In autumn 2022, the College launched a programme to #ShiftTheDial on child health inequalities. We aim to shape health policy and to enhance paediatricians’ expertise to effectively support children and families impacted by poverty. Our second phase looks at how climate change compounds health inequalities in many ways, including environmental exposure and capacity to adapt, food insecurity and the effects of the climate crisis on mental health.
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Child health inequalities part 1 - Talking with families
We know that children living in poverty are more likely to experience poorer health outcomes, and paediatricians are in a unique and crucial position to advocate for lifelong change in their patients.
Dr Helen Stewart, a consultant in paediatric emergency medicine and the College's Officer for Health Improvement, speaks with Dr Ian Sinha, consultant respiratory paediatrician and Dr Alice Lee, paediatric trainee and clinical innovation research fellow, both at at Alder Hey Children's Hopspital.
Ian and Alice are two of the authors of the RCPCH health inequalities toolkit published in autumn. They talk about why paediatricians have a role in addressing health inequalities and provide advice on how open up conversations with families.
Health inequalities podcast – talking with families Transcript of podcast, released December 2022
Helen Stewart
Hi so welcome to the Royal College of Paediatrics and Child Health podcast. This is the first of a short series on health inequalities. My name is Helen Stewart. I'm the College’s Officer for Health Improvement. I'm also a consultant in paediatric emergency medicine in Sheffield and a transport doctor in the North West.
I'm joined today by two of the guys from Liverpool who are going to introduce themselves. Ian, let’s start with you.Ian Sinha
Hi, I'm Ian Sinha. I'm a consultant respiratory paediatrician and at Alder Hey Children's Hospital in in Liverpool. And I work as an associate professor in the University of Liverpool and I co-direct the research group within Alder Hey called the Lab to Life Child Health Applied Data Centre.Alice Lee
And I'm Alice Lee. I'm a paediatric trainee in the north west and I'm currently a clinical innovation research fellow in the Lab to Life Centre doing a PhD in respiratory health inequalities with Ian.Helen
Thanks for joining us. So I thought we'd start by talking about what got you guys interested in health inequalities. What was it that brought it to your attention? Ian, I don’t know if you want to start with that one?Ian
Yeah, yeah., it's something that has always been visible to me is that both as a medical student and as a doctor, and even meeting before being a medical student, and I when I was at medical school at Newcastle, I had a really inspirational and mental in many ways, who was a community paediatrician called Tony Waterstone, who's just a great guy, and he was the person really who gave me the confidence to start questioning why we're doing all the things that we're doing, only to just send children into situations that make them sick. And when I started medical school in 1997, there was a shift in government from the Conservative to the Labour government and there was a real ambition to try and end child poverty.
And so while I was at medical school, opening up children's centres and Sure Start Centres. And so it was just an interesting time to be to be around and thinking in that space. And I think that's really what has sort of prompted my first interest in this.And obviously as times’s gone on as a respiratory paediatrician, I think it's 70 to 80% of what I see is just simply the manifestations of poverty in one way or the other, or complicated by poverty one way or the other. So it’s just very ingrained in in what we do.
Helen
Definitely, I work in emergency department and it's a huge part of a lot of our presentations. Alice, what about you? What got you interested?Alice
Very similar things really. So similarly throughout medical school and early in training, being very aware of, you know, the injustice of what I was seeing presenting to A&E, presenting to the hospital and the situations that we were we were sending families and children back into. And then during my paediatric training, you know. I think it sometimes is a bit corny, isn't it? To quote Michael Marmot. But the whole idea of why send someone home to the same environment that's making them sick.Alice
And so I knew that that was an area that was interested in and spent some time going, you know, signing up to different programs to learn more about that. And eventually, fortunately, was put in touch with Ian by one of the respiratory consultants in Manchester.Helen
Excellent. Obviously you're both interested, but why do you think paediatricians, as a profession have a role in addressing child health inequalities?Alice
I'll let Ian go first there and then I can chip in.Ian
If we think through health inequalities through the life course and Alice mentioned, so Michael Marmot and his team, who showed that, you know, there's an unprecedented worsening of life expectancy for particular groups particularly and the most deprived decile of people and especially in the we saw this early in in women. And actually when you start to trace that back when you trace back any of the health inequalities through the life course that track begins in in childhood. These children are on two separate tracks. You've got children who are disadvantaged and those who aren't. And it's not a case that they that they that these tracks diverge, they just start off in a different place.
And so what we're really seeing in childhood as paediatricians - if I think back to my clinics, all I'm saying when I do clinic or do a ward round is I I'm seeing a child in a snapshot of what their lifelong journey will be. Something's led up to that point and something will happen from that point onwards. And when we see children in clinic, you know, when I do my bronchopulmonary dysplasia clinic with babysit gone home with neonatal lung disease, you know - part of what we do obviously is keeping children safe now.
But I think as paediatricians, we are kind of bought into the idea that we should be thinking about the wellbeing of these children in 30 years time in 60 years time in 90 years time, we want children to live their best life. That's why we go to work and do what we do. We want them to live their best life, to fulfil their potential, achieve everything they want to achieve and that requires a lifelong approach, and we're in a unique position as paediatricians because our adult colleagues who we know and love are basically just managing the decline of long health or gut health or brain health in adulthood. But really what they're doing is addressing things that went wrong 40 years earlier in that person, so we’re the unique and crucial position to try and advocate for a lifelong change. When you get the biggest bang for your buck by investing in in, in making improvements early.Alice
You know, at least when I was in medical school, it was always classed as the wider determinants of health. And I think that kind of puts it in a niche interest box rather than what it is, which is, as Ian said, the vast majority of the reason we're seeing children and adults coming to hospitals and coming to GP services.
And so a phrase that we've co opted from one of Ian's colleagues is that they are now the core determinants of health and the core determinants of child health, and that's how we should be seeing these things.Helen
Ah, interesting. That's really interesting approach because I think I read somewhere that the health service is only responsible for about 15% of health outcomes and actually so much more is due to those environmental social factors.
I think from my perspective as well, just remembering that is a crucial contact with the family that actually we all have responses to make use of to improve the child's health because that might be the only contact they have for quite a long time, particularly in emergency department and primary care so overwhelmed at the moment, isn't it?
So, how do you start to approach this with families? How do you start to have that conversation?Alice
I learned a lot about this from Ian.Ian
I mean you know when we think about how we communicate with people in, in, in general, sometimes we get it right. Sometimes you get it wrong and but the key thing is we've gotta be honest with people, don't we? You know, the golden rule is don't know anything that your patient doesn't know. And our family subscribe to that. There has to be a complete trust. And if there's something important that that could be impacting on their child's health, people have a right to know and as soon as we. Have that then things become a little bit easier to do. We're often told that people feel uncomfortable about asking about living situations and about finances and about poverty and things like this. And I guess that's the way that I look at it - these things, as Alice quite rightly says, other core determinants of health.
