Transforming Young Lives Across Wales: the Economic Argument for Investing in Early Years
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Transforming Young Lives across Wales: The Economic Argument for Investing in Early Years Professor Rhiannon Tudor Edwards Lucy Bryning Huw Lloyd-Williams 1 Acknowledgements The authors would like to thank Public Health Wales for commissioning this report and to Professor Mark Bellis, Director of Policy, Research and International Development and Dr Alisha Davies, Head of Research and Development at Public Health Wales who have assisted in the co-production of this report. We would like to acknowledge the support of our colleagues at CHEME, particularly Alison Shaw for providing reading support and Jacqueline Williams-Bulkeley, Eira Winrow and Dr Carys Jones for providing research support. We would like to acknowledge the reviewers who provided feedback on a draft of our report: • Professor John Ashton, Former President of the Faculty of Public Health • Professor Brian Ferguson, Chief Economist, & Dr Helen Duncan, Public Health England • Professor Judy Hutchings, Centre for Evidence Based Early Intervention, Bangor University • Professor Tracey Bywater, Professor of Family Wellbeing at the Department of Health Sciences at University of York • Dr Julie Bishop, Public Health Wales We acknowledge associates who advised us: Mr Steve Aos, former Director of the Washington State Institute for Public Policy; Mr Jonathan Price, Chief Economist for Wales; Professor Shantini Paranjothy, Institute of Primary Care & Public Health, Cardiff University; and Professor Val Morrison, School of Psychology, Bangor University. Supported by funding from Public Health Wales Public Health Wales is an NHS organisation providing professionally independent public health advice and services to protect and improve the health and wellbeing of the population of Wales. Public Health Wales is an NHS organisation providing professionally independent public health advice and services to protect and improve the health and wellbeing of the population of Wales. Production of this report was funded by Public Health Wales. However, the views in this report are entirely those of the authors and should not be assumed to be the same as those of Public Health Wales. We would also like to acknowledge the support of Dr Christopher Johnson, Specialty Registrar in Public Health, who in addition to providing comments on a draft report, conducted a programme budget exercise as part of an academic placement at CHEME under the supervision of Professor Edwards. The Early Years programme budget is available as a supplementary document to this report on request to [email protected], 01248 382153. We would like to thank the children and staff from our local day-care and child research centre, Tir na n-Og, for providing us with some fantastic drawings and taking part in our hand print project. Tir na n-Og is for children from birth to age 4 and provides an environment for children to be free to explore, learn and play. We have displayed a number of the paintings and drawings throughout our report. Graphic design by Excellent Creative • www.excellentcreative.co.uk 2 Contents Foreword .................................................................................................................................4 Preface ....................................................................................................................................5 Terms of Reference ................................................................................................................6 About the Authors ..................................................................................................................7 Executive Summary ................................................................................................................9 1. Introduction ......................................................................................................................15 1.1. The case for investment in Early Years ......................................................................16 1.2. Why focus on Early Years? The 1000 days window ..................................................17 1.3. Exploring the economic case for investment in Early Years ......................................20 1.4. What methodology is appropriate for economic evaluation in public health? ..........21 1.5. The economy and how the population of Wales is changing ....................................25 1.6. Addressing inequalities in life chances for children living in Wales ...........................28 1.7. What about an asset based approach to public health? ...........................................32 2. Investing in babies and children living in Wales ............................................................35 2.1. Preconception, pregnancy and first year of life .........................................................36 2.2. Planned pregnancy ....................................................................................................37 2.3. Low birthweight ........................................................................................................38 2.4. Breastfeeding ............................................................................................................39 2.5. Early Years immunisation in Wales ............................................................................43 2.6. A spotlight on looked after children ..........................................................................44 3. Investing in the whole family ...........................................................................................45 3.1. Parenting ...................................................................................................................46 3.2. Joined up services and systems for families living in Wales .....................................50 3.3. Adverse Childhood Experiences ...............................................................................54 3.4. Youth offending ..........................................................................................................56 4. Investing in education and skills ....................................................................................61 4.1. Early Years childcare and access to pre-school ........................................................62 4.2. Primary school ...........................................................................................................67 5. Investing in a child’s environment and wider community ............................................71 5.1. Housing for families with young children ...................................................................72 5.2. Accidents in childhood ..............................................................................................74 5.3. Community spaces, parks and playgrounds .............................................................76 5.4. Asset based community development ......................................................................78 6. Potential economic benefits from investment in Early Years ......................................79 6.1. Some lessons from Greater Manchester ...................................................................80 6.2. Who currently pays for children’s service in Wales? .................................................82 6.3. What returns could we expect from additional spending on Early Years in Wales? .83 7. Discussion ........................................................................................................................85 Glossary ................................................................................................................................90 References ............................................................................................................................92 3 Foreword by Professor John R Ashton C.B.E. This report from the Centre for Health Economics and Medicines Evaluation at Bangor University is a major contribution to our understanding of how best to protect and improve the health of our children in the twenty first century. It is relevant not only to the next generation coming through , but also to those of us who are entering the second half of the second half of our journey if we are to have a quality of life in our final years. It is also of international relevance beyond the developed world. In Wales over the next 20 years, the population aged over 65 will increase by 50%, whilst the population of children entering the workforce will continue to decline. Not only will an ageing population produce ever more challenge to health and social care, but a reducing working age population will make it much more difficult to square the circle of caring, not least in an era of reductions in public sector finance. As Mao Tse Tung is reputed to have said ‘if the practice doesn’t work, the theory is wrong’, so we need a new approach. This careful, thorough and evidence based review from one of the UK’s strongest Health Economics centres provides us with such an approach. It is refreshing, comprehensive and creative. It takes us from a tired, if valuable, form of health service economics to a new and emerging discipline of Public Health Economics. Investment in the early years is not a luxury but an economic necessity and that a whole systems approach rather than a narrow, downstream medical approach is vital. An Asset Based Approach to Public health and economic and social development is the logical conclusion with a focus on the life course and a recognition of the intergenerational benefits.