Tameside Strategic Partnership

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Child Poverty Needs Assessment

3. Life Chances: Education, Health and Early Years

3.1 Education and Poverty

Poverty predicts educational outcomes in the UK more strongly than in any other OECD country. According to the End Child Poverty Campaign, by the time they start school, many poor children are already lagging behind their peers, often setting the stage for a downward spiral of unequal chances and diminishing returns that will play out for the rest of their lives. This restricts social mobility and feeds intergenerational poverty. Educational attainment at school has a significant effect on earnings in later life. A lack of qualifications and skills makes it much harder to obtain secure, well-paid employment. A good education is, therefore, critical to breaking this cycle of poverty.

Poverty affects a child’s ability to succeed at school in many ways. School trips, art and music supplies, private tuition, home access to IT and the internet are advantages that are often denied to children growing up in poverty. At Secondary school children living in income deprived households are 3 times as likely to be persistently absent from school as their more affluent peers. The Joseph Rowntree Foundation has compiled a report looking at the effect aspirations, attitudes and behaviour of parents and children have on a child’s attainment. They found that this plays an important part in explaining the gap between richer and poorer children's educational attainment, for example a young person is more likely to do well in their GCSEs if their parents think it likely that the young person will go on to higher education.

Schools have a major role to play in tackling many of the issues raised here. Relevant policies are likely to include how funds are allocated towards pupils from the poorest backgrounds, and the direct teaching support provided to children when they start to fall behind

As discussed earlier in this assessment there is no one simple indicator that can be used to define a child living in poverty, several different factors interact to affect a child’s wellbeing and standard of living. By banding areas in Tameside according to the proportion of children living in households claiming Housing Benefits/Council Tax Benefits (HBCTB) we can look at the link between having a high chance of living in poverty and low levels of educational attainment.

At the end of the Foundation Stage, the year they reach age 5, children are assessed in 13 areas of the foundation stage profile. A child is classed as having a "good level of development" if they achieve 78 points across all the 13 scales and at least 6 points in each of the 7 scales relating to Personal, Social and Emotional Development and Communication, Language and Literacy.

Graph showing percentage pupils attaininga good level of development

From this information we can see that already at age 5 a child’s background is having an effect on his or her development with only 49% of children living in areas with the highest levels of HBCTB claimants attaining a good level of development compared to 71% of children in areas with the lowest levels of HBCTB claimants.

In the tests at the end of Primary School pupils sit the Key Stage 2 tests. The national expectation is for pupils to achieve Level 4 or above in both English and Maths to ensure that they are prepared for the move to Secondary Education.

Percentage Key Stage 2 pupils attaining Level 4 or above in both English and Maths

The pattern here is less striking than for Foundation Stage but there is still a clear difference between the areas with lowest levels of HBCTB claimants (79%) and highest (63%).

In order to progress on to further and higher education pupils need to attain well at Key Stage 4. Gaining a Level 2 qualification at KS4 will allow pupils to progress to Level 3 and higher qualifications after completing compulsory education and therefore improve their opportunities for gaining well paid employment in the future. The most widely used benchmark for attainment at KS4 the percentage of pupils attaining at least 5 A*-C grades (Level2) including English and Maths.

Percentage Key Stage 4 Pupils attaining 5+ A*-C GCSEs including English and Maths

Here the picture is clear, a child living in the least income deprived areas in Tameside is almost twice as likely to attain the standard at Key Stage 4 than their peers living in the most income deprived areas.

  • Key Message 1: The link between poverty and low attainment is clear even from age 5
  • Key Message 2: The link between poverty and low attainment becomes stronger at the end of Secondary School

By looking at attainment and poverty in this way we can see the clear link between the level of child poverty in the area in which a pupil lives and their chances of academic success. As we are looking at an average level of deprivation rather than an individual pupil’s circumstances this can overlook pockets of deprivation in otherwise affluent areas. Another often used indicator of poverty is Free School Meal (FSM) eligibility. A pupil is eligible for FSM if their parents are in receipt of certain benefits. One advantage of using FSM eligibility over HBCTB claimants is that it is possible to link it to the individual child’s results. This ensures that the attainment of children living in poverty is not hidden by a relatively affluent surrounding area. As this information is available at a national level, unlike the HBCTB analysis, it is possible to compare Tameside with the North West and England averages. The main disadvantage of using this measure is that if a parent chooses not to claim FSM despite being eligible the child will appear as nonFSM. Looking at both sets of analysis for an area gives the clearest picture of the true situation.

The current Closing the Gap agenda focuses on reducing the underperformance of certain vulnerable groups including those pupils eligible for FSM. In December 2010 when the coalition government announced the introduction of the pupil premium to help the most vulnerable pupils they chose to target FSM pupils because the link between FSM eligibility and low attainment is strong. By looking at the difference in attainment between FSM pupils and their nonFSM peers (the Gap) it is clear how strong the impact of living in poverty is on a child’s attainment, both at a national and local level.

By calculating the difference between the % nonFSM pupils and the % FSM pupils attaining a good level of development at the Foundation Stage we can compare the picture in Tameside to that Nationally over the past 4 years.

Foundation Stage non-free school meals - free school meals gap

The chart above shows that the gap in Tameside is consistently worse than for England but in line with the rest of the North West. While the gap for England as a whole has remained fairly steady, reducing from 21 percentage points to 19 in 2010, the picture for Tameside is more volatile and the gap is now larger than it was in 2007 (22 from 21). The increased volatility is to be expected given the lower pupil numbers.

At Key Stage 2 we can calculate the gap for pupils attaining Level 4 or above in both English and Maths.

Key Satge 2 non-free school meals - free school meals gap

The pattern nationally is similar here to the Foundation Stage with a reduction in the gap from 2006 to 2010 (25 to 21). The picture for Tameside is again more volatile but despite a sudden increase in 2009 is now lower than in 2006 (26 to 22). However in comparison to the national results the gap has been narrowing more slowly and is now worse in Tameside than for the North West and England.

At Key Stage 4 we can calculate the gap for pupils attaining 5 or more GCSEs A*-C including English and Maths.

Key Satge 4 non-free school meals - free school meals gap

Again the National figures are stable but the gap in Tameside, having remaining steady at 23 for 4 years, jumped to 26 in 2010. Despite this, the gap for Tameside pupils is still smaller than nationally while the gap in the North West is significantly higher.

  • Key Message 3: At age 5 the attainment gap for children in Tameside is wider than for England
  • Key Message 4: The attainment gap at KS4 in Tameside is smaller than the North West and England averages but is now widening.

We can also compare the gap at different Key Stages. Most research has found that the negative effects of child poverty increase as a child progresses through school

Non free school meals - free school meals gap over key stages 2010

The gap is similar at the beginning and end of the Primary phase for both Tameside and the North West, bucking the national trend for the gap to increase through the phases of education. However the gap has increased by the end of the Secondary phase following the pattern for England.

  • Key Message 5: Although the gap widens at high schools this is less marked in Tameside than for England as a whole.

Looking at the gap in attainment at individual secondary schools in Tameside in comparison with % of all pupils attaining 5+ A*-C including English and Maths we see that underlying the Local Authority level picture there is a wide variation in the attainment of all pupils as well as that of FSM pupils.