The analogy would be, you know, if I had a cough and went to a GP and he didn't ask if I smoked, I'd feel a bit short changed. This is the same thing. You know, if we know that there are things that can impact on someone's life, we should be asking about them. And conversely, I think we sometimes forget that the impact of what we recommend, of what we say and do to families has its own burden for them. You know, every time we say come back to clinic in six weeks, that's a big chunk of their time that they're not earning, that they're paying for parking, travel, childcare, all these kinds of things. So it's really important that there's an open discussion about both those aspects, how their living circumstances might impact on their child's health and how their child's health might impact on their living circumstances.
And so I'll be honest, I've never really had a problem myself. No one ever questioned why I'm asking these things. I think it's important that we ask it to everybody and not a believer in the idea that we should target groups that we think might be poor and talk to them about it. Ask everybody, you know, we don't know who's struggling just cause of how someone's turned out. We've got some, you know, certainly in my life I've seen really rich people who look like they're wearing clothes straight out of the bin. And I've seen really poor people who pay so much respect for the NHS and the way they want to show that is by turning up immaculately. And so it's impossible to tell from what people look like. I know of families where there is a really high level of income, who's someone in the family, has got, you know, gambling problem and the money just goes. So there might be a huge income and 0 wealth. So we can't pick that.Alice
No, I completely agree with everything Ian was saying that and I think especially for people who are feeling a little bit nervous about speaking about these things with families. For me personally, learning more about what we can do for families learning more about the community organisations has given me a lot more confidence in approaching these topics because I think sometimes as doctors or medics we were problem solvers, we like to fix things. So I do worry that sometimes we don't ask these questions because we don't have a fix for them.
And so it has helped my confidence from working with people in the community. That I know if someone comes says actually, yeah, I'm really struggling in this area, I know where to direct them and I can say, oh, my colleague from Citizens Advice or I know someone in Shelter who would really be able to help with that. And so that I would recommend people familiarising themselves with what support is in their local area.Helen
That's great advice. I think that's probably applies to quite a few things, isn't it? People want to know that if you're opening up that difficult conversation, that actually there's a purpose and you can actually help in some way.
So do you have a have an opening gambit at a question that you kind of start that conversation with?Alice
I can say what Ian tends - it's a really nice way that you approach things in the BPD clinic, actually that I've picked up and especially for new patients who are arriving at the BPD clinic, it's I think we're privileged in that situation where it's automatic to say how long were you in the neonatal unit? Were you working before you had your baby and do you have maternity cover and asking that kind of thing to see how long they've got off after their discharge from the neonatal unit.Helen
Right.Alice
And I've seen you do that a few times and that seems because it makes it a universal issue of having a new baby and the experience of being in neonates. And then filtering it down to, actually that can be really costly for families and how you coping with that.Helen
Interesting. And what about when you're in respiratory clinic? With the older families where you've not necessarily got that hook in with the maternity leave?Ian
So the hook in the asthma clinic is a different one. It's more a biological hope. So the hook in the asthma clinic is asthma is a disease of airway inflammation. There are various things can drive airway inflammation and actually quite a lot of those things are related to poverty. And for the last 30 years, we've got hung up on, you know, rightly we've focused on parental smoking, and that's a really important thing. There's a whole load of other stuff - poor quality food can drive airway inflammation. So that gives us a route to say it's nutrition might be leading to the FeNO [Fractional Exhaled Nitric Oxide] being up. And you know something like 60% of our severe asthma clinic is overweight or obese so that gives us a route to say, well, I wonder if we think about nutrition as being something that might contribute to your asthma and I wonder if that ultra processed food is important.Alice took the lead at our end on developing some work for the RCPCH toolkit and one of the things she came up with was this a cost clock capacity analysis. In other words, simple things that we think are simple that we say to families: just eat better. Go on, you know, go and eat better. Actually, when you sort of break down that process, there's so many different steps and there are so many different barriers that that gives you a route into, say, well, I wonder why nutrition is a problem. And you know what all roads lead to poverty. It does for that.
Similarly for housing, we say to people, well, if you've exhaled nitric oxide, that’s a good marker of airway inflammation that's persistently high. We know you're taking your treatment. We know you're not smoking. We know this, this and this. I wonder if there's something in the home that might be triggering that. So there's a biological and clinical route in there. When we see children on intensive care, the route into talking about stuff, And then someone bumped into me yesterday, we were reflecting on a case that we had of a child who literally went on ECMO because of a respiratory infection and when we traced it back, the house was absolutely completely uninhabitable, al because of the mould and our route to that is to say all children get chest infections, hardly any of them go on ECMO. Are there other things?
And, you know, parents don't feel judged at that point, because they're part of the circle of that team, you know they're a central part of that team. It's not us and them, not us, asking them. I'm sure when we get it wrong, it's perceived by paren, us was asking them, you know. We have to do sensitively. But this is very much about putting together as much information as we can to help that child, and we're all there for the same reason. So the hook is whatever it is that you're seeing that child for - unless you're seeing them for gout - there's a 99% certainty that there is some evidence that that disease could be, youknow, contributed to or is associated with or increased rate or different type of phenotype, whatever it is with not having as much money. And there's 100% certainty that whatever it is that you do will have an impact on that family's finances. So yeah, there are always ways in and doing it early and doing it sensitively is important.
Helen
So basically finding a medical element of that childcare and exploring it that way, rather than just coming out and asking.Ian
Absolutely.Alice
I think yeah, the work that so the parent champions that myself and Ian work with as well. You know they have been really instrumental in helping me approach these topics as well in the hospital and also so much of it is avoiding that stigma and being really careful that you're not perceived as being voyeuristic or trying to put them in their place, and that links into what Ian was saying, is that actually if you're sharing knowledge with them so that you are on the same page, that does help to address that stigma and make it so that actually here is what I know you need, you tell me what you know and let's work on this together.Helen
Yeah, I mean, that's definitely been our challenge in ED in that we've created this leaflet for resources, but how do we make sure the right people get them? Because as you say, we can't profile people and say ooh, you look poor, here's this leaflet, but also people who don't need it don't want it. And we were giving it to everybody, but it ends up on the floor. So that's been a real challenge to work out how to make sure people who need it do get that information.Alice
And what's your approach been there, Helen?Helen
Well, and what we've done is we've created a welcome to the emergency department leaflet. So that kind of kills two birds with one stone in that it explains the process, explains what might happen. It explains why there might be a wait where the toilets are, where the water fountain is, but then also the link is on there. So that actually if we point people in direction of that, then they get the information as well. So it's still in a PDSA cycle, we're still working on it but yeah, it's something to be aware of, yeah.Ian
There was some work that I I spoke with an anaesthetic trainee from your neck of the woods, Helen, who was again interested in going back to what you said earlier, and probably a similar thing to ED, she said, you know, we wanted to know as an anaesthetist, what can we do about this? And we were just shooting the breeze and talking. And actually one of the key things that came out was that in the same way that you said, you know, we might be the only person, the only professional that has touched base with a particular family. You know, we kind of realized that an anaesthetist taking someone for an appendectomy or whatever they're taking for might literally be the only person that looks in that child's mouth for their entire life, you know?
