Integrated early years care and government policy to address child health inequalities: lessons from the UK and international contexts

Introduction

Child health inequalities, strongly associated with poverty, continue to widen across the UK and globally. In the UK, children from the most deprived areas face significantly higher risks of hospitalisation, developmental delay and long-term morbidity.¹ Globally, 250 million children under 5 are at risk of not reaching their developmental potential due to poverty and associated adversities.² Integrated early years care—linking health, social care and education—has gained traction as a policy solution to mitigate these effects.

This viewpoint draws on UK and international evidence to outline key implementation strategies and policy enablers for addressing child poverty and scaling up integrated care models that improve outcomes for children living in such circumstances. It argues for a long-term, national policy and systems-level commitment that is not only ethically necessary but economically justified.

What is integrated early years care?

Integrated care in early childhood combines health, education, parenting support, nutrition and social services to address the multifaceted drivers of poor child health. It may involve co-located services, shared governance, joint data systems and community engagement. Successful models typically span universal and targeted services—a principle known as proportionate universalism.³

UK-based evidence

The UK has a history of pioneering early years integration, notably through:

• Sure Start Children’s Centres: launched in the late 1990s, these hubs co-located services in deprived areas. An Institute for Fiscal Studies evaluation found that Sure Start reduced hospitalisations for 5- to 11-year-olds by 13 150 annually, with the greatest benefits in deprived communities.⁴

• Incredible Years Parenting Programme: delivered within Sure Start and elsewhere, this intervention significantly reduced conduct problems in young children.⁵

• Children and Young People’s Health Partnership and Connecting Care for Children: more recent models integrating paediatric care into primary care settings, with early evaluations showing improved access and more appropriate and efficient service use.⁶

Despite these successes, policy inconsistency, funding cuts and limited evaluation infrastructure have restricted sustained implementation and scale-up.⁷

International evidence

Globally, integrated care models have shown impact across low-, middle- and high-income settings:

• Muso Proactive Community Case Management (Mali): delivered through community health workers using proactive case detection, this approach led to a tenfold reduction in under-five mortality.⁸

• Conditional Cash Transfers+Stimulation (Colombia): combining financial support with parenting and stimulation improved cognitive and language outcomes in a large randomised controlled trial (RCT.⁹

• Integrated Child Development Services (India): a nationwide programme linking nutrition, health and early education through community workers has shown reductions in malnutrition and increased preschool enrolment, though quality and reach vary.¹⁰

• Care Groups (multiple low- and middle-income countries): volunteer-based maternal and child health promotion groups have improved breastfeeding, immunisation and nutrition outcomes.¹¹

• Australia’s programme, Strengthening Care for Children (SC4C) and in the USA, All Children Thrive have similar features of physicians and primary care working closely with communities to identify issues of joint concern and improve efficient, equitable and holistic care at the place-based level.

These models demonstrate that integration need not be expensive to be effective—many rely on community-based infrastructure, tailored to local needs and supported by continuous data monitoring.

Can these service reconfigurations really address the upstream ‘causes of the causes’ of disease; the key foundations of shelter, food and parental support services in the context of increasing global economic stress? One international policy initiative which has tried to address the issue of the prerequisites for a healthy life course has been the development of a Child Guarantee in the European Union (EU).

Effectiveness of the European Child Guarantee

This programme originated in 2015 with the aim that every child in Europe at risk of poverty (including refugee children) has access to free healthcare, free education, free childcare, decent housing and adequate nutrition. This led to two feasibility studies and a funding commitment of €6.7–8.9 billion from the European Social Fund over a 7-year period (2021–2027).

What does the data show 10 years later? Nearly one in four EU children (about 24%–25%) are still at risk of poverty or social exclusion in 2022–2023—a level largely unchanged since the scheme began. There has also been a slight increase in the participation of children in poverty in early childhood education and care, reaching 24% in 2023; a rate lower than that of more advantaged children, suggesting persistence of accessibility issues. Educational inequalities have widened, with an increase of 5 percentage points (pp) in the rate of school underachievement among disadvantaged children in 2022 compared with 2018. Access to adequate housing has slightly worsened, with, for instance, a 2 pp rise in the incidence of energy poverty among households with children in poverty recorded in 2023.

Despite these generally disappointing findings, there are some beacons of hope with a number of countries. Slovenia presents an outstanding example of how the foundations of good health and well-being have been strengthened and there is much to be learnt from this approach (box 1).

