Agenda item

Report of the Director of Public Health

Helene Denness, Consultant in Public Health, and David Johns, Speciality Registrar in Public Health, presented the revised report which was electronically circulated as a supplement to the agenda, and delivered a presentation which focuses on the work undertaken to address the following:

o  proportion of women smoking in pregnancy;

o  number of babies that die in the first year of life;

o  percentage of children aged 5 years with tooth decay;

o  proportion of year 6 children who are obese.

The report contains detailed information and statistics in each of these areas, which were summarised as follows:

Smokers at the time of delivery. 

(i)  It is estimated that 17.6% of women in Nottingham are smoking at the time of delivery, this is against the national average of 10.7%. However, due to the overall lack of detailed information, it can’t easily be established how many women were smoking at the beginning of their pregnancy and had stopped during pregnancy;

(ii)  smoking during pregnancy is the most important modifiable cause of stillbirth;

(iii)  since funding has been withdrawn for the New Leaf stop-smoking service, other approaches and ways of working need to be considered;

(iv)  as between 30 and 40% of pregnant women do not engage with smoking cessation services, on site specialist maternity stop smoking support, may have a greater influence;

(v)  ‘love your bump’  a social media campaign may also influence women’s decision to stop smoking.

The number of babies who die in their first year.

(vi)  With an infant mortality number of 5.9 deaths per thousand live births, Nottingham has a higher infant mortality rate that the English average which is 3.9 deaths per 1000 live births, with little indication of a decrease. It is noted that stillborn deaths are not included in the statistics;

(vii)  a healthy pregnancy is important including mothers refraining from smoking or drinking alcohol, and fully engaging with the midwife at the early stages of pregnancy to ensure that any early signs for concern are recognised and can be appropriately dealt with;

(viii)  further work needs to be undertaken with regard to safer sleeping of infants to prevent avoidable deaths.

Oral health

(ix)  Good oral health is important for the broader health and well-being of children and young people as poor oral health negatively impacts on the ability to sleep, eat, speak, play and socialise with other children. There is currently no new data on the number of children with missing or decayed teeth since the last update to the Board, but it is recognised that deprivation has a noticeable impact on oral health;

(x)  current and future work to address oral health issues will be challenging, particularly as funds are not available to continue existing preventative work. A new approach will require working with partners including health visitors promoting oral health.

Childhood Obesity

(xi)  During the 2016/17 academic year, 26% of reception aged children were considered obese or overweight and 39.7% of year six children were considered obese or overweight. As illustrated by the graph in the report, this indicates an upwards trend. Whilst local and national initiatives such as ‘change4life’ aim to change parental and child behaviour, there is still much work to be done.

Joint Chair, Councillor David Mellen, stated he was ‘not encouraged’ by the overall statistical picture of health and well-being for children and young people in Nottingham. As concerted work was needed on childhood obesity it was suggested that it may be appropriate, given the joint work needed, that this group be a sub-group of the CYP Partnership.

The following responses were given to questions from the Board:

(a)  the Small Steps Big Changes (SSBC) programme has been trying hard to encourage Parent Mentors to support other parents as there is evidence that this has worked very well in other areas such as breastfeeding;

(b)  the ‘Cook and Eat’ courses run in the SSBC wards are designed to promote healthy eating and change behaviours and are held without a crèche to encourage parents to be seen to be cooking healthily by their children and potentially encourage  the involvement of their children in healthy cooking from an early age;

(c)  dental services commissioning is not a responsibility of Public Health but there may be opportunities to involve local dentists in the promotion of oral hygiene in schools. However, there needs to be a responsibility on parents for oral health and promoting physical activity;

(d)  it is not yet clear what the impact of vaping will have on the population e.g. will we see further reductions in the number of smokers. Evidence suggests that vaping is less harmful than smoking. However there are concerns about the availability of untested and un-safe vaping products;

(e)  parents need to be engaged to ensure that Public Health initiatives aimed at children work effectively.

Joint Chair, Councillor Sam Webster, commented that from the data presented, some public health interventions such as New Leaf, has not made much of an impact. Cllr Webster also suggested that Public Health funds should be spent on the most effective interventions.

Helene Denness highlighted the decrease in smoking prevalence across Nottingham City as a whole and that the data she presented didn’t go back far enough to illustrate these reductions.

RESOLVED

(1)  to note the contents of the report and progress on health and wellbeing outcomes in the Nottingham City Children and Young People’s Plan;

(2)  for Nottingham Children’s Partnership Board partners to continue to support activity to improve health and wellbeing of children and young people in Nottingham;

(3)  for Helene Denness to bring a proposed approach on childhood obesity, including proposed task and finish group membership, to a portfolio holder briefing;

(4)  for an agenda item on Childhood Obesity to be added to the Forward Plan for further consideration.