• health services research
• paediatric practice
• health service

Many governments around the world have had different policies aimed at improving child health, but which policies are most effective? Here we propose that there is potential to understand how UK government policy can benefit child health by using robust methodologies1 to evaluate the impact of the 1999 devolution of government in the UK. Since 1999, the National Health Service (NHS) in Scotland and the NHS in England have taken slightly different routes to deliver healthcare. Perhaps the most striking difference is that there is an internal market in NHS England but not in Scotland, meaning that English hospitals are in direct competition with each other for the funding that accompanies provision of patient care. Have these differences in strategy led to differences in health outcomes?

The NHS was formed in 1948, and since then, the health of infants, children and young people in the UK has improved dramatically. Despite being an income-rich country, many of UK’s children continue to face significant health challenges. Compared with our continental neighbours, childhood mortality2 3 and obesity4 in the UK are already, or will soon be, among the worst in Western Europe. For example, girls born in the UK in 2015 had the lowest life expectancy across Europe.5 Compared with Sweden, there are approximately 100 excess deaths per annum in children and young people in the UK.3

Poverty remains the biggest determinant of child health and well-being in the UK.6 Economic policy can directly reduce poverty. Social policy can mitigate against the link between poverty and poor health by delivering state-funded healthcare, school meals, housing, education and, where required, material goods such as clothing. In 2000, just after devolution, 32% of children in England and Scotland were living in households whose income was below the national average. …