Transcript Understanding youth exclusion critical moments, social

Making the case for
young people’s health
Janet Shucksmith
Professor in Public Health
University of Teesside
[email protected]
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The case makes itself?
Making changes
Barriers and concerns
Opportunities and openings
The case makes itself?
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Focusing on 3 recent policy
documents that almost make the
case on their own:
Innocenti report card 9
 Marmot – one year on
 No health without mental health
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Innocenti report card 9
• UNICEF November 2010
• Premise - true measure of
nation’s standing is how well it
attends to its children – health
and safety; material security;
education and socialisation;
sense of being loved, valued,
included
• Protecting children during vital,
vulnerable years of growth is
mark of a civilised society and
means of building a better
future
Report Card 9:
Children ‘Left Behind’
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Uses new method of measuring how far most
disadvantaged children allowed to fall behind those at
median level in health, educational and material well-being
Ranks all 24 countries according to the size of this gap
UK ranked alongside countries such as Hungary, Slovakia
and the Czech Republic in the bottom two fifths of countries
Today, ‘bottom-end inequality’ is no longer a concern only of
the political left. In the United Kingdom, for example, a
Conservative Prime Minister has argued that “We should
focus on closing the gap between the bottom and the middle
not because that is the easy thing to do, but because
focusing on those who do not have the chance of a good life
is the most important thing to do.” (p3)
Fair Society, Healthy Lives
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Published February 2010
Year long independent
review into health
inequalities in England by
Professor Sir Michael
Marmot
Proposes most effective
evidence-based strategies
for reducing health
inequalities in England
from 2010
One year on…
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February 2011 - London Health Observatory
examines key indicators for monitoring health
inequalities for all ‘upper tier’ local authorities in
England – those which will take over the
responsibility for public health
Indicators at local authority level:
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life expectancy at birth
children reaching a good level of development at age five
young people not in employment, education or training
(NEET)
percentage of people in households receiving means
tested benefits
Off to a poor start
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Just under half (44%) of all five
year olds in England not
considered by their teachers to
have good level of development
in first year of school
Giving every child the best start
in life was highlighted in Fair
Society, Healthy Lives as the
highest priority recommendation
for reducing health inequalities report called for ‘second
revolution in early years’
Lost generation
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Average of 7% of young
people in England not in
Employment, Education
or Training (NEET) in
the three months to
January 2010
Largest percentage in
Redcar and Cleveland,
nearly 14%
No health without mental health
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DH, but cross government
mental health outcomes
strategy for people of all
ages
Amongst the main thrusts of
activity - promotion of
positive mental health and
prevention of mental
disorder in childhood and
adolescence
No brainer?
Conduct disorder most common
mental disorder in CYP
70 times more
likely to go to
jail
Half go on to develop
anti social behaviour disorder
as adults
No brainer?
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Annual cost of crime in England and Wales committed
by adults who had conduct disorder as children and
adolescents estimated at £22.5 billion
Good evidence that parenting interventions are effective
and extend into adult life
Total gross savings over 25 years estimated at £9,288
per child and thus exceed average cost of the
intervention by a factor of around eight to one
Schools can improve health
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Reviews of social and emotional learning
programmes show improvement in
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social emotional skills
attitude about self and others
social behaviour and academic performance in children
reduced emotional distress and conduct problems
Economic estimates suggest cost savings over
two years are more than twice the initial
investment with cumulative net savings per child
of £6,639 after five years and £10,032 after 10
years.
Building up trouble for the
future?
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Problems ahead for Coalition agenda of
localism?
Swingeing cuts in local authorities’ budgets loss of services for most vulnerable and needy?
Cost borne later by central government (in
spades)
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NEET - cuts in youth support likely to increase the
£12 billion life-time cost of NEET very significantly
EMA - scrapping this will increase NEET numbers and
create short term hardship for poor families who
cannot afford post-16 education
(Cole 2011)
The case makes itself?
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Social and health inequalities are inextricably linked
We are a far from equal society – social justice and the
need to maintain our position as an advanced industrial
country means we cannot afford such inequalities
Saving on services for young people now may simply
stack up costs and problems for the future
We have cost effective, evidence based interventions
that we know are effective, e.g. family nurse
interventions with teenage mothers to prevent the
recycling of poor health and poverty
Making changes
Structural aspects of health services
 Age appropriate
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No gaps between child and adult services
No assumption of homogeneity for services
for young people between 6 months and 18
years
Integration with other children’s and
young people’s services
Informed by young people’s views
Outreach and location may be critical
Making changes
Professional aspects of services
 Fewer service silos
 Fully trained and better supported
staff
 Young people’s health and wellbeing
everyone’s responsibility – a new
ethic of service
Making changes
Individual aspects
 YP educated to be emotionally literate
 Recognition that resilience comes from
overcoming challenges, not from being
mollycoddled
 Overwhelming need for emotional
stability means we have to tackle
parenting
Barriers and concerns?
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Ongoing paradox in policy
YP seen both as ‘at risk’
and ‘risky’ –
simultaneously
vulnerable and vile!
Over emphasis on policing
(and self policing)
individual behaviours
Insufficient attention on
tackling structural issues
about supply of drink,
tobacco smuggling,
obesogenic modern life
Barriers and concerns?
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(Legitimate?) concerns
about ‘dangerous rise of
therapeutic education’
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Poorly supported professional
‘extension’
Lack of respect for children’s
privacy
Medicalisation of normal
problems
Focus on weakness and
problem finding rather than
resilience and problem solving
Opportunities and openings?
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A time of great ‘churn’, but opportunities for YP
health as public health moves away from NHS
and back to LA?
 More prospect of joined up services
 More chance of YP voices being heard
 Less emphasis on (medicalised) health and
more on wellbeing – upstream approaches
Opportunities and openings?
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Potential only likely to be
realised if policymakers and
legislators take on board the
need to ‘spend to save’
where young people’s health
is concerned
Current attempts to be tough
and strong in order to reduce
the nation’s debt may be
perceived as weedy and
misplaced ‘solutions’ in the
long run.