Percentage of pupils attaining 5A*-C including English and Maths vs free school meals percentage point gap 2010

The overall attainment level does not seem to be linked to the size of the gap in schools in Tameside. Several schools have a very small gap suggesting that there are effective policies for ensuring that FSM pupils do not always attain below their peers, for instance in School 9 the FSM group outperforms the non FSM group. This is a reassuring sign that work to improve outcomes for children from disadvantaged backgrounds is already impacting in some areas of Tameside but there is clearly still much more to be done if we are to ensure that a child’s background does not reduce their chance of gaining a good education.

  • Key Message 6: There is no link between the FSM gap and overall performance of a school.
  • Key Message 7: Underperformance of children living in poverty is not inevitable.

3.2 Health and Poverty

3.2.1 Factors affecting health

Health is an essential part of quality of life for local residents. However, a person’s health is affected by a wide range of factors, and whilst people are living longer, many people suffer from poor or ill health for much of their lives.

The rainbow model below is a way of looking systematically at the factors affecting health. The individual is at the centre of the model, with factors affecting their health radiating outwards, starting with individual behaviour that can be changed or modified. Individual behaviour can in turn be influenced by the behaviour norms of their community: for example, people are more likely to smoke if their friends, family and local community smoke. On the other hand, community networks can also positively influence health by providing mutual support during tough or adverse times. The structural influences are shown next, such as income, access to health services and education. These have great influence over health outcomes. Finally, the wider policy areas are shown.

Figure 1: Model of Health

Source: Dahigren and Whitehead (1991). Policies and Strategies to promote social equity in health. Institute of Future Studies. Stockholm.

Rainbow model of health

"Health inequalities" is a term used to describe the existence of preventable differences in the health related factors described above. The result of health inequalities is that certain groups or communities experience poorer health than others. Often these inequalities cluster in specific groups of people such as homeless people, some older people, ex offenders, people from Black and Minority Ethnic (BME) communities, the unemployed or people on low incomes. These vulnerable groups are sometimes also referred to as socio-economically deprived because they have less access to, and less uptake of, the social and economic factors that can help lead to improved health.

Summary of Key Messages:

  • A person’s health is affected by not only their lifestyle choices, but also by wider influences such as community networks, housing, education and employment.
  • Health inequalities are preventable differences in the determinants of health, which result in poor health. They often cluster in vulnerablecommunities, such as those in poverty.

3.2.2 How to address child poverty

The influential 1998 Acheson Report (Acheson, 1998. Independent Inquiry into Inequalities in Health Report) concluded that: "The weight of scientific evidence supports a socio-economic explanation of health inequalities. This traces the roots of ill health to such determinants as income, education and employment as well as material environment and lifestyle."

To reduce health inequalities, the barriers to health encountered within the local community, and by these vulnerable groups in particular, need to be tackled, reduced and removed.

The rainbow model in Figure 1 demonstrates how influential income and employment are on the health of individuals, and they can influence every other factor which impacts on a person’s health. Therefore, to make any major improvement in the health of local people, there needs to be a focus on improving the wider determinants of health such as living and working environments, rather than purely focussing on improving individual lifestyle factors.

In addition, concentrating on just the most disadvantaged will not reduce health inequalities sufficiently. Professor Sir Michael Marmot explains that to reduce the steepness of social gradient across the population, "...action must be universal with a scale and intensity that is proportionate to the level of disadvantage"(Marmot, M.,2010, Fair Society, Healthy Lives: Strategic Review of Inequalities in England post 2010). This is termed proportionate universalism.

Marmot recommends six overarching policy objectives to address health inequalities:

1. Action is needed to reduce health inequalities before birth, thereby giving every child the best start in life. There needs to be increased expenditure focused proportionately across social gradient including early education and childcare.

2. Enable children, young people and adults to maximise their capabilities and have control over their lives;

- Education affects mental health as well as employment opportunities. However, families rather than schools have most influence on educational outcomes. There needs to be closer links between schools, the community and parents, with a school based workforce to build skills in working across school-home boundaries, increase quality of lifelong learning and the number of opportunities to access such learning.

3. Create fair employment and good work for all. Get people into work is good for mental health and physical health.

4. Ensure a healthy standard of living for all. There are gaps between the minimum income for healthy living and the level of state benefits payments many groups receive. To improve the situation the government needs to reduce financial disincentives for people to enter the workforce.

5. Create and develop healthy and sustainable places and communities. By building social capital in communities, one can give people greater control other their lives and policies which affect them- examples include greater green spaces, public transport etc. Social Capital describes the link between individuals and the links that bind and connect people within and between communities. Together these links provide social support critical to physical and mental well being.

6. Strengthen role and impact of ill-health prevention as chronic diseases follow the social gradient. Funding should be increased for prevention, with a focus on partnerships between primary care, local authorities and the third sector to deliver universal and targeted prevention interventions.

These policy objectives underpin subsequent recommendations within this chapter.

3.2.3 The impact of socio-economic deprivation on health in Tameside

Adults

Health in Tameside is generally worse than the average for England (Health Profile 2010: Tameside. Association of Public Health Observatories). There is a strong association with deprivation with more affluent local authorities experiencing better health than the England average, and areas with high levels of deprivation, such as Tameside, experiencing worse health than the average for England (Health Profile 2010: North West. Association of Public Health Observatories).

In addition, local inequalities exist within Tameside. As a result, men in the least deprived areas of Tameside can expect to live almost seven years longer than men in the most deprived areas; for women the difference is almost six years.

Understanding adult health issues is essential when considering child health, as evidence shows that the health behaviour of children follows the health patterns of the adults round about them. In addition, a mother’s physical and mental health is one of the key drivers of childhood life chances (Field, F, 2010. The Foundation years: preventing poor children becoming poor adults).

Children

In developed countries, respiratory infections are the most common cause of child ill health. Infections such as tuberculosis and bronchiolitis are associated with urban living, overcrowding and poor housing conditions, and not surprisingly children in more deprived areas are more at risk of these infections than less deprived children. In addition, children in lower social classes are affected at a younger age than more advantaged peers (Spencer, N. (2000). Poverty and Child Health, 2nd Edition. Oxfordshire: Radcliffe Medical Press).

Poor children are also more likely to suffer conditions caused by acute illnesses than less deprived children, and chronic diseases are more likely to have a worse impact. There is also evidence of an increased risk of emergency hospital admissions.

In Tameside, child health is generally worse than the average for England and compares poorly to the majority of other local authorities in the North West (Child Health Profile, 2011). This reflects the strong relationship between deprivation and poor health. Within the Be Healthy section of the Child Health Profile5, there is only one indicator (out of thirteen) for which Tameside is significantly better than the England average: Children who have someone to talk to. In contrast, there are seven indicators for which Tameside performs worse than the England average:

  • Breastfeeding initiation
  • Obese children (age 10-11 years)
  • Participation in at least 3 hours of sport/PE
  • Decayed, missing of filled teeth (age 5 years)
  • Teenage conception rate (age under 18 years)
  • Emergency hospital admissions (age 0-18 years)
  • Emergency hospital admission rate for asthma (age 0-18 years)

3.2.4 Child health indicators

The following sections set out some of the health issues facing young people in Tameside, including the indicators listed above.