So it's about just taking all those opportunities. It would be really interesting to see what comes out of that of that work in ED in Sheffield as well. I think there's a lot to learn from there. And Alice, with the parent champion model that she said, you know, these are women that have got both credibility and reach that that we don't have. These are people that we got a grant to work in children's centres in Liverpool talking to other mums, new and expectant mums about smoking, housing, breastfeeding and poverty, bronchiolitis, people's rights - you know, all these kinds of things that impact on child health and childhood respiratory health. They've been really useful because they've fed back to Alice some of the terminology that we kind of take for granted as being acceptable. So you had some good examples.Alice
Oh yes, so recently the parent champions themselves can also directly refer families to the perinatal Citizens Advice scheme.Helen
Oh, brilliant.Alice
But what the feedback that we got was that they, families don't like the word ‘refer’ because as soon as they say I can refer you to someone, they were saying that a lot of families like no, I don't need any referral and it's the fear of I'm going to be criticised for this situation that I'm in.Helen
That's very interesting. We got similar feedback about the word ‘vulnerable’ actually from some of our parent groups. They don't like being referred to as vulnerable, and that's the young people as well, particularly. They feel that is a stigma. And actually, as someone pointed out, we are all at some point in our lives could be considered vulnerable. There's always a period in our lives where our mental health might not be great or we've got an illness or we've lost a job or there's always, everyone has the potential to be vulnerable at some point in time. And they don't like that phrase, so it's really is really important to get that information from families, isn't it?Ian
Vulnerable is a great example. It's something that we think and I get by great example. What I mean is a great example of why all these things, however little, however big, have to be codeveloped with families and with communities. Because actually the families with the least, in some ways, and you know the the least one over, because they are so strong, they're so resilient, so resourceful, so intelligent, so good at getting through with, you know, billion walls in front of them that we surrounded by barriers and. And so, yeah, I think vulnerable is a is a great example of a word that we use as a throwaway word, which is incredibly.Alice
It's so weighted, isn't it? That word?Helen
If you ever had a negative reaction to bring you up any of these conversations?Alice
Personally I’ve not had a negative reaction. I think quite a few of us have experienced and including the parent champions have experienced and what Ian was saying - is that actually, because there is so much stigma related to deprivation and poverty that you may not get, you know, the way that you approach it, you may not get the response. You may not get the person to say actually I'm really struggling and I do need this help. And that is more challenging in terms of building up a rapport. And I guess we're more privileged because we're seeing children again and again in clinic to get that insight.Helen
What about you, Ian, have you ever had a negative reaction?Ian
In context of what Alice has just said, which is very important, that we… By the time people get to tertiary services that they often treat us a little differently, they've, you know, speak to us about different. And I totally get that and it's wrong and I do feel sad about it, but it does make my life a bit easier.
So it all comes back to the stuff we were taught in first year medical school. How do you speak to people? What are their ideas, concerns, expectations? How do you communicate? What do you look like when you communicate? How do you sound? It never comes down to this was seen as a very sensitive topic.Alice
I guess that goes back to what we were saying about the paternalistic aspect of medicine as well. And yet a lot of the families that we've worked with have said if I'm in the hospital with my child and I'm worried I don't want a telling off
and I don't want a telling off behind a curtain where I know the whole of the rest of the ward can hear me.Helen
Ah, yes, of course, yeah.Alice
Which just even increases the stigma or even more so I think choosing both the approach and the setting and making sure it's not paternalistic.Helen
Lovely. Well, thank you so much for taking the time to have this tab today, guys really appreciate it. It's been so interesting and hopefully give everyone something to think about.
If anyone out there is interested in learning more, Ian and Alice have both worked really hard on our toolkit, which is on available on the website. There's some stuff in there about having difficult conversations as well as some other information which will be covering in future podcasts. It's at www.rcpch.ac.uk/shiftthedial or at www.rcpch.ac.uk/health- inequalities. So thank you so much. And no, it's been it's been a real pleasure.Ian
Thank you very much.Alice
Thanks for taking time with us. -
Child health inequalities part 2 - interviews with two quality improvement projects
In this podcast, we hear from two teams doing innovative work to better understand the impact of poverty on children and young people’s health, and design NHS services that provide targeted support for families.
Child heath inequalities I Case studies Transcript
Helen Stewart
Welcome to this Royal College of Paediatrics and Child Health podcast. This is the second episode about how paediatricians can tackle child health inequalities. We're focusing on quality improvement, and how to better understand the impact of poverty on children and young people's health, which can help design NHS services to provide targeted support for families.My name is Helen Stewart, and I'm the College's Officer for Health Improvement. I'm also a consultant in paediatric emergency medicine in Sheffield and a transport doctor in the North West.
First, I speak with two trainee paediatricians in Belfast, Naomi and Anne-Marie. They had noted a real disparity in how children from different socioeconomic backgrounds were impacted by COVID-79 restrictions. Following initial research, they've conducted an observational study to gather information about the effects of the cost of living crisis on the home and social environment and the health of primary school-aged children in Northern Ireland.
Later in this episode you'll hear from a team in Birmingham that has put child health care services right in the heart of the community- to better access the families who need support most. Fran, a GP, and Caroline who leads on innovation and early help at a housing provider, explain how they introduce health promotion at every opportunity, liaising with multidisciplinary health professionals and local community services. It's a fascinating approach to delivering services.Helen Stewart
I'm here at chatting to Naomi and Marie who are paediatric registrars in Belfast. Hi, guys. Nice to meet you. And I'll let you just introduce ourselves a little bit.Naomi Kirk
I'm. Hi. Yes. And my name's Naomi Kirk. And I'm a paediatric registrar based in Belfast and currently I'm working in general paediatrics and infectious diseases.Anne-Marie McLean
Hi, my name is Anne-Marie McLean. I'm a paediatric registrar also based in Belfast. My interests are in general paediatrics, gastroenterology and nutrition. Both myself and Naomi are interested in understanding the impact of child inequality on child health as a whole.Helen
Great. So can you tell me a little bit about what you've been working on in Belfast?Naomi
And so as we all know that health inequality exists. But I think the COVID pandemic was really crucial in bringing it to our attention. And for Anne Marie and I, the concerns and we had initially were relation to childhood obesity as we know that that's something affected by socio economic status. So we've been chatting about lockdowns and restrictions and childhood activity and how we felt this could be adding to those existing inequalities and what impact this might have.So this was actually our initial focus and idea and off the back of this we carried out a small observational study in 2027 and focused on parental perception of weight and physical activity during lockdown with a comparison of socioeconomic status.
Anne-Marie
And there was also this initial lockdown study, however, highlighted to us that there were so many other wider issues to consider as many parents were reporting that their child had mental health problems and that there had been a change in the food they were able to provide to their families during the lockdown restrictions as well as changes in the family's nutrition and physical activity levels. It really highlighted to us the impact that a child's home environment could have on their health during lockdown restrictions.
