Overall child and maternal health in North Yorkshire is very good and is generally better than the average for England. On the whole the county performs better (and in many cases significantly exceeds) the England average across a wide range of child and maternal health indicators. Although we should be pleased about the positive results for North Yorkshire as a whole and we should celebrate the general high quality of children’s health across the county we should not be overly complacent about our achievements (and our good fortune
The health gap
We know that we need to continue to address the inequalities in children’s health which exist between the richest and poorest parts of the county and we recognise that reductions in child health inequalities can only be achieved when we take into account the wider determinants of health that directly affect our day-to-day life and standard of living. We need to adopt a system-wide approach to improve children’s overall health and wellbeing which acknowledges the significance of the wider social and economic problems associated with children’s health and the need to work together in partnership to create the right conditions to give all children and young people a healthy start to life.
North Yorkshire County Council recognises the wider determinants of health and is determined to reduce the inequalities in health which exist across the county. The Children’s Trust Board have commissioned a Child Health Summit, to take place in spring 2016, to consider the wider structural context of children’s health and identify the right child health models to tackle the inequalities iss
Critical Issues
Low birth-weight babies, childhood injuries, and children’s mental health
The rate of low birth-weight babies born in North Yorkshire is worse than the national rate and the percentage of mothers who smoke at the time of delivery (a known risk factor for low birth-weight babies) is classified as significantly worse in North Yorkshire than the England average.
The overall rate of unintentional injuries in children and young people in North Yorkshire is higher than the average for England (and most of our statistical neighbour averages) across all three age groupings. Two out of three measurements also show that the rate of childhood injuries has increased in North Yorkshire since the previous year and there is an emerging trend which shows a relatively high incidence of emergency admissions to hospital due to deliberate self-poisoning (The Paracetamol Challenge) amongst older youths.
Interrogation of the council’s own data-sets derived from its comprehensive survey of children and young people shows a marked and continuous decrease in emotional resilience and mental wellbeing by age group where children at KS4 record the lowest levels of good mental health across all age groupings.
Life expectancy at birth and child poverty
Life expectancy at birth varies significantly across North Yorkshire. Two children born in North Yorkshire today might well experience totally different health trajectories based uniquely on where they are born - when we might board a train at Northallerton, by the time we arrive at Scarborough a child’s life expectancy has been reduced by more than three years, at least. Inside North Yorkshire variations in the distribution of child poverty are as wide as anywhere in England and in some parts of the county the rates of child poverty (which are strongly linked with child health outcomes) are as high as some of the poorest places in England. Analysis of the relationship between geographical variations in life expectancy at birth and the distribution of child poverty levels across the county highlights the wide and worsening inequalities in health between the county’s districts which are strongly correlated with comparable variations in the distribution of child poverty rates. When we consider the wide range of risk factors which contribute most significantly to the widening inequalities in children’s health which we observe today in North Yorkshire low household income and resulting child poverty is perhaps the most important variable that we need to think about.
Strive to be outstanding
In spite of the better than average health and wellbeing in North Yorkshire overall, when we consider the various health scores for the county against England’s best results in 2015 the county is not included in the upper (best) quartile for any of these measurements. We need to think of better ways to evidence the effectiveness of our interventions. To achieve this, it could be that we need to start to compare ourselves and measure our progress against national and international best practice.
Ensure a healthy start to life
The number of mothers who continue to smoke during pregnancy in North Yorkshire is classified as significantly worse than the average for England, whilst children in care are less likely to have up-to-date immunisations compared with other children across the county. We need to ensure that all children have a healthy start to life, not just from birth onwards but even before birth, and that access to health services for children in care, including vaccinations, are continuously improved.
Tackle the incidence of injuries and accidents
Interrogation of objective national data-sets highlights the higher levels of childhood injuries in North Yorkshire compared against all the usual benchmarks. We need to reverse the present upward trend in the rates of childhood injuries for some key age groups and we need to develop our understanding of and address some of the major causes of injury at different stages of the life-course. Intelligence also shows that there are a disproportionately high number of young people admitted to hospital due to deliberate self-poisoning and we have a high number of children who are killed or seriously injured in road traffic accidents in North Yorkshire. We need to work in partnership to reduce the rate of deaths and injuries due to road traffic accidents and to develop our understanding of where and why they occur in the county. We also need to work harder and smarter to understand and reduce the numbers of young people engaged in risky lifestyles, especially for some of the emerging dangerous behaviour such as deliberate self-poisoning (‘The Paracetamol Challenge’) amongst older youths.
Listen to and learn from what children tell us (e.g. about their mental health)
Listening to children and young people is at the very heart of our strategic planning process so when older children tell us that many of them do not find their school lessons around mental health useful we need to respond to this and think of new and better ways to engage with older children about mental health issues – especially when the largest proportion of pupils with poor mental health are at KS4. Many young people in North Yorkshire have poor mental health which is excessively concentrated in certain parts of the county – often (but not always) associated with poverty. We need to work together to ensure that all children and young people enjoy good emotional and mental health and we need to target our support to those who need it most.
Keep our promise to address the wider determinants of health
As with many other parts of the country, the stubborn issue of widening inequalities in health is perhaps the most challenging problem which we need to address in North Yorkshire today. If we wish to fulfil our pledge to make our best effort to reduce inequalities in health we need to recognise and tackle what we know to be the root cause of inequality which is child poverty. North Yorkshire recognises the significance of inequalities in child health outcomes across the county and realises the relationship with the wider social and economic problems often associated with poverty and deprivation, but the current strategic approach for tackling inequalities in health is centred on a narrow medical model of public health which prioritises the early development of healthy behaviours and promoting healthy lifestyles. We need to acknowledge that inequality is largely a structural problem which can only be partially resolved by individuals and families. We need to work together in partnership with a broad(er) range of agencies to build stronger communities and address the wider structural determinants of health.
Please visit the Public Health England Child Health profile below;
http://fingertips.phe.org.uk/profile/child-health-profiles/data#page/0
Download the data here:
https://hub.datanorthyorkshire.org/dataset/jsna-data/resource/a135cac3-240a-4581-90d3-36ae975383e7
Author: Anthony Ruddy
Date published: 16/03/2016