Healthy Start and Early Years

1. Healthy Start and Early Years Anna Kitt Anna.Kitt@dh.gsi.gov.uk

2. What is Healthy Start? • Replaced Welfare Food Scheme in 2006 • A statutory scheme • A nutritional safety net • A public health tool

3. Inter related infant health initiatives

4. What does it provide? Vouchers:Vitamins: Liquid milk For women Fresh fruit and vegetables For children Infant formula milk Eligible families are able to get these from 10wks pregnant to their child’s 4th birthday AND: Information on breastfeeding and healthy eating through the Healthy Start magazine sent with the vouchers 4

5. Who is it for? Pregnant women and families with children under four getting: • Income Support, or • Income Based Jobseekers’ Allowance, or • Income related Employment and Support Allowance, or • Child Tax Credit (but not Working Tax Credit) with an annual family income of £16,190 or less. And ALL pregnant under 18 year olds NOTE: There are no back payments for missed time periods

6. The Voucher £3.10 each week Issued 4 weekly to beneficiaries Double vouchers for under 1’s (£6.20/week) Voucher value reviewed annually Over the course of a pregnancy this equates to £93 food vouchers 6

7. Health professionals can make a huge difference! Role of Health Care Professionals The way the parents find out about the scheme effects their relationship with the scheme.

8. Healthy Start is a Statutory Scheme Health Professionals are given the key tasks of: Signposting to the scheme Supporting applications Signing application forms PCTs have a duty to make Healthy Start vitamin supplements available

9. Healthy Start application process Family becomes eligible Midwife/Health Visitor Invitation from HSIU Application form in GP surgery Tax credits helpline Potential beneficiary hears about Healthy Start Pregnancy or Birth to Five Book Jobcentre Plus Internet Poster in children’s centre Get application leaflet/Form Website GP Surgery HSIU Helpline Complete Form Health Visitor Get signature from midwife or health visitor Submit to HSIU

10. HSIU receives application form Fully completed Wrongly completed Clearly do not qualify Application for pregnant Application includes children Returned to applicant Applicant informed Vouchers Issued Validate against HMRC and JCP data Validation checks later Match not found Match found Inform applicant and invite to give additional information. Repeat 2/4 weekly checks for 3 months Vouchers Issued No match found Match found Vouchers not issued Repeat validation checks every 2 wks (HMRC) or 4 wks (JCP) Voucher Issued Letter confirming match not found

11. Why give Vitamins? • Sufficient evidence to convince COMA and SACN to recommend supplementation • NICE report on Maternal and child nutrition (March 2008) places the onus on PCTs to ensure supplementation happens Source: COMA – Committee on Medical Aspects of Food and Nutrition Policy SACN – Scientific Advisory Committee on Nutrition NICE – National Institute for Clinical Excellence

12. Vitamin Facts Children’s Drops Women’s Tablets

13. Vitamin Collection Points • Local Vitamin Collection Points (marketing) • Collection of vitamin coupons (administration)

14. Arrow points towards either the women’s or children’s vitamins depending on which product they should be picking up.

15. Synthesis of Vitamin D Our main source of vitamin D is that made by our own bodies. 90% of our vitamin D is made in the skin with the help of sunlight

16. Dietary Sources of vitamin D • Oily fish including trout, salmon, mackerel, herring, sardines, anchovies, pilchards, and fresh tuna • Amount will depend on preparation, with smoked herring containing approximately 4μg per 100 g and raw herring 40μg per 100g • Cod liver oil and other fish oils

17. 90% of the UK lies above the latitude that permits exposure to the ultraviolet B wavelengths necessary for vitamin D synthesis

18. Vitamin D deficiency is Sunlight Deficiency UK :13-28% of women of childbearing age have low plasma vitamin D levels 2 hours/week sunlight exposure if face only, 30 minutes face, arms and hands is sufficient for Vitamin D synthesis. (SPF 8+prevents) Darker skin blocks some of the UV rays, so need more exposure to make Vit D In UK the wavelength of sunlight received in winter (November to March) is not effective at making vitamin D. Univ Westminster Carol Williams, 2009

19. Who gets vitamin D deficiency? • Pregnant or breast-feeding women. Vitamin D deficiency is even more likely to develop in women who have had several full-term pregnancies with short gaps between them. • In the last three months of pregnancy, babies are growing at their fastest and mothers often become short of vitamin D especially if these months occur during winter or early spring.

20. Who gets Vit D Deficiency? • Breast-fed babies whose mothers are lacking in vitamin D, or with prolonged breast-feeding • Bottle-fed babies do not need vitamin D supplements as formula milk is fortified with vitamin D

21. Explanations provided for low sun exposure and low vitamin D intake by mothers (Outpatient survey, West London) • Little time outside: busy indoors or at work • Going “out” often includes shopping in malls • Use of sun block • Dislike or fear of sunlight for themselves and their infants • Use of skin lightening creams regularly • No Healthy Start vitamins • No mention of vitamin D in antenatal care • No knowledge of vitamin D • How to improve knowledge and healthy behaviour relating to vitamin D (Michie C. London Journal of Primary Care, 2010)

22. Rickets • Vitamin D insufficiency is common in the UK population • Vitamin D deficiency typically presents with bony deformity (rickets) or hypocalcaemia in infancy and childhood, and with musculoskeletal pain and weakness in adults • Currently there is a lack of coding of vitamin D deficiency in primary care and secondary care

23. Vitamin D SupplementRecommendation

24. Vitamin D Supplements Prices correct Nov 2010 Holland & Barrett 10mcg (100 tablets) £3.19 Healthy Start (56 tablets) 10mcg 90p • Boots • 12.5mcg (90 tablets) £2.79 • ASDA • 10mcg (60 tablets) £2.23

25. Vitamin D in the Headlines