Public Health for Children Professor Diane DeBell Anglia Ruskin University, Cambridge UK ddebell@compuserve.com

Publication date: December 2015

Why public health? “Health matters have for too long been viewed as somehow separate from the societies in which they are in fact embedded.” (Coburn 2003) Is Britain a toxic environment for children growing up in the 21st century? “It could be argued that if one applies a holistic definition of health, young people are no healthier than they were a century ago.” (Hall 2006)

Public health is about prevention What is public health? Public health is about prevention Kate Billingham 1997: “Public health is a distinctive way of seeing health problems: public health nurses and doctors ask different questions about their practice, looking beyond individuals to populations: Why is this happening? How often? What is the social context? Who else should be involved? What works and what doesn’t?

Billingham 1997 continued “Public health nurses and doctors also make different connections: Between individuals and social structures Between the stories that people tell them and the epidemiological evidence Between health services and other agencies Between medical and social models of health services and other agencies Between medical and social models of health Between health and social policies. They tend to have a commitment to a set of values based on equity, justice and work for social change at local and national levels.”

Why children & young people? 25% of the UK population are children. Despite having one of the most advanced health systems in the world, child physical and emotional outcomes in the UK are among the poorest in western Europe.

Thinking about children & young people 25% of the UK population are children. The UK has one of the poorest records of child mortality in Europe. (Everyday in the UK, 5 children die who would not have died if we had the same mortality rate as Sweden.) Half of all mental health problems begin before the age of 14; 75% by age 21. Children growing up without a father in the home: UK – 21.5% USA – 25% Germany – 15% Italy – 20% Projection for the UK – by 2025, the numbers will be 35% of all children. Reality – 67% of children in poorest communities in the UK live without both parents in the home – today. 3.5m children live in poverty in the UK. Despite having one of the most advanced health systems in the world, child physical health outcomes in the UK are among the poorest in western Europe.

Overview Main cause of childhood illness and death in Europe Non-communicable diseases (The Lancet, 2015) Contemporary risks to child health in the UK Poverty Nutrition Accidental injury Unmet sexual health needs Early years deficits Emotional and mental health needs unmet Poor coordination of services – health, education, social care

A closer look (examples) Nutrition and weight gain (causal factors) Poverty Poor control of the food industry Failure to provide physical exercise opportunities Sexual health needs unmet Mental health needs unmet Ask yourself whose responsibility are these health needs?

Public Health England Since 2013, gradual separation of function away from the NHS Transfer of PH functions and of budget control to local authority management by autumn 2015 Public health commissioning by local authorities/not by the NHS Public health functions that affect children & young people: Joint Strategic Needs Assessments (local analysis) Employment of health visitors and school nurses Local public health directors for each local authority Financial changes: Local authority funding of front-line staff £200m funding cuts (announced July 2015) Average cut of @ £1m/local authority

What does this mean for school nursing? Refer to my research findings over the past 20 years. Case study of Oxfordshire school nurse (10 July 2015, The Guardian) – key features of the work: Full-time post located in a secondary school A school nurse office/room for privacy Child/young person access via phone/text Teaching input to the school day We need to focus on Secondary school-age young people (age 11+) Collaboration with health visitors (early years at school)

Contact details Professor Diane DeBell Anglia Ruskin University Cambridge UK 44+(0)7801-262454 ddebell@compuserve.com Public health for children (2nd edition) Ed Diane DeBell Taylor and Fisher publishers To be published December 2015