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Reducing health inequalities among children and young people

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

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Reducing health inequalities among children and young people

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  1. Reducing health inequalities among children and young people Director of Public Health Report 2012/13

  2. 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

  3. Hastings similar population structure to England but older

  4. 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

  5. Relatively deprived Borough • 24 (45%) LSOAs in the Borough are amongst the most deprived 20% of areas in England

  6. 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

  7. Percentage of children aged under 16 living in poverty, 2010, counties in England Source: HM Revenue and Customs, Child Poverty Statistics, October 2012

  8. 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

  9. Maternal smoking

  10. Chapter 4: Children of pre-school age Immunisation • Increase in primary vaccination rates in last 7 yrs, 95% in some areas • MMR vaccination rates low at 87% compared to the 95% target • Sustained clusters of cases of measles in East Sussex • National 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

  11. Chapter 5: Children and young people with additional needs • Priority groups astend 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Smoking rates highest in Hastings

  17. Smoking at home highest in Hastings

  18. Alcohol

  19. Drugs

  20. Sexual health

  21. Teenage Pregnancy

  22. Healthy Eating/Healthy Weight

  23. Physical activity

  24. Internet usage and safety

  25. 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 Chapter 7: Children and young people and healthcare

  26. 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 The NHS Atlas of Variation in Healthcare for Children and Young People

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. Thank you • Any Questions

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