3.2.4.1 Babies and infants

Low birth weight

It is important for babies to get a healthy start in life. Evidence suggests that events during foetal development, such as low birth weight, are linked with risk of certain chronic illnesses in middle and later life . The major factors associated with low birth weight, and other indicators of healthy early development and growth of babies, are plural pregnancy (multiple births), poor nutrition, low socio-economic status, teenage pregnancy and smoking and drinking in pregnancy (Donaldson and Donaldson: Essential Public Health. Petroc Press 2003 and Vernon, H.M. (1993) Health in relation to occupation. London: Oxford University Press. 1993).

Tameside has a higher proportion of babies weighing less than 2,500g compared to the North West and England, although this difference is not statistically significant. For babies weighing less than 1,500g, Tameside has a similar proportion to the North West and England.

Figure 2: Local, regional and national percentage of all births (live and still) where the baby has a birth weight, <1,500 and <2,500 grams, 2006 to 2009.

Local, regional and national percentage of all births (live and still) where the baby has a birth weight, <1,500 and <2,500 grams, 2006 to 2009

Source: National Compendium of Clinical and Health Indicators.

Recommendations to prevent low birth weight focus primarily on smoking cessation and nutritional interventions, as smoking and poor maternal nutrition preconception and during pregnancy are risk factors for low birth weight (Health Development Agency (2003) Prevention of low birth weight: assessing the effectiveness of smoking cessation and nutritional interventions):

  • Early intervention – targeting pregnant women as early as possible during pregnancy has a significant impact on low birth weight
  • Specialist support with smoking cessation for pregnant women during the ante-natal stage
  • Participation in at least 3 hours of sport/PE
  • Smoking cessation intervention aimed at pregnant women during pre-conception stage can be even more effective
  • Teenage conception rate (age under 18 years)
  • Calcium supplements during pregnancy reduce the rate of hypertension and preeclampsia, resulting in prolonged gestation and therefore higher birth weight.

Infant mortality

Although infant mortality is closely associated with socio-economic deprivation, fewer babies die in Tameside than would be expected considering its level of deprivation. The figure below shows that local infant, neonatal and perinatal mortality rates are lower than in England, although not significantly lower.

Figure 3: Local, regional and national infant, neonatal and perinatal mortality rates per 1,000 live births, 2004-06 to 2007-09.

Local, regional and national infant, neonatal and perinatal mortality rates per 1,000 live births, 2004-06 to 2007-09.

Source: Compendium of Health and Clinical Indicators, 2011.

A good practice guide has recommended the following actions to reduce the health inequalities in infant mortality (Department of Health, 2007. Implementation Plan for Reducing Health Inequalities in Infant Mortality: A Good Practice Guide):

  • Reduce the prevalence of obesity in routine and manual (R&M) groups to the current levels in the population as a whole.
  • Meet the national target to reduce smoking in pregnancy from 23% to 15%, particularly within the R&M group.
  • Reduce sudden unexpected death in infancy (SUDI) by persuading 1 in 10 women in the R&M group to avoid sharing a bed with their baby or putting their baby to sleep prone (on its front).
  • Reduce under-18 conception rate in the R&M group.
  • Reduce the number of children in relative low-income households by increasing the income in the R&M group.
  • Promoting early antenatal booking among disadvantaged groups.

The following are examples of local interventions aimed at tackling low birth weight and infant mortality:

  • The Maternal Healthy Weight Pathway provides support to women during the pre-conception and pregnancy, including information and advice on healthy lifestyles.
  • Healthy Start vitamins are provided to pregnant women at NHS clinics
  • All pregnant women in Tameside who smoke, are offered referral to a specialist advisor from NHS Stop Smoking Service.
  • Targeted sexual health outreach in areas with high teenage pregnancy rates.

Breastfeeding initiation

There is an extensive evidence base suggesting that breastfeeding promotes the health of both mothers and infants. Formula-fed babies are more likely to develop a number of conditions including gastrointestinal, respiratory and urinary tract infections and are more likely to be hospitalised as the result of infection. Blood pressure, total cholesterol, prevalence of overweight/obesity and type 2 diabetes are also lower among breastfed babies. Whilst breastfeeding mothers are more likely to return to their pre-pregnancy weight (Infant Feeding Survey 2005: A commentary on infant feeding practices in the UK. Position statement by the Scientific Advisory Committee on Nutrition, 2008), mothers that have not breastfed are at greater risk of some cancers in later life, particularly breast and ovarian cancers.

The most recent Infant Feeding Survey (Infant feeding Survey 2005. The Information Centre, 2007), showed that younger mothers, mothers from lower socio-economic groups and mothers with lower educational levels appeared least likely to initiate and continue breastfeeding. Mothers from these groups were also more likely to introduce solids, follow-on formula and additional drinks at an earlier age, and less likely to attend antenatal check-ups and classes, or use dietary supplements.

In line with the socio-economic profile of Tameside and Glossop, a lower proportion of mothers initiating breastfeeding locally compared to the North West and England.

Figure 4: Local, regional and national prevalence of initiation of breastfeeding, 2006/07 to 2009/10.

Local, regional and national prevalence of initiation of breastfeeding, 2006/07 to 2009/10.

Source: Department of Health, Vital Signs Monitoring Return, 2011.

Research suggests that young women from low-income areas are least likely to breastfeed for a variety reasons including embarrassment, lack of role models, fear of pain, misconceptions that their baby will not gain sufficient weight from breastfeeding alone, and exposure to a bottle feeding culture. Young mothers often lack access to key sources of information and advice on infant feeding such as antenatal classes, peer support programmes, friends, family and other social support networks(Infant Feeding Survey 2005, The Information Centre, 2007).

There is a need to change the current dominant bottle feeding culture, so that breastfeeding is seen as the norm. The following actions will help to make a difference (North West Regional public Health Group, 2008. Addressing Health Inequalities: A North West Breastfeeding Framework for Action):

  • The Maternal Healthy Weight Pathway provides support to women during the pre-conception and pregnancy, including information and advice on healthy lifestyles.
  • Hospitals working towards UNICEF Baby Friendly Initiative accreditation, which ensures that good practice is implemented within hospitals.
  • Ensure a local breastfeeding peer support programme is in place.
  • Ensure promotion and advertising of infant formula is banned, as well as use of any leaflets, posters and any other materials produced by infant formula manufactures.
  • Ensure workplaces, including NHS and local authority premises, support breastfeeding for mothers returning to work
  • Ensure women feel comfortable breastfeeding in public
  • Ensure the wide range of health professionals that come into contact with mothers support breastfeeding, promote consistent messages about breastfeeding, and know how mothers can access additional support.

Within in Tameside, these recommendations are being implemented. For example, NHS Tameside and Glossop commissions Little Angels to provide a breastfeeding peer support service for families in Tameside, which includes telephone support and home visits, particularly in areas with low uptake of breastfeeding, They also support women in hospital during the antenatal period and after delivery, to complement the midwives’ advice and support. In addition, Tameside General Hospital has achieved Stage 2 accreditation level for the Baby Friendly Initiative(Baby Friendly Awards).