Box 1. Slovenia National Action Plan Initiatives for Child Guarantee.

https://eurochild.org/resource/biennial-reports-on-the-implementation-of-the-european-child-guarantee/

Early childhood education and care: fees scaled to family income; financial support and specialised assistance (eg, for Roma) to increase access.

Education and school activities: free textbooks for early grades, subsidised transport, extracurriculars and excursions; targeted support for migrants, ethnic minorities and children with disabilities.

Nutrition: free or subsidised kindergarten meals, school lunches and morning snacks for low-income pupils; initiatives like fruit and milk schemes.

Healthcare: universal free coverage, expansion of child/adolescent mental health centres (22 nationwide), counselling services and addiction prevention—though access disparities and wait times persist.

Housing: enhanced public rental housing, rent subsidies, anti-homelessness strategies and specific provisions for unaccompanied minors.

Social inclusion: cost‑of‑living allowances for benefit recipients, state action on Roma inclusion (eg, truancy-linked benefit sanctions, infrastructure upgrades) and interdepartmental working groups.

Slovenia boasts the lowest child poverty among EU members—about 10%–11%, compared with the EU average of ~24%. It recorded the biggest improvement (2012–2021) in the EU/Organisation for Economic Co-operation and Development (OECD) cohort, dropping from 13.5% to 9.3%, and reducing severe poverty from 4.4% to 1.1%. Slovenia integrates social pedagogy, emphasising systemic, family-centred interventions—housing, mental health, welfare—not just child-specific fixes.

Collaboration between government, non-governmental organisations (NGOs) and direct involvement of children in shaping the action plan (eg, guaranteeing 13 000 deprived children computer access by 2024) highlights a participatory, rights-based approach.

Italy has also been successful in their Nidi Gratis (Free Nests) scheme in Tuscany which provides 30 000 free accredited early childcare places to those who reside in the region.

Shared features of effective models of early years integrated care and national policy strategies

Across settings, certain implementation strategies consistently support the impact of integrated care:

• Co-location of services (as in Sure Start and OECD-recommended child and family hubs) reduces access barriers and improves coordination.

• Multidisciplinary teams facilitate holistic care, especially when supported by shared electronic records.

• Community engagement enhances cultural relevance and improves trust and uptake.

• Use of existing delivery platforms (eg, health visitors, early years centres, cash transfer programmes) enables scalable implementation.

• Robust outcome monitoring ensures accountability and supports continuous improvement.

There are a number of key elements which support the success of national policies to address child poverty successfully:

• A holistic and inclusive strategy: coordinated cross-sectoral plans covering all key pillars.

• Universal social protections: paid parental leave, family allowances, free school meals and progressive childcare fees. It is notable that Sure Start and other social protections for young families in the UK have been systematically cut and subjected to austerity since 2010 with adverse effects on perinatal and child health.¹²

• Meaningful stakeholder engagement: children, NGOs and local communities are active in both design and delivery.

• Equity-driven focus: targeted actions for migrants, unaccompanied minors, Roma and low-income families, with sanctions like benefit conversion to in-kind support for truancy.

These large-scale policy and local system-based initiatives can suffer from loss of sustainability, gaps in service provision and lack of sufficient engagement with local communities and the voluntary sector. Long-term commitment is vital to ensure full realisation of the desired outcomes.

Policy implications for UK rollout

To support a UK-wide scale-up, several enablers must be in place:

• Secure, long-term funding: programmes like Sure Start suffered from budget volatility. Ring-fenced, multi-year funding indexed to deprivation is essential.

• Statutory duties to collaborate: legal obligations for health, education and local government to coordinate—similar to Scotland’s Children and Young People (Scotland) Act 2014—could reinforce integration.

• Workforce investment: recruitment, training and retention of early years professionals (health visitors, social workers, child psychologists) is vital.

• Shared metrics and evaluation frameworks: standardised child development and health equity indicators should be embedded at local and national levels.

• Framing integrated care as an investment: evidence suggests these programmes yield high economic returns through reduced healthcare use, better educational outcomes and improved long-term productivity.^{4 9}

Conclusion

Integrated early years care together with sustained child and family friendly national policies provides a powerful and evidence-based approach to reducing child health inequalities. UK-based programmes and global examples show that well-designed models can yield meaningful improvements, particularly when tailored to context and supported by strong governance and funding. In the face of rising child poverty and deepening inequalities, now is the time to make integrated care and adequate social protection a strategic priority for all UK nations—and to align with international efforts for early childhood development.