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Don’t forget the basics: Health Malmö, September 26, 2013 Stefan Kling, MD City of Malmo, Sweden

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Presentation on theme: "Don’t forget the basics: Health Malmö, September 26, 2013 Stefan Kling, MD City of Malmo, Sweden"— Presentation transcript:

1 Don’t forget the basics: Health Malmö, September 26, 2013 Stefan Kling, MD City of Malmo, Sweden

2 The European health report 2005 Public health action for healthier children and populations

3 The Scandinavian Welfare societies Belief in social engineering Contract between citizens and state: state provides social and economic security, but has a certain right to intrude into the private sphere for control of misuse and reliable statistics as a base for health and social policy.

4 Personal ID number (PNR) All nordic countries have a unique personal ID number for its residents Makes it easy to follow individuals over time in national registers and health records Makes it easy to link data from different sources to individuals

5 I. Childrens Health in Sweden – What do we know? 2 million children 60-70% live with both parents Majority – good psychosocial health Psychosocial health and wellbeing among schoolchildren worsen across ages Students not living with their parents – most vulnerable

6 II. Childrens Health in Sweden – What do we know? Majority of children – good psychosocial health Percieved physical impairment – 14 % of students - allergies or asthma - overweight - visual and/or hearing impairments - ADHD - chronic disease; epilepsy or diabetes - dyslexia (Swedish National Institute of Public Health, 2009; National Board of Health and Welfare, 2009)

7 The Swedish school system Preschool for all from 3 years of age (not compulsory, but includes >95% of resident children) Optional preparatory year from age 6 (preeschool class) A unitary compulsory primary school of nine years from age 7 to 16. A diverse secondary school from age 16.

8 Health Care System for Children Child Health Service, age 0-5 School Health Service, age 6-18

9 Child Health Service Development assement visits Growth checks Vaccination schedule Parental support

10 School Health Service Health profiles (preschool, grade 2-4-8, upper secondary school) Growth checks (incl. BMI) Vision Hearing Back checks Vaccination schedule Individual health talks

11 Substitute Care Any kind of custodial or residential care for a child that is ordered or otherwise sanctioned by the court, and in which a child does not continue to live with either of the birth parents.

12 How many are they? 4% of all Swedish children are taken into care during their childhood 1% spend at least 5 years in the care system 2/3 are teenagers when they first enter care

13 Care for younger children Usually foster care Foster homes are more and more often mini- institutions (HVB-hem), with one family caring for 3-5 children. Many are integrated into companies with many homes, run by the municipalities or private entrepeneurs

14 Care for older children A mix of foster homes and institutions Many institutions mix children with diverse problems, and include both genders Foster homes are more and more often mini- institutions (HVB-hem), with one family caring for 3-5 children. Many are integrated into companies with many homes, run by the municipalities or private entrepeneurs

15 Physical health - Scandinavian studies. Swedish National Board of Health and Welfare: 2/3 of 108 children in foster care reported at least one physical health problem (Socialstyrelsen, 2000) Longitudinal Danish study: At 7 years of age disabilities and chronic disorders are much more common than in the general population At 11 years of age difference in health status remain (Egelund et al. 2008)

16 Physical health - International studies I 92% have some physical ”abnormality” 35% a chronic disorder N= Chernoff et al, 1994, USA

17 Physical health - International studies II High prevalence of untreated acute conditions, chronic illnesses, poor nutritional status, and inadequate immunization coverage (Hochstadt, Jaudes, Zimo, & Schachter, 1987; Simms & Halfon, 1994;). Very few children in foster care are noted to have normal physical examinations (Silver et al., 1999)

18 Physical health - International studies III 97% of the sample reported levels of physical discomfort 45% of the youth had some medical condition Health status of young offenders and their families (Shelton D, 2000), Maryland, USA

19 Physical health - International studies IV Extremely high rates of co-occurring health risk behaviours Lacking access to the health care system Extremely high rates of physical and sexual health problems The health status of youth in juvenile detention facilities (Golzari et al, 2006), California, USA

20 How about immunizations? Spanish study (Olivian, 2001) 17 % of adolescents, age 13-17, had incomplete immunizations on medical examination Canadian study (Bartlett et al, 2008) 73 % of adolescents, age 12-17, incomplete vaccinations

21 …………and oral health? A majority of detainees in this study had unmet dental treatment needs. (Bohlin, 2006), Texas, USA

22 What happens if society takes responsibility and steps in to protect the child? When society takes the role of the parent? What is the role of health care then?

23 AAP Guidelines 2002 – children should receive and be assigned…….. a health evaluation shortly after, if not before, entering foster care to identify any immediate medical needs; a thorough pediatric assessment within 30 days of entry; a consistent source of medical care (referred to as a “permanent medical home”) to ensure continuity of care; ongoing developmental, educational, and emotional assessments.

24 Fosterbarns Hälsa – Malmö 2010 Children i Foster Care - a retrospective review Children, age <16, n= 121 (121/223, 54 %) Retrospective study Data obtained from Health records: Child Health Care School Health Care (Kling et al, 2010)

25 Results Child Health Care 15 % incomplete immunizations 50% missing screening test for vision, age 4 School Health Care 10 % incomplete immunizations 10 % missing screening tests for hearing and vision 15 % missing health dialogue

26 Conclusions High rates of missing screening tests for hearing and vision High drop-out rates for health dialouges High percentage of incomplete immunizations.

27 Summary I Monitoring child development, preventive medicine, immunization against preventable diseases is a complex process. Optimally effective health care is based on active collaboration between families and health care professionals.

28 Summary II National Guidelines for health supervision provides effective approaches to caring for children and families whose health and adaption are thought to be in the normal range.

29 Summary III The high incidence of somatic health problems among children in care is well documented in international litterature. Differentiating between physical symptoms of organic cause and symptoms of a psychosocial nature is a professional challenge

30 Summary IV A pediatric health supervision visit, including medical interview, physical examination and screening procedures is an opportunity to explore issues of physical symptoms and to manage failure of previous attempts to address health prevention and medical problems.

31 Summary V All children in foster care need to receive initial health screenings and comprehensive assessments of their medical, mental, dental health and developmental status. Results of these assessments must be included in the court-approved service plan.

32 Yours sincerely –


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