Transcript Slide 1
Reducing health
inequalities among
children and young people
Director of Public Health Report 2012/13
Contents
Summary
Setting the scene
Antenatal and postnatal period
Children of pre-school age
Children & y.people with additional needs
School age children and young people
Children and young people and healthcare
Hastings similar population structure
to England but older
East Sussex Females
85+
East Sussex Males
80-84
England Females
75-79
England Males
70-74
65-69
60-64
Age group
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
10%
5%
0%
Percentage of population
5%
10%
Birth and child populations
Birth rates increasing over last 10 yrs; but appear to
have peaked and will now stabilise or reduce
East Sussex 5,400 births in 2010
Highest birth rates are in Hastings (68.9/1,000 15-44 yr
olds) and Eastbourne (66/1,000)
Hastings consistently higher birth rate than England
21,000 children & young people (0–19 yrs) in Hastings
Relatively deprived Borough
24 (45%) LSOAs in
the Borough are
amongst the most
deprived 20% of
areas in England
Children living in poverty
Almost one in five (18.8%) across county
Ranked 95th out of 152 top tier LAs in
England but highest of 26 two-tier counties
Highest % Central St Leonards (47%)
Highest numbers in Hampden Park and
Langney in Eastbourne
Both higher percentage and higher number in
urban compared to rural areas
18.7%
18.6%
18.5%
18.4%
17.8%
17.4%
17.4%
17.3%
16.8%
16.0%
15.9%
15.8%
15.5%
15.4%
14.9%
14.6%
14.4%
14.0%
13.8%
13.7%
13.4%
12.8%
12.7%
12.2%
12.1%
10.8%
10.6%
Norfolk
Kent
Lancashire
Nottinghamshire
Derbyshire
Essex
Lincolnshire
Northamptonshire
Suffolk
Staffordshire
Worcestershire
Cumbria
Gloucestershire
Somerset
Warwickshire
Devon
Hertfordshire
West Sussex
Dorset
Cambridgeshire
Hampshire
Oxfordshire
Leicestershire
North Yorkshire
Buckinghamshire
Surrey
0%
East Sussex
Percentage of children aged under 16 living in poverty,
2010, counties in England
25%
20%
England,
21.1%
15%
South East
Region, 15.5%
10%
5%
Source: HM Revenue and Customs, Child Poverty Statistics, October 2012
Chapter 3: Antenatal and
postnatal period
Infant Mortality rate higher in Hastings than East
Sussex but not statistically significant
To reduce infant mortality need to:
Reduce under 18 conceptions
Reduce rates of smoking in pregnancy - contributes to 40% of all infant
deaths; 22% mothers smoking at delivery in Hastings
Reduce prevalence of obesity - Associated with a higher rate of stillbirth,
prematurity and congenital abnormalities
Increase breastfeeding rates - About 49% of mothers B/F at 6-8 weeks;
varies with age - 20% in under 20 yrs - 72% in 40yrs & over Reduce
child poverty
Mental health problems in pregnancy - increase
likelihood of parenting problems - new perinatal MH
service launched in 2011
Maternal smoking
Chapter 4: Children of pre-school age
Immunisation
Increase
MMR
in primary vaccination rates in last 7 yrs, 95% in some areas
vaccination rates low at 87% compared to the 95% target
Sustained
National
clusters of cases of measles in East Sussex
MMR campaign in progress (PHE)
Oral health
Improved
nationally - rates of tooth decay linked to deprivation
Services aimed at reducing inequalities
Family
Nurse Partnership, Children’s Centres and the new early
years and health visiting model (Good Start) all aim to improve
outcomes for vulnerable families through early intervention
Chapter 5: Children and young people
with additional needs
Priority groups as tend to have poorer health outcomes
Looked after Children;
children with Child Protection issues,
Special Educational Needs and Disability,
Not in education employment or training (NEETs)
Continued rise in child protection & safeguarding
activity over past 4 years resulting in increased demand on social
care, health, police and education services
ESCC has invested in the THRIVE programme
to reduce the number of children subject to child protection plans concentrates on early help services and family assessment
Chapter 6: School age children &
young people
Educational achievement is a key determinant of health
58% 5 A*-C grade GCSEs in 2011/12 – lowest in Hastings (46%)
Gaps in attainment:
between pupils eligible for free school meals (31%) and others (62%)
between those with special educational needs and other pupils
Rates of pupil absence & school exclusions contribute to health
inequalities – persistent absence higher in East Sussex than England