For example, whether or not that access to your garden, we could say that there was real disparity in terms of how children were impacted by COVID-79 restrictions, depending on what their socioeconomic background was. And as we were analysing our results from this first lockdown study, and we're entering the current cost of living crisis and we thought it would be more useful to do a comprehensive study to gather information about the effect of the cost of living crisis on the home social environment and the health of primary school aged children in Northern Ireland we really wanted to identify which children and families are most vulnerable to poor health due to financial strain in the hope that we could then raise awareness and offer support.Naomi
Yeah. So I guess this was the background to this study and off the back of this then we developed a new study and which we named cost and I and completed in partnership with some colleagues and vanilla and Donna and Tom Waterfield, also based in Belfast.
And so this study was a cross-sectional observational study, and we used an on line questionnaire and to gather information from parents. And we distributed to primary schools in Northern Ireland and asked them to sort of share the survey via whatever online app they used to communicate with their families. So we wanted to ensure for this study that we captured enough information to understand the socio-economic context of the children. And we felt the primary schools were a good way to do this.
And rather than, say within a healthcare setting which might only capture certain cohort of children, so we used the usual demographic questions, but also included questions and whether they were eligible for free school meals, benefits, weekly household income. And the free school meal question really arose because it's a relatively straightforward way of determining the economic status because we have that clear criteria for who is eligible.
And through this questionnaire we received 799 responses and which encompassed results in about 299 children, because obviously there was more than more than one children in some families.Helen
What do you think your key learning points were from the study?Anne-Marie
Well, we're still in the process of writing up our results, but some have really stood out just and one of the biggest ones is that 56% of parents reported that their child or children and were experiencing increased stress or anxiety due to the cost of living crisis. And this increased to 77% in the low income group with a significant difference between the low income and higher income group.
And that test for us was really concerning given the already very long waiting lists and for mental health services for children.Naomi
Yeah. And I think for the purposes of the study, we'd considered a family to be seriously affected by the cost of living if they reported living in cold or damp homes, fearing homelessness or being unable to provide regular meals. And when we compared across some composite groups. So we looked at single parents, people who were renting, children who were attending clubs less and being of an ethnicity other than white. We found that this doubled the family's likelihood of being seriously affected by the cost of living.
And I think if you asked anyone, including us, if they find it surprising that these groups seem to be most affected, we'd probably have said no. But what has come across through the study is really just the extent of the inequality that we're seeing across these groups.Helen
I see it sounds like a huge piece of work. What do you think you'll be able to take forward from this? How do you think you'll be able to make a difference based on the results that you've got?
Anne-Marie
We hope to share our results as widely as possible and we want to write up our study, get it published and share it with the schools and the teachers and the families who participated in the study and also with the charitable organisations which helped us shape some of the questions. And we're hoping that we can promote discussion and raise awareness really as our primary aim.Naomi
Yeah. I think onething that came across that we weren't really expecting was sort of the signs of poverty that can be a bit more subtle. So one question we asked about was whether children and families were able to continue extracurricular activities such as clubs and sports, and found that those that had reduced their involvement in these activities were significantly more likely to be worried that they would have to use a food bank in the future, more likely to report cold homes and unable to heat and more likely to report damp and mould. So I suppose for us, you know, often we see sort of these things as optional, they're privileged or even maybe associated with pushy parents, but actually, you know, extracurricular activities are a lot more than that, and it's just raising that awareness of maybe that these things can be a bit more subtle than you might first think.Helen
And did you meet any resistance to this from any of the families, all the schools at all?Anne-Marie
No, no, we didn't. The schools could opt to participate with us fully and voluntary- so it was entirely up to them whether they wanted to share it and with the families attending their school or not. I think maybe the only barrier we encountered was that there was industrial action at the time. So some of it maybe was perceived as an additional workload for teachers, but the skills could decide whether or not to participate.Naomi
Yeah, I think we could get some feedback that which schools maybe felt the questions were a bit invasive despite being anonymous, but there was - no one seemed to have any any issue with it. It seemed to be primarily a logistic and time based on the on behalf oft the school, as to whether they agreed to participate or not.Helen
Let me see. And I'm just wondering if you had a chance to look at where the schools are situated, are they, do you have a widespread of schools in terms of socioeconomic circumstances, or do they tend to conform particular section?Anne-Marie
That is a limitation to our study as we don't for the to keep it anonymous.Helen
Of course.Anne-Marie
We don't have identifiers and in terms of geographical location on the questionnaires. So we don't know the previous lockdown study that we did, we looked at two schools, one from a wealthy area, where they had less than 70% of children receiving free school meals and then a school in more deprived area. There was over 60% of pupils receiving free school meals. But for this particular study we don't know. We just have the information of the parents of the household income. But we don't have any geographical information.Helen
Fair enough. But you did open it to all, didn't you? So whoever could choose to participate? Yeah. Oh, interesting.
So, how did you guys get interested in health inequalities?Naomi
Yeah, I think a lot of this, arose, well, Anne Marie has done a lot of work in relation to obesity and that was something we were both kind of interested in, had been discussing about. I've spent a bit of time away. I worked in Malawi for a year where the health inequalities are very obvious.
But I think really just post COVI Dover the past year - I think they've just been maybe more obvious to everyone involved in healthcare and then it's just something that we've been chatting about.Anne-Marie
Yes, I would echo that. I think it's something that's becoming more obvious and it's something that you can't really ignore, especially as we're seeing an increased migration into Northern Ireland as well. And that's something that came through in our study and that if you were of an ethnicity other than white, you're much more likely to be impacted. And I really think it's our duty as paediatricians to understand the wider social context and the home environment.
Of the children and families that are presented to us, especially whenever some of the health problems can be contributed can be due to due to the home environment or the wider social determinants of health.Helen
That's really interesting. Thank you guys. And was there any other... if you had to pick one key message from your study to shout out to everybody, what do you think it would be?Naomi
I think mine would be - and Anne-Marie and I were talking about this last night actually mine would be just to ask the question. So we were saying it's a bit like when you're in training and you're always told to ask about social work, involvement with families. And at first you find, oh, this is going to be awkward. And then actually, once you get it into your... it becomes a routine part of your questioning. Then it's automatic and you don't discriminate and you ask about it all the time. And we were saying really sort of asking about the socio economic situation and struggles should maybe just become part of your routine questioning and you're building it in so that you're just aware that. It's part of that child's health background.Helen
Absolutely.Anne-Marie
Yeah, and that we're not singling out particular families that we're asking. It is standard to all families. So it becomes something that's asked naturally and doesn't come across as the certain families are being targeted.Helen
Absolutely. I would absolutely echo that and obviously we've got the health inequalities toolkit at the College, which does have a section on how to have those difficult conversations with children, because as you and families, as you say, people can feel quite awkward about it, a bit uncomfortable about it. And I think sometimes also it's what do you do afterwards when you've opened that conversation and you've had those discussions and how can you support the family going forward if you had any particular experience of how you're able to do that locally.Naomi
I think sort of at the beginning of COVI D there was some links established with our local ad and storehouse, which is a local food bank. So it just kind of raised clinicians' awareness that if they there was issues how to signpost people towards that and there's loads of other you know that's just one example of a charity that's linking in. And so I think our you know our hope would be to try and maybe create a resource or something that when these issues are identified that clinicians have somewhere that they can sign post families to.Anne-Marie
Yeah, we plan to talk to the social work departments and in our trust as well because another thing that really came out for me is transport to appointments and being aware of that -you know why your families are missing appointments - is transport the issue.
