On the morning of Valentines’ Day 2020, I decided to support the local “Youth Strike for Climate” involving hundreds of Cambridge schoolchildren marching out from the County Council site. As these determined young people set out, I happened to be standing by the Cambridge Register Office. “Hatch, match and despatch” is a nickname for an office that registers births, marriages and deaths and the births, marriages and deaths column of a newspaper. In teaching public health, I always encouraged my trainees to take a lifecourse perspective on the determinants of health. The impact of some experiences can be delayed for years after the salient event and some cumulative impacts can have a damaging or protective effect on later health. As I learned from refugees and from young people in care, even one kind and encouraging relationship can change the trajectory of someone, who had felt they were lost and forgotten.
From birth, characteristics of the parents can steer a child’s course. The consequences of a mother or father with depression (Psychogiou et al, 2020) or with alcohol dependence (Stafford and Henriques, 2020) can cast a long shadow, but early intervention makes a critical difference – if it is available (O’Keefe, 2020).
Recently, it has become clear that the antecedents of criminality happen early in childhood, not in teenage delinquency (Davis, 2020). About the age of 11 years is also a key period for the antecedents of severe mental illnesses to occur (Laurens et al, 2020). Children known to self-harm between the ages of 10–18 years have 30 times greater annual incidences of death by suicide than other young people (Hawton et al, 2020). In the UK, rates of self-harm are rising at all ages under 30, with a doubling of self-harm in the past decade (Donnelly, 2020). A sense of identity (e.g. with a famous football team) often develops at school age and this can include positive developments such as “a Planetary identity” (Easton, 2020), which many of the climate marchers displayed on this Valentine’s Day. However, in a context of feeling helpless (“we won’t die of old age, we’ll die from climate change”), 11 year olds can develop climate anxiety severe enough to need interventions such as the Force of Nature resilience programme (Taylor, 2020). In general, for children in Britain, there is a huge treatment gap between the rising prevalence of illness and access to help (Iacobucci, 2020). The Lancet (2020) describes it rightly as a “crisis” in child mental health services.
Engaging with young people’s needs is not just a matter of enough funding. Countries with limited clinical resources (such as Kenya and Tanzania: Venkatesan, 2020) have created services for childhood trauma, and television tailored to young viewers can promote mental health in relation to hidden problems such as bullying (Ukraine: Bezpiatchuk, 2020). However, the world needs better evidence, both on the early determinants of illness or well-being and about effective interventions. I await eagerly for evidence from the new Institute for Children and Young People’s Mental Health at King’s College London (see www.slam.nhs.uk/media/news/new-centre-for-children-and-young-peoples-mental-health).
as Along with trajectories for individuals, there are also trajectories for communities that may change with new policies. For example, a recent event at the Institute of Alcohol Studies looked at the way tax revenue is raised and at related government spending on public services (Mind the Gap. Alcohol and Inequalities, Seminar, London, 18 February 2020). The natural environment, such as “so many beautiful creatures”, has a big local impact on the health of adult populations (Pugh, 2020), if we enable it to. As local government and Public Health England develop their new Prioritisation Framework (Maniatopoulos et al, 2020), it is vital that we consider a variety of public health assets and systems – including the place of beauty and friendship.
Health inequalities are most apparent in mortality among older people. In England, older women in poorer communities are now dying at younger ages (Caan, 2020). Sometimes grass roots initiatives can address loneliness and exclusion among older women (Nicol, 2020) and sometimes it needs action by national policymakers (Welsh Government, 2020).
Hatch, Match and Despatch
Day after day
Life events fill the newspaper pages,
Unfolding at all ages.
When stories join:
People grow resilient and respected,
The more they feel connected.
