1. CHIMAT ANNUAL CONFERENCE Informed Decisions and Intelligent Investment: The Future of Child and Maternal Health services ENGLISH CHILD HEALTH IS DIRE Jonathan Bradshaw The Royal York Hotel 18 March 2010

2. Summary  If we look at trend data – the main child health indicators are improving  But we should be very worried about  Those that are not improving  The inequalities in outcomes – especially spatially  Our comparative position is dire  What needs to be done

3. Evidence base  York books monitoring child well-being  ESRC and Save the Children – latest 2005  York comparative work on child well-being  UNICEF Report Card 7 (2007)  Child Wellbeing in the EU29 (2009)  OECD (2009)  York spatial analysis of child well-being  CLG project  CHIMAT

4. Child health is improving  Infant mortality (and its components)  Low birth weight  Child deaths  Child accidents and injuries  Self reported health of children  Sexual competence of young people  Teenage conceptions  Smoking  But for some the improvements are miniscule

5. Not improving  Parental assessments of child health  Infectious diseases  Early sex and sexually transmitted diseases  Diabetes and Asthma  Obesity  Drinking  Drugs  Mental health  Subjective well-being?

6. Inequalities  Almost all child health indicators strongly associated with poverty/class/inequality  Inequalities not falling – despite targets  Here are some data

7. infant mortality rate by deprivation quintile* 2002-04 Source: NCHOD Compendium *LAD deaths and livebirths aggregated into quintiles of equal livebirth numbers

8. % of births (with known birthweight) weighing <1.5kg and <2.5kg by deprivation quintile* 2004 Source: ONS 2004 birth extract *Super Output Area births aggregated into quintiles of equal birth numbers

9. All causes directly standardised mortality rate by deprivation quintile* 2002-04 (ages 0-19 years) Source: ONS annual death extracts/population mid-year estimates *LAD deaths/populations aggregated into quintiles of equal 0-19 years population

10. Our comparative position is dire  In EU  In OECD  In  health at birth,  immunisation,  self reported health  health behaviours (drinking, drugs, smoking)  adolescent fertility  The exception is accidental deaths - ?trade- off with freedom

11. Child well-being: EU29 Summary

12. OECD Doing Better for Children (2009)

13. Percentage of all births which are teenage births

14. Children who rate their health as fair or poor

15. What can be done?  Public health interventions do work  SIDS  Traffic  More of it more radical  20 miles per hour  Alcohol pricing, food advertising  Breast feeding  But key to progress is child poverty and inequality  Child poverty strategy  Marmot  Investing in child health saves money!  Evidence base critical.