Transcript Reducing health inequalities among children and young

Reducing health
inequalities among
children and young people
Director of Public Health Report 2012/13
Demography
• East Sussex has a generally older population profile compared to
England.
• The highest birth rates are in Hastings and Eastbourne
• Almost one in five (18.8%) of children are living in poverty across the
county.
• There is almost a six-fold difference in the number of children living
in poverty in urban areas compared to those living in rural areas.
• The area with the highest percentage of children living in poverty is
Central St Leonards, 50% and the area with the highest numbers of
children living in poverty is in Hampden Park and in Langney, 795.
Recommendation
• Local Authority need to ensure partnerships, strategies, policies and
services are informed by this analysis of child poverty
Birth rates
Children living in poverty
The antenatal and postnatal period
Infant Mortality
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The infant mortality rate in East Sussex in 2008-10 was 4.6 per 1000 live births, though the rate in
Hastings is higher at 6.1
The following factors need to be tackled:
Maternal Smoking
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Smoking in pregnancy contributes to 40% of all infant deaths
17% mothers smoking at delivery (ranges from 10% in Lewes to 22% Hastings)
Areas of deprivation account for a four fold difference in smoking rates
Breastfeeding
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About 49% of mothers are breastfeeding at 6-8 weeks
The rates vary from 20% in women under 20 years to 72% in those aged 40 and over.
Maternal obesity
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Associated with a higher rate of stillbirth, prematurity and congenital abnormalities
Reducing under 18 conceptions
Reducing child poverty
Infant mortality
Maternal smoking
Breastfeeding
Children of pre-school age
Immunisation
• Our rates of primary vaccination have increased over the last 7 years and now
reach 95% in some areas
• Our rates of MMR vaccination are low at around 85% compared to the 95% target.
• We have had a sustained increase in clusters of cases of measles in East Sussex.
• Some people are at a high risk of serious complications from getting measles,
mumps and rubella, which are readily preventable by 2 doses of MMR
• There is a new national vaccination programme against whooping cough
Oral health
• Although oral health has improved nationally, rates of tooth decay are strongly
related to deprivation and is mainly a preventable disease
Services aimed at reducing inequalities
• There are a range of services including Family Nurse Partnership, Children’s
Centres and the new early years and health visiting model, Good Start, which all
aim to improve outcomes for vulnerable families through early intervention
Immunisation Coverage
Recommendations
• Public Health commissioners need to ensure improved performance
of stop smoking services and prioritise pregnant women and young
people.
• NHS Maternity service commissioners need to monitor BMI and
offer information and support on weight management; and provide
more support for younger women and those in deprived areas to
breastfeed.
• The NHS Commissioning Board needs to work in partnership with
parents and primary care to improve vaccination uptake; and East
Sussex County Council needs an assurance process to ensure the
public’s health is protected.
• Commissioners for Children's services need to ensure that:
– the Family Nurse Partnership continues to be evaluated and improves
performance in stopping smoking, low birth weight, A&E attendances
and use of Long Acting Reversible Contraception.
– That the Good Start model meets local needs and improves care for
vulnerable families.
– That Children’s Centres are targeted on improving the health of the
most vulnerable and deprived communities.
School age children and young people
Educational achievement
• a key determinant of health.
• rates vary across the county and some indicators are below the regional
and national levels.
• there are gaps in attainment between pupils eligible for free meals and
other pupils (32%), and those with special educational needs and other
pupils
• Rates of pupil absence and school exclusions are factors that contribute
to health inequalities
• Young people who are not in Education, Employment or Training are of
particular concern due to the impact of their current and future
employment on their long-term economic well-being and health.
• In 2011/12 there were 387 (3.5%) 16 and 17 years olds who were not in
Education, Employment or Training and of these 46% had special
educational needs.
Recommendations
• Schools and academies should increase
efforts to improve educational attainment
in vulnerable groups.
• Children’s Services Commissioners need
to ensure that the health needs of children
with special educational needs and
disability are met.
Schools Health-related Behaviour Survey
Undertaken in the Spring of 2012 with over 4,500 14 and 15 year olds taking part.
Good news
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Alcohol use has reduced
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Drug use has reduced and fewer young people start taking drugs at an early age (aged 13 or
under)
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Bullying has reduced
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The proportion of young people who know where to get free condoms has increased
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The proportion of young people who know about the local sexual health services for young people
has increased
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The proportion of pupils who claim that they have been the victim of violence or aggression in the
area where they live in the last 12 months has reduced
Areas of concern
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Smoking rates have not reduced and there has been an increase in Hastings
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There has been an increase in the proportion of pupils saying they are quite or very unhappy with
their lives at the moment
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Exercise levels have not improved
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Eating habits have got worse
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Fewer young people are eating the recommended five portions of fruit and vegetables per day and
fewer young people are eating breakfast compared with 2007
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One in 10 pupils state that they never or rarely eat fresh fruit
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The rate of young people in sexual relationships has increased
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Fewer young people know about drug and alcohol treatment services for young people
Participants in Wealden
Smoking
Smoking at home
Alcohol
Alcohol use
Drugs
Teenage Pregnancy
Sexual health
Healthy Eating/Healthy Weight
Physical activity
Recommendations
• Local Authority commissioners and schools and
academies should ensure a whole schools
approach to healthy lifestyles for pupils, with a
focus on smoking, exercise, healthy eating and
emotional health.
• Schools and academies and Public Health
commissioners need to ensure that young
people know how to access the range of sexual
health services available
• Public Health should commission evidencebased weight management services for obese
children and their families.
Children and young people and
healthcare
The NHS Atlas of Variation in Healthcare
for Children and Young People
Recommendations