PHRC Phase 2 (2011-2019) projects – Projects related to children and young people

Evaluating the impacts of policies on child health inequalities: How best can we exploit the predictive value of the integrated pre-school checks?

Lead investigator

Professor Margaret Whitehead, University of Liverpool


Age 2-3 years is a crucial development stage when problems with speech, behaviour, and child development become visible, yet there is time to intervene to make a difference. The Government are currently creating a universal 2.5 year-old health check – the “Integrated Review” - to provide a unique picture of the ‘whole child’. This data will provide an opportunity to inform intervention strategies at the individual and population level to improve health and reduce inequalities.

Aims, methods and contribution

  • To examine how researchers can exploit the predictive value of the integrated pre-school checks to improve child health and reduce inequalities.
  • To identify opportunities to use the pre-school checks to evaluate the impacts of policies on child health inequalities.

The programme of work focused on the following three objectives: 1) to examine the policy context of the integrated health check; 2) to assess the predictive value of child health and development measures at age 2-3 years; 3) to explore the feasibility of linking the Integrated Review data to other child health data sources at local and national levels for the evaluation of natural policy experiments.

The main analysis used nationally representative contemporary data (Millennium Cohort Study), and datasets with more detailed information on early child development (e.g. the MRC Wirral Child Development Study - WCHADS) to explore the relationship between measures of early childhood development at 2-3 years, and a range of subsequent health and development outcomes up to the age of 14 years.

Children in the UK have poor health compared to other Western European countries (1), and there are large inequalities in life chances. This is a critical moment for children and families in the UK, facing changes to preventative services in the community at the same time as levels of child poverty increasing. Important changes include the transfer of public health commissioning duties to local authorities; the Health Visitor Implementation Programme; the expansion of entitlement to free early education for two-year-olds; and the impact of cut backs to the role of children’s centres in delivering the early years agenda.

The Government’s Integrated Review was being implemented to capture a snapshot of population child health and development at age 2-3 in England, combining data from the Early Years Foundation Stage Progress Check and the Healthy Child Programme health and development review. A key step to improving child health and reducing inequalities was to establish data systems that can track longitudinal child health and development trajectories for whole populations. The analysis we undertook would help clarify the utility of using population level data on early child development to predict health and social problems in later childhood.

First, the analysis would support the interpretation of the results of the new child health checks, providing a better understanding of what the results mean for future population health. Furthermore, clear pathways need to be set out locally for children’s needs that may arise from any domain of the new Integrated Review. Developing a better understanding of the predictive value of the review would help inform practice in local areas, and support commissioners and Health and Wellbeing boards to use this information to ensure the most effective provision of services for local populations.

Secondly, we assessed the potential for data linkage using the new dataset. A linked dataset could be used innovatively to evaluate policy interventions. Building on our experience with the developing methodologies to reduce inequalities (DEMETRIQ) project, and through our links to the MRC Farr Institutes we initiated discussions about the collection, linkage and interpretation of integrated health check data at local levels.

This project built links to the PHRC project “How does educational achievement impact on health and health inequalities? An analysis of trajectories to inform policy options and development” headed by Professor Catherine Law.


    • Catherine Law, Institute of Child Health, UCL
    • David Taylor-Robinson, University of Liverpool
    • Ben Barr, University of Liverpool

Duration: 01/02/2017 – 31/01/2019 (24 months)