Summary of Key Messages:

  • Poor foetal and infant health is linked to certain chronic diseases in later life.
  • Low infant mortality, low numbers of babies born with low birth weight and high uptake of breastfeeding indicate healthy infants, and are more prevalent in more less deprived areas.
  • Infant mortality and low birth weight in Tameside is lower than the deprivation profile would suggest, giving babies a better start in life than otherwise would be expected.
  • Breastfeeding initiation is relatively low in Tameside compared to England, which can negatively impact on the health of babies and mothers.
  • Babies in areas of deprivation within Tameside are at risk of having a less healthy start in life as those in more affluent areas because of poor maternal lifestyle factors such as diet, smoking and breastfeeding.

Recommendations

Ensure women from areas of deprivation:

  • Access appropriate health information and interventions which support healthy lifestyles pre-conception.
  • Access antenatal services at the appropriate time.
  • Access support to maintain healthy lifestyles and breastfeeding.

3.2.4.2 Childhood lifestyle factors

Obesity

There are rising levels of obesity in childhood and adolescence, which is of concern as evidence suggests excess weight in childhood continues into adulthood. It is estimated that, based on current trends, levels of obesity and overweight will rise to 60% in men, 50% in women and 25% in children by 2050 (Healthy weight, healthy lives: a cross-government strategy for England. Department for Health, 2008).

The health risks of obesity are considerable. People who are overweight or obese are at a greater risk of diabetes, coronary heart disease and cancer (Department of Health (2004) Choosing Health: making healthy choices easier. London: Department of Health). Estimates suggest that obesity reduces life expectancy by between 3 and 13 years(Department of Health (2008) Healthy weight, Healthy Lives: A toolkit for developing local strategies. London: Department of Health), and in Tameside and Glossop, the three primary causes of mortality and health inequalities are all associated with overweight and obesity.

In Tameside, local rates of overweight and obesity are only slightly higher than in Greater Manchester or England: around one in four children in Reception year is overweight or obsess compared to around one in three children in Year 6.

Figure 5: Local, sub-regional and national prevalence of overweight and obesity, reception and year 6 children, 2009/10.

Graph showing local, sub-regional and national prevalence of overweight and obesity, reception and year 6 children, 2009/10.

Source: National Child Measurement Programme, Information Centre, 2010.

When national data is analysed, there is a statistically significant link between childhood obesity prevalence and IMD 2007 scores: obesity prevalence in the most deprived tenth of local areas is almost double that in the least deprived tenth (National Obesity Observatory, 2010. NOO data briefing: Childhood obesity and socio-economic status). The Income Deprivation Affecting Children Index (IDACI) shows a similar increase in child obesity as income deprivation increases: child obesity prevalence in areas with the highest level of income deprivation is almost double that of areas with the lowest level.

Locally, ward data also suggests a link between deprivation and obesity and overweight, however, due to the small numbers of children involved, the data is not statistically significant. Nevertheless, the national evidence supports that view that the link between deprivation and obesity also exists in Tameside.

Figure 6: Prevalence of obesity, year 6 pupils, Tameside, 2007/08 to 2009/10 (pooled).

Graph showing prevalence of obesity, year 6 pupils, Tameside, 2007/08 to 2009/10 (pooled).

Source: National Child Measurement Programme, 2010.

The complexity of obesity means that policies aimed solely at individuals or efforts to expand small scale interventions, will not be sufficient to reverse prevalence trends. Therefore, it is essential that interventions aimed at individuals, communities and local organisations link together to develop a living and working environment that supports healthy weight maintenance.

The following recommendations aimed at reducing prevalence of obesity were included within the local obesity strategy, and are based on good practice (Tameside & Glossop Healthy Weight Strategy, 2010-15)

  • Develop a living and working environment which supports active and healthy living
  • Ensure there is a consistent message promoted by all front line staff which promotes healthy lifestyles, including those behaviours which help prevent overweight and obesity
  • Enhance access to, and availability of, a range of evidence based treatment services for overweight and obese adults and children.

The following are examples of interventions being delivered locally:

  • Front line staff are being trained to deliver very Brief Advice interventions so they can promote healthy lifestyles when engaging with the public.
  • LEAP 4 Life - an 8 week community based lifestyle programme incorporating healthy eating, oral health and physical activity for families with children aged between 18 months and 4 years.
  • The multi-agency 0-4 years and 4 -11years Healthy Weight Pathways provide support for overweight and obese children by providing parents with information, advice and referrals to appropriate services.

Physical activity

Physical activity promotes musculoskeletal health and mental health and well-being. Physical inactivity and low fitness are major independent risk factors for coronary heart disease in both men and women, at a level similar to that of smoking cigarettes. Inactive and unfit people have almost double the risk of dying from coronary heart disease compared with more active and fit people. Low levels of physical activity in England are a significant factor in the dramatic increase in prevalence of obesity.

In children, benefits for physical activity effects are predominantly seen in reducing risk factors for disease, avoidance of weight gain, achieving a high peak bone mass and mental wellbeing. For children and young people, the advice is to take part in one hour of moderate intensity physical activity each day and this can be continuous activity or intermittent throughout the day (Chief Medical Officer: Department of Health, 2004. At least five a week: evidence on the impact of physical activity and its relationship to health).

Nationally, during the 2009/10 academic year, 57% of school pupils (years 1-11) took part in 3 hours of PE or out of hours school sport, which increased from 51% achieved during the previous year. However, Tameside performed poorly against other Greater Manchester local authorities, with only 47% of local pupils taking part in 3 hours of school related activity each week.

Figure 7: Proportion of pupils (year 1-11) who participate in at least 3 hours of high quality PE/ School sport in typical week, Greater Manchester local authorities, 2009/10.

Graph showing Proportion of pupils (year 1-11) who participate in at least 3 hours of high quality PE/ School sport in typical week, Greater Manchester local authorities, 2009/10.

Source: TNS-BMRB, on behalf of the Department for Education, 2010. Annual PE and Sport Survey 2009/10.

At a national level, a link between activity levels and eligibility of free school meals (FSM) can be seen: 40% of schools with lower levels of pupil activity were categorised as having a high % of pupils eligible for FSM, compared to only 33% of schools with high activity levels (High FSM is defined as more than 20% of children eligible; medium as 7%-19% of children; low as less than 7% of children). As FSM is an indicator of poverty, this demonstrates a link between poverty and low activity levels. Nevertheless, Tameside’s level of activity is lower than its deprivation profile suggests. As indicated earlier, this is of concern as low activity levels can lead to various forms of ill health.

