Will we ever win the fight against child sexual abuse? This important question is one I've debated this week at the NSPCC's How Safe are our Children conference.
And I think it is time to prioritise child abuse as a public health issue like heart disease, smoking and obesity. These diseases get a high profile in part because they have a cost, not only in human misery but also for the economy.
It sounds crass at first but we all know money talks, and if we can put a cost on the long term damage that child abuse does to society I believe this could be the catalyst needed to make it a public health priority.
The NSPCC is currently researching the economic costs to the UK of child sexual abuse and it is likely that it will be billions of pounds a year.
Billions every year are being spent now in concerted efforts to reduce cancer, heart disease, to give people a better quality of life and save a lot of money now and down the line.
We need to be doing the same to tackle child sexual abuse and we need to wake up to its entirely preventable impacts and costs.
Childhood experience of abuse and neglect effects brain functioning and behaviour and can lead to an increased risk of a wide range of problems from behavioural disorders, to depression, to personality disorders, to poor reading skills.
Some key building blocks are now in place with the establishment of the Home Office National Group on Sexual Violence Against Children and Vulnerable Adults. We must maximise the opportunity provided by the establishment of this important and very welcome development.
To give an idea of the scale of the problem facing us, there were a total of 23,663 sexual offences against children recorded by the police in the UK in 2012/13. These are shocking numbers and we must never forget that behind these numbers are children who have suffered appalling abuse.
However, we also know that 1 in 3 children abused by an adult did not tell anyone else at the time and 4 out of 5 young people sexually abused by a peer did not tell anyone else at the time. This isn't only a UK problem of course, and international estimates are that between 60-90% of all sexual abuse and exploitation never gets disclosed.
So it is clear that when it comes to exposing child sexual abuse we've barely scratched the surface.
Savile, Hall and other high profile historic cases of child sexual abuse and the much-publicised child sexual exploitation cases in Rotherham, Rochdale, Oxford and elsewhere as well as our growing awareness of the online abuse of children have brought the sexual abuse and exploitation of children into a sharper focus.
But the child protection system is still catching up and it needs to quickly.
There is some good news from our latest research report, which shows there is an increased willingness to speak out about abuse and neglect. For example, contacts to the NSPCC helpline increased by 15% in 2012/13 compared with the previous year.
But by the time abuse is reported the damage has been done. So how do we prevent abuse from happening in the first place?
Why don't more children speak out when they are sexually abused? Because child sexual abuse is fundamentally about the abuse of power usually fused with a sexual interest in children. This unequal power dynamic means that children can be groomed and shamed into silence, feeling that that they cannot really make sense of that they were in some way to blame for what happened, they are often left feeling impossibly confused, prematurely sexualised and utterly powerless.
All this means that children, young people and adults find it incredibly difficult to begin to talk about what happened for fear of not being believed, for fear of what they say spiralling out of their control and for fear of how they will be treated in the court system.
Those on the front line of child protection- social workers, the police, teachers and health workers - are getting better at identifying victims and perpetrators of child sexual abuse and child sexual exploitation. It's vital that anyone whose work could involve stopping abuse gets regular, up to date training in the latest evidence and best practice.
The NSPCC has commissioned research to help us understand social workers' levels of confidence and competence working with child sexual abuse. We are also examining the impact of online abuse on children and into the impact of pornography on children and young people. All this learning will help us to respond as an organisation and importantly, collaboratively with other organisations to some of key issues in the UK.
And when we catch offenders treatment is vital to prevent reoffending. We know what works with offender treatment; let's make it available to all those for whom it will be effective.
The NSPCC is not shying away from this difficult and often controversial work. Our services work with children and young people with harmful sexual behaviour, and with adults who pose a sexual risk to children.
Public education is also vital so that everyone - children and adults - know what abuse is and how to get help. That has to include good quality and consistent, and well evaluated relationships and sex education for children and young people starting in primary school delivered by well trained and supported teachers and relevant advice for parents such as that provided by the very successful NSPCC Underwear Rule campaign.
It is only through rigorously testing approaches and then sharing what we learn with other child protection professionals that lasting and sustainable improvements can be made to preventing child sexual abuse.
We should all remember that child sexual abuse and child sexual exploitation will not ultimately be prevented by government, the NSPCC or any other single organisation.
Whilst we can all play our part, particularly if we work together, it is well informed, aware and passionate individuals, families and communities that in the long term will make the biggest impact.
Can we prevent all child sexual abuse? I hope one day we can. We owe to children today and in future generations to make this the number one social challenge of our time.
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