8 th & 9 th November 2007 University of Mauritius Child health in UK primary care Dr Sonia Saxena General practitioner & senior lecturer

Agenda: child health in UK primary care Global burden of child ill health The state of child health in the UK 5 keystones to promoting child health in primary care Our reflections: Primary heath care provision for Mauritian children

Global child mortality

Death rates in UK and Mauritius country comparisons Source WHO

Death rates in children < 5 years old UK Mauritius Neonatal Injury Pneumonia Diarrhoea

Advantages of primary care setting for child health promotion UK NHS primary care is population based High contact rate in primary care Most prescriptions in primary care Continuity of care Focus on primary prevention Policy shift from responsive to strategic care (QOF)

Child health in primary care: Key areas for prevention and promotion Infection Injury Obesity Health inequalities and unequal access to healthcare Poor parenting

5 cornerstones in improving child health Nutrition Immunisation Environment Access to high quality health care Information for good parenting

5 cornerstones in improving child health Nutrition Immunisation Environment Access to high quality health care Information for good parenting

Evolution in the developed world

% Obese 0-9.9% % % % % ≥30% Self Reported data North America 14-30% South Central America 16-28% Africa 5-10% South East Asia & Pacific Region Nauru 80% Tonga 47% Cook Island 41% French Polynesia 36% Samoa 33% Eastern Mediterranean 26-36% European Region 23-30% © International Obesity Task Force, London –January 2007 Global Prevalence of Obesity in Adult Males

Bare facts Rising prevalence of obesity in England 1 in 2 adults are overweight 1 in 4 children overweight Estimated cost of obesity & overweight £6.4 billion pa

FRENCH FRIES 20 Years AgoToday 210 Calories 2.4 ounces How many calories are in today’s portion of fries? Determinants: diet

610 Calories 6.9 ounces Calorie Difference: 400 Calories FRENCH FRIES 20 Years AgoToday 210 Calories 2.4 ounces Diet

Sedentary lifestyle: 50% US adults

Ethnic group Adjusted odds ratio Ethnicity: obesity in British boys Saxena et. al Arch Dis Ch Data from Health Survey for England

Nutrition Mothers advised to breast feed Healthy eating guidelines in over 2’s Avoid sugar to limit dental caries Growth monitoring

5 cornerstones in improving child health Nutrition and sanitation Immunisation Environment Access to high quality health care Information for good parenting

Who is this and what is he doing?

What are the benefits of immunisation?

Annual measles notifications & vaccine coverage England and Wales MMR vaccine Measles vaccine MR campaign Source: Office for National Statistics and Department of Health

The measles story Daily Mail newspaper

Confirmed measles cases Source: Notifications of Infectious Diseases confirmed by salivary antibody detection at the PHLS Enteric and Respiratory Virus Laboratory

Key messages: immunisation Central to GP role for child health promotion Vaccine controversy Communication about benefits Respect parental choice Implementation is key-monitor and audit uptake

5 cornerstones in improving child health Nutrition and sanitation Immunisation Environment Access to high quality health care Information for good parenting

Environment

Environment impact on sedentary behaviours In the 6-17 year old age group, children play on average 8.3 hours per week What if we could turn this completely sedentary time into 100% physical activity? Gamer cycle

Key messages: outside environment Encourage physical exercise: Walk or cycle to school (safely) schemes Safe places to play, sports facilities Safety outside: Road visibility when walking Car seatbelts Speed restrictions

Key messages: home environment Smoking Smoke detection Childproof medicines

5 cornerstones in improving child health Nutrition and sanitation Immunisation Environment Access to high quality health care Information for good parenting

UK primary care

Access to primary health care -US

Mean consulting rates for severity of illness by social class Saxena et al BMJ 1999

5 cornerstones in improving child health Nutrition and sanitation Immunisation Environment Access to high quality health care Information for good parenting

Education education education

Information for parents

Conclusions 1.Nutrition 2.Immunisation 3.Environment 4.Access to high quality health care 5.Information for good parenting

Reflections: How well does primary care in Mauritius address these key areas? 1.Nutrition 2.Immunisation 3.Environment 4.Access to high quality health care 5.Information for good parenting

8 th & 9 th November 2007 University of Mauritius Happy Diwali