1. 8 th & 9 th November 2007 University of Mauritius Child health in UK primary care Dr Sonia Saxena General practitioner & senior lecturer

2. 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

3. Global child mortality

4. Death rates in UK and Mauritius country comparisons Source WHO

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

6. 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)

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

8. 5 cornerstones in improving child health Nutrition Immunisation Environment Access to high quality health care Information for good parenting

9. 5 cornerstones in improving child health Nutrition Immunisation Environment Access to high quality health care Information for good parenting

10. Evolution in the developed world 1980 -2005

11. % Obese 0-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥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

12. 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

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

14. 610 Calories 6.9 ounces Calorie Difference: 400 Calories FRENCH FRIES 20 Years AgoToday 210 Calories 2.4 ounces Diet

15. Sedentary lifestyle: 50% US adults

16. Ethnic group Adjusted odds ratio Ethnicity: obesity in British boys Saxena et. al Arch Dis Ch 2004. Data from Health Survey for England

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

18. 5 cornerstones in improving child health Nutrition and sanitation Immunisation Environment Access to high quality health care Information for good parenting

19. Who is this and what is he doing?

20. What are the benefits of immunisation?

21. Annual measles notifications & vaccine coverage England and Wales 1950-2000 MMR vaccine Measles vaccine MR campaign Source: Office for National Statistics and Department of Health

22. The measles story Daily Mail newspaper 28.6.2002

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

24. 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

25. 5 cornerstones in improving child health Nutrition and sanitation Immunisation Environment Access to high quality health care Information for good parenting

26. Environment

27. 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

28. 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

29. Key messages: home environment Smoking Smoke detection Childproof medicines

30. 5 cornerstones in improving child health Nutrition and sanitation Immunisation Environment Access to high quality health care Information for good parenting

31. UK primary care

32. Access to primary health care -US

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

34. 5 cornerstones in improving child health Nutrition and sanitation Immunisation Environment Access to high quality health care Information for good parenting

35. Education education education

36. Information for parents

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

38. 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

39. 8 th & 9 th November 2007 University of Mauritius Happy Diwali