PHE Starting Well Presentation August

Starting Well
Evidence to Lancashire Fairness
Dr Ann Hoskins
Director Children, Young People and Families
UK’s u15s mortality is now amongst the
worst in Europe
Since 1980 UK child
mortality rate has
moved from one of
the best in 11
European countries
to the worst.
Overview of issues to be covered
• Laying the foundations for good parenting
including a healthy pregnancy
• Early years development that supports children
from 0-5 and their families build their skills and
resilience so that they are ready for school
• Support to teenagers and adolescents to build
life skills and personal resilience to prepare
them for the transition to adult life
Giving Every Child the Best Start in Life
is crucial to reducing Health Inequalities
across the life course
 Ensure high quality maternity services, parenting
programmes, childcare and early years education
to meet need across the social gradient
 Ensuring that parents have access to support
during pregnancy is particularly important
 An integrated policy framework is needed for early
child development to include policies relating to
the prenatal period and infancy, leading to the
planning and commissioning of maternity,
infant and early years family support services
as part of a wider multi-agency approach to
commissioning children and family services
Children, Young People and
Families: Life course approach
Marmot 2010, Fair Society, Healthy Lives: The Marmot Review
Why Children and Young People
are a Priority
The evidence base shows we can make a difference through early
intervention and public health approaches ( and
There are economic and social arguments for investing in childhood. The
Family Nurse Partnership estimated savings five times greater than the cost
of the programme in the form of reduced welfare and criminal justice
expenditures; higher tax revenues and improved physical and mental health
(Department for Children, Schools and Families (2007) Cost–Benefit Analysis of Interventions with Parents.
Research Report DCSF-RW008)..
Marmot showed that of c. 700,000 children born in 2010, if policies could be
implemented to eradicate health inequalities, then each child could expect
to live two years longer. (
Child poverty has short, medium and long term consequences for
individuals, families, neighbourhoods, society and the economy. These
consequences relate to health, education, employment, behaviour, finance,
relationships and subjective well-being (
Environment matters for short, medium
and long term outcomes
Inequality in early cognitive development of children in the 1970 British
Cohort Study, at ages 22 months to 10 years
Environment matters for short, medium
and long term outcomes
Blackburn with Darwen Adverse Childhood Experiences:
Increased risk of having health behaviours/conditions in adulthood
for individuals who experienced four or more ACE
STIs: risk is increased 30-fold
Heroin or Crack user: risk is increased 10-fold
Prison or cells: risk is increased 9-fold
Hit someone last 12 months: risk is increased 8-fold
Morbidly Obese : risk is increased 7-fold
Been hit in last 12 month: risk is increased 5-fold
Pregnant or got someone accidently pregnant under 18: risk is increased 4-fold
Regular heavy drinker: risk is increased 4-fold
Liver or digestive disease: risk is increased 2-fold
Adverse childhood experience;retrospective study to determine their impact on adult health behaviours and health outcomes in a
UK population. Bellis M,Lowey H, Leckenby N, Hughes K, Harrison D Journal of PH, advance access 013/04/14
Early years
Key factors for poor development outcomes
Parental depression*
Parental worklessness
Parental illness or disability
Teenage mother
Smoking in pregnancy*
Parental lack of basic skills, which limits
daily activities
Parent at risk of alcoholism
Household overcrowding
Domestic violence
Financial stress*
Teenage mother, smoking in pregnancy and parental depression frequently
occur together
* Associated with worst outcomes – cognitive emotional, conduct,
hyperactivity, peer & pro-social Analysis of MCS, Sabates & Dex, 2013
The Scientific Base
Protective factors
• Breast feeding and nutrition Bernardo LH, Rajiv
B, Jose Cm, Cesar GV (2007) Evidence on the longterm effects of breastfeeding. Systematic reviews and meta-analysis, Geneva, WHO
• Immunization NICE (2009) reducing the differences in the uptake of
immunizations (including targeted vaccines)
among children and young people under 19 , NICE PH guidance 21 London : NICE
• Parenting and parent–child relationship Gardner FEM (1987) Positive interaction between
mothers and children with conduct problems: is there training for harmony as well as fighting? Journal of Abnormal Child 15, 283- 93
• Relationship between parents Coleman L, Glenn F (2009) When couples part, Understanding the
consequences for adults and children London: One plus One
Opportunities for LAs with transfer
commissioning 0-5 years
Healthy Child Programme
Joining up commissioning in local authorities for children’s public health,
early years and wider family services
Involving HWB to promote aligned/joint commissioning between LA, CCGs
(which commission NHS children services) for services around the child and
Streamlining universal access to Healthy Child Programme with early
intervention and targeted interventions/programmes for families needing
more help
Joining up 0 – 5 Healthy Child Programme with 5 – 19 Healthy Child
Programme (which is already commissioned by LAs)
Better integration of services at point of delivery with improved access and
Improved outcomes for children families and communities and
reduced inequalities
Commissioning HCP 0-5
Progressive universalism
Universal plus
Core universal
Additional parenting support
e.g. sleep, feeding, behaviour
partnership plus
e.g. Interagency
work to support
children in need
Child protection &
Healthy Child Programme (HCP): best start
for all children and extra help where needed
Health and development reviews
Screening and physical exam.
