Scotland's public health time bomb is ticking

The proportion of children not meeting their development goals is captured in the dark blue part of the diagram. In fine motor skills, problem-solving and personal-social, six out of 10 of the children are not meeting the expected child development standard. More than one out of two are behind in communication.

At this point you need to stop and pause and let the bomb go off.

It is tempting to think that the best will happen; children will grow out of it. Perhaps a few children will catch up. But for the majority that thinking is delusional.

If you do not have these life skills at two years of age, the foundation is missing and all of subsequent life is more likely to be impaired. I repeat: the majority of children do not catch up.

Mother nature sets the rules

Mother nature and science give us three clear messages about child development:

• Child development is sequential. Like house building, the site, drainage, and foundation need to be right before the walls go up. Babies need a healthy pregnancy and good early attachment to thrive.
• Child development is cumulative. It builds, good upon good, bad upon bad. Good attachment and healthy stimulation make it easier for a child to have relationships and prosper at school. Neglect or a series of adverse childhood experiences make it harder for a child to learn and cope with life.
• Child development starts before conception and peaks from womb through to two years of age. On the downside, folic acid deficiencies, alcohol and drugs and toxic stress all kick in from before and during the first days in the womb.

We can see from the ScotCen report that more than one out of two children studied are behind their developmental milestones. If this were the equivalent of a life course presented in a nursery school sports day, you would see a group of children sprinting ahead. Way behind with tethered legs come the fallers and stragglers. Is this over-dramatic?

Closely watch life unfold

What if we monitored a group of 1,000 children between the ages of two and three? Recorded their key characteristics as small children and then faithfully followed up as adults to see what happened to them at, say 38 years of age?

We do not need to wait. In 1972 in New Zealand, the Dunedin Multidisciplinary Health and Development Programme followed the entire group of children born that year in the city, just over 1,000. This group with few dropouts are contenders for being the most intensively studied group of people in the world.

What the researchers found was that 22% of the children when they became 38-year-old adults were responsible for: 81% of criminal convictions; 78% of prescriptions; 77% of fatherless child rearing; 66% of welfare benefits and 57% of hospital nights.

In examining the data of the 22% of the children/adults that carried the greatest burden, one predictor stood out: “brain health” at age three. It involved a neurological examination and assessments of verbal comprehension, language development, motor skills and social behaviour. Not exactly the same assessments as the ASQ, but close enough.

The research team behind the study agree on their most significant finding: “Self-control in childhood is more important than socio-economic status or IQ in predicting adults’ physical health, wealth, life satisfaction, addiction, crime and parenting of the next generation.”

Lessons to be learned

Dunedin helps to show that poor mental and physical health, inadequate attainment at school, criminal behaviour and substance abuse are not different problems; the root is the same and lies in the first 1000 days.

A group of 574 children might be too small a sample to make a big bomb. The children in the Scottish sample attend day-care. We do not know if the parents of eligible two-year-olds who do not attend day-care are doing better or worse in meeting development milestones.

From other government sources we know a big number of very young children are not getting a proper start. In 2017-18, one out of four children taken into care is under 20 days old. They are being protected from “significant harm or likelihood of significant harm”. Children under the age of one are the fastest expanding group going into care. Under-ones are the most murdered age group in Scotland according to homicide figures (click to read).

Covid-19 has paused the expansion of day-care. When the virus allows, it makes sense to move on. The current no-man’s land from preconception to two years of age is in need of being reclaimed. Vulnerable babies have vulnerable parents. Many day-care workers and health visitors are frustrated but what can an individual do when day care starts at two years of age or they have 749 other parents and children to see.

Parenting is joyous and frustrating. But like Covid-19 it is a public health issue. We should know by now that prevention and early intervention work best and that blind spots (think care homes) are best avoided.

The sense of direction is clear: children benefit throughout life if they have good self-control and life skills by three years of age. This is about having the will to do it.

Alan Sinclair started Heatwise Glasgow and the Wise Group, where he was Chief Executive for 17 years. He was the Senior Director for Skills and Learning at Scottish Enterprise and was given a CBE for training unemployed people in 2000. He has been studying Scotland’s poor child wellbeing performance for more than a decade. His findings and conclusions were published in 2018 in Right From the Start, part of the Postcards from Scotland series of books.

We expect and encourage responses to this guest opinion piece, published as part of our contribution to dialogue in the sector across the full breadth of policy issues relating to children, young people and families.