Priorities for a national strategy on the first 1000 days of life

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Day one of a newborn's first 1000 days of lifeEarlier this year I wrote about how the UK’s longitudinal studies have been a leading source of evidence about how our early lives continue to shape us as we grow up and grow old, and clearly demonstrate how far-reaching the effects of disadvantage can be.

In our latest submission to the Health and Social Care Committee inquiry into the early years of a child’s life, we build on that evidence base using research from the CLOSER studies to help identify the top priorities for a national strategy on the first 1000 days of life.

Building Great Britons

Informed by the best available evidence at the time, the 2015 Building Great Britons report highlighted how from the moment of conception, through to birth and the first year of life, every aspect of a baby’s environment influences its physical, emotional and social development. More recent research using our world-class longitudinal studies has shone new light in this area, evidence from which informed CLOSER’s recommendations for a national strategy.

Importance of the preconception period

The first and fundamental point to make is that a national strategy requires a sharper focus on interventions to improve women’s nutritional status and health behaviours before they become pregnant. While the period after conception directly influences a baby’s physical, environmental and social development, evidence from the Southampton Women’s Survey (the only birth cohort study in Europe in which the mothers were recruited before their child’s conception) has shown that the preconception period is also vitally important.

Any national strategy should recognise the importance of this preconception period, which means new guidance on parental preparation for pregnancy, beginning before conception, is required to protect the health of children. Crucially this must include both parents, as men’s health behaviours before conception are important too, particularly in influencing the diets of others in the home.

There is a need for heightened awareness of preconception health, especially in relation to diet and nutrition.  This means supporting ‘Healthy Conversation Skills’, used in maternal and child health contexts around the world, and extending this skills training to other relevant health-care practitioners, including community health workers.  Women and children in disadvantaged areas, in particular, need support in engaging in ‘healthy conversations’ to enable them to improve their diets and lifestyles.

Identifying people contemplating pregnancy provides a window of opportunity to improve health before conception, while population-level initiatives to reduce the determinants of preconception risks, such as obesity and smoking, irrespective of pregnancy planning, are essential to improve outcomes. Such population-level initiatives are likely to need to start in schools as after children leave school they are hard to access in order to provide the necessary support.  Adolescence is a crucial time when health behaviours are developed and intervening then would have the triple benefit of improving their current and their future health as well as that of their future children.

Major risk factors

We also need to have a renewed focus on the major risk factors that adversely influence the early years of a child’s life. We need to identify early those mothers with these risk factors and develop appropriate interventions to reduce these risks. Linked to this is the encouragement of protective factors, particularly breastfeeding, and the identification and provision of supplementary support for mothers who are struggling. Finally, further investment in longitudinal studies with repeated measures will help to understand the impact of interventions over the life course.

Our submission to the Health and Social Care Committee inquiry details the key evidence from longitudinal studies, which I hope will inform their recommendations to government. We have an opportunity to improve the lives of millions of children by intervening at the earliest stage of their lives or even before that life begins. The bulk of public spending during a child’s life comes in their teenage years, but there is a strong case for investing public money much earlier, targeting and supporting parents and parents to be.  An early intervention, preventative agenda, which our new Health Secretary Matt Hancock seems to support, is vital to this approach.