Recommendations to increase physical activity levels (Department of Health and Department of Children, Schools and Families, 2008. Healthy Weight, healthy lives: A cross-governmental strategy for England):

  • Promoting participation in physical activity
    • Sport England are expected to deliver increased community sport
    • Investment in infrastructure during the lead up to the Olympic Games in 2012
  • A supportive built environment
    • Promote active travel
    • Promote walking or cycling for short journeys
    • Effective street design which enables and promotes active living and active transport

The following are examples of actions within the local Healthy Weight Action plan that have been delivered with the aim of increasing local physical activity levels:

  • Delivery of community based exercise sessions via the Health Trainer service
  • Delivery of community based sports sessions for young people delivered by the Sports Trust
  • Using local parks and green spaces to delivery activity sessions
  • Supporting local business to promote physical activity to their staff

Oral Health

Tooth decay causes pain, sepsis, disfigurement leading to a lack of confidence, missed school days, and involves children in avoidable and often unpleasant dental treatment, which can be traumatic for children.

Tooth decay tends to be linked to:

  • Bottle feeding, especially where sweetened drinks gradually replace formula milk
  • Weaning on to high sugar foods
  • Poor family diet

Tooth decay in young children can therefore be an indicator of poor diet and future obesity, and levels of tooth decay are closely linked to levels of socio-economic deprivation.

Every two years the British Association for the Study of Community Dentistry (BASCD) conduct a national survey of the oral health of five year old children. The following table shows that the severity and prevalence of tooth decay in local five year olds are now below the North West average, though still significantly higher than the England average.

Table 1: Decayed, missing and filled teeth (dmft) in Tameside 5 year olds compared to England and the North West, 2007/08.

Area

% Children Examined

Ave number of dmft (severity of decay)

5 with dmft >1 (prevalence of decay)

Tameside 89% 1.42 ± 0.14 37.4 ± 2.7
North West 65% 1.52 ± 0.03 38.1 ± 0.6
England 67% 1.11 ± 0.01 30.9 ± 0.2

Source: BASCD, 2007/08.

This is the first time since surveys began that significant improvements in the oral health of five year olds have been seen; previously only marginal improvements have been seen. Tameside’s results have also improved relative to the North West, with local oral health being slightly better than the North West average, when historically it has been slightly worse. Nevertheless, the North West has among the poorest levels of oral health in England.

In addition, inequalities between amongst children living in Tameside can be seen, with children from specific community groups being most at risk from poor oral health: those in areas of socio-economic deprivation or from Pakistani or Bangladeshi backgrounds. It can be seen from the following figures that the severity and prevalence of tooth decay closely mirrors areas of socio-economic deprivation: Ashton St Peters, Hyde and Hattersley.

Map 1: Severity of decay (average number of decayed, missing or filled teeth) by Middle Super Output Area (MSOA).

Map showing Severity of decay (average number of decayed, missing or filled teeth) by Middle Super Output Area (MSOA)

Source: BASCD, 2007/08.

Map 2: Prevalence of decay (average number of decayed, missing or filled teeth) by Middle Super Output Area (MSOA).

Map showing Prevalence of decay (average number of decayed, missing or filled teeth) by Middle Super Output Area (MSOA)

Source: BASCD, 2007/08.

In order to improve the oral health of Tameside children to the England average, and to improve the health of children in areas of socio-economic deprivation, especially those from Pakistani or Bangladeshi families living in areas such as Hyde and Ashton St Peters, efforts to maintain oral health must be maintained and built on.

Tooth decay is caused by frequent intake of sugary foods and drinks and can be prevented by reducing sugar intake in line with a healthy diet; application of fluoride to the teeth, especially by regular brushing with family strength fluoride toothpaste from as soon as the teeth come through; and appropriate weaning.

Local actions to improve child oral health include:

  • Improving diet and reducing sugar intake
    • Promoting breast feeding, healthy infant feeding and weaning
    • All pregnant women receive advice at ‘booking in’ clinic
    • Oral health training to partners includes information on breast feeding, infant feeding and healthy eating in line with PCT policy
    • Oral health team work closely with childrens nutrition team, to prevent obesity and improve oral health
    • Delivery of joint oral health/nutrition award to early years providers
    • Support accredited nutrition training for staff from childrens centres and early years
  • Toothbrushing with family strength fluoride toothpaste
    • All 6 month old children receive toothbrush, paste and advice through the post
    • Home visits to families where English not the first language
    • Nursery nurses give out brushes, paste etc at 6 month developmental check
    • Fluoride brushes and paste are available at affordable prices at Tameside children’s centres
    • Dental teams, health and early years professionals are trained on evidence based principles of improving health of young children

Teenage Conceptions

Becoming a teenage parent can have a negative impact on the health of the mother and child. Becoming a teenage parent can result in reduced access to education and employment consequently causing a socio-economic decline. Children born to teenage parents have a 60% higher rate of infant mortality and are 25% more likely to have a low birth weight. Girls under 18 years living in deprived neighbourhoods are more likely to become pregnant than those living in affluent neighbourhoods.

Tameside is experiencing a steady increase in teenage conceptions, whereas there is a downward trend in England.

Figure 8: Quarterly conception rates per 1,000 women aged under 18, Q4-1998 to Q1- 2010 (rolling average across 4 quarters), Tameside MBC, Greater Manchester, North West and England.

Graph showing quarterly conception rates per 1,000 women aged under 18, Q4-1998 to Q1- 2010 (rolling average across 4 quarters), Tameside MBC, Greater Manchester, North West and England

Source: ONS, 2011

However, it can be more useful to compare Tameside rates to other comparable areas. The four other areas included in the figure below are the nearest Children’s Services statistical neighbours (Source: Children’s Services Statistical Neighbours Benchmarking Tool), which are used as benchmarks in the Local Authority Teenage Conception Analysis (ONS 2010). This shows that Tameside experiences a less fluctuating rate that other areas, but one which is still very high compared to others; although two neighbours have achieved large reductions in recent quarters, and two have seen increases.

Figure 9: Quarterly conception rates for women aged under 18, 2008-Q1 to 2010-Q1, Tameside MBC and Children’s Services statistical neighbours.

Graph showing quarterly conception rates for women aged under 18, 2008-Q1 to 2010-Q1, Tameside MBC and Children’s Services statistical neighbours

Source: ONS, 2011

Teenage pregnancy is an ongoing priority of local partners, and initiatives are in place with the aim of reducing the number of teenage conceptions in Tameside, including:

  • Ensuring quality Sex and Relationship education (SRE) is available in a variety of settings for all young people, including those that do not attend school regularly and other vulnerable groups.
  • Ensure sexual health services are available at times convenient for young person
  • A young person health mentor works with young woman to try and prevent repeat terminations
  • Provision of quality sexual health promotion in schools and colleges, and via outreach to vulnerable groups and settings
  • Provision of Emergency Contraception (EC) in non-clinical settings, e.g. pharmacies

Substance Misuse

Alcohol harm in Tameside is extensive, and it adversely affects overall quality of life and perpetuates inequalities. The Tameside Alcohol Needs Assessment highlighted some key areas of concern in relation to young people. It found, for example that there are high rates of binge drinking in males from aged 15, and female acute intoxication admissions aged 10-14 outnumber males. When looking at acute intoxication admission rates to A&E (all ages) broken down by ward, a clear correlation is evident with areas with high levels of deprivation.

