Doctors specialising in child health want Wales to take dramatic, controversial steps to address the huge health problems of many of the nation's children.
The Royal College of Paediatrics and Child Health (RCPCH) says Wales faces "particular challenges".
Its landmark report the State of Child Health 2017 published today cites issues for Wales including:
- A "devastating" link between poverty and the likelihood of death
- A quarter of children are overweight or obese
- Worrying figures on mental health and wellbeing.
The Royal College is the professional body of the UK's paediatricians.
It found that poorer children in the most deprived fifth of the population are 70% more likely to die than children in the wealthiest fifth.
Dr Mair Parry, the body's Wales' officer, said: "We must show real leadership to prevent illness from the very start of life and promote good health and wellbeing.
"If we don't, we will fail a whole generation in Wales".
Its specific recommendations for Wales include:
1. Changing driving licences for young people
Road traffic injuries are a leading cause of death in young people in the UK.
Across the UK young drivers make up 2% of licence holders but are involved in 12% of road traffic accidents.
And half of deaths of 12 to 18-year-olds are due to external factors such as accidents, suicide and assault.
The RCPCH wants "graduated" licensing schemes.
It would mean new drivers to build up their driving skills and experience gradually.
This includes learner drivers waiting a year before taking their driving test and a ban on young drivers carrying passengers under 25 unless supervised - at least for the first two years they hold a driving licence.
In New Zealand, such a scheme cut injuries by 23% for 15-19 year olds and 12% for 20-24 year olds, according to Brake.
2. Compulsory sex and relationships education in all primary and secondary schools
The RCPCH says it wants “experienced, credible, influential and relatable” people to teach young people about sex and relationships education.
But it says the new curriculum for Wales, due to be available from September 2018, will improve this key aspect of education.
The organisation says there should also be compulsory education tackling issues around bullying, drug and alcohol use and mental health.
3. A ban on fast food outlets near schools
The number of fast food chains in Wales has rocketed in the past two decades as is seen as one of the major contributing factors to the obesity epidemic.
The RCPCH says the Welsh Government should audit local authority licensing and catering arrangements.
It wants it to draw up formal recommendations on reducing the proximity of fast food outlets to schools, colleges, leisure centres and other places where children gather.
4. Make alcohol more expensive
The number of teenagers who report drinking alcohol has fallen across the UK in the past decade.
But latest figures show that 13% of 15-year-olds in Wales admit to drinking alcohol once a week.
Those aged between 15 and 17 are more likely to binge drink, which is linked to other “health risk behaviours” such as unprotected sexual activity, antisocial and criminal behaviour, self-harm and thoughts of suicide.
The RCPCH wants the Welsh Government to introduce a minimum unit price, which would be set at 50p per unit.
It would make the cheapest alcoholic drinks more expensive and tackle the impact on health and society of drinking too much alcohol.
5. Give mothers better mental health support
Maternal health and wellbeing has a profound impact on the health of children, says the RCPCH.
Being a healthy weight, breastfeeding and stopping smoking have all proven to improve health outcomes for both mothers and infants.
The organisation says the Welsh Government should develop a national strategy on infant feeding and safe sleeping practices for babies.
It should also set and monitor targets for increasing breastfeeding and reducing smoking in pregnancy and early childhood.
6. Introduce 20mph speed limits in built-up areas
Obesity is one of the biggest health problems facing the Welsh NHS.
The RCPCH says one of the ways of tackling this is for local authorities to introduce more 20mph speed limits in built up areas, to create safe places for children to walk, cycle and play.
It also wants Public Health Wales to expand the Child Measurement Plan for Wales to measure children after birth, before school and in adolescence.
This is what the authors said about the report
Dr Mair Parry, RCPCH Officer for Wales, said: “The Welsh Government has done much in recent years to improve child health.
“We welcome innovative new policies such as the Healthy Child Wales programme, ongoing action to reduce smoking rates and much-needed increases in funding for child and adolescent mental health services.
“These are big and important steps in the right direction – but it isn’t enough.
“The UK’s child health outcomes lag behind the rest of Western Europe.
“We face particular challenges in Wales, with worrying figures on the mental health and wellbeing of children and young people, over a quarter of children overweight or obese and strong and ongoing associations between socio-economic inequalities and poor health outcomes, most devastatingly in terms of child deaths.
“The Welsh Government’s commitment to tackling inequality is welcome but recent news that the target of ending child poverty in Wales by 2020 cannot be met should worry us all.”
The report says the gulf between wealth and poverty is "alarming"
The report, compiled by child health experts with input from children and young people, argues that Wales will continue to fail children’s health unless it targets support to those most in need.
