P57 Cuts to spending on sure start children’s centres and childhood obesity: evidence from a national, longitudinal ecological study in England

Abstract

Background Childhood obesity is rising in disadvantaged areas in the UK. Whilst the causes of childhood obesity are multiple and complex, modifiable pathways may operate through provision of community-based services in the early years, where healthy nutrition and physical activity can be supported in numerous direct and indirect ways. In England, local authority-run Sure Start children’s centres have been an important source of parenting programmes; early learning and childcare; promotion of breastfeeding, active play and good nutrition; and links with employment and welfare support. Austerity measures adopted by the UK government since 2010 resulted in large cuts to local authority (LA) budgets and, consequently, dramatic reductions in many councils’ expenditure on non-statutory services, including Sure Start centres. Reduced investment in these centres may affect a range of child health and development outcomes, including childhood obesity. We assessed whether spending cuts were associated with the prevalence of obesity at school reception (age 4–5 years). Methods This is a longitudinal ecological study over the period 2010–2017. Our main exposure was LA expenditure on Sure Start centres using data from the Department for Education. Our outcome was obesity prevalence at reception, using data from the National Child Measurement Programme. We used fixed-effects panel regression, controlling for secular changes in obesity prevalence and time-varying confounding by local economic conditions and levels of child poverty. We examined interactions with LA deprivation and pre-2010 obesity trends, and conducted a negative control analysis using spending on services for older children as a control exposure. Results Between 2010 and 2017, spending on Sure Start and early years’ services decreased by 56% on average across LAs in England, and more in deprived areas. Childhood obesity prevalence plateaued overall, but continued to increase in some areas, particularly more deprived areas. Our analysis indicates that, on average, obesity prevalence increased in areas with larger cuts to Sure Start spending. We estimate that each 10% spending cut is associated with a 0.34% relative increase in obesity prevalence (95% CI:0.15%-0.53%). There is some evidence that this association is stronger in the most deprived areas and in areas where obesity prevalence had been falling prior to 2010. Conclusion Our findings suggest cuts to local authority spending on children’s centres are associated with increased childhood obesity. Disinvestment in the services these centres provide in the early years may be undermining progress in reducing the prevalence of childhood obesity. Limitations of the study include a reliance on area-level obesity data.