CHIMAT ANNUAL CONFERENCE Informed Decisions and Intelligent Investment: The Future of Child and Maternal Health services CHILD WELL-BEING Jonathan Bradshaw The Royal York Hotel 18 March 2010

Objectives  Introduce two sources of data now available through CHIMAT  Comparative data on child well-being and health  Bradshaw, J. and Richardson, D. (2009) An index of child well-being in Europe, J. Child Indicators Research, 2, 3, a a7476b b9750b54d&pi=0 6a a7476b b9750b54d&pi=0  Area level data on child health and well-being at small area level in England  Bradshaw J, Noble M, Bloor K, Huby M, McLennan D, Rhodes D, Sinclair I, Wilkinson K. (2009) A Child Well-Being Index at Small Area Level in England, J. Child Indicators Research 2, 2, dwellbeing dwellbeing2009  Show them on CHIMAT  Introduce some analyses that are possible

Conceptualisation of child well-being  Multi-dimensional approach  Based on children’s rights as outlined in the UN CRC  “the primary consideration in all actions concerning children must be in their best interest and their views must be taken into account”  What children think and feel is important  Aspirations  Child the unit of analysis  Well-being more important than well-becoming  Focus on outcomes not inputs  Use direct measures

Data Sources for EU index 2009  Surveys  Health Behaviour of School Aged Children (HBSC) at 2005  Programme for International Student Assessment (PISA) at 2006  Survey of Income and Living Conditions (EU) at 2006  Series  WHO mortality data base  World Bank World Development Indicators  OECD Health Indicators  EU Health for All Data base  OECD Education at a Glance,

DOMAINS OF WELL-BEING  43 indicators  20 components  7 domains

DOMAINS OF WELL-BEING  Health  Subjective well-being  P ersonal relationships  Material resources  Education  Behaviour and risks  Housing and the environment

Child well-being: Summary

Health Child health from birth Mortality rate, infant (per 1,000 live births)2006World Development Indicators Low birth weight newborns (lower than 2.5kg, [%])circa 2006OECD Health and EU Health for All Databases ImmunisationImmunization, measles (% aged months)2006World Development Indicators Child immunization rate, DPT3 (% aged months)2006World Development Indicators Child immunization rate, Pol3 (% aged months)2006HNP stats Children’s health behaviou r Children who brush their teeth more than once a day2005/06HBSC (Currie et al, 2008) Children who eat fruit daily2005/06HBSC (Currie et al, 2008) Children who eat breakfast every school day2005/06HBSC (Currie et al, 2008) Children's physical activity2005/06HBSC (Currie et al, 2008) Children who are overweight (BMI)2005/06HBSC (Currie et al, 2008)

HEALTH

CHIMAT: Health Map

Risk and safety Risk and Safety Violence and violent behaviou r Children involved in physical fighting at least once in the past year 2005/06HBSC (Currie et al, 2008) Children who have been bullied at school at least twice in the past 2 months 2005/06HBSC (Currie et al, 2008) Child deathsAll child deaths: All under 19 deaths per 100,000 childrencirca 2005WHO Mortality Database Risk behaviou r Adolescent fertility rate (births per 1,000 women ages ) 2006World Development Indicators 15-year-olds who have had sexual intercourse2005/06HBSC (Currie et al, 2008) 15-year-olds who used a condom at last sexual intercourse2005/06HBSC (Currie et al, 2008) Children who smoke at least once a week2005/06HBSC (Currie et al, 2008) 13 and 15 year olds who have been drunk at least twice2005/06HBSC (Currie et al, 2008) 15-year-olds who have ever used cannabis in their lifetime2005/06HBSC (Currie et al, 2008)

Components of risk and safety

Child well-being by GDP Euros per capita

WELL-BEING BY CHILD POVERTY RATE

Overall child well-being by spending on families with children 2005 as %GDP

16 Child well-being at small area level: Background  Index of deprivation 2004  Contains IDAC and education data  But need for age specific indices  CLG commission one on children to coincide with ID 2007  Thrust of policy increasingly local  Children’s Trusts  Every Child Matters  Comprehensive Spending Review  Child Poverty Unit

17 Methods  Child well-being rather than child deprivation  Multi-dimensional  Lower level super output areas and LAs  Mainly administrative data but census for housing and CiN survey  Domains: material well-being, health, education, crime, housing, environment and children in need  2005  Denominators pop estimates  Children 0-16 or 18 in FTE  Some indicators weighted. No weights applied to domains  Shrinkage estimation, factor analysis and exponential ranking

18 Material well-being  Children aged 0-15 in households claiming Income Support (Source: DWP, 2005).  Children aged 0-15 in households claiming Income Based Jobseeker’s Allowance (Source: DWP, 2005).  Children aged 0-15 in households claiming Pension Credit (Guarantee) (Source: DWP, 2005).  Children aged 0-15 in households claiming Working Tax Credit in receipt of Child Tax Credit whose equivalised income (excluding housing benefits) is below 60 per cent of the median before housing costs (Source: HMRC, 2005).  Children aged 0-15 in households claiming Child Tax Credit (who are not eligible for Income Support, Income Based Jobseeker’s Allowance, Pension Credit or Working Tax Credit) whose equivalised income (excluding housing benefits) is below 60 per cent of the median before housing costs (Source: HMRC, 2005).