In addition, the use of drugs is also a risk to people’s health and well-being: their own and that of their families and the community at large, for example through poor parenting or through involvement in crime to fund their drug use. Mental health problems are also common among drug misusers. Drug use and dealing also exacerbates health inequalities since often the communities most affected by drug activities are those with the fewest resources.

Children and young people who smoke experience more respiratory symptoms than those who do not smoke and are two to six times more susceptible to coughs, increased phlegm and wheezing. Smoking has been established as a cause of impaired lung growth in children and young people and can also cause of asthma-related symptoms in childhood and adolescence (Information Centre, 2008. Drug use, smoking and drinking among young people in England, 2007). Children are also less likely to give up, and more likely to smoke more, than those who start smoking later in life. As a result someone who starts smoking at age 15 is three times more likely to die of cancer due to smoking than someone who starts in their mid-20s (Information Centre, 2008. Health Survey for England 2007).

The TellUs4(Source: Tellus4, Department for Children, Schools and Families, 2010) survey of year 6,8 and 10 pupils indicates that local levels of smoking, drinking alcohol and taking drugs (15.4%) are the highest in Greater Manchester and are above the regional (11.0%) and national average (9.8%). Although, it should be noted that these survey provide self reported results, it still indicates high levels of substance misuse locally.

Figure 10: Self reported NI 115 Substance Misuse results, Tellus3 (2008) and Tellus4 (2009).

Graph showing Self reported NI 115 Substance Misuse results, Tellus3 (2008) and Tellus4 (2009).

Source: Tellus4, Department for Children, Schools and Families, 2010.

N.B. As there were some differences between Tellus3 and Tellus4 methods, Tellus3 results have been amended to reflect Tellus4 methodology. Year 6 children were not asked in they used drugs.

The following actions to reduce alcohol harm in young people are taken from the Tameside Alcohol Harm Reduction Strategy 2010-2013:

  • Increase the availability of diversionary activity for young people, including alcohol free venues and vocational opportunities
  • Consider local family model interventions for young people and parents needing support to reduce their alcohol consumption
  • Develop pathways in dealing with young people in alcohol related crime within the criminal justice and children and young people services
  • Ensure access to housing provision for young people with complex needs in addition to alcohol misuse

With respect to drugs, the national strategy to reduce drug harm includes recommendations to (HM Government, 2007. PSA Delivery Agreement 25: Reduce the harm caused by Alcohol and Drugs):

  • Disrupt the supply of illegal drugs
  • Intervene early to prevent and reduce the harms caused by substance misuse, particularly amongst the most at risk young people and families
  • Provide effective treatment, social care and support to improve the health and well-being of young people and adults who are already using drugs in harmful ways and to help them re-establish themselves in the community
  • Tackle crime and anti-social behaviour associated with drug misuse and reduce the harms caused by drugs to the community and use the criminal justice system to help offenders engage with treatment services

The following recommendations to help young people to be tobacco free are taken from the evidenced based guide on to how effectively reduce smoking prevalence in local communities, written by the Tobacco Control National Support Team (Department of Health, 2008. Excellence in Tobacco Control: 10 high impact changes to achieve tobacco control):

  • Work with Trading Standards to educate retailers, reduce underage sales and increase test purchasing in all retail environments where young people can access tobacco, including those with tobacco vending machines
  • Support local actions to stem the flow of illegal tobacco imports and educate the general public on illicit sales to further reduce access on streets

Locally the following actions to address substance misuse (drugs, alcohol and tobacco) are being delivered as part of the Tameside Young People’s Treatment Plan 2008/09 (Tameside Strategic Partnership, 2008. Tameside Young People’s Treatment Plan 2008/09) and Children and Young People’s Plan 2010-11:

  • Continue to develop universal education and prevention drugs programmes through schools and partner agencies for YP; including Parents and carers support work
  • Improve planned discharges from the young people’s substance misuse services
  • Ensure that there is a sufficient range of treatment modalities to respond to need’s of Tameside young people’s profile
  • Trading Standards have targeted under age sales of tobacco in shops, test purchases of vending machine sales, and a programme of awareness raising for businesses about illicit tobacco

Childhood Lifestyle Factors Summary of Key Messages:

  • Many childhood lifestyle factors, such as obesity, poor dental health, teenage conceptions and substance misuse, are strongly linked to socio-economic deprivation
  • This link can also be seen in Tameside, meaning that children from areas of deprivation are more likely to have unhealthy lifestyles
  • Preventative individual interventions are needed, but must also be complemented with multiagency family and community wide interventions which focus on the behaviour norms and environment in which children and their families live

There are strong health inequalities within Tameside, meaning that children in areas of deprivation less likely to have healthy lifestyles than those in more affluent areas, thereby putting them at greater risk of chronic disease in later life

Recommendations

  • Universal and targeted prevention interventions should be available to prevent unhealthy children becoming unhealthy adults, and should involve primary care, local authorities and the third sector
  • Support aimed at children should involve families and the local community and should be delivered across school and community settings

3.2.4.3 Hospital Admissions

Emergency admissions are admissions to hospital that are not predicted and happen at short notice because of perceived clinical need. High emergency admissions cause concern not only because of their high associated costs, but also because of the disruption they can cause to planned hospital care. The evidence shows that people from lower socio-economic groups are at higher risk of avoidable emergency admissions, as are babies and very young children (Sarah Purdy, The Kings Fund, 2010. Avoiding hospital admissions: What does the research evidence say?).

The rate of emergency admissions rate/100,000 for those aged 0-18 years, is statistically higher in Tameside than in England: 9,466 and 7,256 respectively (2009/10) (Child Health Profiles, 2011).

In the figure below, Tameside’s Super output areas (SOA’s) have been ordered by the number of emergency admissions during 2010/11 (blue diamonds). Their corresponding deprivation score (IMD 2010) is also shown (red squares), along with its associated trend line. It can be seen that as the deprivation score increases (which indicates higher levels of deprivation), so too does the number of emergency admissions, and the correlation is moderately strong (r=0.6).

Figure 11: Emergency admissions amongst under 18s (2010/11) and deprivation score (IMD 2010) for Super Output Areas (SOAs) in Tameside.

Graph showing emergency admissions amongst under 18s (2010/11) and deprivation score (IMD 2010) for Super Output Areas (SOAs) in Tameside.

Source: IMD 2010, HES 2011.

To reduce emergency admissions (Sarah Purdy, The Kings Fund, 2010. Avoiding hospital admissions: What does the research evidence say), evidence suggests that self management can be effective for certain conditions such as asthma, and that education for children and their carers can also be effective. Primary care interventions, such as good continuity of care can make a difference, however there has also been much debate regarding changes in provision of out of hours primary care, which are thought to have led to increased A&E attendances.

Emergency asthma admissions

Asthma is the most common childhood chronic disease, with a prevalence of around 17% and 23%. Nearly 1 million children in the UK are affected, although asthma attacks can vary in frequency and severity (NICE (2007) Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12 years).

Tameside’s rate of emergency asthma admissions per 100,000 for young people aged under 16 is significantly worse than the national average: 316 and 257 respectively (2008/09 Indirectly age and sex standardised to 2005/06 baseline), but is lower than the North West average of 385. When trends over recent years are reviewed, it seems that there has been an improvement in Tameside, the North West and England. Nevertheless, the change between 2007/08 and 2008/09 was significantly worse in England and the North West, and although there was an improvement in Tameside, it was not statistically significant.

