births in 2016). ^2.1

230,000 children live in relative poverty after housing costs in Scotland, this is around 1 in 4 children. At least seven out of ten of these live in a house where at least one adult is working. ^2.2

B r eas t f ee ding

63% of babies are breastfed for at least some time after birth, but only 41% were being breastfed by 6-8 weeks of age.

Those in the wealthiest areas are 1.7 times as likely to be breastfed at birth, and 2.3 as likely at 6-8 weeks as those in the most deprived areas. ^2.3

Survey data from England has shown: almost half (47%) of individuals experienced at least one adverse childhood experience. ^2.5

Experiencing four or more ACEs was associated with:

• 0 3 x odds of smoking as an adult
• 0 6 x odds of unintended teenage pregnancy
• 0 8 x odds of violence perpetration as an adult

One in four children from the most deprived areas (24%) had at least one developmental concern identified in their 27-30 month review compared to one in nine for the least deprived areas (11%). ^2.4

7944 teeth are extracted under general anaesthetics every year at a cost of approx. £5m and at least 8000 days are lost from school/nursery and their parents’ work. ^2.6

School leavers from the wealthiest areas are three times as likely to be going to higher education as those in the most deprived areas

School leavers in the most deprived areas were more than five times as likely to be unemployed on leaving school as those from the wealthiest areas. ^2.7

62% of 15 year old girls and 36% of 15 year old boys feel pressured by schoolwork ‘a lot’, the highest ever level. ^2.8