And there are resources there to support families. It's just becoming more aware of it.Helen
Yeah, absolutely. We've done something similar locally, looking at vouchers for buses, et cetera, to try and try and help people with that.
Fantastic. That's great. Thank you so much for taking the time to talk to us about your project guys. It's it's obviously incredibly important to understand your local community to be able to understand how to help them and at best. If anyone wants to get in touch with you and askquestions about your project, how can they best to contact you?Naomi
Probably email address. I don't know if that can be linked.Helen
Yeah, we'll put that on the information for the podcast because people might want to replicate this elsewhere. So if you, if you're happy to share information, that would be fantastic.Anne-Marie
Yes, of course, we're very happy to share, and also very happy to learn as well if anybody is running similar projects elsewhere in the UK, would be really interested to hear about them and because we're always trying to learn really and improve what we can do.Helen
Fantastic. That's great. Well, thank you so much guys.Naomi
Thank you.Anne-Marie
Thanks very much.
[music] Helen
I have with me,Frances and Caroline, who are going to introduce themselves, but we're gonna talk about a project that they've been doing locally to them. OK, Frances, you go first.Fran Dutton
I'm, I'm Fran. I'm a GP. I work in Birmingham and I also work in the emergency department of Birmingham. And as you say, I do a project with Caroline.Caroline Wolhuter
Hi, I'm Caroline Wolhuter. I work for GreenSquareAccord, which is a national housing and care provider. I'm the Head of Innovation, Impact and Early Help in Birmingham and we manage the early health contract for the voluntary and community sector in the Hall Green constituencies and the project we're going to talk about today lies in the Hall Green locality.Helen
Brilliant. Thank you. So, obviously Fran, you're a GP and you work in the acute trust. And Caroline, how did you guys come to work together?Fran
That's a really good question, isn't it? So we've been working together for several years now and it's started off in COVID, COVID. I'm sure you will remember really well with the time of huge change in the emergency department. There was a few months in the beginning where it actually went really quiet and it gave us the space to think we'd been mulling over in the department having a GP stream because the attendances just kept going up and up and up and it gave us space to think.
And it was Chris who is the third part of the trio that we are. So Chris Bird, emergency department consultant in Birmingham, he said. One day, Fran, I think we should do something different. I think we should do, I think we should do a clinic, do a do a project, do something but actually in the area where the children live. So I don't think we should run that GP stream in the hospital.
And then we started developing an idea and ran with it. And then we talked to you later on other people. And very fortuitously, one day we met Caroline. And then we as a trio, kept on talking to a lot of people, and then eventually we got some funding and started to put our talking into action.Helen
Amazing. Yeah, I know Chris quite well. We trained on the training programme at the same time. And So what actually is the project, what's the end result of all that work?Caroline
So the project is the Sparkbrook Children's Zone, which is a clinic run out of the Sparkbrook community and medical centre, one day a week. It's a joint clinic between the children's hospital, the local PCN and our early help team in the community. And this is one of the poorest neighbourhoods in England. It's got exceptionally high - I think if it's not the highest - one of the highest infant mortality rates in Europe. It's got lots and lots and lots of health, housing, social challenges. A very rich community of people from all over the world. It's a very diverse community. It's got lots of community activity taking place. Huge challenges. And excessing support at the right time in the right place, with the right language support, cultural access, etc. are all challenges for people. People don't have information about where to go and I think that's why sometimes the hospital seems like the best port of call.
But our job from an early help perspective is ready to connect people to support locally and find solutions to build their resilience, to be able to manage their lives in the way that they want to live. You know. So having the opportunity to work with, with real live doctors, you know, in a way that you don't have huge waiting lists and times. And with Fran and Chris's complete passion, it has been such a privilege to be able to bring the team into a setting and jointly be looking at cases, case managing and triaging, supporting people, also getting the message out into schools and other community settings.Helen
Brilliant. And so how do people access the clinic? What are the criteria and the stated aims of the clinic?Fran
So the children and families access to clinic, usually by the GP making a referral. So we work, as Caroline stated, with a PCN, and that PCN, for those that don't know what that means a group of GP that have been asked to work together and they fulfil some targets. And they also can operate things like some clinics. So we work within the Sparkbrook area and the child or the family will go and see the GP. Or even phone up the receptionist.
And if they're deemed to need a face to face appointment, or even some advice with a virtual review, the GP or the receptionist can book in. They need to do a simple form, just so that we canshare information with them. And that's it. So we see anyone under the age ofl6 andwesee pretty much anything. We probably started off with more restrictions, but now pretty much take everyone.
What we don't see is injuries because we don't have X-ray facilities. We don't do blood tests, so again we wouldn't do those kind of interventions. The typical patients that we see are young children - so like baby problems, infant feeding, things like that. We'll see lots and lots of children with constipation, asthma, eczema, behavioural concerns, lots and lots of different things. And so we also - this the mainstay of the clinic: the children that's booked in for medical needs predominantly.
And then every child that turns up is offered - we've also got our family advice worker in the room next to us. Would you like to go and see them? This is all of the services that they're able to offer on a leaflet. Would that appeal to you? That's a barrier-free referral, they can just be escorted down the corridor and go and see them.
We've also opened up appointments for GPs to have direct referral into early help. So everybody within Birmingham can access early help. There's no restriction on it, apart from the fact that you need to do a fairly long form.
And actually, as GPs - and you'll know that Helen from your work in emergency department - we've got so little headspace and so little time, that doing a form which requires all the family members, a description of what's going well, what's going badly and what needs to happen and the current support in place, is sufficient barrier that I think it doesn't get done. But what we've said to these GPs is just right click, click on the slot, we'll do the forms,just make it easy for you and we'll do that. So we can access, so that means GPs can access the early help support if they think the medical need isn't actually needing a second opinion or anything at that point.
And so yeah, that that's probably where we are there.Helen
Perfect. So so basically it's a a clinic where GP's can refer children on for paediatric needs, but you use that opportunity to offer additional social support and advice. Is that right, Caroline?Caroline
Yes, I think and I thinkjust for people who are not familiar with the term early help and it's important to to just to clarify that it's, while we sit in that prevention and early help area, we look first and foremost at basic needs. Do people have food? Do they have clothing?
Do they have electricity, gas? What is their housing condition? Are there other things going on in the family? Are they safe? Is there a SEND need? Is there a parenting need? Is there any substance misuse issues? Are there any issues around antisocial behaviour or what we call contextual safeguarding, so that could be online challenges? It could be community challenges with anysort of gangs or child criminal sexual exploitation issues. Debt - massive issue around debt and finance, we've got lots of people who are living on, you know, very, very little money with no recourse to public funds sometimes, etc.
