A radical rethink on child health is needed according to a new report from the World Health Organisation, UNICEF and the Lancet which states that no single country is adequately protecting the future of children’s health and their environment.

Over 40 child and adolescent health experts from around the world wrote the report and found that the health and future of every child and adolescent worldwide is under immediate threat from ecological degradation, climate change and exploitative marketing practices that push heavily processed fast food, sugary drinks, alcohol and tobacco at children. 

The report - A Future for the World’s Children? - includes a new global index of 180 countries, comparing performance on child flourishing, including measures of child survival and wellbeing, such as health, education, and nutrition; sustainability, with a proxy for greenhouse gas emissions, and equity, or income gaps. 

How does the UK fare for child and adolescent health?

The UK was in the top ten countries for child flourishing but the report said that despite dramatic improvements in survival, nutrition, and education over recent decades, today’s children face an uncertain future. 

The evidence is clear: early investments in children’s health, education, and development have benefits that compound throughout the child’s lifetime, for their future children, and society as a whole.

This was recognised in the NHS Long Term Plan, published in January 2019, that contained the following measures: 

  • by 2028, children and young people in England will have better physical health, mental health and wellbeing
  • children and young people, and their parents and carers, will experience a seamless service delivered by an integrated health and care system
  • there will be a skilled workforce that listens to them, responds, and meets their needs.

Former Prime Minister of New Zealand and Co-Chair of the Commission, Helen Clark, said: “Despite improvements in child and adolescent health over the past 20 years, progress has stalled, and is set to reverse. It has been estimated that around 250 million children under five years old in low- and middle-income countries are at risk of not reaching their developmental potential, based on proxy measures of stunting and poverty. But of even greater concern, every child worldwide now faces existential threats from climate change and commercial pressures.

“Countries need to overhaul their approach to child and adolescent health, to ensure that we not only look after our children today but protect the world they will inherit in the future."

Technology and harmful marketing threats

The report said that new technologies are exacerbating and creating new threats to children that are not well understood. Gambling is a potentially large and unaddressed public health challenge for children.

The number of children classed as having a gambling problem is 55,000, according to the Gambling Commission. The Commission also found that 450,000 are gambling regularly, more than those who have taken drugs, drunk alcohol or smoked.

As a result, the first NHS gambling clinic for children will open this year as part of a new network of services for addicts being rolled out as part of the NHS Long Term Plan.

The report added that children’s online exposure is nothing short of enormous. A review in the UK, published in 2018, showed that children aged 5–15 years, spend on average two hours online on a weekday and three per day at the weekend.1

There is also a distinct threat posed to children from harmful marketing. Evidence suggests that children in some countries see as many as 30,000 advertisements on television alone in a single year, while youth exposure to vaping (e-cigarettes) advertisements increased by more than 250% in the USA over two years, reaching more than 24 million young people. 

Professor Anthony Costello, one of the Commission’s authors, said: “Industry self-regulation has failed. Studies in Australia, Canada, Mexico, New Zealand and the USA – among many others – have shown that self-regulation has not hampered commercial ability to advertise to children. For example, despite industry signing up to self-regulation in Australia, children and adolescent viewers were still exposed to 51 million alcohol ads during just one year of televised football, cricket and rugby. And the reality could be much worse still: we have few facts and figures about the huge expansion of social media advertising and algorithms aimed at our children.”

Children’s exposure to commercial marketing of junk food and sugary beverages also needs to be addressed. The authors said predatory marketing was linked to the alarming rise in childhood obesity. The number of obese children and adolescents increased from 11 million in 1975 to 124 million in 2016 – an 11-fold increase, with dire individual and societal costs.

Childhood obesity was addressed by the UK government in the recent green paper, Advancing our health: prevention in the 2020s, and it admitted that it had limited success in tackling this major health challenge.

The government says it will be consulting on making calorie labeling mandatory in the out-of-home sector, such as restaurants, takeaways and cafes. It will also end the sale of energy drinks to children under the age of 16 and has recommitted to considering extending the sugar levy to high sugar milk drinks.

A report in the BMJ said that taxing high sugar snacks such as biscuits, cakes, and sweets might be more effective in the UK at reducing obesity levels than increasing the price of sugar sweetened drinks.

The Obesity Health Alliance said that while the green paper proposals address important areas, real progress won't be made without structural changes that address the way less healthy food is marketed, promoted and sold.

Carbon emissions and impact on future generations

According to the WHO report, while the poorest countries need to do more to support their children’s ability to live healthy lives, excessive carbon emissions – disproportionately from wealthier countries –  threaten the future of all children. If global warming exceeds 4°C by the year 2100 in line with current projections, this would lead to devastating health consequences for children, due to rising ocean levels, heatwaves, proliferation of diseases like malaria and dengue, and malnutrition. 

To protect children, the independent commission authors call for a new global movement driven by and for children. Specific recommendations include:

  • Stop CO2 emissions with the utmost urgency, to ensure children have a future on this planet;
  • Place children and adolescents at the centre of our efforts to achieve sustainable development;
  • New policies and investment in all sectors to work towards child health and rights;
  • Incorporate children’s voices into policy decisions;
  • Tighten national regulation of harmful commercial marketing, supported by a new Optional Protocol to the UN Convention on the Rights of the Child.

Henrietta Fore, UNICEF Executive Director, said: “From the climate crisis to obesity and harmful commercial marketing, children around the world are having to contend with threats that were unimaginable just a few generations ago. It is time for a rethink on child health, one which places children at the top of every government’s development agenda and puts their well-being above all considerations.” 


1. Children's Commissioner. Who knows what about me? A Children's Commissioner report into the collection and sharing of children's data. Children's Commissioner of EnglandLondon 2018