One in five Highland children are living in poverty. The NHS Highland Director of Public Health calls for urgent whole-system action in a landmark early years report.
NHS Highland’s Director of Public Health report for this year has been launched, and calls for bold collective action to give every child in Highland and Argyll and Bute the best start in life - describing early investment as both a moral imperative and the most cost-effective action system leaders can take.
The Director of Public Health Annual Report 2025 - A Strong Start: health and wellbeing in the early years is the first annual report by Jennifer Davies since taking up post as Director of Public Health and Health Policy for NHS Highland. The report sets out clear, evidence-based recommendations across five interconnected themes: prevention, social and economic factors, places and communities, enabling healthy living, and equitable health and care.
The report paints a detailed picture of early years health in the region. Of the 12,834 children aged under 5 in NHS Highland in 2024, more than one in five (21.9%) live in relative poverty, a figure that has not improved since 2010. One in three children live in a remote or rural area, with around half of all NHS Highland children living in the most access-deprived 20% of areas in Scotland.
The data reveals stark health inequalities linked to deprivation. The rate of low birthweight babies in the most deprived areas (9.0%) is more than five times that of the least deprived (1.7%). Tooth decay in five-year-olds in the most deprived communities stands at 42.7%, compared with 15.4% in the least deprived. Childhood vaccination coverage has declined since 2020, with a widening social gradient that leaves the most vulnerable communities at greatest risk.
Jennifer Davies, Director of Public Health and Health Policy for NHS Highland, said: "The early years are the most important window of opportunity we have to shape health for a lifetime. We know that if left unchecked, health inequalities accumulate across the life course and that acting early is both the most effective and the most cost-efficient thing we can do.
"Our region is a beautiful place to grow up, and the vast majority of our children thrive here. However, the sheer geographic scale of our region means that for families living in remote and rural communities, simply reaching services can take considerable time, cost and effort. These are the daily realities of children's lives, and closing the current poverty gap that affects one in five of our children across Highland is a responsibility we share across the whole system: health, local government, communities and beyond."
Grounded in children’s voices
Unusually for a public health report, A Strong Start draws directly on the experiences of more than 170 children and parents across Highland and Argyll and Bute. Working with the Care and Learning Alliance (CALA) and Let’s Grow Kids UK, the report used specialist play-based research methods to capture the perspectives of children as young as two, recognising that traditional engagement techniques are not suited to the very young.
Children identified what matters to their health not in terms of clinical services, but in terms of everyday life: outdoor spaces, parks and beaches, family routines, community connections, feeling safe, and having enough. Some spoke clearly about financial constraints. One child aged 3 to 5 said: "I want to go to a café, I’ve never been before". Another, asked about swimming, said: "I can’t go because you have to have a car and money".
Jennifer Davies added: "What is clear from our research is that our children not only experience inequalities, they express them. These children’s voices should be central to how we plan and design the services and communities that shape their lives."
A call to system-wide action
The report sets out five areas where collective action is needed across NHS Highland, local authorities, third sector organisations and communities.
- Invest early in prevention. System partners have committed to reducing child relative poverty to below 5% by 2030. We should focus our collective resources on preventative action, making decisions through the lens of equity to improve the economic, social and environmental conditions that help children and families thrive.
- Tackle the drivers of poverty. Most children in poverty in Scotland live in working households. We should promote fair work, strengthen family support, and maximise access to childcare, healthy food and income benefits.
- Create child-friendly places. Argyll and Bute declared the UK’s first Scottish housing emergency in 2023. We need to address the demand for housing, improve transport access, invest in play spaces, and apply a child health lens to planning.
- Strengthen universal services. We should improve Health Visitor pathway coverage and expand access to family support programmes, including the long established Family Nurse Partnership.
- Ensure equity and children’s rights. Around half of NHS Highland children live in Scotland’s 20% most access-deprived areas, making equitable service design essential. With the UN Convention on the Rights of the Child (UNCRC) now in Scottish Law, public bodies must embed children’s rights and voice in decisions on health, housing, transport and communities.
The economic case for early action
The report cites evidence from economist James Heckmann suggesting that prioritising social investment in the first 1,000 days of life can return up to £10 for every £1 invested, through reduced social care and medical treatment costs, lower unemployment, and improved community outcomes.
Jennifer Davies concluded: "Investing in the early years is not just a moral imperative, it is the most effective economic and social investment we can make. By protecting the spark of potential in every Highland child today, we are securing the health and prosperity of our region for generations to come. I believe it is our joint responsibility to make that a reality."