So it's looking at firstly, what are your most immediate needs? You know that's, you know, that's the early intervention element. That's the early help and then, you know, the and then asking what, what do you want to happen? It's all about people being, you know, consenting and being an equal partner, and families being equal partners in making decisions about, you know, as a professional, sometimes you think this should be a priority, you know, over something else. But actually it's what the what that family wants in place to support the way that they want to live - as happy and healthy as possible.
So we start off with basic needs, and then we start looking at some of the more complicated interventions that are needed, whether it's housing intervention, domestic abuse intervention, debt management, and family support. You know wider social care. And cases are escalated, but most aren't. I think most of the 37,000 cases that we were dealt with in early help over the last 2 l/2 years, only 6% of cases were escalated to into statutory services.Helen
OK.Fran
Can I also add a a little bit? Is that all right, Helen? And it's so the clinic experience is also slightly different. I would say to use your clinics, we've got a heavy focus on health promotion. So we tried to shoehorn in health promotion at every opportunity. And when we when we just when we discover something that maybe we do want to encourage some behavioural change of, we've always got an offer with what that can be and how to make that easy for a family.
So we've got a template that we run down because otherwise I would forget. So presume the other people probably got better memory than me, but I would forget it if I didn't have that. And so you just run through it with the families. So it starts off with allyour immunisations up to date.
After that we ask about whether a child is exposed to smoke at home. And then we've got a care plan that we've written which says how they can access smoking cessation support within the local area, what's available to them, what can they expect. Again, we just try and make it as easy as we can.We give healthy start vitamins to all eligible children, which is all children before their 4th birthday. We ask a question - this is Caroline;s request lately, she said. Can you ask a question about nursery? Because in Birmingham, we're not seeing enough uptake of the statutory early yea rs provision. So we ask a11 chi Id ren between the age of two and four if they attend nursery, do they know if they're eligible? If there's any questions on that, we just basically say please go and speak to your family advice down the corridor and they'll be able to help you with eligibility and for applications.
We've got care plans for asthma, eczema and constipation. We've also got toothpaste packs. So we try and look at everyone's teeth. We're not dentists, but I can - I'm pretty good now at seeing holes in people's teeth - but I obviously can't treat or anything like that. But it's mainly to say, look at the teeth - brush your teeth twice a day, modify the sugar and acid intake, but mainly the sugar intake at that age, and go and see the dentist. So we've got really good support with that.
We also measure each child with their height and their weight, and we calculate their BMI centile and we will make onward referrals to bodies who provide a obesity services within our local area. So we really try and shoehorn in as much health promotion as we can.Helen
Amazing. And so how long is your length of appointment that you have allocated? 20 minutes.Helen
Yeah. So you mentioned you got funding. Who does fund this? Obviously you've got primary care, secondary care and early help input. How is it all funded?Caroline
It's funded through a combination of funds. The early help component is currently funded through Birmingham City Council and the early help contract.Fran
The NHS funding is through a pilot studies called IMOC, integrated models of care, a national pilot. It's just so happened that the stars aligned and this pilot project came up at a time when we were talking to everyone about it. We really didn't expect the funding at that stage. I don't think it came too early, but we were just resigned that it would be years and years before we got funding. But it just popped up and we've got funding.
The funding originally was for three years we've got funding guaranteed for two years. We've just finished our first and so hopefully we'll have another year after that if the original three years can be stuck to, fingers crossed.Helen
And have you been able to assess the impact of it in any kind of formalized way? I know it's difficult and obviously feels like the right thing to do,but have you been able to evidence that in any way?Fran
So we write in the GP notes which is called EMIS and we extract data from that monthly into a big spreadsheet which says number of children seen, the interventions given. So for instance in January- it wasa quiet month, we only saw 34 children. However, 74 were referred to early help. In terms of the percentages getting on a social prescribing type route, that's quite a high percentage that we're getting. So I think we're describing the offer and encouraging families in a positive way to take up that offer.
We've got plans for a through evaluation with University of Birmingham. That is afoot, that is going to be some time away, isn't it Caroline?Caroline
There's some great haste studies about how we've impacted on individual children and their families, you know, a child's coming in with - he isn't sleeping very well, and actually you start unpicking what's going on in that family, why she's not sleeping well? Well, the house is massively overcrowded. They've got a disabled child sleeping in the room with her who needs to be carried up and down the stairs because there's no access within the property. The parents both have muscular, skeletal problems as a result of this, there's another child also sharing the room, who also has problems, and no wonder this child's not sleeping very well. We can't solve every problem, but we can solve many, you know, and we can support people to find alternative solutions to many, many of the challenges that they facing.Helen
Amazing. Uh, fantastic. So if someone, um, heard this and obviously thought it was a fantastic idea and wanted to implement locally, what would be your top tips?Fran
Think about health promotion in whichever department you're in, be that the community or in the hospital. Think about the experience for the family. You weigh children all the time in A&E. What do you do with that information? Do you tell families when they're overweight? Do you offer them a solution? Because, again, frankly, it's not good enough to tell the child. I mean, not the child themselves, but to tell the child and the family that their child's overweight and not offer anything because we know the links with poverty are so strong. You're just telling a family in a really hard situation that they're doing a really bad job. I mean, that's not gonna make anything any better. Is it? You need to be able to provide support with that.
So things like smoking weights... nursery- how often do you ask two and three and four year olds whether they're in nursery? We don't. I didn't think about it much until Caroline pointed it out. Yet in Birmingham, they do promote health a huge amount through nurseries. We need to be helping families access the support that is there for them.Helen
Yeah, brilliant. And is there an advantage, because this sounds it's about having all the right people in the right place at the right time, isn't it? So that you can people can easily access those people. And is there advantage of having that in a primary care practice over having it in say an paediatric outpatient department of a big children's hospital?Caroline
I think there's advantages in having joined up working in all sorts of settings. People don't necessarily need to be accessing a whole wider wraparound service of support at that point. What they need at that point is a contact to be facilitated, whether that is through a signposting or referral. If there is someone to speak to, that's great, but there are, I think you know and in COVID we learned there's all sorts of ways to provide services and outreach to people if they're not immediately there.
But I think that context really important. I think the most important thing is to be open to partnership working. And when we are talking about integrated health and social care, too many of the discussions are focused around the integration between primary and secondary care, and between services within the health service. It is really, really difficult to say, you know, with the best will in the world, you know some of the problems that you're trying to solve are not going to be addressed by you just improving the communication and efficiencies within the NHS.
