Children

Sir Michael Marmot’s review of health inequalities recommends that action in the early years is crucial to giving every child the best start in life to reduce health inequalities across the life course.  The foundations of many aspects of human development (including physical, intellectual and emotional) are laid in utero and in early childhood.

The importance of the health and wellbeing of children is well documented.  There is national recognition of the importance of health/behaviour during pregnancy and the early years of life, with significant emerging evidence related to neo-natal science.  In particular, the importance of early experiences, responsive parenting and secure attachment.

The following JSNA topics are the most significant factors that increase a child’s risk of poor life chances:

Wider determinants of health

Education

Children who achieve low educational attainment are likely to suffer from lower life chances.

Poverty

Growing up in poverty can affect every area of a child’s development and future life chances.  Children from low income households are less likely to achieve their academic potential, less likely to secure employment as adults, more likely to suffer from poor health, more likely to live in poor quality housing and they are more likely to reside in unsafe environments.

Behaviour and lifestyle

Alcohol misuse

Alcohol misuse during pregnancy poses a significant health risk to the unborn child.

Children living with parents who are dependent on alcohol are more likely to suffer from emotional and educational neglect.

Children living in homes with adults who abuse are at a higher risk of becoming alcohol abusers themselves.

Illicit drug use

Children living with parents who abuse drugs are more likely to suffer from emotional and educational neglect.

Children living in homes with adults who abuse drugs are at a higher risk of becoming drug abusers themselves.

Smoking

Smoking during pregnancy poses a significant health risk to both the mother and the unborn child.

Parents who smoke around their children are significantly increasing their child’s risk of disease and ill-health.

Diet and nutrition

Breastfeeding gives a child the best start in life and is beneficial for the health of the mother.

Nutrition has a key role in the prevention and management of diet-related diseases (such as cardiovascular disease, cancer, diabetes and obesity).

Obesity

Obesity is one of the biggest risks to the health of the population. 

Obesity in children can lead to poor physical health (including increased risks for elevated blood pressure and Type 2 diabetes) and poor mental health (including low self-esteem, anxiety and depression).

Illness and death

Injuries

Injuries are a leading cause of death and illness of children and one of the most common reason for hospital admissions. 

Mental health

One-in-ten 5 to 15-year-olds has a mental health problem. Many continue to have mental health problems as adults.

Last updated: 2018-08-14 12:15:14
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1. What are the key issues?

Wider determinants of health

Education

A slightly lower proportion of children in Hartlepool (56%) achieve 5 A*-C GCSEs (including English and Maths) compared to the England average (58%).

Poverty

A higher proportion of children in Hartlepool (30%) are living in poverty compared to the England average (22%).

Behaviour and lifestyle

Alcohol misuse

A slightly lower proportion of adults receiving alcohol treatment in Hartlepool (30%) are in contact with their children compared with the England average (32%).

A higher proportion of dependent drinkers in Hartlepool (32%) are in treatment compared to the England average (13%).

Illicit drug use

Almost one-third (30%) of adults in treatment for substance misuse in Hartlepool have (or are living with) children.

Smoking

A higher proportion of adults in Hartlepool (22%) smoke regularly compared to the England average (21%).

A higher proportion of pregnant women in Hartlepool (23%) are smoking at the time of delivery compared to the England average (14%).

Diet and nutrition

A lower proportion of mothers in Hartlepool (46%) initiate breastfeeding compared to the England average (75%).

Obesity

A slightly higher proportion of reception age children (5-year-olds) in Hartlepool (9.9%) are obese compared to the England average (9.5%).

A higher proportion of children in year 6 (11-year-olds) in Hartlepool (24%) are obese compared to the England average (19%).

Illness and death

Injuries

A higher proportion of children (under 18-year-olds) in Hartlepool (152 per 10,000) are admitted to hospital due to injury than the England average (123 per 10,000).

Mental health

It is estimated that one-in-ten children have a mental health condition. Local data is not sufficient enough to provide evidence of the scale of the mental health problems among children in Hartlepool.

