Child Health in Nottingham – getting better, more to do
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Transcript of Child Health in Nottingham – getting better, more to do
Child Health in Nottingham – getting better, more to do
Dr. Peter CansfieldConsultant in Public Health Medicine
NHS Nottingham City and Nottingham Children’s Partnership
Areas to cover today
• The scope of child health• Why child health is important• Factors that influence child health• Illustrations of child health issues in
Nottingham and progress• Importance of wider issues
What do we mean by ‘health’
‘A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’
WHO Constitution 1946
Dimensions of ‘health’
• Broad definition – physical, mental and social well-being
• Dynamic –resilience in face of challenges to health
• Developmental – growth, patterning• Comparative – eras, ages, abilities• Individual and population health – cultural
norms / perceptions, groups
Why does children’s health matter?
• Directly to them• Long term repercussions• Development - Early intervention - Barker• Avoiding disadvantage and unfair
participation in wealth of society
Population level problems• Affect large numbers and relatively high impact• Difficult to tackle
• Child obesity• Teenage pregnancy• Chlamydia• Dental health• Childhood accidents• Infant mortality• Medical morbidity – asthma, diabetes, epilepsy
Individual level problems• Relatively small numbers but high needs / cost• Vulnerable groups
– Child protection– Looked After Children– YOT
• Specific conditions– Asthma / Diabetes / Epilepsy etc..– Disability – Learning Disability, Neuro-disability– MH issues – Autistic Spectrum Disorder, Attention
Deficit Hyperactivity Disorder, Anorexia / bulimia– Sickle cell / genetic
Measures of health• Too complex to sum up ‘health’
in one or even a few numbers?• Complex indexes are hard to
understand but useful tools for describing need, setting priorities and targeting intervention– e.g.’s Index of Multiple
Deprivation, Child Health Index, Health Poverty Index
– They don’t usually help with trends
• Simpler measures may be better understood and can help with specific issues and trends, but may be selective, and tend to fall back on ill-health as the measure– E.g.’s Infant Mortality Rate,
Teenage Pregnancy Rate
Demography• Total population = 289,000: 68,000 or 23.7% aged 19 or
under (c.f. 24.2% for England)• BME all ages = 19.0%, 0-15 years = 24.7% (40% Asian
British, 26% British Black, 18% Mixed)• Aspley has highest proportion u19 yrs = 36.9%, and
Dunkirk & Lenton the lowest =10.2%)• Projected growth to 2020: 0-4 years 17.5%, 5-9 years
35.7%, 10-14 years 18.8%, 15-19 years -9.3%• Women of child bearing age = 52.2% (c.f. 40.6% for
England)• Fertility rate is lower than England (54.8 per 1000 cf
62.3) but is rising
Causes of death in children
• 2,200 in England per annum, 30 in Nottingham UA• Main causes are perinatal• Other major causes are accidents, congenital problems, cancer,
mental problems / nervous system problems
7%
11%
1%
5%
0%
11%
6%
7%3%
1%
1%
11%
15%
10%
11%
Infectious and parasitic diseases II Neoplasms III Diseases of the blood IV Endocrine, nutritionalV Mental and behavioural VI Diseases of the nervous IX Diseases of the circulatory system X Diseases of the respiratory system XI Diseases of the digestive system XIII Diseases of the musculoskeletalXIV Diseases of the genitourinary system XVI Perinatal conditions XVII Congenital / chromosomalXVIII Other symptoms, signs XX External causes of morbidity and mortality
Child health is improving
• Medical, technological, social and economic advances
• Shifting focus of concern for child well-being with targeted investment
• Improvement in some broad indicators of children’s health in Nottingham
• Despite progress, inequalities in child health remain, nationally and locally
Infant Mortality
Infant death rates - inequalities
How are we doing on Infant Mortality?
