THE HEALTH CHALLENGE Sheila Shribman National Clinical Director Children, Young People & Maternity

The scale of the problem High prevalence of risk factors compared to other European countries (e.g. births to women under 20 years of age; women smoking during pregnancy) Risks are not distributed equally; links to deprivation and with a growing impact of economic recession Our rising birth rate, relatively high incidence of teenage pregnancies and rising proportion of pregnancies in older women means more risk to manage and a growing target group for health promotion. Increased hospital activity and preventable child deaths 1.1 million children with asthma in the UK (3 children in every classroom) Type 2 diabetes likely on the increase as a result of the increased proportion of obese children Disability services lack consistency across the country, with evidence of unmet need Significant prevalence of mental and emotional disorders with consequences for educational outcomes

Neonatal and infant mortality Reductions in infant mortality (1970 to 2006) in England & Wales to 5 per 1,000 live births are: leveling off unevenly distributed (inequalities by region, maternal age and country of birth) a poor position compared to other European countries Range of actions needed to impact on closing the gap in infant mortality, e.g. reducing conceptions in under-18s reduce overcrowding in the routine and manual socio-economic group reduce the rate of smoking in pregnancy reduce the prevalence of obesity and improve infant nutrition early booking and optimal pre-conception care England’s neonatal mortality rate of 3.4 deaths per 1,000 includes wide variations, from 1.8 in Surrey and Sussex to 4.8 in South West Midlands

Long-term conditions and hospital activity Emergency admissions have increased over the past decade in the 0-19 age group Over 800, 000 emergency admissions of children and young people in England every year, with wide variations in rates at PCT level Long term conditions accounting for high numbers of emergency bed days are asthma, diabetes, epilepsy, cystic fibrosis and sickle cell disorders Children in England have one of the worst incidences of type 1 diabetes and one of the worst records of diabetic control Opportunities for health gain: the example of asthma: over past six years, average of 27, 500 hospital admissions each year for asthma in 0-18s cost of treating a child with asthma exceeds adult asthma treatment cost the more deprived a child is, the more likely that the child will attend A&E for an asthma-related admission an estimated 75% of current asthma related childhood hospital attendances are avoidable

Disability Research suggests 3 to 5.4% of under-18 population has a disability Evidence (from mapping) that outreach work is extending into community settings: family homes; schools; extended schools; children’s centres However, a lack of consistency in sources of information (such as definitions and eligibility criteria) used by Local Authorities for planning Large variation across PCTs in the adoption of key worker system – a system supported by evidence in the ability to improve quality of life for families Data from The Compass show that parents of 39% of children aged over 5 tell us that their child has unmet leisure needs A series of reviews on disabled children, mental health services and speech and language needs have reported confusion among parents and children about expectations of support

Mental health In 2004, one in ten children and young people aged 5-16 had a clinically recognisable mental disorder; 4% of children had an emotional disorder Children with emotional disorders were more than twice as likely as other children to have had unauthorised absence from school (21% compared with 9%) There were no changes to the prevalence of mental disorders for children and young people between 1999 and 2004 (ONS data) The UK ranked bottom amongst developed counties (OECD) for subjective wellbeing indicator The prevalence of mental disorders is greater among children and young people in certain family-types:

Our focus remains - a high priority for Children Challenges persist e.g. Infant mortality, teenage pregnancy, hospitalisations, LTC management, disability, mental health New challenges arising e.g. Obesity, autism, service redesign, NHS reform Unacceptable variations in risks and outcomes Children’s early experiences can have lifelong consequences: How do we ensure prevention early intervention and support No room for complacency: The Child Health Strategy is the vehicle for making it happen ChiMat informs local action