Figure 12: Indirectly standardised rate of emergency asthma admissions, 0-18 years, Tameside, North West and England, 2004/05 to 2008/09.

Graph showing indirectly standardised rate of emergency asthma admissions, 0-18 years, Tameside, North West and England, 2004/05 to 2008/09.

N.B. The date for each year was indirectly age and sex standardised to 2005/06 baseline. Source: NCHOD, 2010

Evidence indicates that educational intervention for children who have attended the emergency department for asthma lowers the risk of the need for future emergency department visits and hospital admissions. Any educational intervention can be targeted at children, their parents or both, individually or as a group. The educational intervention may take place in the emergency room, the hospital, at home or in the community. The intervention could involve a nurse, a pharmacist, educator or health or medical practitioner associated with the hospital or referred to by the hospital (The Cochrane Collaboration (2010) Interventions for educating children who are at risk of asthma-related emergency department attendance).

In Tameside, self care is promoted with a range of information available for patients and clinicians.

Emergency alcohol admissions

Children who drink at an early age are more likely to develop alcohol related problems in adolescence and adulthood. However, the rate of young person’s admissions to hospital for alcohol specific conditions is higher in Tameside than the North West or England: 123, 109 and 65 respectively. In addition, the Tellus4 survey (Tellus4, Department for Children, Schools and Families, 2010) of school pupils indicated that there is a higher prevalence of substance misuse (including alcohol) amongst Tameside young people compared to England. The previous Substance misuse section described the link between deprivation and admissions to hospital for acute intoxication (all ages), and it is likely that this link also exists amongst young people.

Figure 13: Persons aged under 18 years admitted to hospital with alcohol specific conditions, crude rate per 100,000 population, 2004/5-06/07 to 2006/07-08/09.

Graph showing persons aged under 18 years admitted to hospital with alcohol specific conditions, crude rate per 100,000 population, 2004/5-06/07 to 2006/07-08/09.

Source: Local Alcohol Profiles for England

Parental monitoring and close family relationships play an important part in delaying alcohol initiation in early adolescence. Preventative steps to avoid alcohol related health emergencies in children include (Department of Health (2009) Guidance on the consumption of alcohol by children and young people):

  • Parents and carers should discuss the dangers associated with drinking alcohol and set clear boundaries for drinking
  • Parents and carers should avoid drunkenness and binge drinking in front of children
  • Educational curriculum in schools should highlight the advantages of alcohol free childhood
  • There should be consistent social marketing campaigns that highlight the dangers of excessive alcohol consumption

Locally, the Tameside Children and Young People’s Alcohol Action Plan (involving a wide range of partner organisations) outlines strategies for preventing alcohol related harm in children. One example is the Children and Young People’s Health Mentor (CYPHM) service, which provides an early intervention health mentoring programme for children and young people on a range of health issues, including alcohol.

Hospital Admissions For Injury

Injuries disproportionately affect children, especially those living in areas of deprivation (Towner, E. (2002) The prevention of childhood injury). In 2009/10 Tameside experienced significantly higher rates of hospital admissions due to injury amongst under 18s compared to England: 1,793 and 1,443 per 100,000 respectively.

With regard to admissions for injuries, the link with deprivation can be seen locally. The figure below shows the SOAs in Tameside ordered by deprivation score (blue diamonds; IMD2010), and the red squares are the number of admissions. It can be seen that the higher the deprivation score, the higher the number of admissions, and this correlation is moderately strong (r=0.6).

Graph showing emergency admissions for unintentional and deliberate injuries amongst under 18s, 2008/09 to 20010/11 pooled, Tameside

Source: IMD 2010, HES 2011.

Accidental injuries in children occur in three main environments – road accidents, at home and during leisure activities (Towner, E. (2002) The prevention of childhood injury). The preventative measures that are effective include (Health Development Agency (2003) Prevention and reduction of accidental injuries in children and older people):

  • Enforcement of 20mph zones, which can lead to reduction in road traffic accidents
  • Encouraging children to wear cycle helmets when they are cycling
  • Ensuring that all children wear seat belts when travelling in a car
  • Window bars to prevent accidental falls

Safeguarding children and young people is a key priority for the Tameside Children’s Trust and the Tameside Safeguarding Children Board, particularly reducing the impact of abuse and neglect through targeted multi agency action and improvements to services. This particularly applies to reducing the impact of domestic violence on children and young people, bullying, neglect, road safety and e-safety/safe use of technology, and a range of agencies are involved. For example, health visitors work with families to promote a safe living environment, and Road Safety staff promote road awareness in schools.

Hospital Admissions: Summary of Key Messages

  • Evidence shows that people from lower socio-economic groups are at higher risk of avoidable emergency admissions, as are babies and very young children
  • This link can be seen in Tameside, with children and young people living in areas of deprivation being more likely to have emergency admissions, particularly for alcohol and injury.
  • Health improvement interventions, self management, effective access to primary care, and living in a safe environment can all help to reduce emergency admissions in general

Children living in areas of socio-economic deprivation are more likely to experience emergency hospital admissions, which can often be prevented with the help of families and wider community.

Recommendations

  • Effective self management and health improvement interventions to promote healthy lifestyles and safe home environments should be offered at an individual level.
  • Agencies such as the local authority and the third sector should work with local communities and families to build social capital (Social capital describes the links between individuals and the links that connect people within and between communities) and provide a safe, healthy and sustainable environment for children, young people, families and communities.

3.2.4.4 Mental Health and Parental Influence

Mental Health

Nationally, one in ten children between the ages of 1 and 15 have a mental health disorder (ONS (2005) Online) and research suggests that 20% of children have a mental health problem in any given year, and about 10% at any one time (Mental Health Foundation (2005) Lifetime Impacts: Childhood and Adolescent Mental Health, Understanding The Lifetime Impacts), with depression and anxiety being the most common conditions.

There is a greater prevalence of mental health disorders among children and young people in (Mental health of children and young people in Great Britain 2004. (2005) The Stationery Office: London):

  • Families where both parents are not working (20%) in comparison to those families where both parents worked (8%)
  • Families that have less than £100 gross weekly household income (16%) in comparison to families with gross weekly income of £600 or more(5%)
  • Households that have a member within the family receiving disability benefit (24%) in comparison to those who did not receive any disability benefit (8%)
  • Families who lived in social and rented housing (14% to 17%) in comparison to those who lived in privately owned houses (7%)
  • Families living in ‘hard pressed’ areas (15%) in comparison to families who lived in areas categorised as ‘healthy achievers’ or ’urban prosperity’ (6% to 7%)
  • Families where parents have no educational qualification (17%) in comparison to those who had degree level academic qualifications (4%)

and amongst children and young people that (Building resilience and reducing risk to emotional well-being in school age children and young people in Tameside and Glossop – a needs assessment (2010)):

  • Face domestic violence
  • Are looked after children
  • Are young carers
  • Have learning disabilities
  • Are from ethnic minorities
  • Raise child protection concerns
  • Are children in need
  • Are involved with the criminal justice system
  • Have chronic illness
  • Are bereaved

It has been estimated that there are over 3,300 children and young people in Tameside with some form of mental disorder, as shown in the table below.