A higher proportion of adults in Hartlepool have certain mental health conditions than the England average.

Last updated: 18/11/13

2. What commissioning priorities are recommended?

Wider determinants of health

Education

Offer schools a more coherent package of school improvement measures. This can be done through a targeted, flexible and bespoke school improvement service level agreement (designed to meet the specific needs of individual schools).

Poverty

Tackle issues relating to employability and worklessness.

Behaviour & lifestyle

Alcohol misuse

Promote sensible drinking to reduce the harm caused by alcohol misuse.

Deliver a co-ordinated, stepped programme of treatment services that are effective, appropriate and accessible. The programme requires adequate capacity to meet demand and should be evidence based.

Illicit drug use

Improve the integrated substance misuse assessment, screening and core co-ordination.

Smoking

Develop service level agreements which require all health professionals (including staff from primary and secondary care, midwifery and mental health) to raise the issue of smoking through a brief intervention and refer to Stop Smoking Services for support.

Diet and nutrition

Implement evidence-based best practice to maximise breastfeeding initiation and continuation.  Ensure appropriate support services are in place and health professionals are appropriately trained to provide support and consistent advice throughout antenatal and postnatal periods.

Increase the promotion and uptake of the national ‘Healthy Start’ initiative (particularly vitamin supplements) to both professionals and the target group.

Obesity

Invest in the development and delivery of a children & young people’s weight management pathway/service.

Illness and death

Injuries

Ensure adequate resources are available for local partnerships and prevention strategies.

Mental health

Undertake a needs analysis of the emotional health and wellbeing of children and young people.

Last updated: 18/11/13

3. Who is at risk and why?

Wider determinants of health

Education

Children are at greater risk of low educational attainment if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Have a family member who misuses substances;
  • Live in a single parent family;
  • Are a looked after child;
  • Have a poor school attendance record;
  • Suffer from poor mental health; and
  • Have a learning disability.

Poverty

Children are at greater risk of being subjected to the effects of poverty if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Have a family member who misuses alcohol;
  • Have a family member who uses illicit drugs;
  • Live in a single parent family; and
  • Are a looked after child.

Behaviour and lifestyle

Alcohol misuse

Children are at greater risk of being subjected to alcohol misuse if they:

  • Live in a deprived area;
  • Have a family member who misuses alcohol;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family; and
  • Are a looked after child.

Illicit drug use

Children are at greater risk of being subjected to illicit drug use if they:

  • Live in a deprived area;
  • Have a family member who uses illicit drugs;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child (they are four times more likely to use illegal substances than children raised in a household); and
  • Are in contact with the criminal justice system.

Smoking

Children are at greater risk of being subjected to passive smoking if they:

  • Live in a deprived area;
  • Have a family member who is a smoker;
  • Have a family member who misuses alcohol;
  • Have a family member who uses illicit drugs;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment.
  • Live in a single parent family; and
  • Are a looked after child.

Diet and nutrition

Children are at greater risk of having a poor diet and poor nutrition if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Are not breastfed at birth;
  • Have a learning disability; and
  • Are from a black or minority ethnic group.

Obesity

Children are at greater risk of being obese if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Are not breastfed at birth; and
  • Have a learning disability.

Illness and death

Injuries

Children are at greater risk of being injured if they:

  • Live in a deprived area;
  • Are under-5 years old (under 5-year-olds are more vulnerable to unintentional injuries in the home);
  • Are over-11 years old (11 to 18-year-olds are more vulnerable to unintentional injuries on the road);
  • Have a disability or impairment (physical or learning);
  • Are from a black or minority ethnic group;
  • Live in accommodation which potentially puts them more at risk (including multiple-occupied housing and social and privately rented housing); and
  • Are a 1 to 14-year-old boy (twice as likely to die of injuries than girls).

Mental health

Children are at greater risk of having poor mental health if they:

  • Live in a deprived area;
  • Face three or more stressful life events (three times more likely than other children to develop emotional and behavioural disorders);
  • Have stressful family situations;
  • Have a family member with poor mental health;
  • Live in rented accommodation;
  • Are in local authority or residential care;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Have a learning disability;
  • Have a  physical disability; and
  • Have a serious or chronic illness.
Last updated: 18/11/13

4. What is the level of need in the population?

Summary of child health and well-being in Hartlepool.