NEET young people impacts on long-term economic well-being & health
387 (3.5%) 16 & 17 yr olds in E Sussex who were NEET in 2011/12, 46% of
whom had special educational needs
Schools Health-related
Behaviour Survey
Undertaken in Spring 2012 with over 4,500,
14 and 15 yr olds, taking part (85% of pupils
on school roll)
721 Hastings – 364 boys; 357 girls
Previously survey conducted in 2007
Good news
Reduction in:
Alcohol and drug use & fewer young people start
taking drugs at an early age (aged 13 or under)
Bullying
% pupils who’ve been the victim of violence or
aggression in area they live in the last 12 months
Increase in:
% who know where to get free condoms
% who know about local sexual health services for
young people
Areas of concern
Smoking rates not reduced; increase seen in Hastings
Increase in the % saying they are quite or very unhappy with
their lives at the moment
No improvement in exercise levels
Eating habits have worsened
Fewer eating 5 portions of fruit and vegetables per day
Fewer eating breakfast
One in 10 state they never or rarely eat fresh fruit
% in sexual relationships has increased
Fewer aware re drug & alcohol treatment services for y people
Smoking rates highest in
Hastings
Smoking at home highest in
Hastings
Alcohol
Drugs
Sexual health
Teenage Pregnancy
Healthy Eating/Healthy Weight
Physical activity
Internet usage and safety
Chapter 7: Children and young people and
healthcare
Emergency admissions to hospital
In 2 yrs 2010 - 20112 around 15,000 emergency admissions in <18 yrs
Children <5 yrs = 78%; 5-9 yrs 12%; 10-14 yrs 5%; 5-17 yrs 5%
Main causes:
Respiratory conditions – 20% of all admissions;
Unintentional deliberate injuries and poisonings – East Sussex higher than
national rate
Main causes of accidental and deliberate injury:
0-4 yrs falls (56%) and exposure to inanimate mechanical force (16%);
5-17 yrs falls (49%) and transport accidents (20%)
Hastings and Rother have a higher rate of under 18s admissions due to
accident or deliberate injury for both 0-4yrs and 5-17yrs, than nationally
The NHS Atlas of Variation in Healthcare for
Children and Young People
Hastings & Rother Primary Care Trust among the 20% nationally
with the highest rates of:
Admissions for Gastro-Intestinal endoscopy
Hospital admissions for diabetic ketoacidosis in children known
to have diabetes
Rate of perinatal mortality
Recommendations (1)
Antenatal and postnatal period
PH commissioners:
improve performance of stop smoking services and prioritise
pregnant women & young people
NHS Maternity service commissioners:
monitor BMI and offer information and support on weight
management;
provide more B/F support for y women & in more deprived areas
NHS England:
Improve vaccination uptake
Recommendations (2)
Children of pre-school age
PH commissioners to work with primary care to improve
immunisation up-take & make recommendations to NHS England
Commissioners for Children's services to ensure:
FNP effective in improving performance in smoking cessation, low
birth weight, A&E attendances, use of Long Acting Reversible
Contraception
Good Start model meets local needs & improves care for vulnerable
families
Children’s Centres work to improve health of the most vulnerable
and deprived communities
Recommendations (3)
Children with additional needs
LA & NHS commissioners to prioritise the needs of looked
after children
PH commissioners to ensure health improvement
interventions are targeted at most vulnerable families through
THRIVE programme
LA commissioners to evaluate parenting groupwork and
early help services as part of THRIVE programme
Recommendations (4)
School age children and young people
LA commissioners, schools & academies - ensure
whole schools approach to healthy lifestyles; focus on
smoking, exercise, healthy eating & emotional health
Schools & Academies, PH commissioners - ensure
y. people aware re accessing sexual health services
PH commissioners - evidence-based weight mngt
services for obese children & their families
Recommendations (5)
Children and young people and healthcare
Public Health Commissioners to support
households at greatest risk of accidents at home,
including provision of home safety assessments
Clinical Commissioning Groups to review areas
where hospital service use appears to be relatively
high, to ensure that commissioning is cost effective
Thank you
Any Questions