Memorandum by Professor Sarah Stewart-Brown,
Professor of Public Health, University of Warwick (WP 06)
I welcome the recognition implicit in this White
Paper that child health underpins adult health. I also welcome
the recognition that children's emotional and social development
is a key determinant of their future health and well-being, and
that it plays a part in determining inequalities in health. I
am, however, concerned that the potential for supporting children's
emotional and social development through cost-effective interventions
is not fully realised in the text of the White Paper and more
particularly in the Summary of Intelligence papers which accompanied
the White Paper.
The key determinant of children's emotional
and social development and of future mental heath and emotional
well-being is the quality of the relationship between them and
their parents. Relationships with others—for example early
years workers, teachers, social workers and relatives and friends—are
also important, but it is the parental relationship, particularly
in infancy and the early years, which is critical. The White Paper
proposes to provide additional information and support for parents.
However, it is far from clear what this information and support
will entail. In particular, it is not clear that it will offer
parents the evidence-based programmes which are known to improve
the quality of the parent-child relationship.
Will the proposals enable government to achieve
its public health goals?
In the absence of support for parenting of the
sort that improves relationships, it is unlikely that the government's
mental health, health related lifestyles or social inequalities
targets will be achieved. The Summary of Intelligence on Mental
Health paper, produced to support the White Paper, makes no mention
of any intention to provide the kind of programmes which would
improve parent-child relationships. It does propose a programme
to support the relationships which early years workers make with
children, and a programme to support parents' involvement in learning.
Both of these are important, but neither will have more than a
peripheral effect on parent-child relationships.
Are the proposals appropriate, will they be effective
and do they represent value for money?
The content of the information and support the
government proposes to offer to parents is not clearly defined.
Information is critical for public health improvement, but it
is not in itself a sufficient basis for behaviour change or improvements
in relationship quality. Research on parental support shows this
to be widely appreciated by parents, but, on its own, also cannot
be relied on to change these two aspects of parenting.
Structured programmes, provided in acceptable
and accessible settings, which challenge parents in a supportive,
non-judgemental atmosphere, are necessary to enable parents to
change the way they relate to their children. Although more research
in a UK context is needed, a wide range of systematic reviews
now attest to the fact that it is possible, with relatively low-cost
interventions, to improve the quality of the parent-child relationship.
The sort of programmes which can be effective in this respect
are those quoted in the Case Study on page 47. They are also well
described in core standard two of the National Service Framework
for Children, Young People and Maternity Services.
Do the necessary public health infrastructure
and mechanisms exist to ensure that the proposals will be implemented
and goals achieved?
The types of parenting programme which would
increase the chances of the White Paper achieving its goals can
be delivered by a range of different practitioners. Many sound
programmes are also offered by the voluntary sector. It is essential
that those running programmes are equipped with the necessary
knowledge, skills and support to do so; some of this could be
achieved through continuing professional development. The new
children's centres provide an ideal geographical location for
such programmes.
January 2005
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