Source: Child and Maternal Health Observatory - ChiMat

Wider determinants of health

Education

It is clear from the scatter chart below that the electoral wards in Tees with the least proportion of children who have five or more GCSEs graded A* to C, are those with higher proportions of children living in a workless household.

Children in workless households v GCSE results, Tees electoral wards, 2010

The chart below shows that in Hartlepool, the proportion of 5-year-olds described as “good” (in the early years foundation stage profile) compared with those who receive 5 or more GCSEs graded A* to C has been decreasing over the last six years, there has however been an increase in the last year.

Poverty

The bar chart below shows that Hartlepool has a higher percentage of children living in poverty than the England average.

The map below shows the percentage of children living in poverty for the electoral wards in Tees.

The wards with the highest proportion of children living in poverty in Hartlepool are Dyke House, Owton and Stranton.

Tees map to % Children living in poverty, borough rank, by ward, Tees, 2010

Behaviour and lifestyle

Alcohol misuse

Content under development

Illicit drug use

The bar chart below shows that Hartlepool is estimated to have a higher rate of opiate and/or crack cocaine users than the North East and England average.

Smoking

The chart below shows that the proportion of pregnant women in Hartlepool who are recorded as smoking at the time of delivery is reducing each year. However, the proportion still remains higher than the North East average and significantly higher than the England average.

Diet and nutrition

The chart below shows that the proportion of women in Hartlepool who are breastfeeding at 6-8 weeks has remained static each year. Moreover, the proportion still remains lower than the North East average and significantly lower than the England average.

Obesity

The chart below shows that the prevalence of obesity of reception (5-year-olds) children in Hartlepool is reducing each year for both males and females. In 2009/10, the prevalence of obesity for males was lower than the national average.

The chart below shows that the prevalence of obesity of year 6 (11-year-olds) children in Hartlepool is reducing each year both males and females. However, the proportion still remains higher than the England average.

Illness and death

Injuries

The chart below shows that Hartlepool is estimated to have a higher rate of hospital admissions due to falls (under 5-year-olds only) than the England average.

The chart below shows that the rate of hospital admissions due to injury (under 18-year-olds only) in Hartlepool is increasing each year. This rate remains much higher than the England average.

Mental health

The chart below shows that Hartlepool is estimated to have a lower rate of adults with depression than the England average. This information must be treated with caution as the awareness of people with depression is estimated to be greatly under-recorded.

Last updated: 02/01/14

5. What services are currently provided?

The local Family Information Service (FIS) provides a range of information on all services available to parents and also hold up-to-date details of local childcare and early years provision:

http://www.stockton.gov.uk/citizenservices/learning/fis/

Please refer to individual JSNA sections for topic specific services.

Last updated: 18/11/13

6. What is the projected level of need?

Wider determinants of health

Education

As a result of the updated OFSTED schedule of inspection, it is likely that there will be an increased number of Hartlepool schools judged to be ‘satisfactory - requires improvement’. These schools will require co-ordinated support packages in order to bring about strong and sustainable improvement within the 24 months stipulated by OFSTED.

Poverty

Behaviour and lifestyle

Alcohol misuse

Unable to identify the local projected levels of need.

Illicit drug use

It is difficult to project the level of need due to the complex nature of illicit drug use.

Smoking

Content under development.

Diet and nutrition

Obesity

Obesity prevalence is forecast to rise for both adults and children.  The trend has been upward for decades, and suggests that by 2030 41-48% of men and 35-43% of women could be obese. The most recent data suggests that the rise in obesity is levelling off.  However, more than one-quarter of adults are already obese and there is a serious and growing burden of obesity-related ill-health.

The Foresight report suggests an increase in the prevalence of obesity among people aged under 20 to around 15% by 2025.  The proportion of boys having a healthy BMI will be 45% while for girls only 30% will be in the healthy weight category (Government Office for Science , 2007).

