Correspondence
Child mortality in the UK The UK did particularly poorly in terms of the mortality estimates for children younger than 5 years, produced by the Global Burden of Diseases team (Sept 13, p 957).1 At 4·9 deaths per 1000 in 2013, the UK has almost the highest rate in western Europe, double that of Sweden, a country with one of the lowest mortality estimates.2 Furthermore, high-income countries with a high proportion of children living in relative poverty, have a high rate of under-5 mortality (figure).1,2 Child poverty in high-income countries varies greatly, suggesting that the level of poverty might be a policy choice, amenable to change by national governments. Analyses consistently show that much of this variation is directly related to differences in tax and benefit systems.3 Unfortunately, signs of concern suggest that present policies in the UK might be making the situation worse.4 Absolute child poverty increased for the first time in 17 years in the UK, during changes to the tax and benefit system that are reducing the
adequacy, eligibility, and access to benefits, especially for some families with lowest incomes with children.4 Governmental cuts to spending for the public sector are affecting services relied on by families with low incomes who have children, with the largest spending cuts to budgets of local authorities in deprived areas.5 If we are to reduce the number of child deaths in the UK we need a welfare system that prioritises children, with a renewed focus on improving the circumstances in which children grow up, alongside systematic improvements in health services.6 We declare no competing interests.
*David Taylor-Robinson, Jonathan Bradshaw, Ben Barr, Margaret Whitehead
[email protected] Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK (DT-R, BB, MW); Population, Policy and Practice, Institute for Child Health, University College London, London, UK (DT-R); and Department of Social Policy and Social Work, University of York, Heslington, UK (JB) 1
Wang H, Liddell CA, Coates MM, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 957–79.
Number of deaths (per 1000 livebirths)
10
Bulgaria
8 Malta Slovakia
USA Latvia
6
New Zealand
Canada
Hungary UK
Poland Ireland Lithuania Australia Switzerland Austria Greece Estonia Belgium Italy Denmark France Spain Portugal Germany Slovenia Czech Republic Finland Norway Japan Luxembourg Sweden Iceland Netherlands
4
Cyprus
2 0 0
5
10
15 Relative child poverty
20
Figure: Child poverty and mortality in 35 countries in the Organisation for Economic Co-operation and Development Child relative poverty rates (having equivalised household income of less than 50% of the national median) are from the 2013 UNICEF report.2 Mortality estimates are for children younger than 5 years for 2013 from the Global Burden of Diseases analysis by Wang and colleagues.1 Linear regression trend line; mortality in children younger than 5 years is calculated by 1·94 + 0·22 × relative child poverty; p
