Child Public Health What every GP should know

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Child Public Health What every GP should know

• David Stone
• Paediatric Epidemiology and Community Health
  (PEACH) Unit
• University of Glasgow/Yorkhill Hospital

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WHY FOCUS ON CHILD PUBLIC HEALTH?

• Children are as deserving of good health as
  adults
• Todays children are tomorrows adults
• Early origins of major adult diseases (Barker and
  ACE Hypotheses)
• Children have specific legal rights that are
  relevant to health services

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All doctors are public health practitioners now

• Patients must be able to trust doctors with
  their lives and health. To justify that trust you
  must show respect for human life and you must
• Make the care of your patient your first concern
• Protect and promote the health of patients and
  the public
• Provide a good standard of practice and care
• Duties of a Doctor, Good Medical Practice (GMC
  2006)

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WHAT IS CHILD HEALTH?

• WHO definition of health as it relates to
  children
• A state of complete physical, mental and social
  wellbeing and not merely the absence of disease
  or infirmity

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WHAT IS PUBLIC HEALTH?

• The science and art of preventing disease,
  prolonging life and promoting health through the
  organised efforts of society
• Faculty of Public Health Medicine 1992

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Child public health is an interface activity
Clinical child care
Public health
Child public health
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The Public Health Approach

• Needs assessment (diagnosis) What are the
  nature, scale, and determinants of the problem in
  the population?
• Population-wide intervention (treatment) What
  can and is being done to address the problem?
• Evaluation or monitoring (follow up) How well
  are interventions currently being implemented and
  how might they be improved?

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KEY ELEMENTS OF CHILD PUBLIC HEALTH

• Epidemiological indicators of need
• Causes and consequences of child illness/health
• Types of intervention
• Ethical and legal aspects

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Evidence of need for child public health in UK

• High level of relative poverty/inequality in UK
• UNICEF 2007 report
• Links between child and adult health (Early
  Origins, ACE hypotheses)
• Breaches of UN and European law
• Adverse childhood experiences

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UNICEF review of child well-being 2007

• Of the 21 countries of the OECD UK children had
  the lowest level of well-being as measured across
  six dimensions
• Material
• Health and safety
• Educational
• Family and peer relationships
• Behaviours and risks
• Subjective
• UK level close to (but still below) average

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Epidemiological indicators of child health

• Demography
• Mortality
• Morbidity
• Use of services
• Other

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Geography of Demography (GROS 2006 based)
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Determinants of child health (after LaLonde
1974)

• Biology (e.g genes, viruses)
• Environment (e.g. poverty, climate)
• Lifestyle (e.g. smoking, alcohol)
• Services (e.g. health, education)
• A New Perspective on the Health of Canadians

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Public Health Diagnosis -Dahlgren and Whitehead
model
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The Social Ecological Model
Societal
Community
Relationship
Individual
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Main global threats to child health in 21st
century

• Injury and abuse
• Congenital anomalies
• Infection
• Respiratory disease
• Cancer
• Psychosocial disorders

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Sensitive Periods in Early Brain Development
School years
Pre-school years
High
Numbers
Peer social skills
Language
Symbol
Sensitivity
Habitual ways of responding
Emotional control
Vision
Hearing
Low
1
2
3
6
5
4
7
0
Years
Graph developed by Council for Early Child
Development (ref Nash, 1997 Early Years Study,
1999 Shonkoff, 2000.)
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LIFECOURSE INFLUENCES ON HEALTH 3
INTERCONNECTED PROGRAMMING HYPOTHESES

• Biological (Barker et al)
• Psychological (Felitti et al)
• Social (Ben Shlomo et al )

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SOME KEY EARLY BIOLOGICAL PREDICTORS OF LATER
HEALTH

• Maternal health and nutritional status
• Birth weight
• Breast feeding in infancy
• BMI in childhood/catch up growth

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ACE studies of Felitti et al
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Mortality from childhood injuries involving head
injury in Northern Region, 1979-86
Source Sharples et al, 1990
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Categories of Deprivation( of population) in
Britain
England Wales
Deprivation Category
Scotland

• Most affluent 1 6.1 23.8
• 2 13.7 30.4
• 3 21.8 21.5
• 4 25.5 14.1
• 5 14.8 6.7
• 6 11.4 2.9
• Most deprived 7 6.8 0.5

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Proportion of 15 year old children with decay
experience in the British Isles 2002-3
Source Nunn JH. The burden of oral ill health
for children. Archives of Disease in Childhood
2006 91 251-253
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Who currently practices child public health in
the UK?

• Public health professionals
• General practitioners and paediatricians
• Academics/researchers
• Others (e.g. teachers, social workers, planners)

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Improving child health depends on both

• Public health measures
• and
• Clinical services
• Examples of overlap
• surveillance, immunisation, screening, child
• protection, parenting support

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Contribution to additional life years (Bunker and
MacFaul) 1900-1950 30 yrs 1950-2000 7 yrs

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Treating individual children contributes to
public health

• Acute illness
• (e.g. infection, respiratory disease, surgical
  conditions)
• Chronic disorders
• (e.g. cerebral palsy, Down syndrome, asthma,
  diabetes)

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EARLY YEARS - THE GROWING RESEARCH EVIDENCE

• That early life experience influences later life
  outcomes
• That early life interventions can make a
  difference to later life outcomes
• Parents are key in both causing and preventing
  poor health and other outcomes

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Parenting support is potentially the most
powerful and useful vaccine of the 21st century

• but dont forget other interventions in early
  life
• Preconception and genetic counselling
• Screening (antenatal, neonatal, childhood)
• Immunisation programmes
• Nutrition (pregnancy, infant, child)
• Lifestyle (diet, alcohol, smoking, drugs)
• Creating a healthy and safe environment
• Antipoverty and inequality policies
• High quality health and social care

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UN Convention on theRights of the Child 1991
3 Ps

• Protection from hazards and exploitation
• Provision of basic care and services
• Participation in decision making

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Childrens (Scotland) Act 1995 and medical consent

• Applies to children under 16
• Children can give own consent if judged capable
• Parents/guardians lose veto but should be
  involved in discussion
• If in doubt, best interests of child are paramount

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Summing up

• Children are a vulnerable minority
• Children (usually) grow into adults
• Role for health promotion and healthcare
• Children have specific legal protection
• Poverty is greatest global threat to health
• Growing parenting/pre-school agenda

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