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

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

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

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

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?

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

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

% 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

All causes directly standardised mortality rate by deprivation quintile* (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

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

Child well-being: EU29 Summary

OECD Doing Better for Children (2009)

Percentage of all births which are teenage births

Children who rate their health as fair or poor

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.