Professor Jonathan Bradshaw. English child health is dire (Plenary). CHIMAT Annual Conference: Informed Decisions and Intelligent Investment: The Future of Child and Maternal Health Services, Royal York Hotel, York, 18 March 2010.

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


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


ESRC and Save the Children – latest 2005
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
2.2
England
1.4
1.5
3.3
2
3
4.8
2
3.9
1.2
4
3.2
1.9
6
2.5
Rate per 1,000 livebirths
8
0
Least
deprived
Neonatal
4
IMD 2004 quintile
Most
deprived
Post-neonatal
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
12%
10%
8%
7.1%
1.7%
1.9%
6.3%
1.5%
5.5%
Least
deprived
0%
1.3%
2%
1.1%
4%
5.1%
6%
8.3%
England
2
3
4
Most
deprived
Under 1500 grams
IMD 2004 quintile
1500 to 2500 grams
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)
70
50
England
47.5
20
43.3
62.0
30
52.9
40
37.5
DSR per 100,000
60
10
0
Least
deprived
2
3
4
Most
deprived
IMD 2004 quintile
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 - ?tradeoff with freedom

11. Child well-being: EU29 Summary
Rank
Country
Child well-being
in the EU 29
Health
Subjective
Relationships
Material
Risk
Education
Housing
1
Netherlands
117.3
2
1
1
7
4
4
9
2
Sweden
114.8
1
7
3
10
1
9
3
3
Norway
114.8
6
8
6
2
2
10
1
4
Iceland
112.7
4
9
4
1
3
14
8
5
Finland
111.0
12
6
9
4
7
7
4
6
Denmark
109.6
3
5
10
9
15
12
5
7
Slovenia
107.1
15
16
2
5
13
11
19
8
Germany
106.1
17
12
8
12
5
6
16
9
Ireland
105.3
14
10
14
20
12
5
2
10
Luxembourg
104.8
5
17
19
3
11
16
7
11
Austria
104.2
26
2
7
8
19
19
6
12
Cyprus
103.7
10
13
Spain
103.6
13
4
17
18
6
20
13
14
Belgium
103.0
18
13
18
15
21
1
12
15
France
100.9
20
14
28
11
10
13
10
16
Czech Republic
98.9
9
22
27
6
20
3
22
17
Slovakia
98.7
7
11
22
16
23
17
15
18
Estonia
96.9
11
20
12
14
25
2
25
19
Italy
96.1
19
18
20
17
8
23
20
20
Poland
94.6
8
26
16
26
17
8
23
21
Portugal
94.5
21
23
13
21
9
25
18
22
Hungary
94.3
23
25
11
23
16
15
21
23
Greece
94.0
29
3
23
19
22
21
14
24
United Kingdom
92.9
24
21
15
24
18
22
17
25
Romania
87.0
27
19
5
24
27
26
Bulgaria
84.9
25
15
24
26
26
27
Latvia
84.1
16
24
26
22
27
18
26
28
Lithuania
82.3
22
27
25
25
28
24
24
29
Malta
81.9
28
28
21
13
11
14

12. OECD Doing Better for Children (2009)
Overall rank
Average rank
1 Sweden
4.5
2 Iceland
6.2
3 Norway
6.7
4 Korea
6.8
5 Denmark
8.0
6 Netherlands
8.3
7 Finland
10.3
8 Australia
11.0
9 Switzerland
11.2
10 Luxembourg
12.0
11 Japan
12.8
12 Canada
13.0
13 Ireland
13.5
14 Germany
14.2
15 Spain
15.3
16= France
16.0
16= Hungary
16.0
18 Austria
16.2
19 Belgium
16.7
20 United Kingdom 16.8
21 Czech Republic 17.7
22 Poland
17.8
23 United States
18.8
24 Portugal
19.3
25 Italy
19.7
26 New Zealand
20.2
27 Slovak Republic 20.7
28 Greece
21.0
29 Turkey
26.2
30 Mexico
28.4
Material Housing and Educational
well-being environment well-being
6
8
1
13
2
9
4
15
7
3
22
14
17
16
24
10
20
5
11
12
18
28
23
25
19
21
27
26
30
29
3
4
1
n.a.
6
17
7
2
n.a.
8
16
n.a.
5
18
13
10
21
9
11
15
24
22
12
20
23
14
25
19
n.a.
26
9
14
16
2
7
4
1
6
10
17
11
3
5
15
21
23
12
18
20
22
19
8
25
26
28
13
24
27
30
29
Health
and
safety
3
2
16
10
4
8
6
15
21
7
13
22
25
9
12
19
11
27
26
20
5
14
24
18
17
29
1
23
30
28
Risky
Quality of
behaviours school life
1
8
4
2
21
9
26
17
5
14
2
10
19
18
16
12
25
27
13
28
23
20
15
6
11
24
22
7
29
30
5
1
2
n.a.
8
3
18
n.a.
13
23
n.a.
16
10
9
6
22
7
11
19
4
17
15
14
21
20
n.a.
25
24
12
n.a.

13. Bulgaria
Romania
United Kingdom
Estonia
Slovakia
Hungary
Lithuania
Ireland
Iceland
Latvia
Portugal
Poland
Malta
Austria
Czech Republic
Luxembourg
Germany
Finland
Spain
Greece
Norway
Cyprus
Belgium
France
Slovenia
Italy
Denmark
Netherlands
Sweden
Percentage of all births which are teenage births
Adolescent fertility rate (births per 1,000 women ages 15-19), 2006
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0

14. ov
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G ia
re
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Sp
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It a
Fi ly
nl
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Bu nd
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Au a
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Sw n d
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R nia
ep
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Fr ic
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to
Po nia
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G uga
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m l
D any
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Po rk
N
et lan
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Lu rla
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R and
om
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N ia
or
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ni
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a
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La
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Ki t via
ng
d
H om
un
ga
ry
M
al
ta
Sl
Children who rate their health as fair or poor
HBSC 2005/06: Children who rate their health as fair or poor
25.0
20.0
15.0
10.0
5.0
0.0

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.