1. Reducing health inequalities among children and young people Director of Public Health Report 2012/13

2. Demography East Sussex has a generally older population profile compared to England. The highest birth rates are in Hastings and Eastbourne Almost one in five (18.8%) of children are living in poverty across the county. There is almost a six-fold difference in the number of children living in poverty in urban areas compared to those living in rural areas. The area with the highest percentage of children living in poverty is Central St Leonards, 50% and the area with the highest numbers of children living in poverty is in Hampden Park and in Langney, 795. Recommendation Local Authority need to ensure partnerships, strategies, policies and services are informed by this analysis of child poverty

3. Birth rates

4. Children living in poverty

5. The antenatal and postnatal period Infant Mortality The infant mortality rate in East Sussex in 2008-10 was 4.6 per 1000 live births, though the rate in Hastings is higher at 6.1 The following factors need to be tackled: Maternal Smoking Smoking in pregnancy contributes to 40% of all infant deaths 17% mothers smoking at delivery (ranges from 10% in Lewes to 22% Hastings) Areas of deprivation account for a four fold difference in smoking rates Breastfeeding About 49% of mothers are breastfeeding at 6-8 weeks The rates vary from 20% in women under 20 years to 72% in those aged 40 and over. Maternal obesity Associated with a higher rate of stillbirth, prematurity and congenital abnormalities Reducing under 18 conceptions Reducing child poverty

6. Infant mortality

7. Maternal smoking

8. Breastfeeding

9. Children of pre-school age Immunisation Our rates of primary vaccination have increased over the last 7 years and now reach 95% in some areas Our rates of MMR vaccination are low at around 85% compared to the 95% target. We have had a sustained increase in clusters of cases of measles in East Sussex. Some people are at a high risk of serious complications from getting measles, mumps and rubella, which are readily preventable by 2 doses of MMR There is a new national vaccination programme against whooping cough Oral health Although oral health has improved nationally, rates of tooth decay are strongly related to deprivation and is mainly a preventable disease Services aimed at reducing inequalities There are a range of services including Family Nurse Partnership, Children’s Centres and the new early years and health visiting model, Good Start, which all aim to improve outcomes for vulnerable families through early intervention

10. Immunisation Coverage

11. Recommendations Public Health commissioners need to ensure improved performance of stop smoking services and prioritise pregnant women and young people. NHS Maternity service commissioners need to monitor BMI and offer information and support on weight management; and provide more support for younger women and those in deprived areas to breastfeed. The NHS Commissioning Board needs to work in partnership with parents and primary care to improve vaccination uptake; and East Sussex County Council needs an assurance process to ensure the public’s health is protected. Commissioners for Children's services need to ensure that: –the Family Nurse Partnership continues to be evaluated and improves performance in stopping smoking, low birth weight, A&E attendances and use of Long Acting Reversible Contraception. –That the Good Start model meets local needs and improves care for vulnerable families. –That Children’s Centres are targeted on improving the health of the most vulnerable and deprived communities.

12. School age children and young people Educational achievement a key determinant of health. rates vary across the county and some indicators are below the regional and national levels. there are gaps in attainment between pupils eligible for free meals and other pupils (32%), and those with special educational needs and other pupils Rates of pupil absence and school exclusions are factors that contribute to health inequalities Young people who are not in Education, Employment or Training are of particular concern due to the impact of their current and future employment on their long-term economic well-being and health. In 2011/12 there were 387 (3.5%) 16 and 17 years olds who were not in Education, Employment or Training and of these 46% had special educational needs.

13. Recommendations Schools and academies should increase efforts to improve educational attainment in vulnerable groups. Children’s Services Commissioners need to ensure that the health needs of children with special educational needs and disability are met.

14. Schools Health-related Behaviour Survey Undertaken in the Spring of 2012 with over 4,500 14 and 15 year olds taking part. Good news Alcohol use has reduced Drug use has reduced and fewer young people start taking drugs at an early age (aged 13 or under) Bullying has reduced The proportion of young people who know where to get free condoms has increased The proportion of young people who know about the local sexual health services for young people has increased The proportion of pupils who claim that they have been the victim of violence or aggression in the area where they live in the last 12 months has reduced Areas of concern Smoking rates have not reduced and there has been an increase in Hastings There has been an increase in the proportion of pupils saying they are quite or very unhappy with their lives at the moment Exercise levels have not improved Eating habits have got worse Fewer young people are eating the recommended five portions of fruit and vegetables per day and fewer young people are eating breakfast compared with 2007 One in 10 pupils state that they never or rarely eat fresh fruit The rate of young people in sexual relationships has increased Fewer young people know about drug and alcohol treatment services for young people

15. Participants in Wealden

16. Smoking

17. Smoking at home

18. Alcohol

19. Alcohol use

20. Drugs

21. Teenage Pregnancy

22. Sexual health

23. Healthy Eating/Healthy Weight

24. Physical activity

25. Recommendations Local Authority commissioners and schools and academies should ensure a whole schools approach to healthy lifestyles for pupils, with a focus on smoking, exercise, healthy eating and emotional health. Schools and academies and Public Health commissioners need to ensure that young people know how to access the range of sexual health services available Public Health should commission evidence- based weight management services for obese children and their families.

26. Children and young people and healthcare

27. The NHS Atlas of Variation in Healthcare for Children and Young People

28. Recommendations