I am wrestling with the emerging realisation that leadership in our world of child health is tough—possibly tougher than it has ever been. We live in a world of work where our colleagues are exhausted, burnt-out1 and many are questioning whether their career decisions were the right ones. We are facing accelerating and well evidenced examples of health inequities2 that are compounding the problems children were facing before the COVID-19 pandemic—racism, climate change, poverty, housing problems and much more. And in the UK, this is all against a backdrop of increasing numbers of frail elderly who justifiably need resource and attention, but where this is currently at the expense of any political attention, and therefore resources, for children.

One can so easily look at this array of challenges and feel defeated. As paediatricians, though, we have a gnawing voice in the back of our minds that was best articulated by Don Berwick last year when he said ‘It is not a smart investment for society to keep running health care as a repair shop without also moving upstream to the real generators of illness, injury, injustice, and disability’.3

Paediatricians understand the social determinants of health better than most healthcare professionals. We see the evidence in the children who frequently attend our emergency departments, in the mothers who deliver prematurely, in the stories families tell us about poor housing and struggles to put healthy food on the table. Such is the impact on clinical practice that the Royal College of Paediatrics …