George Hosking, WAVE Trust

Primary Prevention – cheaper than cure, better outcomes for children

Church House, Westminster, 21st March 2013

The Case for Primary PreventionThe Case for Primary Prevention

• Without dramatic change, within 20 years Council unable to provide any services except adult social care and children’s services

• Irrespective of savings planned demographic change – more children, more elderly – will soak up every available penny

Barnet Graph of Doom

The Barnet Graph of Doom

• Continue on current path

or

• Paradigm shift: Invest in primary prevention

Fundamental choice

Continue on current path?• Out of 12 million children under 16 in UK:

• Severely maltreated 1 to 1.6 million

• Physical neglect over 1 million

• Alcoholic in household 1 million

• Witnessing domestic violence ¾ million

• 40% of all spending on public services accounted for by interventions that could have been avoided by prioritising preventative approach

• Must prioritise expenditure which prevents negative outcomes arising

Scotland: Christie Commission on Future Delivery of Public Services

Annual waste from adverse early years over £200 billion, nationally

Includes cost of welfare benefits, crime, mental health, alcohol and drug abuse, violence, family breakdown, domestic violence, NEETS, prison service, looked after children, young offenders, special education

doesn’t include...Lost tax revenue and costs of poor physical health

Costs of continuing on current path

• National and local strategies of primary prevention, rather than reaction

• Transformation of the quality of parenting –

• Respect for children’s right not to be abused or neglected

• Adoption of early years’ interventions that work

A new paradigm

• At birth: 10 trillion synapses - 200 trillion by age 3

• Emotional brain largely created by experience in first 18 months; acutely vulnerable to trauma

‘The child’s first relationship, the one with the mother, acts as a template … permanently moulds the individual’s capacity to enter into all later emotional relationships’

Key: understand the infant brain

• Attunement between mother and infant develops empathy– lack of attunement means empathy does not develop

• Low maternal responsiveness at 10-12 months predicted:– at 1.5 years: aggression, non-compliance, temper tantrums– at 2 years : lower compliance, attention getting, hitting– at 3 years : problems with other children– at 3.5 years: higher coercive behaviour– at 6 years : fighting, stealing

Key factor: Attunement and Empathy

Primary Prevention does work

Successful Primary Prevention

Successful Primary Prevention

Need for Primary Prevention

?

A National Strategy of PreventionSweden UK

% Live Births to teen mothers 1.6 7.1Infant Mortality (per 1,000 live) 2.5 5.1Smoking (% per day aged 15+) 16 25Alcohol (litres per person p.a.) 7 11Adult Obesity (% of population) 11 23Smoking Related Deaths (per 100,000 popn)

196 245

Chronic Liver Disease Deaths, < 65 yrs (per 100,000)

4 9

Cancer Deaths, < 65 yrs (per 100,000) 56 67Circulatory Disease Deaths, Under 65 32 43

A National Strategy of Prevention