In our quest to improve people's health in the UK, we sometimes crave silver bullets. Regardless of how big or complex the problem facing the health service, our desire to find the perfect solution seldom diminishes. Few problems are more complex than teenage pregnancy.
England has the highest rate of teenage pregnancy in western Europe, which prompted the government to launch a strategy in 1999 aimed at reducing the rate of conceptions among under-18s by 50 per cent by 2010. The strategy showed how young women from poor neighbourhoods were more likely to conceive. Being a teenage mum meant you were less likely to have the training and career opportunities afforded to others. It minimised the chance of getting out of poverty. As such, teenage pregnancy was a consequence and a cause of social exclusion.
The reasons young women became pregnant were complex, the strategy argued, and as such responses needed to have many component parts. No one service could reduce teenage pregnancy by itself. It would demand the concerted and co-ordinated efforts of a range of agencies, not least those concerned with family planning and contraception, education and youth services. Crucially, the challenge was to raise the aspirations of young women, encouraging them to be more ambitious and delay parenthood until qualifications were won and futures secured.
However, implementing the strategy was, on occasion, challenging. Progress was thwarted by the media's hostility towards the plans, with sensationalists and moralists alike wringing their hands with glee at the confrontation.
Progress was uneven. Some services, such as family planning, could immediately see the challenges and what needed to be done. School nurses rose to the challenge, social workers played their part. Others, such as those working to increase the number of jobs, occasionally found it harder to make the connections. In some places efforts foundered.
There were successes. And while the government will find meeting the target a challenge, teenage pregnancy is at its lowest rate for 20 years. One such success is Hackney, a culturally diverse and deprived borough in east London. Its rates were high and its challenges immense - government set a 60 per cent reduction target. Where other boroughs assembled groups to identify individual tasks, Hackney knew something else was needed: a whole-system approach.
Clear objectives were devised and shared by all relevant partners, and reducing teenage pregnancy was integrated into a broader agenda of improving the quality of life for local residents. Reducing teenage pregnancy was not seen as a discrete outcome of one organisation or group - everyone had a part to play.
Committed to change
Success had several ingredients. The organisations' commitment was vital, as was the determination of colleagues who championed the cause. Political will was backed up by hard cash to fully fund the implementation and enable the step change that was needed to secure success. Engaging young people as partners was crucial, because without them the strategy would have failed.
Doing more of what we knew worked well was important. Services were commissioned from a range of providers. Peer education featured strongly, as did sex and relationship education in schools. The effects were dramatic: there was a 28 per cent reduction in teenage conceptions and a 51 per cent reduction in live births within this age group.
There are lessons from Hackney for other health challenges, including obesity and substance misuse. Quick fixes provide only fleeting success, but whole-system approaches deliver sustainable results.