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Factors Influencing the Implementation of Disease Prevention Programs for Children

Many disease prevention and health promotion programs are directed at the health of children and young people because they can prevent both immediate problems (mortality and morbidity) and long term problems. However, even where there is evidence to support such public health interventions, implementation in different settings and countries has met with varying degrees of effectiveness and sustainability. The issues addressed in this synthesis concern the main reasons for the success or failure of such programs in Europe.

The research evidence shows that the most effective programs for children and young people are carried out at the government level, supported by society in general, and promote national policies to decrease poverty and increase social equality. The second most effective interventions are coordinated government policies such as pricing, legislation and other policies. For example, the most effective interventions against tobacco use are increasing the price of tobacco, banning tobacco product advertising, banning smoking in public places and legislation prohibiting the sale of tobacco products to young people. There is also evidence that simultaneous, multi-dimensional inputs at national, local and individual level increase the effectiveness of general health promotion campaigns. The health promotion interventions that are least likely to work are ones that deal with single issues, are ‘negative in the message’, and delivered at only one level of society.

In examining effective public health interventions it is essential not to conceptualize children as “mini-adults,” but rather to see them as having specific health needs related to their age and stage of development. Nevertheless, a child is also a person, a citizen, and an individual in his or her own right with equal value to any other individual. This statement is clearly laid out in the United Nations Declaration and Convention on the Rights of the Child. Further, the burden of ill-health in children and young people has, in many ways, greater significance than the burden of ill health in adults as it can have a longer life-time effect and wider impact – on parents, families and society.

There is evidence that some disease prevention and health promotion interventions, when carefully planned, systematically implemented, well assessed and aimed at specific health problems, can make a difference. Some of these are outlined in the next section, along with interventions where the evidence is unclear. Such interventions may work in a controlled setting (for example, a vaccine trial), but the effectiveness of a program will depend on a sustainable strategy for long-term application in the local context. The following two items will be considered in this review to determine the factors that influence effective implementation of programs: interventions applicability in settings other than those of the original research and their sustainability over time.

Examples of public health interventions that show evidence of effectiveness

Preventing or decreasing social inequalities and poverty

The consequences of poverty and socio-economic inequity, including parenting difficulties, are still the major threats to child health, even in developed countries. Epidemiological and other evidence clearly indicates that the elimination of these factors will, in the long term, have the greatest effect on child, adolescent and adult health.

Immunization

Evidence indicates that immunization programs with high coverage offer one of the most cost effective health interventions, compared to other methods of preventing illness.

Folic acid supplementation during pregnancy

A meta-analysis undertaken by the Cochrane collaboration has shown that folic acid supplementation taken by women in the period around the time they conceive has a strong protective effect against foetal neural tube defects.

Promotion of breast feeding

A meta-analysis undertaken by the Cochrane collaboration indicates that extra support for mothers reduces cessation of breast feeding before the child being six months old. Extra health or medical professional support is beneficial for any breast feeding (mixed with bottle feeding) and non-health or medical professional support is effective in exclusive breast feeding. The benefits of professional support for breast feeding include a significant reduction in the risk of gastro-intestinal infections and atopic eczema. Research indicates that general support both from health and medical professionals and non-professionals enhances both the number of mothers breastfeeding and the length of time for which they do so.

Prevention of sudden infant death syndrome (SIDS)

Sudden death in the first year of life was moderately common (around 1 to 2 per 1000 live births) in Europe until a decade ago. Systematic epidemiological reviews found an association between babies sleeping face downwards and an increased risk of these sudden deaths, which led to the general recommendation that babies, during the first year of life, should be put down to sleep on their backs. Subsequently there has been a significant drop in sudden infant deaths.

Injury prevention

Examples of interventions that have been shown, by epidemiological studies, to be effective in reducing unintentional injury in children and young people include compulsory cycle helmet use, area wide traffic calming methods, child-safety restraints, child-resistant containers and window bars to prevent falls. Legislation generally has been found to be most effective means of implementing these, but environmental modification and education also play a part in preventing or reducing childhood injuries and their effect when combined is encouraging.

Cessation of cigarette smoking

A synthesis of the Health Evidence Network on interventions for tobacco control has shown that one of the most effective public health interventions to encourage cessation of smoking in adults and adolescents is increasing the price of cigarettes. Smoking restrictions, cigarette advertising bans and more accessible nicotine replacement therapy are also recommended. There is little evidence that school-based programs for the prevention of smoking uptake by young people are effective, but there is some limited support for the effectiveness of community interventions in helping prevent the uptake of smoking in young people.

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