You need to be reaching out to the communities and they are all there. Every single community that we work in has a voluntary and community sector that is doing amazing work, and is meeting people's basic needs.Fran
And I think from my perspective again, we need to be advocating for Caroline and for everyone that works in prevention. And it's so important. We've got as much as I say that we've got a lot of traction with families. Still, we surely have got some traction with policymakers. We have got to be working much, much more. Like Caroline said, fairly, not being the medics in the room that talk the loudest and that the most important of the university for the longest and all of that, we've got to really share the platform and advocate the people that probably do a great deal more for child health than we do.Helen
Very possibly. Oh, thank you so much guys. It's been it's been really interesting and I've now got lots of things I need to pester my trust about. Thanks very much!Helen
If you're interested in learning more about child health inequalities, please do take a look at the College's toolkit on our website. This includes advice on how to run your own quality improvement project around the topic, as well as speaking with families about poverty and doing advocacy at a local level. You'll also find more written case studies. Visit www.rcpch.ac.uk/Healthlnegualities.And to find out more about Naomi and Anne-Marie's research study in Northern Ireland, and about Fran and Caroline's work in Birmingham, there are links in the shownotes.
Thanks! -
Shift the dial on climate change and health inequalities
Climate change poses an existential risk to child health and is exacerbating health inequalities. But paediatricians can play an important role in sharing information and advocating for action.
Dr Helen Stewart and Dr Alex Lemaigre introduce the College’s new toolkit for paediatricians. Our first tool helps you understand how climate change impacts on children and young people’s health and exacerbates health inequalities. And our second equips you to influence climate change policy locally, regionally and nationally.
Alex and Helen talk about why paediatricians have a role in addressing health inequalities impacted by climate change. And they provide advice on how to start conversations with key decision makers to address this.Helen Stewart
Hi, welcome to the next podcast in our Shift the Dial on health inequalities series. This one is about climate change and its impact on child health inequalities in the UK. I'm Helen Stewart and I'm the Officer for Health Improvement at the College and I'm joined by Alex.Alex Lemaigre
Yes. Hi, I am Alex Lemaigre. I am a paediatric trainee based in London. I'm also part of the Climate Change working group. As the deputy chair of the advocating for change work stream and I was one of the members of the Clinical Reference Group for this toolkit that we're going to be talking about today.Helen
Fantastic. So you've been involved in climate work for a while then. So what was it that got you interested in it?Alex
I think I I've always had or it's certainly in my adult life an interest in climate change and just gradually over time have just become increasingly aware of exactly how far reaching the consequences are. You know, when you're first introduced to the concept, it's kind of framed in an ice caps and polar bears and penguins and then... eventually you realise that it affects everybody on the planet. And the more you find out, the worse it is.
And so I got to a point where I wanted to do more than just change things in my daily life and try and have an impact and the RCPCH climate Change Working Group was formed and this just felt like the right opportunity to get involved and try and make a difference.Helen
Brilliant. So I suppose as a paediatrician for myself, I don't think it's something that is particularly part of the conversation or hasn't certainly hasn't been until quite recently and I certainly until doing this piece of work, didn't feel that I had a real grasp of it. So what do you think it is that paediatricians need to know about the impact of climate change on child health and on inequalities in the UK?Alex
I think the first thing is actually being aware that it that it does have an impact because as you say, it's not really, it doesn't really feature in the curriculum and it doesn't necessarily come up that much in your day-to-day practise unless you're aware of it. So it can affect lots of different ways. But in child health, particularly looking at things like the impact on air quality and air pollution on health is one of the most direct things that we can see.
And the fact that actually there is so much evidence now to say that poor air quality affects you from the moment you're a foetus right the way through your life and leads to poorer health outcomes, which is something that I don't think is publicised enough in the media.
And yeah, like you, I just wasn't quite aware of how profound the impact was until I started getting more involved.Helen
Yeah, absolutely. I think I've definitely been guilty of the ice caps and polar bears type view in the past. And I think doing this piece of work- because we have produced a piece of work that goes hopefully give paediatricians the information that they need as part of this toolkit. And it was really eye opening in terms of the kind of local impact directly, as you said, air quality really big, really big part of it. But also the flooding risks etc. so that the coastal communities often are quite deprived areas, which already brings its own problems, but they're going to be more at risk of flooding and don't have the resources to leave those areas. So it was really interesting for me to see how actually it's a very clear and present danger in our own backyard.Alex
Yeah, exactly. You know.just being able to cope with the changes that we're seeing already just in our own climate here, which is, you know, by no means on a global scale the most affected of course. But you know, you think back to the heatwave last summer and how difficult that was. And how, if you're in a low-income household, actually being able to cope with that heat is really difficult because you can't, you know, you can't -- it's very it's unlikely that you'll be able to afford to put in air conditioning, and it's going to become a much more prevalent problem. So it's a real issue.Helen
Yeah, absolutely. Yeah, absolutely. And with the flooding and the increase in damp housing and the impact on respiratory health already impacted by other issues to do with health inequalities, it's really it's, it's really increasing in its in its impact, I would say.
I mean, we're having the hottest October we've had for many years, aren't we at the moment? So it really has been brought into focus.
So as paediatricians, I think traditionally we've always focused on health and illness. So do you think we have a role in trying to address these climate change related inequalities?Alex
Yeah, I think I think we have to, you know, if our job is to try and improve child health, not just deal with the consequences of poor health and, you know, ideally every time you see, every consultation, you're doing a little bit of health promotion. Hopefully, you know, we advise on healthy eating and exercise and all of this. And then you've got all these other factors that people maybe aren't aware of or that are having an impact and a significant impact.And so yes, if we're going to try and promote good health in the children, and that's both physical and mental health 'cause it does have an effect on both, then we, then we have to be tuned into this and try. And it can feel overwhelming, of course, because it's such a big issue, but try to advocate for our patients and do what we can to at least raise awareness and then mitigate in in however way we can the effects.
Helen
Definitely I found it really interesting to see the impact it was having on mental health actually because obviously we've all seen a rise in mental health problems in young people. I work in emergency department and we're seeing a lot, a lot more presentations of quite severe mental health difficulties and actually eco-anxiety is part of that. Which I was really surprised about. Like young people are incredibly aware of what's going on and are very informed about the impact it's having and concerned for their future.Alex
And rightly so, because it's a real issue and they're obviously going to suffer the most because they're going to be on the planet for longer. And yet there's this kind of societal expectation that they're the generation that are going to fix it, where currently they they have really, young people certainly have, you know, not as much in terms of agency or influence on policy and things. So they have, you know, the pressure of being expected to fix something that they haven't really contributed to. And that's going to affect them greatly over the, you know, the course of their lifetime.
And that's a lot to bear. And I think it's understandable that it's such a heavy burden for them and having such a profound effect on their mental health.Helen
Definitely. So what we're trying to achieve with this toolkit is obviously that we can educate paediatricians, provide the information there for them to understand the impact it's having on their patients. And also try and support them in being active and doing something about it.
So we've produced a piece on advocacy for action as well. So do you have any particular top tips for paediatricians to start with advocacy on action for climate change?Alex
Yeah, it's a hard one, isn't it? Because it, like I said before, I think it can feel really overwhelming and certainly that's where I was where before I joined the climate change Working group. I think for me the first thing is be informed, you know, improve your understanding and really understand the effects because that will. I was certainly as it did for me really motivate you and inspire you to want to do something about it.
And the second thing is not to. It doesn't have to be a huge thing. Youcan advocate at, you know, I don't want to say lower level because everything you do has an impact, but you know at a sort of more individualised level and start small and gradually build up as you increase your comfort zone.
