Child Health in Nottingham – getting better, more to do

Dr. Peter CansfieldConsultant in Public Health Medicine

NHS Nottingham City and Nottingham Children’s Partnership

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

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

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

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

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

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

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

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

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

7%

11%

1%

5%

0%

11%

6%

7%3%

1%

1%

11%

15%

10%

11%

Infectious and parasitic diseases II Neoplasms III Diseases of the blood IV Endocrine, nutritionalV Mental and behavioural VI Diseases of the nervous IX Diseases of the circulatory system X Diseases of the respiratory system XI Diseases of the digestive system XIII Diseases of the musculoskeletalXIV Diseases of the genitourinary system XVI Perinatal conditions XVII Congenital / chromosomalXVIII Other symptoms, signs XX External causes of morbidity and mortality

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

Infant Mortality

Infant death rates - inequalities

How are we doing on Infant Mortality?

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2

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14

1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008Years (3-yr pooled data)

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Nottingham City PCT - mortality rate per 1000 livebirthsEngland - mortality rate per 1000 live births

European Union

Linear (Nottingham City PCT - mortality rate per1000 live births)Linear (England - mortality rate per 1000 live births)

Trend in infant mortality rate

falling faster than England

Large fall in 2008 – rate for 2008 = 4.3

compared with England rate of 4.7

Nottingham now below the England

average

Gap reducingGap reducing

Infant Mortality Progress

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

Breast Feeding Map

• Lower rates of breast feeding in deprived areas

• Similar patterns for child obesity, teenage pregnancy, and other child health related issues

Breast Feeding Progress

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

2004

/05

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2004

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2004

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2005

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2008

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Time Period

% B

irths

Whe

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Initi

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Quarterly FigureAnnual Out-turn2008/9 Target

Child health indicators in Nottingham

2009

2010

NCMP 200708 Histogram of BMI ZScores

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200

-5.2

-4.9

-4.6

-4.3 -4 -3.

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3 -1 -0.7

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-0.1 0.2 0.5 0.8 1.1 1.3

5 1.6 1.9 2.1 2.4 2.7 3 3.3 3.6 3.9 4.2 4.5 4.8

Z Score

Num

ber

91st and 98th Centile markers

Increasing weight

Incr

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199091%

below98%

below

Healthy weight in childhood

Teenage pregnancyNottingham City Teenage Pregnancy Projections

-20.0

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40.0

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80.0

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Time Period

Und

er 1

8 Ye

ars

Con

cept

ion

Rat

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r 100

0 W

omen

Age

d 15

-17

Year

s

Quarterly data to date

Projection based on whole time period since1998Linear projection based on last 2 years rate offallGrowth projection based on last 2 years rate offallProjection based on end of benefit of 'earlywins'

Note: Projections are derived mathematically from previous trends and do not represent modelling of outcomes based on interventions.

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%

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

Situation for health - Health Poverty Index

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.

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