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1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008Years (3-yr pooled data)
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Nottingham City PCT - mortality rate per 1000 livebirthsEngland - mortality rate per 1000 live births
European Union
Linear (Nottingham City PCT - mortality rate per1000 live births)Linear (England - mortality rate per 1000 live births)
Trend in infant mortality rate
falling faster than England
Large fall in 2008 – rate for 2008 = 4.3
compared with England rate of 4.7
Nottingham now below the England
average
Gap reducingGap reducing
Infant Mortality Progress
Inequalities• Nottingham ranks 13th
highest IMD score out of the 354 districts in England (c.f.7th in the 2004 indices)
• 56 of the 176 City Super Output Areas (SOAs) are amongst the 10% most deprived in the country -106 are in the worst 20%
• The lowest ranking SOA = Aspley, 36th out of 32,482
• 41.3% of children in Nottingham (more than 20,000) are affected by income deprivation
Breast Feeding Map
• Lower rates of breast feeding in deprived areas
• Similar patterns for child obesity, teenage pregnancy, and other child health related issues
Breast Feeding Progress
40.0%
45.0%
50.0%
55.0%
60.0%
65.0%
70.0%
75.0%
80.0%
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Time Period
% B
irths
Whe
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Quarterly FigureAnnual Out-turn2008/9 Target
Child health indicators in Nottingham
2009
2010
NCMP 200708 Histogram of BMI ZScores
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-4.3 -4 -3.
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5 1.6 1.9 2.1 2.4 2.7 3 3.3 3.6 3.9 4.2 4.5 4.8
Z Score
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91st and 98th Centile markers
Increasing weight
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199091%
below98%
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Healthy weight in childhood
Teenage pregnancyNottingham City Teenage Pregnancy Projections
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40.0
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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Time Period
Und
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8 Ye
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Rat
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0 W
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Age
d 15
-17
Year
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Quarterly data to date
Projection based on whole time period since1998Linear projection based on last 2 years rate offallGrowth projection based on last 2 years rate offallProjection based on end of benefit of 'earlywins'
Note: Projections are derived mathematically from previous trends and do not represent modelling of outcomes based on interventions.
Children’s Mental Health – A Spectrum
• 9% of young people in Nottingham have ‘very low’ life satisfaction and can be considered at very high risk of depression
• 23% of young people who are scoring ‘low’ in life satisfaction are also at risk from depression (NEF survey 2007)
• Above average rates of diagnosable mental health conditions – estimated 8,000 children
• Of those referred to CAMHS (JSNA 2010):– Emotional disorders – 51%– Neurodevelopmental – 12%– Behavioural – 15-20%– Self Harm 5%– Substance misuse – 3%
Outline of interventions• Core Health and Local Authority services
delivering Healthy Child Programme (Children’s Centres, FNP, Nutrition, Youth Services, Education)
• Specialist services: delivering hospital and community care for higher levels of need(e.g. LD, MALTs TaMHS, CAMHS)
• Children & Young People’s Plan priority areas and other partnership work to tackle broader health issues
Situation for health - Health Poverty Index
Nottingham Plan 2020 Targets• Halve the proportion of children living in poverty• Move Nottingham out of the bottom 10% most deprived authorities
in England• Ensure no neighbourhood is in the most deprived 5% nationally• Raise the % of children developing well across all areas of the early
years foundation stage so that Nottingham is in the top 25% local authorities
• Child obesity will be reduced to 18%, reduce the proportion of overweight and obese adults to 60%
• Teenage pregnancy will be halved• Raise the % pupils achieving 5+ A*-C GCSEs including English and
Maths, so that Nottingham is in the top 20% most improved local authorities
• Reduce to 0% the number of pupils leaving school with no qualifications
• The Nottingham Plan also has the cross-cutting aims of raising aspirations, making Nottingham a fairer city, and moving towards a more sustainable economy and way of life. These will also help to reduce health inequalities.
Summary• Child health is improving - but not equally for all
children• Nottingham has some higher rates of child ill-
health when compared with less disadvantaged areas and the England average
• Many health problems in childhood have long term repercussions and therefore important for both individual and population health, and reducing the burden on the public purse
• A broad range of influences affect health making it everybody’s business