Transcript Public Health Aspects of Child Health

Child Public Health
What every GP should know
David Stone
Paediatric Epidemiology and Community
Health (PEACH) Unit
University of Glasgow/Yorkhill Hospital
WHY FOCUS ON CHILD PUBLIC
HEALTH?
• Children are as deserving of good
health as adults
• Today’s children are tomorrow’s adults
• Early origins of major adult diseases
(Barker and ACE Hypotheses)
• Children have specific legal rights that
are relevant to health services
All doctors are public health
practitioners now
Patients must be able to trust doctors with their
lives and health. To justify that trust you must
show respect for human life and you must:
• Make the care of your patient your first concern
• Protect and promote the health of patients and
the public
• Provide a good standard of practice and care
Duties of a Doctor, Good Medical Practice (GMC 2006)
WHAT IS CHILD HEALTH?
WHO definition of health as it relates to children
A state of complete physical, mental
and social wellbeing and not merely the
absence of disease or infirmity
WHAT IS PUBLIC HEALTH?
“The science and art of preventing disease,
prolonging life and promoting health
through the organised efforts of society”
Faculty of Public Health Medicine 1992
Child public health is an interface
activity
Clinical child care
Public health
Child public health
The Public Health Approach
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Needs assessment (“diagnosis”): What are the
nature, scale, and determinants of the problem in
the population?
Population-wide intervention (“treatment”):
What can and is being done to address the
problem?
Evaluation or monitoring (“follow up”): How
well are interventions currently being
implemented and how might they be improved?
KEY ELEMENTS OF CHILD PUBLIC
HEALTH
• Epidemiological indicators of need
• Causes and consequences of child
illness/health
• Types of intervention
• Ethical and legal aspects
Evidence of “need” for child public
health in UK
• High level of relative poverty/inequality in UK
• UNICEF 2007 report
• Links between child and adult health (Early
Origins, ACE* hypotheses)
• Breaches of UN and European law
*Adverse childhood experiences
UNICEF review of child well-being
2007
Of the 21 countries of the OECD UK children had the
lowest level of well-being as measured across six
dimensions:
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Material
Health and safety*
Educational
Family and peer relationships
Behaviours and risks
Subjective
*UK level close to (but still below) average
Epidemiological indicators of child
health
• Demography
• Mortality
• Morbidity
• Use of services
• Other
Geography of Demography
(GROS 2006 based)
Determinants of child health
(after LaLonde 1974*)
• Biology (e.g genes, viruses)
• Environment (e.g. poverty, climate)
• Lifestyle (e.g. smoking, alcohol)
• Services (e.g. health, education)
*A New Perspective on the Health of Canadians
Public Health Diagnosis Dahlgren and Whitehead model
The Social Ecological Model
Societal
Community
Relationship
Individual
Main global threats to child health in
21st century
• Injury and abuse
• Congenital anomalies
• Infection
• Respiratory disease
• Cancer
• Psychosocial disorders
Sensitive Periods in Early Brain Development
School years
Pre-school years
High
Numbers
Peer social skills
Language
Symbol
Habitual ways of responding
Emotional control
Vision
Hearing
Low
0
1
2
3
4
Years
5
6
7
Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999;
LIFECOURSE INFLUENCES ON HEALTH:
3 INTERCONNECTED “PROGRAMMING”
HYPOTHESES
• Biological (Barker et al)
• Psychological (Felitti et al)
• Social (Ben Shlomo et al )
SOME KEY EARLY BIOLOGICAL
PREDICTORS OF LATER HEALTH
• Maternal health and nutritional status
• Birth weight
• Breast feeding in infancy
• BMI in childhood/catch up growth
ACE studies of Felitti et al
Mortality from childhood injuries involving head injury in
Northern Region, 1979-86
Mortality per 100,000
16
14
12
10
8
6
4
2
0
14.0
5.7
3.4
3.7
5.8
4.7
3.4
4.2 4.4
0.9
1
2
3 4 5 6 7 8 9
Deprivation rank of wards
10
Source: Sharples et al, 1990
Categories of Deprivation
(% of population) in Britain
Deprivation
Category
Most affluent 1
2
3
4
5
6
Most deprived 7
England
Scotland & Wales
6.1
23.8
13.7
30.4
21.8
21.5
25.5
14.1
14.8
6.7
11.4
2.9
6.8
0.5
Proportion of 15 year old children with decay
experience in the British Isles 2002-3
Source: Nunn JH. The burden of oral ill health for children. Archives of Disease in Childhood 2006; 91: 251-253
Who currently practices child
public health in the UK?
• Public health professionals
• General practitioners and paediatricians
• Academics/researchers
• Others (e.g. teachers, social workers, planners)
Improving child health depends
on both
Public health measures
and
Clinical services
Examples of overlap:
surveillance, immunisation, screening, child
protection, parenting support
Contribution to additional life
years (Bunker and MacFaul)
1900-1950 +30 yrs
1950-2000 +7 yrs
25
20
15
Public health
Clinical care
10
5
0
1900-1950
1950-2000
Treating individual children contributes
to public health
• Acute illness
(e.g. infection, respiratory disease,
surgical conditions)
• Chronic disorders
(e.g. cerebral palsy, Down syndrome,
asthma, diabetes)
EARLY YEARS - THE GROWING
RESEARCH EVIDENCE
• That early life experience influences later life
outcomes
• That early life interventions can make a
difference to later life outcomes
• Parents are key in both causing and preventing
poor health and other outcomes
Parenting support is potentially the most
powerful and useful vaccine of the 21st
century
but don’t forget other interventions in early life:
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Preconception and genetic counselling
Screening (antenatal, neonatal, childhood)
Immunisation programmes
Nutrition (pregnancy, infant, child)
Lifestyle (diet, alcohol, smoking, drugs)
Creating a healthy and safe environment
Antipoverty and inequality policies
High quality health and social care
UN Convention on the
Rights of the Child 1991
3 Ps
• Protection from hazards and exploitation
• Provision of basic care and services
• Participation in decision making
Children’s (Scotland) Act 1995 and
medical consent
• Applies to children under 16
• Children can give own consent if judged
capable
• Parents/guardians lose veto but should be
involved in discussion
• If in doubt, best interests of child are
paramount
Summing up
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Children are a vulnerable minority
Children (usually) grow into adults
Role for health promotion and healthcare
Children have specific legal protection
Poverty is greatest global threat to health
Growing parenting/pre-school agenda