Analysis: How local services can bridge the gulf in child health
Tuesday, July 1, 2008
For the first time, the Department of Health has provided a detailed breakdown of child-health indicators at local level. Joe Lepper examines the figures and finds out what lessons can be learnt from the best and worst areas in the country.
Teesdale District Council's lead member for health, Keith Stansfield, is in celebratory mood. The latest government health figures revealed that the district has the lowest childhood obesity rate in England.
A major factor in this success, says the independent councillor, is a strong focus on leisure; the council's Teesdale Leisure Centre works closely with schools.
"It's a great centre, and we make sure it is an attractive place for children to come to. You can't improve the health of children without making sure they have good facilities in which to play sport and exercise," he says.
The Department of Health's latest statistics cover a wide range of indicators, and, for the first time, they have been broken down to a local authority level.
This local breakdown will feed into the government's child health strategy, which is due out later this year, and will help primary care trusts and councils better target services by identifying "local health hotspots", according to public health minister Dawn Primarolo.
Wide gap in children's health
One of the major themes to arise from the figures is the wide gap between the best and worst performing areas in terms of children's health. Poor urban areas came out particularly badly.
Among the worst areas is the London Borough of Hackney, where 16 per cent of its reception-year children are obese. This is the worst rate in England, and compares with just five per cent in Teesdale and an England-wide average of 10 per cent.
Tam Fry, a National Obesity Forum board member and chair of the Child Growth Foundation, says Teesdale's emphasis on leisure is a lesson for areas with poor children's health.
"There is so much that councils and trusts can be doing, and leisure is vital," he says. "In some areas, parks are no-go zones. Some councils are putting in park rangers to clear out the drug abusers and alcoholics and work with children to make them pleasant places to go."
Schools need to do more with the meals they provide, he adds. Other areas of good practice included banning fast food vans from outside schools, preventing pupils from leaving school premises at lunch times to stop them buying fast food, and spending more on healthy school meals.
Fry is also concerned about the state of many swimming pools. "Some councils are putting up charges or closing down pools altogether. What they should be doing is offering free sessions," he adds.
He argues that council action should be wider still, extending even to the planning department, with councils urged to ensure fruit and vegetable shops are readily available, "rather than concentrated in the rich areas".
Hackney has taken on board much of Fry's advice. Through links-ups in health, education and leisure, the council now offers free fresh fruit in schools. It has also carried out healthy cooking sessions at 70 children's centre nurseries, and there is free swimming for under-18s at council pools.
Its status as a host borough of the London 2012 Olympics has prompted further activity in Hackney. Pupils at 10 of its schools have been given the chance to take part in Olympic sports such as discus through a scheme called Personal Best. To coincide with World Olympics Day, the borough staged its first Hackney Summer Games last week.
Labour councillor Rita Krishna, Hackney's lead member for children's services, is optimistic that the area's poor record on obesity can be addressed effectively through such projects. "There is a link between poverty, deprivation and obesity in Hackney, but there is partnership work going on to tackle this," she says.
Sport in school is another of the child-health indicators covered in the figures. This is measured in terms of the proportion of five- to 16-year-olds taking part in at least two hours of physical education or school sport a week. The Department of Health's figures put Malvern Hills District Council, in Worcestershire, top, with 99 per cent, well above the national average of 86 per cent.
Conservative councillor Serena Croad, Malvern Hills council's leader and lead member for children and young people, says: "Improving outcomes for children, and, in particular, health has been highlighted as a priority for us. Because of this it runs through all our services and is a focus of our partnership work."
This includes the district council spending more on school sports facilities and encouraging sporting link-ups between youth clubs and schools. "We work closely with the parish councils in the area to make sure that public open spaces are well maintained and enjoyed. If you provide the facilities, then young people will use them," says Croad.
Malvern has already improved. The Department of Health's school sport figures, for the year 2006/07, show a six per cent rise on 2005/06. "We don't want to stop there. Our next priority is to increase the number of pupils taking part in sports for at least five hours a week," adds Croad.
The worst-performing area in terms of school sport was Newcastle-under-Lyme in Staffordshire, where just 63 per cent of children in this age group take part in this level of activity.
A spokeswoman for Staffordshire County Council says one factor was a late start for the town's schools sports partnership, which has responsibility for meeting the two-hours target and for encouraging sporting link-ups between schools. This only launched in 2006, six years after the partnership model was developed at national level. Newcastle-under-Lyme's partnership was also hampered by the departure of its first partnership development manager after just two terms.
Physical activity
The council's spokeswoman added that, since then, a new manager has been in the job for more than a year, every secondary school now has a sports co-ordinator, and every primary school a primary link teacher, a role that links up with the partnership.
"The issue of childhood physical activity is a county priority in Newcastle. Adult participation is also lower in the area, so the task is not just about schools, it is about changing behaviour across the board," she added.
Jo Butcher, assistant director of well-being at the National Children's Bureau, is optimistic that the examples of good practice highlighted by the figures will feature in the government's child health strategy.
"Having access to the best services and practice around is enormously useful. I hope that a lot of the issues will be flagged up, such as the importance of partnership working and good leisure facilities," says Butcher.
Jason Pollard, policy officer at children's charity NCH, says the early signs from ministers are that the strategy will have a strong focus on early intervention and prevention to tackle children's health inequalities.
"Getting messages out to parents at the earliest stage about nutrition and exercise is important. Children's centres, as well as those in health and councils, have a role here," he says.
Partnerships are another area Pollard wants to see flagged up in the strategy: "Improving children's health is something for many different organisations and needs good working relationships between councils, primary care trusts and the voluntary sector. Co-locating services is one recommendation we hope is in there."
Stansfield echoes the need for partnerships across health and councils in order to improve children's health.
"One of the main reasons the results show our children are healthy is because of the strength of our strategic partnership. This makes sure what we all do joins up, and that those in health, leisure and education all work together," he says.
- www.lho.org.uk/health_inequalities/health_inequalities_tool.aspx
FIGURES SHOW THE STATE OF THE NATION
Indicators included in the Department of Health's figures include the dental health of five-year-olds. Those in Blackburn with Darwen have on average 3.2 rotten teeth, more than double the national average. Children in Lichfield District Council, in Staffordshire, have the best teeth.
In terms of infant deaths, West Lindsey, in County Durham, has the worst record, with 10.3 per 1,000 births, double the national average.
The London Borough of Lambeth was the best in England at encouraging breastfeeding but also has the worst record on teenage pregnancies, with 83 out of 1,000 under-18s conceiving, more than double the national average.
A Lambeth Primary Care Trust spokeswoman says the borough's social deprivation is a factor in the high teenage pregnancy rate. The trust has highlighted reducing this rate as a priority and improvements have taken place. Figures from the trust show the conception rate among teenagers has reduced by 8.4 per cent since 1998.
Work includes targeting sexual health promotion among the most at-risk groups, and providing information in different languages.