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I believe that children are our future… (Whitney Houston) – a blog by Dr Sohail Munshi, Chief Medical Officer at Manchester Primary Care Partnership

22nd September 2017

So last week my 18 year old son completed his A levels and our thoughts have turned to his future – which university depending on results, accommodation, travel, independent living and the excitement of first steps into the “real” world. The first world travails of a professional father you may (rightly) think. But as I type this sitting in my GP practice in Beswick I reflect on the children I’ve seen this month: school refusal and conduct disorders, safeguarding issues, eating disorder in an adolescent and severe obesity manifesting as low back pain and foot pain in a 10 year old boy who I came across in an overcrowded, messy front room on a home visit in Clayton. It’s a job that shatters the incorrect (but commonly held) myth that GPs are somehow divorced from the family and financial fractures that permeate the lives of people on our “lists”.

I’m not in a “Beswick bubble “it appears either – this is a typical Manchester picture. Stats released only this week show

  • Manchester is one of the 20% most deprived districts/unitary authorities in England and about 36% (36,300) of children live in low income families.
  • In Year 6, 25.1% (1,422) of children are classified as obese, worse than the average for England.
  • Levels of teenage pregnancy, GCSE attainment, breastfeeding initiation and smoking at time of delivery are worse than the England average.
  • Rates of sexually transmitted infections are worse than average.

It’s also been the 69th anniversary of the birth of the NHS this week. This reminded me that Bevan had said “no society can legitimately call itself civilised if a sick person (child) is denied medical aid because of a lack of means”. The social determinants of health and in particular the early year disadvantages that my patients face – broken families, poverty, low incomes leading to poor diets and prioritisation of survival over oral health, exercise, freedoms of choice mean in 2017 I’m not confident I could look Bevan in the face and give the answer he would want to hear – our children might have (variable) access to “medical aid” but they’re already disadvantaged by the age of pre-school entrance with a lifelong disadvantage to health, happiness and wellbeing therefore already sketched in.

Describing a problem is of limited value however unless we plan to address it. The ambition of our local care organisation (LCO) to look at wellbeing, community assets, exercise and recreation, housing, employment, debt and addiction in the specific context of overlaps with health and wellbeing feels long overdue. Joint planning of these work streams and including the people they are intended to help, support or enable are the first steps. Focusing resources – whether health or social care – at risk families and individuals will improve population outcomes. More importantly championing and supporting our communities and people and working in partnership with them will hopefully address our short termism. Who knows we might finally start to invest in prevention strategies with no short term gains so that more of the children in Manchester can start to achieve their potential.

By the way – I’m not even a Whitney fan…