The Marmot report was published on 11th February. The list of contributors reads like the Who’s Who of researchers and opinion leaders in the field of research into the links between deprivation and health over the last two decades. It is a report for the Department of Health in England. I hope that the newly rebranded Public Health Wales and the Assembly will read, learn and act. The authors’ biggest priority is the improvement of the lives of the youngest living in poverty:”giving every child the best start in life”.

The Report talks about ‘positive attachment between a young child and the care giver’:

“Early, secure attachments contribute to the growth of a broad range of competencies, including the self esteem, self-efficacy and positive social skills that are associated with better educational, social and labour market outcomes in later life.”

In his BBC News interview Professor Marmot was more direct about what this actually meant:

Every child needs to be nurtured at an early stage.
“In one study, mothers were asked whether it was important to cuddle and talk to a child.
“I would have thought every mother would have said yes to that – but not all of them did.
“That made my hair stand on end.
“And it follows the social gradient – women from less well-off families are less likely to see this as important.
“But then by the age of three, these children had more behavioural problems and worse cognitive skills.
“Then they have less readiness to learn, and the problems continue.”

We know from research on Romanian orphans that by the age of three neglected children have irreversible brain damage on MRI scans. This fits with my experience as a Valleys general practitioner although the picture is much more complex: whilst it is common to find infants and toddlers strapped in pushchairs and baby seats on a home visit at some addresses, it is rare to find emotionally cold, show home-tidy and socially isolated homes in those streets.

Over the years I have got very angry with commentators who have told me that the answer to Merthyr’s problems is to make everyone middle class with middle class values. I have also been rebuked by Health Visitors and Social Workers when I have used sitting with an infant and reading as a measure of good parenting. How do those of us concerned with addressing these complex challenges bring about change sensitively and effectively and break the generational cycle of inadequately cwtched infants?