Investing today for tomorrow Why child health matters to all of us Reimagining health, North Yorkshire, April 2016 Eustace de Sousa National Lead: Children, Young People and

“A child can teach an adult three things: -To be happy for no reason -To always be curious -To fight tirelessly for something” Paulo Coelho PHE, alcohol and drug prevention 2

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Healthy and safe pregnancies Giving every child the best start in life Health and wellbeing of school age children and young people Specific focus on child obesity 5 Headline national public health priorities

Healthy and safe pregnancies

A decrease in stillbirth and infant mortality rates A decrease in under-18s conceptions A decrease in smoking in pregnancy An increase in breastfeeding Perinatal mental health Some key maternity indicators

Giving every child the best start in life

every child ready to learn at 2/2.5 years every child ready for school Giving every child the best start in life

Emotional and social development Good oral health Healthy weight and physically active Safe from injury Communication and motor skills Some key best start indicators

11 Why is this important? Up to 20% of women develop a mental health problem during pregnancy or within a year of giving birth. This can lead to disordered early attachment with long term consequences for mother and baby 1 Around 1 in 10 (9.1%) of children are obese at age 4/5 years 2 Approx. 80% of brain development takes place by the age of % of children have tooth decay at age 5 years 4 £23bn per year: the costs of failing to deal adequately with perinatal mental health problems and child maltreatment 5 7% of children around five years of age have speech, language and communication needs (SLCN) 6

Health and wellbeing of school age children and young people

We are seeing a mixed picture… 13 There are 7.4 million adolescents aged living in the UK, accounting for 12% of the population and forming part of 4.8 million UK households 1 The under-18 conception rate is at its lowest level since 1969, but remains twice that of 16 other European countries 2 Smoking, Drinking, Drugs survey shows declining trends in substance use overall in under 16 3 Since 2000 the trend has been one of stabilisation and decline across all the main drugs from heroin to cannabis Hagell, Coleman and Brooks Public Health England’s written response to the Health Education Select Committee inquiry into PSHE, July – Smoking, Drinking and Drugs Survey 2013

We are seeing a mixed picture… 14 Overall, 26% of young people feel low at least once a week Increases with age Gender differences Health Behaviour of School Age Children Survey England, 2014 Overall, 22% of young people said they had self- harmed In comparison with other studies, self-harm increasing over the past decade

15 Behaviour across adolescence Source: Hawkins & Monahan 2009

School Age and Young People Emotional health and wellbeing Resilience Safety Oral health Healthy weight and physically active

Six principles to shape our thinking about young people’s health PHE, alcohol and drug prevention 17 Putting relationships at the centre Focusing on what helps young people feel well and able to cope Reducing health inequalities Championing integrated services Understanding changing health needs as young people develop Delivering accessible, youth friendly services

Under-18 conception rate: England progress % reduction in under 18 conception rate – from 1998 to 2013 (22.8/1000) The lowest rate since 1969 when conception data collection began Proves that high rates are not inevitable, even in deprived areas, if young people are given choices Evidence that concerted effort – and sufficient time - can make a difference to complex public health issues 18

Great progress…but more to do!  England’s teenage birth rate higher than comparable European countries  Some LAs have seen increases between  Progress varies between and within local authorities: almost a third of LAs have a conception rate significantly higher than the England average  North Yorkshire has achieved great success with a 54.4% reduction; but Scarborough and Selby have rates significantly higher than the LA average & 22.2 respectively 19

20 The case for a shift to prevention Youth unemployment: £133m per week Estimated costs of dealing with a range of health and social problems Youth crime: £1.2bn per year Educational underachievement: £22bn per generation One year in a children’s residential home: £149,240 One year in foster care: £35,152 Admission to inpatient CAMHS: £24,482

Education is our greatest liberator … 21 Students with better health and wellbeing are likely to achieve better academically Effective social-emotional competencies are associated with greater health and well- being and better school performance There is a positive association between academic achievement and physical activity levels of students School culture, ethos and environment influences student health and wellbeing and readiness to learn

Child obesity

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Obesity prevalence by deprivation decile National Child Measurement Programme 2014/15 24

25 Obesity prevalence by ethnic group National Child Measurement Programme 2014/15 Children in Reception (aged 4-5 years) Children in Year 6 (aged years) Child obesity: BMI ≥ 95 th centile of the UK90 growth reference

26 Oral health – not just teeth Oral health is improving however in England almost a third (27.9%) of 5 year olds have tooth decay with 3 or 4 teeth affected (PHE 2012) Hospital admissions for yr olds were 9,585 Hospital admissions for 5 – 9 yr olds were 26,356 Stark inequalities exist with some of the most vulnerable, disadvantaged and socially excluded facing significant oral health problems - 44% of variation explained by deprivation Impact of poor oral health: Pain School absence/school readiness Treatment  fear and anxiety  time off school and work. Cost across all ages – £3.4 billion NHS

27 Childhood obesity work programme: 3 key stages across the lifecourse. Pre conception and maternity Women achieving a healthy weight before and between pregnancies Window of opportunity for families to commit to healthy lifestyles Early years - up to school age (0-5) Children starting school a healthy weight Physical activity and reduce sedentary behaviours School age (5-19) Primary school as a crucial period for intervention Maximising the opportunity for NCMP to raise awareness for children, families, schools and LA’s Physical activity and reducingsedentary behaviours

Taking Action

PHE Approach Universal services, targeted support based on the evidence Professional public health leadership Across all priorities focus on the range of inequalities Holistic and asset based approach – for children this includes the family Product ideas, development and dissemination done through collaborations with Assoc of DCS, Assoc of ADPH, and Local Government Assoc National team works in partnership with PHE Centres – support, inform, advise Embed public health in national/local programmes 29

Local leadership… 30 Source: A New Home for public health services for children aged 0-5: A Resource for Local Authorities. Local Government Association, Sept

“Healthy children become healthy people who create better lives for themselves, their communities and their countries” UNICEF PHE, alcohol and drug prevention 31

For more information Eustace de Sousa Web: 32

Resources

34 Screenshot of webpage

35 Updated C4L Sugar swaps leaflet to include: Explanation of the new guidelines Clear message about sugary drinks Introducing the new sugar app Lots of sugar swaps suggestions for cutting back on sugar throughout the day Recommended maximum sugar intakes for different ages Illustration of how much sugar is in everyday drinks, snacks and puddings Change4Life resources

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Healthy Lives, Healthy People: A Call to Action on Obesity in England obesity-in-england obesity-in-england Health Visiting Programme The five universal reviews key-visits/ key-visits/ The six high impact areas health-services-for-childrenwww.gov.uk/government/publications/commissioning-of-public- health-services-for-children Healthy Start voucher scheme Information Service for Parents Change4Life PHE Obesity website 37

What can we do to ensure that more children at KS4 find lessons about emotional health beneficial? 38

Designed in partnership with local communities ; Emphasising young people as a local asset ; Embedding young people’s voices ; Co-producing services with young people’s involvement ut