Percentage of children predicted to be obese by age and sex, England, 2004 and 2025

Gender

Age

2004

2025

Boys

6-10

10%

21%

11-15

5%

11%

All under 20

8%

15%

Girls

6-10

10%

14%

11-15

11%

22%

All under 20

10%

15%

Source: Foresight report

 

For children, there is evidence from the last three to four years of HSE data that the increase in child obesity is slowing. This is also evident from the local NCMP data. Forecasts to 2020 show encouraging signs that the rising trend may be levelling out, suggesting that there will be considerably lower proportions of overweight and obese children and young people than previously estimated McPherson et al, 2011). While it is encouraging that the trend in child obesity is levelling off, and may reduce in the future, the forecast prevalence of obesity and overweight remains high.

Forecasts for overweight and obesity in children and young people in 2020, England

Gender

Age

Overweight

Obese

‘Foresight’ forecast 2007

McPherson forecast 2011

‘Foresight’ forecast 2007

McPherson forecast 2011

Boys

2-11

22%

17%

20%

13%

12-19

25%

18%

19%

6%

Girls

2-11

34%

17%

14%

10%

12-19

35%

29%

30%

9%

 

Illness and death

Injuries

Mental health

Unable to identify the local projected levels of need.

Last updated: 02/01/14

7. What needs might be unmet?

Wider determinants of health

Education

School-to-school improvement work is still in is infancy and will require careful strategic managing by a range of partners (including the LA, head teachers and the Hartlepool Teaching School Alliance), to ensure that it is able to successfully address issues detailed in the JSNA.

Not enough children are progressing as they should be in Maths and English.

Poverty

Content under development.

Behaviour and lifestyle

Alcohol misuse

More robust data is required in order to identify the number of children affected by parental alcohol misuse.

Illicit drug use

Further consultation is needed to understand service users’/provider’s needs in order to know what needs are unmet.

Smoking

Many women continue to smoke during pregnancy, thus failing to give their child the best start in life.

Diet and nutrition

There in a need to increase the capacity and training of health professionals who are able to support women with breastfeeding in the first two weeks after delivery (as Hartlepool has its greatest ‘drop off’ in the numbers of women breastfeeding).

Obesity

There is a need for a children’s weight management service in Hartlepool. As the number of obese children in Hartlepool increase the demand for this service will grow.

Illness and death

Injuries

Not all schools take up the offer of pedestrian and cycle training.  If all schools did respond to the offer, it is unlikely that the local authority would be able to have the capacity to deliver in all schools.

Mental health

Due to the lack of a robust mental health needs assessment for children and young people, it is difficult to assess what needs are unmet.

Last updated: 18/11/13

8. What evidence is there for effective intervention?

Wider determinants of health

Education

Fair Society Healthy Lives a review of health inequalities (2010); Sir Michael Marmot http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review

Poverty

The foundation years: preventing poor children becoming poor adults (2010); Frank Field http://www.nfm.org.uk/news/77-family-policy/486-frank-field-final-indpendent-report-on-poverty-and-life-chances

Behaviour and lifestyle

Alcohol misuse

Preventing harmful drinking (PH 24) (2010) www.nice.org

Alcohol-use disorders (CG 100) (2010) www.nice.org

Illicit drugs

Drug Misuse: psychosocial interventions (CG 51) (2007) www.nice.org

Smoking

Quitting smoking in pregnancy and following childbirth (PH1) (2006) www.nice.org

School-based interventions to prevent smoking (PH23) (2010) www.nice.org

Preventing the uptake of smoking by children and young people (PH14) (2008) www.nice.org

Diet and nutrition

Breastfeeding:

Promotion of breastfeeding initiation and duration: evidence into practice briefing (2006) (NICE) www.nice.org

Maternal and child nutrition (PH 11) (2008) www.nice.org

Obesity

Weight management before, during and after pregnancy (PH 27) (2010) www.nice.org

Behaviour change at population, community and individual levels (PH6) (2007) www.nice.org

