Child Health in Nottingham – getting better, more to do

1. Child Health in Nottingham – getting better, more to do Dr. Peter Cansfield Consultant in Public Health Medicine NHS Nottingham City and Nottingham Children’s Partnership

2. Areas to cover today • The scope of child health • Why child health is important • Factors that influence child health • Illustrations of child health issues in Nottingham and progress • Importance of wider issues

3. What do we mean by ‘health’ ‘A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ WHO Constitution 1946

4. Dimensions of ‘health’ • Broad definition – physical, mental and social well-being • Dynamic –resilience in face of challenges to health • Developmental – growth, patterning • Comparative – eras, ages, abilities • Individual and population health – cultural norms / perceptions, groups

5. Why does children’s health matter? • Directly to them • Long term repercussions • Development - Early intervention - Barker • Avoiding disadvantage and unfair participation in wealth of society

7. Population level problems • Affect large numbers and relatively high impact • Difficult to tackle • Child obesity • Teenage pregnancy • Chlamydia • Dental health • Childhood accidents • Infant mortality • Medical morbidity – asthma, diabetes, epilepsy

8. Individual level problems • Relatively small numbers but high needs / cost • Vulnerable groups • Child protection • Looked After Children • YOT • Specific conditions • Asthma / Diabetes / Epilepsy etc.. • Disability – Learning Disability, Neuro-disability • MH issues – Autistic Spectrum Disorder, Attention Deficit Hyperactivity Disorder, Anorexia / bulimia • Sickle cell / genetic

9. Measures of health • Too complex to sum up ‘health’ in one or even a few numbers? • Complex indexes are hard to understand but useful tools for describing need, setting priorities and targeting intervention • e.g.’s Index of Multiple Deprivation, Child Health Index, Health Poverty Index • They don’t usually help with trends • Simpler measures may be better understood and can help with specific issues and trends, but may be selective, and tend to fall back on ill-health as the measure • E.g.’s Infant Mortality Rate, Teenage Pregnancy Rate

10. Demography • Total population = 289,000: 68,000 or 23.7% aged 19 or under (c.f. 24.2% for England) • BME all ages = 19.0%, 0-15 years = 24.7% (40% Asian British, 26% British Black, 18% Mixed) • Aspley has highest proportion u19 yrs = 36.9%, and Dunkirk & Lenton the lowest =10.2%) • Projected growth to 2020: 0-4 years 17.5%, 5-9 years 35.7%, 10-14 years 18.8%, 15-19 years -9.3% • Women of child bearing age = 52.2% (c.f. 40.6% for England) • Fertility rate is lower than England (54.8 per 1000 cf 62.3) but is rising

11. Causes of death in children • 2,200 in England per annum, 30 in Nottingham UA • Main causes are perinatal • Other major causes are accidents, congenital problems, cancer, mental problems / nervous system problems

12. Child health is improving • Medical, technological, social and economic advances • Shifting focus of concern for child well-being with targeted investment • Improvement in some broad indicators of children’s health in Nottingham • Despite progress, inequalities in child health remain, nationally and locally

13. Infant Mortality

14. Infant death rates - inequalities

15. How are we doing on Infant Mortality? Infant Mortality Progress Trend in infant mortality rate falling faster than England Gap reducing Gap reducing Large fall in 2008 – rate for 2008 = 4.3 compared with England rate of 4.7 Nottingham now below the England average

16. Inequalities • Nottingham ranks 13th highest IMD score out of the 354 districts in England (c.f.7th in the 2004 indices) • 56 of the 176 City Super Output Areas (SOAs) are amongst the 10% most deprived in the country -106 are in the worst 20% • The lowest ranking SOA = Aspley, 36th out of 32,482 • 41.3% of children in Nottingham (more than 20,000) are affected by income deprivation

17. Breast Feeding Map • Lower rates of breast feeding in deprived areas • Similar patterns for child obesity, teenage pregnancy, and other child health related issues

18. Breast Feeding Progress

19. Child health indicators in Nottingham 2009 2010

20. 91% below 98% below Average 1990 Increasing Number Increasing weight Healthy weight in childhood

21. Teenage pregnancy

22. Children’s Mental Health – A Spectrum • 9% of young people in Nottingham have ‘very low’ life satisfaction and can be considered at very high risk of depression • 23% of young people who are scoring ‘low’ in life satisfaction are also at risk from depression (NEF survey 2007) • Above average rates of diagnosable mental health conditions – estimated 8,000 children • Of those referred to CAMHS (JSNA 2010): • Emotional disorders – 51% • Neurodevelopmental – 12% • Behavioural – 15-20% • Self Harm 5% • Substance misuse – 3%

23. Outline of interventions • Core Health and Local Authority services delivering Healthy Child Programme (Children’s Centres, FNP, Nutrition, Youth Services, Education) • Specialist services: delivering hospital and community care for higher levels of need(e.g. LD, MALTs TaMHS, CAMHS) • Children & Young People’s Plan priority areas and other partnership work to tackle broader health issues

24. Situation for health - Health Poverty Index

25. Nottingham Plan 2020 Targets • Halve the proportion of children living in poverty • Move Nottingham out of the bottom 10% most deprived authorities in England • Ensure no neighbourhood is in the most deprived 5% nationally • Raise the % of children developing well across all areas of the early years foundation stage so that Nottingham is in the top 25% local authorities • Child obesity will be reduced to 18%, reduce the proportion of overweight and obese adults to 60% • Teenage pregnancy will be halved • Raise the % pupils achieving 5+ A*-C GCSEs including English and Maths, so that Nottingham is in the top 20% most improved local authorities • Reduce to 0% the number of pupils leaving school with no qualifications • The Nottingham Plan also has the cross-cutting aims of raising aspirations, making Nottingham a fairer city, and moving towards a more sustainable economy and way of life. These will also help to reduce health inequalities.

26. Summary • Child health is improving - but not equally for all children • Nottingham has some higher rates of child ill-health when compared with less disadvantaged areas and the England average • Many health problems in childhood have long term repercussions and therefore important for both individual and population health, and reducing the burden on the public purse • A broad range of influences affect health making it everybody’s business