Government policies and programmes have not significantly improved the health of the under-fives in the past decade, according to a new study by the Audit Commission.

A recent report, entitled Giving Children a Healthy Start, says more than £10 billion has been spent, directly or indirectly, on improving the health of under-fives in England since 1998. But results are disappointing considering the level of investment.

Some aspects of young children’s health have improved. There are fewer deaths in infancy and obesity rates are slowing overall. But gaps between the health of children in disadvantaged areas and those in better off places have grown. A child in a deprived area is 19 per cent more likely to have bad teeth than the average child.

The report recommends how to achieve better value for the money being spent on young children’s health. Acting now could cut diabetes, heart disease and hypertension and ease a future strain on NHS resources.

Steve Bundred, Chief Executive of the Audit Commission, said: "It's encouraging to see some improvement in the health of babies and young children, but the under-fives rarely seem a priority locally. Overall, the findings are disappointing. Children need a healthier start in life and policies are not delivering commensurate improvement and value for money.

"Large inequalities persist and this report bears out the outcomes displayed on the Oneplace website. Despite progress, our infant mortality rate remains higher than countries such as the Netherlands, France, the Republic of Ireland and Spain. Even before they are born, for many, place and parents’ income determine their quality of life and their lifespan."

Councils and health organisations are aware of health issues facing young children, such as a decline in immunisation rates for mumps, measles and rubella. However, the number of health visitors in England has dropped by 10 per cent. And some parents from vulnerable groups are not using Sure Start children’s centres because they are unaware of the service, or they say they dislike the 'judgemental nature of health professionals'.

Some councils and health organisations have reached out to vulnerable people with tailored services. Yet the gap between rich and poor has hardly changed in a decade and local policies for children vary widely. The Commission found children from minority groups were likely to have poorer health and their parents are less likely to use health services.

Councils and the NHS need to be clear about how much they are spending on the under-fives. The money should be targeted to have the most impact on the most vulnerable groups. And the impact must be monitored and reviewed.

The Audit Commission would like to see a single set of local priorities agreed by those responsible for driving improvements in children’s health, supported by a clear statement of government policy.

The report also recommends that government and local organisations with responsibility for children’s services should monitor the impact of the economic downturn on children’s services.