Five-year-olds in Britain are, on average, up to seven centimetres shorter than children in other wealthy nations, new data has revealed.
The stark figures reported in The Times were met with shock by many, with a poor national diet being blamed for the height difference. But for one leading doctor in Greater Manchester, it’s ‘not a surprise’.
GP Dr Zahid Chauhan OBE warns that the country is yet to see the more serious consequences of malnutrition, which he says is sweeping the UK as the cost of living crisis rolls on. Among the places worst affected are the more deprived boroughs of Greater Manchester which see huge numbers of children living in poverty – and their health suffers for it.
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The average five-year-old boy in the UK is 112.5cm tall, against 119.6cm in the Netherlands, according to data collected by NCD Risk Factor Collaboration. The average girl is 111.7cm tall, while her Dutch counterpart stands at 118.4cm.
By comparison, in Bulgaria, children are much taller, the research showed. There, boys are, on average, 120cm (almost 4ft) tall and girls are 118cm.
Children in Italy, Spain, France and Sweden are all much taller at age five, on average, than UK youngsters of the same age. The average height in Britain has stayed the same since the mid-1980s, whereas children in other countries, especially in Eastern Europe, have grown taller in the decades since.
Some experts have suggested that nutrition, particularly a lack of quality food, could be stunting the growth of British children. Professor Tim Cole, an expert in child growth rates at the Great Ormond Street Institute of Child Health, told The Times that the data is ‘pretty startling’.
In 1985, the UK recorded the 69th tallest five-year-olds in the world. But this has significantly dropped to 96th for girls, and boys' average heights have fallen even further, to 102nd place.
The professor, who was not involved in the most recent study, said wider data on the height of 19-year-olds suggested that growing up in the 2010s “which happens to coincide with the period of austerity … tells me that austerity has clobbered the height of children in the UK.”
In 2020, an Imperial College London team behind a study into height of children up to the age of 19 sawa similar decline. They found global height rankings for the UK had worsened over the past 35 years, with 19-year-old boys falling from 28th tallest in 1985 (176.3 cm) to 39th in 2019 (178.2 cm), and 19-year-old girls from 42nd (162.7 cm) to 49th (163.9 cm).
For Greater Manchester GP, Dr Zahid Chauhan, these figures did not come as a shock. Instead, he said these results show the ‘impact of malnutrition’ that has long plagued the country – and parts of Greater Manchester in particular.
Dr Chauhan is not only a GP, but is also the mayor of Oldham and the founder of a homeless charity. He says he sees poverty on the streets every single day.
“I’m not surprised,” he told the Manchester Evening News. “It might shock people to know that, nationally, 2.5 million children live in households that experience food insecurity. One in two children in Oldham live in poverty, lots of parents sacrifice their own meals to feed their children.
“And they’re often feeding children with food that isn’t nutritious, they get food to make them full because that’s what they can afford. These families are looking at fried chicken and chips for £1.50, £2 – food that’s packed with sugar.”
Elsewhere in Greater Manchester, neighbourhoods are facing similar woes. In Manchester borough, some 42 per cent of children - 46,269 - live in poverty and one in three do not have sufficiently developed speech before starting school. And when they get older, poverty and the ill-health which follows can severely limit their employment opportunities.
“Manchester is known on the global stage for lots of good things. But alongside that, like many other cities across the developed world, inequality remains one of the biggest challenges that we compete with.
“To have Manchester on the global scale, we're one of the fastest growing tech cities in Europe, all of those accolades that we give ourselves, and then at the same time, 42 per cent of our kids are growing up in poverty. That, to me, really shows that we need to be doing more,” council leader Bev Craig told the M.E.N. back in March.
Across the region, longstanding regional inequities have made Greater Manchester’s health worse in comparison to other parts of the country - not just for children. Historically, the region has been poorer than parts of the south of England, meaning more families are left struggling and councils have been disproportionately underfunded, particularly during austerity.
The kind of jobs that are available in Greater Manchester and the transport options Greater Manchester can afford to run are among the issues having a knock-on effect on the health of the population. For example, manual jobs in areas less well-connected to public transport mean workers might have to drive to work, rather than being able to walk or get exercise heading to a bus stop.
"There's a clear problem within Greater Manchester that seems to affect us more than other cities,” Jaydeep Sarma, a consultant cardiologist at Wythenshawe Hospital told the M.E.N. as the NHS pushed for more awareness of serious heart problems. “Certainly there's, there's a north-south divide.
“One of the things that we are aware of as doctors is that when we talk to people, lifestyle choices and pressures in their workplaces or in their daily lives, do sway the sorts of choices that they make in terms of transport.
“[They sway the choices] in terms of choosing how much or their ability to exercise, their dietary choices in terms of food types, and indeed, the way that they cope with things like stress in the workplace or at home, which might be related to food choices and other habits, including things like alcohol or tobacco consumption.”
“All of these are fundamental principles of good old common sense, healthy living, you don't need a cardiologist to tell you this sort of stuff. But it does play into the fact that cardiac disease is heavily represented here in Manchester, arguably, more so than most other places in the country.
"It's only places like Glasgow, Tyneside, Teesside, and Blackpool that seem to have as much concentration of disease.”
The effect of the north-south divide is shocking - “it could be the difference between having a heart attack in your 60s versus having a heart attack in your 70s or 80s,” adds the doctor.
