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? 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 reducing Infant Mortality Progress

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. Increasing weight Increasing Number Average 1990 91% below 98% below 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