Promotion of health and wellbeing,
e.g.: smoking, diet and physical
activity, breastfeeding and
healthy weaning, keeping safe,
prevention of sudden infant
death, maintaining infant health,
dental health
Promotion of sensitive parenting
and child development
Involvement of fathers
Mental health needs assessed
Preparation and support with
transition to parenthood and
family relationships
Signposting to information and
Universal plus
Emotional and psychological
problems addressed
Promotion and extra support
with breastfeeding
Support with behaviour change
(smoking, diet, keeping safe,
SIDS, dental health)
Parenting support programmes,
including assessment and
promotion of parent– baby
Promoting child development,
including language
Additional support and
monitoring for infants with health
or developmental problems
Common Assessment
Framework completed
Higher risk
Intensive structured home
visiting programmes by skilled
Referral for specialist input
Action to safeguard the child
Contribution to care package
led by specialist service
Common Assessment
Framework completed
Maternity and Early years: targeted interventions
Targeted interventions by HV e.g. postnatal depression
Working with the Troubled Families Programme to develop a health offer
and improve integration with health services
Family Nurse Partnership quality assurance of FNP unit
Working with partners to promote early intervention including the Early
Intervention Foundation / Big Lottery
Every child ready to learn
To prevent early adversities stopping our
children developing their full potential
opportunities available
last year in the England
(ONS 2012)
Adolescence – periods of change
Adolescence and early adulthood
represent a transition period marked by
many pressures and challenges . . .
Physical and emotional changes . . .
Changing social relationships and growing
academic and professional expectations
EuroHealthNet, Making the Link: Youth and Health Equity
Why focus on adolescence?
• There are more than 11.5 million aged 10-24 in England
• The rate of developmental change during adolescence is
second only to infancy
• Good health allows young people to make the most of
their teenage years – education and socialisation
• Many poor health outcomes for adults originate when we
are young, for example smoking, mental health, obesity
and violence
Behaviour across Adolescence
Source: Hawkins & Monahan 2009
Research from the CMO’s report
• All cause mortality for 10-19 year olds is now higher than
for other periods of childhood except for newborns –
main cause is Injury
• Five of the ten riskiest factors for the total burden of
disease in adults are initiated or shaped in adolescence
• Adolescents have higher use of health services than
other child categories above the age of 3
• There appears to be a window of vulnerability to risky
behaviours between 14-17 years
PHE next steps
Adolescent health and wellbeing
A high level document to inform local strategies
that will draw on what works and what matters
Working in collaboration with schools, FE
and Local Authorities
Central to our work to support local improvements
– identifying what works from the evidence base,
supporting evidence into practice
Strengthening the public health
Wider than just ‘public health’ trained workforce –
youth services, children’s centres, VCS etc
Foundations in adolescence and
young adulthood
Our framework will be promoting:
• Using the 10-24 years life course period in line with CMO and WHO
• Raising importance of relationships, especially with parents/carers as well as
• Building life skills alongside raising awareness of key issues, such as sexual
health, drugs and alcohol, positive mental health – and the importance of
schools, colleges and other settings
• Building resilience – risk taking is an important part of development, how can
young people be supported to make safe decisions
• Role of integrated or connected services – minimise the complexity of
accessing services and maximise how they overlap
Challenges and opportunities for achieving public health outcomes for children and young people
How can we make a difference?
• Use knowledge about risk and what builds resilience
• Promote evidence and learning from practice about what works
• Combine targeted help for those most at risk with universal interventions
• Take a life course and place-based approach –early years, schools, families,
and communities
• Work in partnership, taking a coordinated and collaborative approach,
recognising strengths of different partners and using resources effectively
• Listen and act on what children, young people and parents/carers tell us
Challenges and opportunities for achieving public health outcomes for children and young people

similar documents