Transcript Slide 1

Reducing health
inequalities among
children and young people
Director of Public Health Report 2012/13
Contents
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Summary
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Setting the scene
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Antenatal and postnatal period
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Children of pre-school age
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Children & y.people with additional needs
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School age children and young people
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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
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Birth rates increasing over last 10 yrs; but appear to
have peaked and will now stabilise or reduce
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East Sussex 5,400 births in 2010
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Highest birth rates are in Hastings (68.9/1,000 15-44 yr
olds) and Eastbourne (66/1,000)
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Hastings consistently higher birth rate than England
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21,000 children & young people (0–19 yrs) in Hastings
Relatively deprived Borough
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24 (45%) LSOAs in
the Borough are
amongst the most
deprived 20% of
areas in England
Children living in poverty
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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
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Infant Mortality rate higher in Hastings than East
Sussex but not statistically significant
To reduce infant mortality need to:
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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
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Priority groups as tend to have poorer health outcomes
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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
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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
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58% 5 A*-C grade GCSEs in 2011/12 – lowest in Hastings (46%)
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Gaps in attainment:
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between pupils eligible for free school meals (31%) and others (62%)
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between those with special educational needs and other pupils
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Rates of pupil absence & school exclusions contribute to health
inequalities – persistent absence higher in East Sussex than England
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NEET young people impacts on long-term economic well-being & health
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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
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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
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Previously survey conducted in 2007
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Good news
Reduction in:
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Alcohol and drug use & fewer young people start
taking drugs at an early age (aged 13 or under)
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Bullying
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% pupils who’ve been the victim of violence or
aggression in area they live in the last 12 months
Increase in:
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% who know where to get free condoms
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% who know about local sexual health services for
young people
Areas of concern
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Smoking rates not reduced; increase seen in Hastings
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Increase in the % saying they are quite or very unhappy with
their lives at the moment
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No improvement in exercise levels
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Eating habits have worsened
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Fewer eating 5 portions of fruit and vegetables per day
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Fewer eating breakfast
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One in 10 state they never or rarely eat fresh fruit
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% in sexual relationships has increased
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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
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In 2 yrs 2010 - 20112 around 15,000 emergency admissions in <18 yrs
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Children <5 yrs = 78%; 5-9 yrs 12%; 10-14 yrs 5%; 5-17 yrs 5%
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Main causes:
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Respiratory conditions – 20% of all admissions;
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Unintentional deliberate injuries and poisonings – East Sussex higher than
national rate
Main causes of accidental and deliberate injury:
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0-4 yrs falls (56%) and exposure to inanimate mechanical force (16%);
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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
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Hastings & Rother Primary Care Trust among the 20% nationally
with the highest rates of:
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Admissions for Gastro-Intestinal endoscopy
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Hospital admissions for diabetic ketoacidosis in children known
to have diabetes
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Rate of perinatal mortality
Recommendations (1)
Antenatal and postnatal period
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PH commissioners:
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improve performance of stop smoking services and prioritise
pregnant women & young people
NHS Maternity service commissioners:
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monitor BMI and offer information and support on weight
management;
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provide more B/F support for y women & in more deprived areas
NHS England:
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Improve vaccination uptake
Recommendations (2)
Children of pre-school age
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PH commissioners to work with primary care to improve
immunisation up-take & make recommendations to NHS England
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Commissioners for Children's services to ensure:
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FNP effective in improving performance in smoking cessation, low
birth weight, A&E attendances, use of Long Acting Reversible
Contraception
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Good Start model meets local needs & improves care for vulnerable
families
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Children’s Centres work to improve health of the most vulnerable
and deprived communities
Recommendations (3)
Children with additional needs
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LA & NHS commissioners to prioritise the needs of looked
after children
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PH commissioners to ensure health improvement
interventions are targeted at most vulnerable families through
THRIVE programme
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LA commissioners to evaluate parenting groupwork and
early help services as part of THRIVE programme
Recommendations (4)
School age children and young people
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LA commissioners, schools & academies - ensure
whole schools approach to healthy lifestyles; focus on
smoking, exercise, healthy eating & emotional health
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Schools & Academies, PH commissioners - ensure
y. people aware re accessing sexual health services
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PH commissioners - evidence-based weight mngt
services for obese children & their families
Recommendations (5)
Children and young people and healthcare
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Public Health Commissioners to support
households at greatest risk of accidents at home,
including provision of home safety assessments
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Clinical Commissioning Groups to review areas
where hospital service use appears to be relatively
high, to ensure that commissioning is cost effective
Thank you
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Any Questions