Obesity (PH 42) (2012) www.nice.org

Health Development Agency (2003) The management of Obesity and Overweight.  Evidence Briefing http://www.nice.org.uk/niceMedia/documents/obesity_evidence_briefing.pdf

Illness and death

Injuries

Strategies to prevent unintentional injuries (PH 29)  (2010) www.nice.org

Preventing unintentional injuries among under-15’s in the home (PH 30) (2010) www.nice.org

Preventing unintentional injuries among under-15’s: road design (PH31) (2010) www.nice.org

Mental health

Social and emotional wellbeing in primary education (PH 12) (2008) www.nice.org

Depression in children and young people (CG 28) (2005) www.nice.org

Last updated: 18/11/13

9. What do people say?

Wider determinants of health

Education

Approximately 50% of the children and young people surveyed said they worried about school work and exams (this was more common among girls than boys and more common among children in Year 10). Most young people were positive about school and the help and feedback they received (although this declined with age). (TellUs4 survey, 2010)

Poverty

A regional (North East) consultation with children (on poverty) identified a number of priorities highlighted in the JSNA poverty topic.

Behaviour and lifestyle

Alcohol misuse

More than half (51%) of children and young people said that they have never had an alcoholic drink. About two-fifths (42%) said that they had consumed an alcoholic drink and 7% did not wish to say. The majority of all children and young people surveyed had not been drunk in the previous four weeks (68%). (TellUs4 survey, 2010)

Viewpoint (2011) recorded that 63% of the people surveyed stated that better education and raising awareness of the dangers of alcohol misuse would help tackle alcohol-related problems in Hartlepool.

Illicit drug use

Content under development.

Smoking

Most children and young people said that they had never smoked (77%). The minority of children (10%) said that they had only tried smoking once and fewer children (4%) indicated that they had stopped smoking. (TellUs4 survey, 2010)

Diet and nutrition

Most children and young people had eaten fruit and vegetables the previous day (most commonly three or four pieces). (TellUs4 survey, 2010)

Health visitors in Hartlepool collected feedback from 844 women. Of those surveyed, 41% (348) initiated breastfeeding at birth and 14% (117) ceased breastfeeding before the health visitor’s primary visit.

Obesity

There has been some consultation work to develop the children’s weight management service. The results of this are not yet available.

Illness and death

Injuries

Content under development.

Mental health

  • The majority of children and young people said that they have one or more good friends;
  • The majority of children feel happy with life and have someone they can talk to;
  • Boys are more likely than girls to feel happy about life while girls are more likely to talk to their friends when worried than boys are;
  • Young people who said they were disabled are less likely to say they are happy;
  • The most common worries for children and young people are about education and their future;
  • Year 10 (11-year-olds) pupils are more likely to worry about exams than younger people;
  • Girls are more likely to worry about exams than boys. (TellUs4 survey, 2010)
Last updated: 18/11/13

10. What additional needs assessment is required?

Wider determinants of health

Education

No additional needs assessment is needed at present.

Poverty

Behaviour and lifestyle

Alcohol misuse

The Hartlepool Alcohol Action Plan ended in April 2013. An updated Plan for 2013/14 will be developed which will identify further needs assessment.

Illicit drug use

Undertake an in-depth analysis and review to determine best practice in prevention/treatment services.

Smoking

No further needs assessment required at this stage

Diet and nutrition

An analysis of the results of the CQUIN ‘maternity and health visiting antenatal contact pilot’ is required.

Obesity

Further work is needed to identify the views of children and families who will, potentially, use the new children’s weight management service.

Local data collection is needed to identify the prevalence of maternal obesity in Hartlepool.

Illness and death

Injuries

Detailed analysis of the reasons for admissions to hospital for injuries is required (particularly for those in the young age range and those admissions under 24 hours).

Mental health

A needs analysis of the emotional health and wellbeing of children and young people is required.

Last updated: 18/11/13

Key Contact

Name: Rachael Smith/Sally Robinson/Deborah Clark

Job Title:

e-mail: deborah.clark@hartlepool.gov.uk

phone: 01429 523397