And actually the toolkit takes you through different ways that you can do that, starting at an individual patient level and then, you know, if you're somebody who is inspired or who is already really active in this kind of thing, then where you can move on to a more locallevel with maybe your integrated care board or just in your department or your trust, and then at local authority level, national level, etc.
So there's tips for everyone. But I think it doesn't have to be a scary thing and you canjust start small and then build up, I think, yeah.Helen
Yeah, I'm hopeful it won't be a massive change for people, particularly at the individual patient level, because I think there has been a move recently to think more about socioeconomic circumstances, the kind of structural situation going on in their lives and the impact that has. Because some of the child poverty stuff, talking about what housing they're living in, you know, overcrowded housing, access to green spaces, those kind of things. And a lot of it does link in with the climate stuff. So hopefully it shouldn't be a big change to add in a couple of questions about air pollution and other things that might be impacting. Because obviously we've got to think about food insecurity as well, haven't we with because I think nearly half of our food comes from other places?Alex
Yeah.Helen
And so that that supply is going to be an issue as well and that is going to be the people from the more deprived backgrounds that are going to struggle.Alex
Yeah, exactly. And I think it's a good, it's because those are things that we already asked about. So you know, if you're seeing a patient with a respiratory condition, it is becoming routine to ask about mould and smoking and all that kind of thing. And therefore you can tailor that conversation start including things like air pollution.
And what's helpful is if you have a way to a solution. Because it's difficult to aska question and then say, Oh well, too bad. Whereas with air pollution, even though it feels overwhelming, there are things you can do. So if they are going to school via a really busy road. Just a simple change of route you can advise on walking along the quieter route...Helen
That's good, yeah.Alex
...reduces the exposure to particulate matter and air pollution, which can just doing that, can improve their respiratory health. And similarly with the food thing, while it's difficult, obviously we can't do much on a global food security scale. And you're right that, you know, with climate change affecting food production globally plus the energy crisis and everything else, those households who have more limited income are going to really struggle to maintain the same level of food quality and/or quantity. And that brings all of its own health problems- be that malnutrition, obesity, whatever.
But if you're having a conversation about a healthy diet, then maybe familiarise yourself with things locally, you know, if there are food banks or third sector kind of organisations that might be able to help support a household with getting food on the table.Then having kind of that in your armoury might help facilitate those conversations.
Helen
Definitely. There's so much crossover with the poverty work as well, isn't there? It's all very similar.
So I know that colleagues working in general paediatrics - after mould was brought up in a case of a child who unfortunately passed away - they got a real increase in referrals from primary care about housing. And so there'll be a letter with the toolkit that will. I'll be able to send off in support of patients who need improvements to their housing. Won't there?Alex
There is, yeah, it's a really good template letter that wasactually developed by the team at Barts Health, who have a clinic specifically dedicated to this kind of environmental health type stuff. And it's very powerful. It's got lots of legislation and stuff which kind of adds weight to your voice and your opinion about the responsibilities of landlords and things with regards to maintaining safe housing. And so that template will be available for paediatricians to use, and edit as they need to, to help support their patients with housing applications and things like that. And it's nice to have that template because you know that the right information is going to be on there and you can tailor it to your specific patient as well.Helen
Yeah, that'll hopefully be a really useful resource for people.I think the key point for me, as I was going through some of this stuff was like we've said, the crossover with the poverty work, and this is not going to affect everybody equally. It's going to impact on the people that arealready being impacted by inequality in society. And as the climate crisis gets worse, that's only going to increase. So I think, unfortunately, ifwe can't act on this soon, then we're just going to see the inequalities in our society increase even more, aren't we?
Alex
Absolutely. And it's not a problem that's going away. So as you say, it's kind of, it's just going to keep spiralling unless somebody does something. And that's why. This toolkit hasbeen developed to try and increase awareness and hopefully fire up lots of paediatricians to try and do something and add our voice to already quite a lot of voices who are trying to do something about this for our patients.Helen
Yeah. Brilliant. What I do love about the toolkit is we've been able to use some of the work that the fantastic RCPCH &Us group have done. So there's quite a bit of input from the children and young people that we're able to talk to. And a lot of that is very similar to what we've talked about already in terms of kind of concern about the future, concern about the impact on their futures.
And if anyone gets a chance to have a look at the position statement, there's some great illustrations from some of these workshops that have been done and as as we've talked about anxiety breathing problems, general wellbeing, lots of concerns about overheatingand food. And real concern amongst the coming generation that they are going to be the ones that suffer. And it is really powerful to read.
Alex
Yeah, I agree. I think you know, one of the aspects of advocacy is adding patient stories to kind of bring that message home. Because it's quite easy to think about things in the abstract, particularly if you're somebody who's not personally horribly affected by it. And you know, it's like things like their case of Ella Kissi Debrah with the air pollution, and this little boyAwaab Ishak with the mould.
Having the RCPCH &Us voices and their illustrations and their writing. And some of them are really very young and you can seethat they're already impacted by this and worried about it. It really does, yeah, bring that message home. And that policy statement obviously being directed more towards policy makers - hopefully will really add some, some gravitas to to this work.Helen
Mm, it's that kind of voice of the lived experience that really does have does add power, doesn't it? Yeah, it's really interesting.Helen
OK. So we've talked about the toolkit and the various elements and that will be going live on our website and should hopefully be there now if you wanted to go and have a look at the various elements which is on the College website at Shift The Dial on climate change And part of that is there will be a system to e-mail your MP if you're really keen on helping to support this work, we're going to have a roundtable at the House of Parliament on the 12th of December.
And you'll be able to email your local MP to ask them if they'd like to go along. If you go to the website, it will link through. Youcan put your post code in and it will tell you who your MP is, give you a template and let you find the right person so the e-mail will go off.
And the fantastic thing about the event is that there will be children and young people there who will be able to give that perspective that we've been talking about, won't they?Alex
Yeah, exactly. I think that's it's an event that's being hosted by the RCPCH, but there's going to be doctors and representatives from the children and young people's group. So getting as many MPsas possible there to be able to tell them in person and not rely on them to read, you know, read our policy statement or any of that, we'll be able to really hopefully have an impact.
So please, it shouldn't take very long as your first part of advocacy for reducing the health inequalities that are impacted by climate change. Just click on that button and invite your MP along. It'd be great to get as many MPsas possible there and go, you know all these important policymakers fired up, hopefully, to want to make a change and improve the lives of the children and young people in the UK.Helen
Absolutely. It's a fantastic opportunity and I think the kiosk as always is we've just, weneed policy action to stop making health inequalities worse and really start to improve things for children and their health in this country.
Alex
Exactly.Helen
Fantastic. Well, thank you very much, Alex.Alex
Thank you.Helen
So thank you very much for listening and if you'd like more information on any of our health inequalities work, please go to www.rcpch.ac.uk/ShiftTheDial. And if you're specifically looking for the work on climate change, follow that with OnClimateChange. Thank you.
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