Dr. Sebastian Kraemer, Honorary Consultant, Tavistock Clinic

Babies haven’t changed much for millennia. Give or take a few enzymes this perfectly designed little bundle of desires and interests has not needed to evolve. He’ll be fine provided there are some people there to care for him[i]. If not, evolution has taken care of that too. You live in a cruel world and treat him roughly: he will develop into a compulsively self-reliant and ruthless individual with little concern for others. Mean societies produce mean people.

So we know what he needs but the world is not designed to provide it. Through attentive care in the early years we hope to produce thoughtful, curious and confident young people but our social arrangements are essentially hostile and competitive. Having a baby is regarded as an expensive undertaking rather than as a contribution to the future of society. One of the most impressive achievements of twentieth century Sweden was to see this clearly, and to provide for its future citizens accordingly – with excellent perinatal health services, paid leave for both parents, nursery care from graduate-trained staff, and a later start to formal education.

Comparisons with Sweden’s golden age are scorned these days because ‘we can’t afford it’. Why not? Children’s charities and institutes may be anxious not to sound too political yet this is an entirely political matter. The science is clear. Thousands of studies show how attachments – secure, insecure, disorganised – are formed[ii], and how dependent these are on the care parents themselves received as children. In spite of deficits in the previous generation you can make a difference to a child’s life; it just gets harder the longer you leave it. Developmental psychology and children's rights have had an impact on policy. Hospitals – after decades of resistance[iii] – do now encourage parents to visit their children at almost any time. Children are better protected, and physical punishment in schools is not allowed, even though many people would like it back. But it’s an uphill struggle – like walking up a down escalator.

Encouraged by successive governments our world is geared to markets. "It's the economy, stupid" means you can't do anything without money, but the more this idea takes hold the stupider we become. We have instead to ask where the money comes from, and how it is spent. As new Labour learned to their cost, economic ends do not justify the means. The current government’s dedication to £18bn welfare cuts to appease global markets will hit children disproportionately:“…cutting the state means minimising the arena in which women can find a voice, allies, social as well as material support; and in which their concerns can be recognised. It means reducing the resources society collectively allocates to children, to making children a shared responsibility, and to the general "labour" of care and love.”[iv]Neoliberalism is the enemy of children.

This is not the environment in which humans evolved. An infant in a hunter-gatherer band – the way we all lived for 99% of our time on the planet – would have spent many hours being held, since his people were on the move. When they stopped for a break he might be passed around the group, as is still done by the Efé people of the Congo rainforest, recorded by the developmental psychologist Ed Tronick. Babies may be breast fed by other women and become attached to many adults, but when inconsolable still need their mothers. Systematic comparisons by anthropologist Barry Hewlett and colleagues[v] between sedentary foraging and farming people in neighbouring parts of the Congo basin show how much more egalitarian the former are. Both men and women, who see themselves as equal, hold and converse with their tiny children more intensively, let the baby decide when to wean and teach them to share from an early age. Violence is rare, though teasing is common. Such children are more socialised than in the West and at the same time protected from catastrophe in the event of the mother’s death. Tronick makes the important point that “child abuse is more likely to occur in societies where mothers are seldom relieved of their child care responsibilities”.^[vi]

The reverse escalator effect is everywhere. Most people involved in child and family services are keen to promote secure attachments for babies and toddlers. They are committed to the idea of stable and familiar settings in which children can develop, both at home and in day centres and nurseries. But outside there is a freezing gale blowing. Little money is available for perinatal services[vii], [viii], parental leave (in spite of the fact that it saves lives[ix]), quality child care[x], good schools for all, affordable homes, healthy food, family and educational benefits, subsidised transport and energy, sports fields, swimming pools, libraries, parks and playgrounds that make rearing children and adolescents more manageable and more successful. Like children, tax is seen as a ‘burden’. So governments of all parties sign up to reducing it, yet still find money for bank bailouts and unsustainable wars. Whether local or national,tax should be a contribution to the common good, an instrument of social justice. It is collected from citizens, for citizens. In the current climate this equation is neither acknowledged nor understood.

Elegant research shows how sensitive babies as young as three months are to tensions in the interactions of adults around them. [xi]Children will more likely thrive if caregivers – parents and grandparents, childminders, daycare staff, nursery teachers – get on with one another, like a good team. Our social environment does little to support that, the most poisonous threat being from rising inequality, which in Britain has reached levels not seen since the 1920s. The much maligned 1970s, remembered for inflation, strikes and hairy rock bands was actually the most egalitarian in our history. One index of social health is the number of boys born in comparison to girls. Because the male fetus is more vulnerable to maternal stress, women produce fewer boys when times are hard.[xii](For example there is often a fall in the ratio of boys to girls a few months after disasters such as earthquakes and the terrorist attack on 9/11[xiii]). In England and Wales the highest ratio of boys to girls occurred in 1973.[xiv]In terms of contented mothers it was the best of times.

Inequality creates stress in parents who can’t keep up, and anxiety in the better off who fear sliding down. No one is comfortable on a steep slope. It makes all of us less trusting and more averse to communal commitments, such as respecting our neighbours and paying tax. Infant mortality, mental illness, drug abuse, dropping out of education, rates of imprisonment, obesity, teenage births and violence are all higher in unequal countries like ours.[xv] Michael Marmot, Richard Wilkinson, Kate Pickett and Danny Dorling[xvi]have repeatedly published data of this kind with little effect on policy. New Labour, especially Gordon Brown as chancellor, did more for children than the Tory and coalition governments but did not see the inequality elephant trampling all over its plans for poverty reduction, minimum wage, sure start, education (education, education) and health. Neither did they do nearly enough to provide decent housing for a new generation, the bubble went on inflating because property prices were an untouchable fetish for the voting middle class, and unrestrained borrowing a significant source of the nation’s wealth.

