Insert name of presentation on Master Slide

1. Early Years Pathfinder Project Insert name of presentation on Master Slide

2. “Giving every child a healthy start”Fairer Health Outcomes for All WG 2011

3. Giving every child a healthy start • To explore how an explicit evidence based approach and coordination could add value to the public health activity in Wales on early years health. Pathfinder -

4. Women’s health Preconception physical and mental health, lifestyle choices – smoking, alcohol, nutrition, drug use Fertility- time to pregnancy Health services (access, standards and quality of care) Maternal care (breast feeding, safety) Family care (social support) PRIMARY OUTCOMES Birth outcomes: Birth weight, gestational age, congenital malformations, stillbirth, perinatal mortality Intrauterine exposures Child health outcomes: Deaths, nutrition, growth, hospital admissions, healthcare utilisation, infection, respiratory health, injuries Environmental exposures: Housing, neighbourhood and workplace Life course outcomes

5. Reproductive and Early Years Epidemiology • Measuring and tracking progress on outcome indicators (surveillance) • Evidence synthesis

6. Reproductive and Early Years Epidemiology

7. Obesity Source: CEMACE

8. Obesity Mother Baby Stillbirth RR 2 Preterm birth RR 1.2 Intensive care RR 1.5 Large for gestational age RR 2 • Pre-eclampsiaRR 3 • Gest diabetes RR 3 • Thromboembolism OR 2.6 • Post partum haemorhageRR 4 Source: CEMACE

9. Smoking and Pregnancy by mother’s socio-economic classification (NS-SEC) (2010) Base: All stage 1 mothers – weighted base (15,722) Data from the Infant Feeding Survey 2010: Early Results

10. Outcomes attributable to smoking Population attributable risks • Stillbirth 7% • Prematurity 15% • Sudden Unexpected Infant Death 26% • Low birth weight 30% • Source: 1. (NICE) 2010. PH26 Quitting smoking in pregnancy and following childbirth: costing template. 2. Public Health2007;121:861-8 3. Lancet 2011;377:1331-1340.

11. Public Health Wales Observatory

12. Low birth weight Public Health Wales Observatory

13. Inequalities in preterm birth <36 weeks Source: AWPS and NCCHD

14. Wales Electronic Cohort of Children (Lyons et al) 150,000 children, key stage 1, 2003-2008, pass rates adjusted for deprivation measure.

15. Early Years outcome indicators

16. Learning from Glasgow • Scottish Government and Glasgow City Council • assessment of children’s emotional wellbeing at school entry • Maps of distribution of emotional problems

17. Figure 1: Proportion of children classified as vulnerable by the Early Development Instrument, Vancouver, 2007. Hertzman C , Williams R CMAJ 2009;180:68-71 ©2009 by Canadian Medical Association

18. Key points from Canada • Measurement systems are key for improved childhood development outcomes because “what gets counted, counts.” • A high-quality measurement system is critical to determining what support systems are needed for children. • ... coordination, refinement and a national implementation and dissemination strategy are needed. CMAJ. 180:68-71

19. Measuring and tracking progress on outcome indicators Rosalind Reilly, Nathan Lester, Ray Henry

20. Outcome indicators Need to also capture interventions at an individual level

21. Smoking data in Wales

22. PHW Health Boards Stop Smoking Wales Maternity Information systems (various) Data flow established Data exchange established Newborn hearing screening Biochemistry Cytogenetics HIRU – SAIL • Wales electronic child cohort Microbiology RADIS obstetric module – scan data (and BMI) CARIS Health visitor data All Wales Perinatal Survey NWIS National Community Child Health Database Patient Episode Database Wales Child Health System Child Death Review

23. Data Source Extract Data Staging Area Transform Processing Server (SAIL) Loading Conformed Conformed Data Mart Data Mart Data Mart Dimensions Dimensions Analysis Services (OLAP) Storage Area Reporting Server (NWIS) Analysis Services (OLAP) Reporting Services Web Server User Interface Can we do it? Central Information Warehouse

25. Evidence of effectiveness and cost of interventions Siobhan Jones, Jon Brassey, ATTRACT Team, Rosalind Reilly, Stella Botchway

26. EVIDENCE SYNTHESIS1. What should we be doing?2. What will the impact be?3. What programmes are in place?

27. Evidence for interventions Clear evidence base Less clear Obesity prevention Reducing inequalities • Folic acid supplementation • Smoking cessation • Breastfeeding • Newborn hearing and bloodspot screening • Immunisations • Parenting programmes (e.g. Incredible Years) • Family Nurse Partnerships

28. What interventions are in place? • Variation between Health Boards • Pathways for obesity, smoking cessation and perinatal mental health • Flying start – variation in parenting programmes used

29. What will the impact be? Need modelling of potential impact of risk factors and interventions to inform effective targeting of action

30. Reducing inequality gap in infant mortality by 10% in England IN ROUTINE & MANUAL GROUP • Reducing teenage pregnancies by 44% (↓1%) • Prevent 10% SUDI (↓ 1.4%) • Reducing smoking in pregnancy by 2% (↓ 2%) • Reduce obesity to 23% (↓ 2.8%) • Pre-conception care, reducing infections, improve nutrition, reduce poverty, improve housing (↓ 2.8%) DOH Review of Health Inequalities Infant Mortality PSA Target

31. Summary of next steps • Finalise outcome indicators, aligned with the Welsh Government Maternity Strategy. • Pilot a Reproductive and Early Years Surveillance System. • Review literature focussing on specific questions that address effectiveness of interventions and models of service provision. • Model potential impact of risk factors and interventions to inform effective targeting of action

32. Acknowledgements • Siobhan Jones • Rosalind Reilly • Stella Botchway • Nathan Lester • Ray Henry • Susan Belfourd • Ruth Coomber

33. Is my future bright?