19 Health  All emergency admissions to hospital for children aged 0-18 as a proportion of all children aged 0-18 in each LSOA (Source: Hospital Episode Statistics for England 2005/6).  All outpatient hospital attendances for children aged 0-18 as a proportion of all children aged 0-18 in each LSOA (Source: Hospital Episode Statistics for England 2005/6).  The proportion of children aged 0-16 receiving Disability Living Allowance (Source: DWP 2005).

20 Education  Two year rolling average points score at Key Stage 2 (aged 11) derived from test score. Source: Pupil Level Annual Schools Census (PLASC) ( ), National Pupil Database (NPD) ( ).  Two year rolling average points score at Key Stage 3 (aged 14) derived from test score. Source: PLASC ( ), NPD ( ).  Two year rolling average capped (best of 8 GCSE and/or equivalent vocational qualifications) points score at Key Stage 4 (ages 16). Source: PLASC ( ), NPD ( )  Secondary school absence rate – based on two year average of school level absence rates allocated to local area using PLASC. Source: PLASC and DfES absence rate data ( ).  Proportion of children not staying on in school or non-advanced further education or training beyond the age of 16 (2005). Source: Child Benefit ( )  Proportion of those aged under 21 not entering higher education (4 year average, ). Source: Universities and Colleges Admission Service, Higher Education Statistics Agency.

21 Crime  Burglary (four recorded crime offence types, police force data for April 2004-March 2005, constrained to Crime and Disorder Reduction Partnership (CDRP) level).  Theft (five recorded crime offence types, police force data for April 2004-March 2005, constrained to CDRP level).  Criminal damage (ten recorded crime offence types, police force data for April 2004-March 2005, constrained to CDRP level).  Violence (14 recorded crime offence types, police force data for April 2004-March 2005, constrained to CDRP level).

22 Housing  Access  Overcrowding - occupancy rating: the counts of households comprising couples, lone parents, and other types of household containing dependent children living in accommodation with at least one room too few is summed across the tenures and expressed as a proportion of all households to give a rate of ‘overcrowded’ households containing dependent children. Source: Census table CAS053.  Shared accommodation: people living in shared dwellings, aged 0 to 15 as a proportion of all children 0-15 in each LSOA. Source: Census table CAS054.  Homelessness: concealed (not the householder) families containing dependent children as a proportion of all families with dependent children. Source: Census table CAS011.  Quality  Lack of central heating: children aged 0 to 15 years old living in accommodation without central heating as a proportion of all children aged 0 to 15. Source: Census table CAS054.

23 Environment  Environmental quality  Air quality: combined air quality indicator. Source: Geography Department at Staffordshire University.  The natural environment: percentage of green space and woodland; number of bird species. Source: European Environment Agency’s CORINE Land Cover (CLC) database; British Trust for Ornithology bird breeding atlas.  Road safety: severity-weighted accidents per 1000 children aged under 16. Source: Department of Transport.  Environmental access  Availability of opportunities for sports and leisure: average number of different types of sports and leisure facility within walking distance for children aged 11 to 16. Source: Ordnance Survey Points of Interest.  Distance to school: average road distances to primary for children aged 4 to10 years and  secondary schools for children aged 11 to 16 years. Source: PLASC (2005) and Edubase (2005).

24 Children in need  Children in need under 19 as a proportion of all children under 19.  Actually modelled

25 Relationshsips between domains: Spearman’s r

26 Discussion  First attempt ?in the world  Administrative data strengths  Population data  Geographically coded  Up to date  Administrative data weaknesses  Indirect indicators  Nothing on subjective well-being, relationships, behaviour  Some events too rare IMR  Lack of data on eg health outcomes  Will it be useful?

Overall child well-being: York LSOAs

Poverty and health: NE local authority ranks

Poverty and Health in NE: %LSOAs in the lowest quintile

Quintile distribution of material well-being for SOAs in each LA in the NE.

Sources of data  EU29 – me   Child well-being index available at mmunities/childwellbeing2009  Download  Local Index of Child Wellbeing 2009 PDF, 267 kb, 20 pages Local Index of Child Wellbeing 2009  Local Index of Child Wellbeing 2009 MS Word, 166 kb, 20 pages Local Index of Child Wellbeing 2009  Child Wellbeing Index 2009 ZIP, 8781 kb Child Wellbeing Index 2009  Child Wellbeing County MS Excel, 78 kb Child Wellbeing County  Child Wellbeing District MS Excel, 153 kb Child Wellbeing District