1. Exploring health inequalities in the Born in Bradford birth cohort study
Neil Small,
Professor of Health Research,
School of Health Studies, University of Bradford
I’m going to say a few words about data on infant mortality and on life expectancy that identifies worldwide variations
Then look at these phenomenon in “rich” countries
Then consider Bradford
In Bradford I will be focussing on infant mortality , deconstructing figures to identify differences by deprivation and by ethnicity.
Then I will introduce the Born in Bradford study – presenting its rationale/design and some findings, here focusing on ethnic differences an similarities
So if I wanted a metaphor for the presentation is would be peeling layers from an onion, or taking apart a Russian Doll

2. Infant Mortality Rate Bradford 3 year rolling averages

3. Infant Mortality Rate by Quintiles of Deprivation in Bradford
2 times more likely to have an infant death in deprived area compared to an affluent area compared to 9 times more likely 5 years ago
The reduction in the gap between deprived and affluent is partly due to decreases in rates for the most deprived areas but these have been offset by increases in rates in the affluent areas. small numbers
Analyses by quintiles struggles with small numbers so caution in interpretation
Simon to start HB to finish
Clear differences between most and least deprived areas
Increasing rates in the Least Deprived group not significant, due to very small numbers in this group
Could consider grouping the 2 most deprived and 3 least deprived for future trends due to size of nos
Rates nearly double in more deprived areas and rates within Pakistani Community higher than Bradford district rate 3

4. Born in Bradford
A birth cohort study comprising babies born in the city between 2007 and 2011: Mothers 12453: pregnancies : fathers 3448: babies 13818
Half the babies born into the most deprived quintile of the UK’s population.
About 5500 births a year in the city - so if we know that about 2300 babies were born in the UK yesterday 15 of them were born in Bradford.
Prompted by high infant mortality rate + by high morbidity –
Mean age of BiB mothers 27 – range 14 to 49.
We recruited mothers at 26/28 weeks of pregnancy still births – 0.6% of cohort.
The oldest babies in the study are 6 and the youngest 2

5. Who is in the sample? One of the things that makes the BIB cohort so unique is our ethnic diversity. The sample contains 45% Pakistani origin mothers, and 39% white british. This isn’t reflective of bradford as a whole (22% south asian). Of the Pakistani cohort of mothers, 56% were born in pakistan.

6. Comparing white British and Pakistani origin families.
Different patterns of health related behavior
Birth weight and growth – Pakistani origin infants lighter and shorter at birth. Catch up by age 2
SIDS – 4 times less likely in Pakistani babies
Birth defects/ congenital anomalies – cousin marriage doubles prevalence from 3 to 6% in Bradford
Diabetes in pregnancy and low levels of vitamin D higher in Pakistani mothers
Smoking - white British 33.7%; Alcohol (3 months before or during pregnancy 67.4% (Pakistani 3.3% and 0)
Barker hypothesis – on growth in early infancy
The national child measurement programme for reports that 22% of children in reception and 35% percent in Year 6 in Bradford are overweight or obese.
Diabetes – UK prevalence 4.26% (2.8 million) Deprivation – highest compared to lowest x2.5 to get type 2 x3 to have serious complications.
South Asians x4 or 5 (5 times takes the rate up to 21%) (population relatively young and most diabetes diagnosed +60)
1991 Back to Sleep campaign – rate has dropped by 70% since then. Eng and Wales rate (2008) 0.4, rate in Yorkshire and the Humber 0.53 – this approximates to 35 deaths in 2008 in the region –most deaths in babies less than 3 months , more in lower social classes, more in young mothers (under 20) , more boys than girls.
63% of Pakistani mothers in BiB are married to cousins.

7. Similarities in the cohort
Similar take up of antenatal care
Considerable obesity in pregnant women.
Levels of initiating and sustaining breast feeding low
High levels of eczema, asthma and allergies
High levels of acrylamide in diets of pregnant women
High levels of health problems identified by teachers when children start school
High levels of physical inactivity in children
Similarities in reported levels of positive attitudes to living in the city.
Obesity 23% White British + 25% overweight: : Pakistani about 16 and 28%
Has baby ever been breastfed 72.6% yes (UK 78%) White British 63.9%: Pakistani Mean length of time breast feeding WB 2.5 months: Pak 3 months
Rise in infections across the country – measure when immunity is acquired. Measure air quality, water quality
Links with low birth weight - highest rates in cross European study
Teachers identified things that they said wee likely to inhibit learning – poor speech and language development, dental decay, problems in motor skills, hungry children, short attention spans, allergies, autism, body weight, toilet training, behavioural problems, child mental health
Recommendations re physical activity
19.8% of 11 year olds are obese (England average is 18.7%)
Those reporting that they considered themselves a member of a group that was discriminated against – 5.5% Pak women : 1.9% White .

8. Interventions – education/ information + projects
Advice to health professionals re appropriate growth rates
SIDS – what is high risk behaviour
Health education/ promotion re cousin marriage + accurate data collection + plan care provision
Diabetes / vitamin D – pre and early pregnancy advice
Avoid chips and crisps.
Air quality – information to Public Health
Improved communication schools/health services
Open up playgrounds – PiP project
Parenting programmes for those at high risk re obesity
We are a research project – most recommendations are about better knowledge (more nuanced)
We are based in one city so we can work closely with local organisations/local people both re raising awareness and in service innovation
We know many of the underlying factors shaping health are global and structural – but we know that you can do things even within these constraints – some places that are ostensibly similar do better than others, some people do better than others in similar circumstances.
We want Bradford to do better, its children to be healthier and the lessons we learn here taken up so that children in similar cities across the UK and the world can do better.

9.
All studies described, all publications, lots of photographs. Eventually (soon) all data.