Transcript Major causes of death by age

Reducing inequalities in
Infant Mortality
in the South West Region
achieving the 2010 target
(assessed on data 2009-2011)
South West Public Health Observatory
What we hope to cover
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Why?
Context
How are we doing?
What can we do about it?
South West Public Health Observatory
Life course approach to
prevention
Wider determinants of health
Marmot: “the causes of the causes”
Contribution of determinants to reducing infant mortality
Infant mortality England and Wales 1846-2004
Infant
deaths per
1,000 live
births
Infant
mortality
rates by
socioeconomic
group
2002-4
Incidence of diarrhoea in children 0-4
Source: WHO, UNICEF
http://www.worldmapper.org/display.php?selected=233#
DH TARGET (2001)
Starting with children under one year, by
2010 to reduce by at least 10% the gap in
mortality between routine and manual
groups (R&M) and the population as a whole
SOUTH WEST TARGET
…… reduce by at least 10% the gap in infant
mortality between the most deprived quintile
and the South West
How we devised the South West target
• Don’t routinely have parents’ occupation so:
– Divided the Region into quintiles using Income
Deprivation Affecting Children Index (IDACI)
– Counts children in means tested benefit families
• What are the consequences of using the South West
target?
– Harder/easier?
– Who is included/excluded?
South West Public Health Observatory
BUT…
• Not all families in deprived areas are at risk
• Not all high risk families live in deprived areas
• Front line staff will have informal ways of assessing families
at risk
• The skills of front line workers are needed to make sure
that the right services are available at the right time in the
right place
South West Public Health Observatory
Infant mortality rates in the South West Region
and the most deprived quintile 1995-7 to 2006-8
Infant mortality rates in all quintiles of
deprivation: South West Region
25 deaths
per year
The most deprived quintiles of areas has:
• 25% of all births
• 35% of all deaths
• If we could reduce deaths in the most deprived quintile by 2
per year we would achieve the target
• If we could reduce the deaths in the most deprived quintile
to that of the South West Region we could save 25 lives a
year
South West Public Health Observatory
’What would work fastest’
to reduce the gap in infant mortality
DH 2008 (2) Infant mortality National Support Team
www.dh.gov.uk/en/Publichealth/Healthimprovement/NationalSupportTeams/Infantmortality/DH_106482
Indicators of determinants
Some high risk groups
• Mothers who smoke in pregnancy
• Young mothers
• Women from ethnic minorities
South West Public Health Observatory
Research findings relevant to
smoking in pregnancy
• Smoking accounts for 30-40% of inequalities in infant death
• The greatest effect of smoking in post-neonatal deaths (one month to
one year)
• Smoking is associated with higher rates of stillbirth, low birth weight
(small for gestational dates) babies and prematurity. The subsequent
health of those babies who survive may be compromised
• Smokers who give up early in pregnancy have infant mortality rates
similar to non-smokers
• There is a dose-effect relationship. For every 10 cigarettes smoked per
day during pregnancy, there is a 4% rise in hazard of death. Where it is
impossible for smokers to give up completely, minimising consumption
is the least bad strategy
• Increased risks to the mother cost between £8-64 million, with costs for
poor health to a child of 0-12 months of £12-£23.5 million
• Smoking cessation interventions are effective: investing between
£13.60 and £37 would yield positive savings for the NHS
Young mothers
• Babies born to mothers under 20 have an infant mortality
rate 50% higher than those whose mothers are 30-34
• IM rate 6 per 1,000
• In 2008 about 1,700 babies were born to mothers under 18
when they conceived
• About 6% of total births in the region
• If we meet the teenage pregnancy target we might reduce
deaths to babies in this group from 10 to 6 per year
South West Public Health Observatory
Breastfeeding
• Breastfeeding protects babies from a range of problems
• Current SHA ambitions for breastfeeding are to increase
the percentage of women still breastfeeding their children
at six to eight weeks to 60% by 31 March 2011
• By April 2010 over 20% of babies in the region were born in
hospitals fully accredited by the UNICEF Baby Friendly
Initiative and the majority of maternity services are making
progress towards accreditation.
• All PCTs in the South West Region are committed to
ensuring that services to support breastfeeding
women meet best practice standards as set out by UNICEF
South West Public Health Observatory
SUDI
• Declining but over-represented in quintile 5
• environmental tobacco smoke, non-supine sleeping
position and an adverse sleeping environment are the
major risk factors
• 137 cot deaths in the period 2001–07 (8.4% of all infant
deaths).
• Nearly 50% of these deaths were in the most deprived
quintile
• Breastfeeding is protective
• Avoid risky co-sleeping environments
South West Public Health Observatory
Obesity
• Obesity increases the risk of death and morbidity in both
mother and baby.
• New guidelines published jointly by the Centre for Centre
for Maternal and Child Enquiries (CEMACE) and the Royal
College of Obstetricians and Gynaecologists (CMACE
2010).
South West Public Health Observatory
Changes which would achieve the target
• In the most deprived quintile:
• stop 450 women smoking in pregnancy – this would also
reduce the number of stillbirths and low birth weight babies
or
• avoid 340 conceptions in girls under 18
South West Public Health Observatory
BUT WHAT IS LIKELY TO WORK IN PRACTICE IS
• A range of services which are accessible and culturally
appropriate
• Skilled front line staff giving advice and support where
necessary
South West Public Health Observatory
Helen Cooke
Senior analyst
South West Public Health Observatory
0117 970 6474 ext 328
[email protected]
South West Public Health Observatory