1. A call to action: reducing stillbirths? The public health picture in the North Dr Helen Duncan Programme Director, Child and Maternal Health Intelligence Network 22 nd November 2013

2. Mission 2 “To protect and improve the nation’s health and to address inequalities, working with national and local government, the NHS, industry, academia, the public and the voluntary and community sector.” The public health picture in the North

3. Outcome-focused priorities 3 1.Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol 2.Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency 3.Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics 4.Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme 5.Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives The public health picture in the North

4. Intelligence Network – Strategic Context ‘The Chief Medical Officer should consider how an intelligence network for children and young people’s healthcare, which crosses all settings, can be established by 2013, to drive up standards and effective use of data, information and intelligence in decision making’ ‘This could be approached by building on the work of ChiMat, and linking it to other key registries and data collections, ensuring a strong focus on children and young people within the evidence and intelligence function of PHE and the NHS.’ Children and Young People’s Health Outcomes Forum, July 2012 ‘Improving Children and Young People’s Health Outcomes: a system wide response’, February 2013 Pledge: signed by Minister for Health Services and contributing organisations, February 2013 onwards 4The public health picture in the North

5. What we want to achieve Reduce infant and child mortality and morbidity ahead of international trends Improve performance against the health and wellbeing outcomes detailed in the NHS and Public Health Outcomes Frameworks Improve surveillance of the health and wellbeing outcomes recommended by the Children and Young People’s Health Outcomes Forum Reduce variation in health and wellbeing outcomes and in the delivery standards of healthcare and public health services 5The public health picture in the North

6. Annual Report of the Chief Medical Officer The report identifies the main risk factors for stillbirths as: Older and younger mothers Smoking in pregnancy Low socio-economic status of the mother The report suggests that perinatal mortality is an indicator of maternal health and nutrition, as well as antenatal care. Annual Report of the Chief Medical Officer 2012. Our Children Deserve Better: Prevention Pays. 6The public health picture in the North

7. Stillbirths – the scale of the problem Definition: The Office for National Statistics defines a stillbirth as ‘a child that has issued forth from its mother after the 24 th week of pregnancy and that did not at any time after being completely expelled from its mother breathe or show any signs of life. Across England there were 3,357 stillbirths in 2012, which equates to a stillbirth rate of 4.8 per 1,000 total births. In 2009 according to WHO there were estimated to be 2.6 million stillbirths worldwide, 98% of which were in low and middle income countries. 7The public health picture in the North Principle Risk FactorsOther Risk Factors Maternal obesity Smoking Older women having a first baby Teenage mothers (Under 18) Ethnic background

8. Health Inequalities in the North – what the data tells us North East, North West, Yorkshire and the Humber

9. Background demographics 9 INDEX OF MULTIPLE DEPRIVATION, 2010 CHILDREN IN POVERTY, 2011 The public health picture in the North CHILD WELLBEING INDEX 2009 SCHOOL CHILDREN WHO ARE NOT WHITE BRITISH, 2013

10. 10The public health picture in the North Stillbirths per 1,000 total births ONS 2012; map: Child and Maternal Health Intelligence Network England rate: 4.8 North rate: 4.9 5.2 3.9 5.0

11. 11The public health picture in the North Stillbirth rate variance across the North ONS 2012; chart: Child and Maternal Health Intelligence Network

12. 12The public health picture in the North Stillbirths per 1,000 total births ONS 2012; chart: Child and Maternal Health Intelligence Network

13. Adult obesity prevalence by age Health Survey for England 2009-2011 Patterns and trends in adult obesity Adult (aged 16+) obesity: BMI ≥ 30kg/m 2 13The public health picture in the North

14. % Year 6 girls who are obese: England 14The public health picture in the North National Child Measurement Programme; map: Child and Maternal Health Intelligence Network

15. % Year 6 girls who are obese 15The public health picture in the North National Child Measurement Programme, 2011/12; chart: Child and Maternal Health Intelligence Network By Strategic Health Authority

16. Obesity prevalence by deprivation decile National Child Measurement Programme 2011/12 16 Child obesity: BMI ≥ 95 th centile of the UK90 growth reference 16The public health picture in the North

17. 17The public health picture in the North Under 18 conception rate per 1,000 female population aged 15 to 17 years in England Blackpool 58.1 N. Yorkshire 19.8 Rutland 9.4 ONS 2011; map: Child and Maternal Health Intelligence Network 6-fold variation across England 3-fold variation across the North 38.4 33.8 35.3

18. 18The public health picture in the North % Teenage mothers (age under 18 years) Hartlepool 2.8 Trafford 0.8 9-fold variation across England 3-fold variation across the North Wandsworth 0.3 Hospital Episode Statistics (HES). The NHS Information Centre for health and social care, 2011/12; map: Child and Maternal Health Intelligence Network 2.3 1.6 1.7

19. Pregnancy related hospital admissions (including delivery) by deprivation: rate per 100,000 population Hospital Episode Statistics database 19 The public health picture in the North

20. 20The public health picture in the North % Mothers aged 35 years or over City of London 42.6 North East Lincolnshire 9.4 4-fold variation across England 3-fold variation across the North Trafford 25.2 Hospital Episode Statistics (HES). The NHS Information Centre for health and social care, 2011/12; map: Child and Maternal Health Intelligence Network 14.6 16.8 15.3

21. % Smoking at Delivery 21 Trafford 8.2% Blackpool, 29.7% The public health picture in the North Public Health Outcomes Framework, 2011/12; map: Child and Maternal Health Intelligence Network 20.7 16.4 17.1

22. Variations across the North 22The public health picture in the North Lowest in North Highest in North VariationEngland Average Children living in poverty11.936.4x3.120.6 Under 18 conception rate19.858.1x2.930.7 Stillbirth rate2.5*9.5x3.84.8 Perinatal mortality rate4.211.0x2.67.5 Low birth weight5.99.7x1.67.4 Low birth weight of term babies1.64.6x2.92.8 Smoking at time of delivery8.229.7x3.613.2 Deliveries to women 35+9.525.2x2.719.2 Deliveries to women <180.82.8x3.51.3 Babies born to mums not born in UK3.643.5x12.126.7 * Middlesbrough and Darlington each had fewer than five stillbirths in 2012, and therefore the actual number and rate has been suppressed.

23. Summary 23The public health picture in the North Drivers - Maternal health and antenatal care

24. To find out more www.gov.uk/phe www.chimat.org.uk datagateway@phe.org.uk Twitter@PHE_uk Twitter@PHE_children Helen.Duncan@phe.gov.uk 24 The public health picture in the North