1. Insert name of presentation on Master Slide Maternal and child health- Population profile for North Wales 09/09/10 Presenter: Siobhan Jones, Specialty Registrar Public Health

2. Insert name of presentation on Master Slide “science and art of preventing disease, prolonging life and promoting health through the organised efforts of society"health WHO definition of Public Health

3. Insert name of presentation on Master Slide Aims of presentation Summary of population health needs in relation to maternal and child health Determinants of health Importance of introducing evidence based health prevention interventions into clinical settings Agencies working in partnership to improve population health

4. Insert name of presentation on Master Slide Maternity, neonatal, gynaecology and child health review – guiding principles Future health services for women and children will seek to: Take whole systems approach address preventable causes ill health at every opportunity Use early intervention/ primary prevention approach Provide as much clinical care in community settings as possible Provide safe, sustainable, efficient and affordable health services

5. Insert name of presentation on Master Slide Options generated must: be based on assessment of population need maximise health and wellbeing of women, children and families seek to reduce inequality and inequity in provision of health services

6. Insert name of presentation on Master Slide Clinical Programme Group's required to: Understand and account for health needs and demography of population in clinical service planning and delivery Instill wider determinants of health in daily strategic & operational aspects of CPG Introduce health and well being into clinical settings for staff and patients Use PH and Health Improvement measures to drive quality improvement Source: BCU CPG Chief of Staff Job Description

7. Insert name of presentation on Master Slide Health Inequalities Health Inequalities = undesirable differences in health between different population groups. Equity = taking action to tackle those differences when unfair or avoidable.

8. Insert name of presentation on Master Slide Determinants of Health and Well-being Used with permission – Dafydd Gwynne, IoACC Adapted from Dahlgren and Whitehead

9. Insert name of presentation on Master Slide North Wales Demography DemographicsNorth Wales Total population678,50 0 2,980,000 Life expectancy at birth: males 77.2 years 76.8 Life expectancy at birth: females 81.5 years 81.2 % population from ethnic minority background (2001) 1.0%2.1% Total number of births7,57034,572 Total number of deaths7,44832,148 % lower super output areas in most deprived 5 th of Wales 12%20% LA Population breakdown Betsi Cadwaladr University LHB Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham 678.5 69.0 118.4 111.7 97.0 150.5 131.9

10. Insert name of presentation on Master Slide Proportion of population aged under 18

11. Insert name of presentation on Master Slide Population Density

12. Insert name of presentation on Master Slide Deprivation

13. Insert name of presentation on Master Slide North Wales Lower Super Output Areas in most deprived 10% in Wales, 2008 Lower Super Output Area Local AuthorityWIMD 2008 Rank Rhyl West 2Denbighshire1 Queenway 1Wrexham3 Rhyl West 1Denbighshire4 Rhyl S West 2Denbighshire5

14. Insert name of presentation on Master Slide Deprivation and maternal/neonatal health Data for Wales comparing least with most deprived districts: Risk of death between 24 weeks gestation and one year of age 1.53 times higher Stillbirths increased by 41% Neonatal deaths increased by 20% Rate of preterm birth consistently higher [Guildea et al 2001] [Paranjothy S et al 2008].

15. Insert name of presentation on Master Slide Preterm births - inequalities

16. Insert name of presentation on Master Slide Low birth weight

17. Insert name of presentation on Master Slide Deprivation and child health Infant mortality rates are higher in lower socio- economic groups (DH 2007) The lower the socio-economic group the higher the rate of injury mortality. Children who grow up in poverty are more vulnerable and at increased risk of: –Poorer health, –Learning and behavioural difficulties, –Teenage pregnancy, –Lower income / unemployed as an adult –Social isolation (National Public Health Service, 2006, Department of Health, 2010)

18. Insert name of presentation on Master Slide Rate of childhood injury in Wales and deprivation (NPHS 2007)

19. Insert name of presentation on Master Slide Lifestyle factors impacting on maternal health In Wales: 37% mothers smoked at some point during pregnancy 22% smoked throughout pregnancy Mothers in Wales > likely to smoke and < likely to give up than other UK countries 54% NW adult population are overweight or obese. 55% women consumed some alcohol during pregnancy 7% pregnant women drink more than 1-2 units per week [Bolling 2006].

20. Insert name of presentation on Master Slide Risks associated with exposure to smoke in pregnancy and childhood Risks to MotherRisks to child Miscarriage and stillbirth Pre eclampsia Prematurity and low birth weight (LBW) Congenital abnormalities of heart, face and limbs Childhood asthma and wheeze Childhood middle ear infections Lower respiratory infections Meningitis Sudden infant death Children developing a smoking habit

21. Insert name of presentation on Master Slide Risks of obesity in pregnancy Maternal risksFoetal/child risks Maternal death or severe morbidity Cardiovascular disease Miscarriage Pre-eclampsia Gestational diabetes Thromboembolism Increased risk of Caesarean Section (CS) Infection post CS Anaesthetic challenges Infection from other causes /sites Post partum haemorrhage Stillbirth Neonatal death Congenital abnormalities Prematurity Lower breastfeeding rates

22. Insert name of presentation on Master Slide Alcohol Alcohol can adversely affect outcome of pregnancy: Miscarriage Chromosomal abnormality Structural congenital anomaly Disordered foetal growth Perinatal death Developmental delay Susceptibility to disease in later life

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25. Childhood injuries

26. Insert name of presentation on Master Slide Location of injuries

27. Insert name of presentation on Master Slide Immunisation Outbreak North Wales 2009 51 cases

28. Insert name of presentation on Master Slide Exposure to second hand tobacco smoke in children 165,000 new episodes of disease, 300,000 primary care contacts (£10 million) 9,500 hospital admissions (£13.6 million) 200 cases of meningitis 40 sudden infant deaths 23,000 children will go on to start smoking (RCP 2010)

29. Insert name of presentation on Master Slide Public health approaches seek to ensure: Safe, sustainable and high quality health services for population Whole systems approach to health care – primary, secondary, tertiary including working with Local Authorities and other partner agencies Evidence based interventions to prevent ill health systematically introduced as part of clinical practice Health interventions targeted at areas of greatest need Health care delivered as part of wider system

30. Insert name of presentation on Master Slide Future models of health service delivery… …should work with partner agencies to ensure: Key priorities for health prevention work identified Public health interventions are evidence based and cost effective Interventions targeted to reduce health inequality & inequities Identification of interventions most likely to impact on health service use