Benefits to children’s health
By Sarah Cattan, Gabriella Conti, Christine Farquharson and Rita Ginja
Sure Start brought together services, including education, childcare and support for parents wanting to work. But one of the main goals was improving health. Our research looks at the impacts that Sure Start had on children’s health during their primary school years from its start in 1999 and its peak in the late 2000s.
Big benefits for health
We find that Sure Start had big health benefits. Increasing children’s access to Sure Start by adding an extra centre per 1,000 under-fives (about its peak coverage in 2010) reduces hospitalisations at age 11 by 18 per cent of their pre-Sure Start level. That’s equivalent to preventing around 5,500 hospitalisations of 11-year-olds annually.
But not all neighbourhoods benefit from Sure Start. While there are big falls in hospitalisations in the poorest 30 per cent of areas, there doesn’t seem to be any effect on hospital admissions in the richest 30 per cent of neighbourhoods. This means that Sure Start can help to reduce inequalities in hospitalisation rates: we estimate that it closed around half of the gap between these groups at age 11.
One of the surprising findings in our report is that these benefits not only persist as children get older; they get bigger. For example, hospital admissions related to injuries fell by 17 per cent at younger ages, but by 30 per cent at ages 10 and 11. Although our research can’t pinpoint exactly how these benefits come about, these long-lasting and growing impacts suggest that the impacts need to come from changes that persist even after children have ‘aged out’ of Sure Start. For example, possible channels include improvements in parenting or in children’s behaviour.
Some savings for the NHS
The savings to the NHS from fewer hospitalisations at ages five to 11 amount to around £5 million a year, or 0.4 per cent of average annual spending on Sure Start. The types of hospitalisations avoided also have big lifetime costs both for families and the public purse. Including these savings as well, the financial benefits of Sure Start’s effects on hospitalisations amount to around £65 million (or 6 per cent of its budget).
This comparison only takes into account the effects Sure Start had on health. As further evidence about Sure Start’s impacts on other outcomes becomes available, this should be incorporated into the cost-benefit analysis. This comparison looks only at the financial impacts; society might value the improvement in children’s health on its own merits, particularly since these benefits are concentrated in the most disadvantaged areas.
Sure Start’s third decade
Our research provides strong evidence that the Sure Start model has worked better in poorer neighbourhoods, reducing health inequalities. Unpicking to what extent this is driven by choices these centres make or the characteristics of the families they serve should be a top priority for future research into Sure Start. Ahead of the Spending Review, it’s crucial that both central Government and local authorities use the best evidence available to decide on their vision for Sure Start as the programme turns 20.
For now, though, our research suggests focusing limited resources on poorer neighbourhoods rather than spreading them more thinly.
- The health effects of Sure Start, www.ifs.org.uk/publications/14139
The report's key findings
- Sizeable health and financial benefits evidenced
- Institute of Fiscal Studies reports amid centre cuts
Sure Start Children’s Centres significantly reduce hospitalisations for children in poorer areas and save the NHS millions of pounds, a new study has found.
Since the benefits were biggest in the poorest neighbourhoods, access to Sure Start could help close around half the gap in hospitalisations between rich and poor areas, it concludes.
The study by researchers at the Institute of Fiscal Studies followed children who had access to Sure Start right through to the end of their time at primary school.
As a measure of access to Sure Start, the study used the coverage of centres – the number of centres per 1,000 children aged birth to four in a local authority area, averaged over the first 60 months of the child’s life.
One of the goals of the earliest phases of Sure Start was to reduce hospitalisations among children. To find out whether and to what extent there were any benefits in the medium term, researchers looked at hospitalisation rates between the ages of five and 11, after children stopped being eligible for Sure Start.
Researchers studied the impact of the programme on health in England over the period that it was being rolled out, between its start in 1999 and its peak in the late 2000s.
It found that Sure Start has a positive effect on children’s health by the time they finish primary school, reducing hospitalisations, with the strongest benefits on children living in disadvantaged areas.
The researchers said the bigger benefits in the poorest neighbourhoods could come about because disadvantaged children are more able to benefit from Sure Start, because the types of services Sure Start offers in poorer areas are more helpful, or because children in disadvantaged areas are more likely to attend a centre.
Researchers said these effects build over time: while there is no significant effect at the age of five, by age 11, greater Sure Start coverage (one more centre per 1,000 children aged birth to four) prevents around 5,500 hospitalisations per year.
At every age in primary school, Sure Start reduces hospital admissions for injuries.
- While Sure Start has few effects on hospitalisations for respiratory illness, there are big falls in hospitalisations for infections (at young ages) and injuries. These different causes of admission point to potential channels through which the benefits of Sure Start are felt, such as better immune systems, safer home environments or better behaviour of children.
- Sure Start impacts hospitalisations for several types of injuries, some of which have long-run consequences. At almost every age the study considered, Sure Start reduces hospitalisations for fractures. There is also a significant reduction in head injuries at age five. This is particularly important because head injuries have long-lasting impacts on children and healthcare costs.
The study also looked at whether Sure Start has an impact on obesity at age five.
Sure Start provides nutrition advice, including healthy eating during pregnancy and parenting sessions to promote physical activity in childhood.
However, researchers were unable to find any impact of the programme on the BMI or obesity of children in Reception.
The study also found no evidence that Sure Start affects mothers’ maternal health, but the authors said the findings are based on relatively limited data and should be treated with caution. ‘The absence of evidence that Sure Start had an impact on maternal health should not be treated as evidence that there was indeed no impact,’ the report said.