The report found that an estimated 200,000 children live in poverty in Wales – around one in five.
It claimed these children have a higher chance of suffering with poor health because their mothers are more likely to smoke and eat badly during pregnancy.
The royal college also discovered that children from poorer backgrounds were more likely to indulge in more “risky” behaviours such as drinking alcohol, drug use, and smoking.
As a result it concluded that children from the most deprived fifth of the population have a rate of child death 70% higher than those in the most affluent fifth.
Dr Parry added: “In addition to specific actions, we want to see Welsh Government adopt a ‘child health in all policies’ approach.
“That means that whatever policies are made, from whatever Government department, they must consider the impact on child health.
“Many of the illnesses that appear in adults have their roots in childhood – so by investing and intervening early, we’re much more likely to create a healthier population.
“We also want to see the Welsh Government plug the gaps in child health data – particularly in areas such as mental health, disability and obesity.
“We need to have a better picture of the scale, and nature, of the problems so that services can be targeted appropriately. At the moment, what we have is patchy.”
What did other organisations make of the findings?
Commenting on the report, Louise Silverton, director for midwifery at the Royal College of Midwives (RCM), said: “As in previous reports the origin of many of the problems identified in the report lie before birth, in the health and social wellbeing of mothers.
“Interventions before and during pregnancy can produce long-term health gains for both mother and child.
“In particular, we need to see improvements in many areas and to encourage changes in people’s lifestyles. This includes improvements in breastfeeding rates, reductions in drinking and smoking in pregnancy and reductions in obesity, among many issues.
“There is also a pressing need to reduce the widening inequality in the UK. Those in the most disadvantaged groups, adults and children, are the ones often suffering from poorer general health and poorer outcomes for mother and baby in pregnancy.
“All of this needs investment in resources and in staff, but it is investment that will pay dividends in the long run, saving the NHS money and most importantly contributing to a healthier population, with fewer illnesses.”
Here are the major findings from the report, which also featured figures for the rest of the UK:
- Across England, Scotland and Wales more than one in five children during their first year of primary school are overweight or obese
- There has been minimal overall improvement in the proportion of children at a healthy weight in the past decade in any of these countries
- Children living in the most deprived areas are much more likely to be overweight or obese compared to children in the least deprived areas
- In 2013-2014, 73% of children at school entry in Wales were within the healthy weight BMI percentile. That’s less than Scotland and England
- Despite tooth decay being almost entirely preventable, 31% to 41% of five-year-old children across the UK have evidence of tooth decay
- Tooth decay is the most common single reason why children aged five to nine years old require admission to hospital
- The proportion of five-year-old children with no obvious tooth decay in 2013 was 69% in England, 68% in Scotland, 60% in Northern Ireland and 59% in Wales
Children and smoking
- The percentage of 15-year-olds smoking regularly is 6% in England and 8% in both Wales and Scotland
- But there has been a steady decline across all countries and both sexes in the overall number of 15-year-olds recorded as regular smokers since 1998
- Smoking is the single most important cause of inequalities of health in the UK
Children and alcohol/drugs
- Alcohol and cannabis use in young people has significantly declined over the past decade, but the UK still ranks poorly among other European countries
- The proportion of 15-year-olds who reported drinking alcohol weekly (in 2013-14) in Wales was 14% in boys and 12% in girls. That was worse than England but better than Scotland
- The proportion of 15-year-olds who reported ever using cannabis was (in 2013-14) in Wales was 17% in boys and 16% in girls
Children’s mental health
- Since the early 2000s, the three-year average combined suicide rate for children aged 15 to 19 in England was thought to be in steady decline. But in recent years rates appear to have risen, climbing from 34.5 per million to 39.1 per million between 2010 and 2014
- In Wales, 69 per million young people committed suicide in 2014. That’s less than Scotland (54.7), but more than England (43.9)
Other important results in the report
- Road traffic injuries are a leading cause of death in young people in the UK, followed by suicides
- There has been an overall decline in the conception rate of 15 to 17-year-old women since 2007 across England, Scotland and Wales. Conception rates per 1,000 population of 15 to 17-year-old females in 2014 were 23, 21 and 25 for England, Scotland and Wales respectively
- In 2014/2015 around 19% or just under one in five children in the UK were living in relative poverty.
What does the Welsh Government say?
In response to the report, a Welsh Government spokeswoman said: “We are committed to improving children’s health and addressing health inequalities in Wales.
“Our Programme for Government, Taking Wales Forward includes our Healthy Child Wales Programme.
“The programme will ensure that inequalities linked to poor child health are further reduced by ensuring that we deliver a universal service to all children in Wales, with additional support provided in response to identified need.”