“[Where you live] plays into things like social class and access to health care and the ability to look after yourself, what sort of services around you, what sort of pressures are, are there, what sort of food you eat, what sort of habits you have been brought up with, and what sort of food choices and the health choices you're making as an individual.”
That scale of poverty might be manifesting itself in dwindling height among children right now, but there are more serious consequences to come if malnutrition remains the same, warns the doctor.
“The effects on children are huge. Short-term, malnutrition has an impact on growth and also behaviour,” he continued. “What we’re yet to see are the cardiovascular problems stemming from this.
“Often, children are becoming unhealthy because of unhealthy food, not because they’re overeating. That significantly increases diabetes in children, a condition which is now starting at an earlier age.
“I have also noticed a marked increase in the number of milkshake and dessert shops, I think they are more prevalent where poverty exists. It’s a double whammy.”
Latest figures show that 4.3 million people are now living with a diagnosis of diabetes in the UK, according to Diabetes UK. Registration figures for 2021-22 are up by 148,951 from 2020-21, and more than 2.4 million people are at high risk of developing type 2 diabetes in the UK.
Diabetes UK warns the total could hit 200,000 18-39-year-olds by 2027 out of around five million patients in total. Type 2 diabetes is caused by problems with a chemical in the body called insulin.
It’s often linked to being overweight or inactive - and it's a lifelong condition that can affect everyday life, including needing regular check-ups, medication and diet changes.
Rates of type 2 diabetes in the under-40s are now increasing faster than in the over-40s, with cases up by 23 per cent in the last five years. A type 2 diagnosis at a younger age can lead to more complications, including kidney and heart disease, says Diabetes UK.
These health problems will put yet more pressure on the already slammed NHS. More people with more complicated conditions costs more money, explains the GP.
“It’s today’s problem and we’re seeing the impact of decades of austerity, but it’s a future problem as well – particularly from a financial point of view,” says Dr Chauhan.
“Those long-term health impacts will come at a cost to the NHS, already-busy hospitals, social services, and social care. And they will be made worse by the cost of living crisis we have now.
“Inflation isn’t coming down, do we believe that’s not going to have an impact on our children? I’ve seen the impact of a shortage of food and poor nutrition all the time as a GP, but also just on the streets as well.”
But even before the cost of living crisis and the coronavirus pandemic, Manchester knew it had a problem. As town hall leader Bev Craig told the M.E.N.: “Pre-Covid, the city was aware of major gulfs in people’s social lives, financial circumstances and health.
“The virus only proved to worsen the lives of the most vulnerable.
“In January [of 2020], just before Covid, we were on the verge of declaring a public health emergency because of the city's health inequalities - that gap in life expectancy and healthy life expectancy. That still remains the case.
“People that are experiencing health and wealth inequalities tend to be hit hardest. It shouldn't have come as a surprise with Covid that people in insecure low, low paid jobs would suffer economically more, that people already who had a number of long term conditions would suffer more, and that people who faced structural racism and other inequalities would suffer more.”
Dr Chauhan believes that more should be done to ensure children are getting the right kind of food. If politicians are serious about solving these problems, it will not take long before improvements begin to show.
“Places like Oldham and Rochdale already have historic injustices within their societies and for their children. If we’re serious, it could be solved,” he explains.
“Things like universal breakfast clubs could be a great start, they do not need significant investment, and should not be out of the realm of one of the richest countries in the world.
“But it should be universal so as not to stigmatise children, separating them into different groups based on what their parents can afford. That will give children self-respect and dignity.
“At the moment, I don’t think how we feed our children is on the national agenda and it needs to be. I don’t think I could make this point more strongly – children’s nutrition and their school readiness require more investment.”
But over in Manchester, borough leader Bev Craig is putting her political weight behind the cause. “Over the last 13 years with austerity, it's fair to say that it's felt like something that the government does to places rather than places having the ability or ownership to be able to do some things for themselves,” she told the M.E.N. in March, when Manchester Council launched a new plan taking aim at inequality in the city.
“I don't say that lightly. All the trends on inequalities, all the trends around health outcomes have all radically changed over the last 13 years and gone in the wrong direction across the country, Manchester has been no different to that.”
Manchester has started a ‘Making Manchester Fairer’ plan – the radical proposals are set to unfold over the next five years, but town hall chiefs are hoping to make it last a lifetime.
The budget will be used on free school meals and activities; extra support for community groups; ‘trusting people to use cash [to buy what they need] instead of vouchers’ which can be limiting; and increasing wages. By making people wealthier, residents can afford to be healthier, live longer and live better, bosses say.
More than half of the council’s £736.2m revenue budget for 2023/24 will go on helping those most in need.
The plan also promises to take that impending pressure off the NHS, something that national policies have been finding immensely challenging so far. “I think in the city, there's something for me around not waiting for a change of national government to start some of this work,” says Coun Craig.
“While we deal with the consequences of national decisions, there are things that we can do to build some of the change that we need to see. If we're to secure the future sustainability of the NHS, we need to stop people coming in in places like Manchester with late presentation of complicated health issues.”
By focusing on ‘preventing in the first place through a focus on health, activity, wellbeing’, Coun Craig hopes to make her patch a better place. But Dr Chauhan warns that this kind of change needs to be more widespread across Greater Manchester, as well as the rest of the country.
“We will have to pay for these problems either way,” he says. “If we want to prevent a future crisis, we need to act now and it’s the right, human thing to do.”