Yet something has been understood that was not clear before. There is a greater recognition that early intervention is a good idea. Michael Marmot says “to have an impact on health inequalities we need to address the social gradient in children’s access to positive early experiences. Later interventions, although important, are considerably less effective where good early foundations are lacking.”[xvii]The coalition government does want to increase health visitor numbers (but these have fallen since the start of their recruitment strategy[xviii]) and give greater access to the family-nurse partnership and to nursery education for two year olds. There is a steady stream of scholarly reviews on early intervention.[xix]Labour MPs Graham Allen[xx] and Frank Field have each produced reports for the coalition government suggesting how to deliver it. Field’s promising idea is to create a new educational stage ‘the Foundation Years’ integrating services ‘covering theperiod from the womb to five’[xxi]. Significantly neither expect government funding for this. Allen proposes a social bond to encourage the wealthy to invest in the early years. The Prime Minister’s response is revealing. In a letter to Mr Allen, Mr Cameron says he is "supportive of the idea of setting up an independent foundation" which he said could "guide the development of the early intervention market".^[xxii]

It may seem churlish to dismiss such encouragement but – because they divide workers when they need to be working together –markets do not provide integrated services, neither in health nor in education and early years. The questions remain: who pays? who profits? Without public affirmation of a shared social good we are left with a mean and rootless materialism that corrupts those at both ends of the wealth spectrum, whether bankers and traders with no shame or the ‘feral criminal underclass’ who helped themselves to trainers and computers in the 2011 summer riots.

Though often disappointed, babies are born to expect some kind of socialism. What will today’s infants be talking about in 2050? If they know any history they will regret lost opportunities; our collective loss of vision that led to wasted generations. The success of the post war consensus[xxiii]was due in part to the fact that it lasted longer than one or two parliamentary terms, so that children could grow up, get educated and housed, find partners, work and free healthcare without overwhelming instability or despair. The needs of a baby born today are precisely what they were for one born in the 1940s, or 50,000 years ago. Though over the millennia many, especially mothers, will have worked these out for themselves, it took an extraordinary effort of science and scholarship to convert that wisdom into unassailable knowledge. Armed with that, we continue to put more obstacles in the way of secure attachments.

“This neglect of the young makes the financial deficit pale beside the cost the future social deficit. In unemployment, crime, mental health and social breakdown, the damage done will cascade on, down future generations. I doubt many voters know or would approve the price that children are paying as cuts are camouflaged by empty Cameron words of concern. What's needed is a campaign by children's charities to shame the government and to make these facts known. Quiet despair grips those who see it happening, but where is the voice of real outrage?” ^[xxiv]

i]‘him’ is less clumsy than ‘him or her’.

[ii] see Graham Music’s authoritative and readable text Nurturing Natures: Attachment and Children's Emotional, Social and Brain Development (Psychology Press 2010)

[iii]Brandon S, Lindsey M, Lovell-Davis J, Kraemer S. (2009) “What is wrong with emotional upset?” – 50 years on from the Platt Report.Archives of Disease in Childhood 94: 173-177. adc.bmj.com/content/94/3/173

[iv]Stuart Hall, Guardian, 12 September 2011 www.guardian.co.uk/politics/2011/sep/12/march-of-the-neoliberals

[v] Hewlett BS, Fouts HN, Boyette AH, Hewlett BL. (2011) Social learning among Congo Basin hunter-gatherers. Philosophical Transactions of The Royal Society B 366: 1168-1178.

doi: 10.1098/rstb.2010.0373

[vi]Tronick E (2007) The Neurobehavioral and Socio-Emotional Development of Infants and Children. New York: Norton, p.116.

[vii] The pioneering parent infant service in Redbridge and Waltham Forest could be replicated in all areas with dramatic effect. The current marketised view of health means no preventive services are safe. www.nelft.nhs.uk/camhs/camhs_services/wf_parent_infant

[viii] A comprehensive perinatal intervention from Heidelberg ‘Keiner fällt durch’s Netz’ [translated as Nobody Slips through the Cracks] is now implemented and researched in three German states. www.cierpka.de/English/KFDN.html

[ix]Few people, even amongst academics, seem to be aware of the correlation between paid parental leave and infant mortality. This remarkable finding represents just the tip of an iceberg of developmental damage and pathology, which could be modified by intensive early support for families. “A ten week extension in paid leave is predicted to decrease post neonatal mortality rates by 4.1%” Tanaka S. (2005) Parental Leave and child health across OECD countries The Economic Journal 115 (501) F7-F28 doi: 10.1111/j.0013-0133.2005.00970.x

[x] On 7 October Iain Duncan Smith, Secretary of State for Work and Pensions.announced £300m for childcare.James Plunkett writes in The Spectator “Half a million people, the vast majority women, have lost an average £436 a year, with some losing as much as £1,300. Today’s move does nothing to reverse these earlier cuts but it does mean the government has refrained from punching the bruise by making things worse.”

[xi]McHale JFivaz-Depeursinge EDickstein SRobertson JDaley M (2008) New evidence for the social embeddedness of infants' early triangular capacities. Family Process 47:445-63.

[xii]See Kraemer S. (2000) The fragile male British Medical Journal 321:1609-12. www.bmj.com/content/321/7276/1609.full

[xiii]Catalano R, Bruckner T, Marks AR, Eskenazi B. (2006) Exogenous shocks to the human sex ratio: the case of September 11, 2001 in New York City, Human Reproduction 21:3127-3131

[xiv] General Register Office, OPCS and ONS Birth statistics, Series FM1