Table 2: Prevalence and number of children aged 5-16 years with a mental disorder, Tameside, by gender and age.

Age (years)

Boys % number

Girls % number

5-10

10.2 %, 850 5.1%, 400

11-16

12.6%, 1,200 10.3%, 930

Source: Tameside and Glossop CAMHS needs assessment, 2007 – extrapolated from ONS Survey with mid-year ONS 2005 population estimates

Good mental health underlines all aspirations in Every Child Matters (The Stationary Office, 2003. Every Child Matters) and policy guidance places emphasis on agencies working together in a co-ordinated fashion to recognise where problems are arising and ensure that children and families receive the support they need (Building resilience and reducing risk to emotional well-being in school age children and young people in Tameside and Glossop – a needs assessment (2010)).

There is a wide range of universal, targeted and treatment services in Tameside that support children and young people’s mental health needs, including (Building resilience and reducing risk to emotional well-being in school age children and young people in Tameside and Glossop – a needs assessment (2010)):

  • Early intervention for behavioural problems in schools and problems with learning
  • Providing support to parents
  • Counselling services
  • Integrated services that provides a wide range of specialist support services that help children and young people with social aspects of their lives etc...

Emotional Health

Risk factors within the family that can have impact on children and young people’s emotional well-being, including:

  • Domestic violence
  • Breakdown of the family unit
  • Single parent families
  • Inconsistent discipline
  • Parents facing mental health problems (and other problems such as alcoholism, being involved in the criminal justice system etc)
  • Bereavement
  • Physical or sexual abuse
  • Domestic violence

Risk factors in the community include:

There are four individual indicators which contribute to the National Indicator (NI) 50: emotional health and well-being of children:

  • I have one or more good friends
  • When I’m worried about something I can talk to my mum or dad
  • When I’m worried about something I can talk to my friends
  • When I’m worried about something I can talk to an adult other than my mum or dad

The national Tellus4 survey (Tellus4, Department for Children, Schools and Families, 2010) included questions that addressed these indicators. The overall result shows that nationally, 56% of children and young people have good emotional health and well-being. This is lower than within the Tellus3 survey (63%) and is attributed to the fall in the number of respondents who felt that they could talk to an adult other than their parent.

The local results indicate that Tameside young people are similar to others in Greater Manchester with 59% reporting good emotional health locally compared to an average of 58% across Greater Manchester. However, local and regional results are higher than the average across England of 56%.

Figure 15: Self reported NI 50 - Emotional Health and well-being results, Tellus3 (2008) and Tellus4 (2009).

Graph showing self reported NI 50 - Emotional Health and well-being results, Tellus3 (2008) and Tellus4

Source: Tellus4, Department for Children, Schools and Families, 2010.

However, more young people in Tameside felt able to talk to their mum and dad when worried, than any other area in Greater Manchester, and Tameside’s result is significantly higher than England’s: 67% compared to 64%.

Children and young people are able to be resilient and have good emotional well-being when they feel loved, supported and valued within their family, community and by their peers in schools. Positive relationships with teachers at school also support interaction and achievement (Building resilience and reducing risk to emotional well-being in school age children and young people in Tameside and Glossop – a needs assessment (2010)).

Some of the factors that are required for emotional well-being and building resilience in children and young people are as follows:

  • Being a part of a family that is happy and gets along
  • Being a part of a school that values the well-being of all children and young people
  • Taking part in local activities aimed at children and young people
  • Feeling safe, loved, trusted and valued by the family and peers
  • Having the opportunity of trying new activities and challenges without feeling pressured
  • Having a sense of belonging in the family, school and within the community
  • Having the support and ability to face adversity and cope with stress (Mental Health Foundation (2008) Good Mental Health)

Parental Influence

Children can be exposed to many events, as well as emotional and family difficulties, which can result in poor health outcomes or health related problems, and both are closely associated with socio-economic circumstances. Examples of events include divorce and marital conflict, lone parenthood, teenage pregnancy, education underachievement, youth unemployment and admission into care; and the health problems that result from emotional and family disturbance are often related to parenting.

However parenting is not a straightforward issue of competency and skill, but is carried out within a wider social context. Socio-economic issues such as increased family conflict, poor material environments and high levels of parental mental ill health and stress influence the wider social context and impacts on child rearing. In addition, as mentioned previously, children born into poverty are likely to become poor adults, with all the additional adverse health outcomes that are associated with socio-economic deprivation. This results in a perpetual cycle of poverty stretching from one generation to the next.

The positive parenting programme delivered in Tameside and Glossop is a structured and focused short-term programme that provides support to parents and carers of children and young people aged 1 – 17 years. The organisation and delivery of the positive parenting programme is a multi-agency initiative that includes the PCT, Tameside Metropolitan Borough Council, Derbyshire County Council and the voluntary sector (Building resilience and reducing risk to emotional well-being in school age children and young people in Tameside and Glossop – a needs assessment (2010)).

Mental Health and Parental Influence: Summary of Key Messages

  • Vulnerable children, children living in poverty and children that experience family stresses are more likely to suffer from mental ill health
  • Early and co-ordinated interventions for children and young people will help support those with mental ill health
  • Support for families and parents is also effective

Due to the deprivation profile of Tameside, local children and young people in Tameside are at risk of mental and emotional ill-health. However, a relatively high proportion of young people are able to talk to their parents when worried.

Recommendations

  • Children, young people and their families should be supported to maximise their capabilities and have control over their lives, which includes supporting parents to access quality and financially viable training and work opportunities
  • Agencies need to work together to provide early identification of children and young people at risk of mental ill health and provide the support they require
  • Children and young people with mental ill health, and their families, should be able to access effective treatment and support

3.2.5 Recommendations

Babies and Infants

Ensure women from areas of deprivation:

  • Access appropriate health information and interventions which support healthy lifestyles pre-conception
  • Access antenatal services at the appropriate time
  • Access support to maintain healthy lifestyles and breastfeeding

Childhood Lifestyle Factors:

  • Universal and targeted prevention interventions should be available to prevent unhealthy children becoming unhealthy adults, and should involve primary care, local authorities and the third sector
  • Support aimed at children should involve families and the local community and should be delivered across school and community settings

Hospital admissions:

  • Effective self management and health improvement interventions to promote healthy lifestyles and safe home environments should be offered at an individual level
  • Agencies such as the local authority and the third sector should work with local communities and families to build social capital (Social capital describes the links between individuals and the links that connect people within and between communities) and provide a safe, healthy and sustainable environment for children, young people, families and communities

Mental Health and Parental Influence:

  • Children, young people and their families should be supported to maximise their capabilities and have control over their lives, which includes supporting parents to access quality and financially viable training and work opportunities
  • Agencies need to work together to provide early identification of children and young people at risk of mental ill health and provide the support they require
  • Children and young people with mental ill health, and their families, should be able to access effective treatment and support
 
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