Child Health Indicators in the Context of Child

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Child Health Indicators in the Context of Child Wellbeing The EU CHILD Project Michael Rigby Professor of Health Information Strategy Keele University, UK Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Health and Wellbeing • Health is essential for wellbeing • Wellbeing is essential for health • Health domain needs to move beyond ‘health’ as ‘illness’, and recognise it is ‘physical, mental, and social wellbeing’ [WHO] • Child wellbeing domain needs to see health as integral Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project • 2000 – 2002 • 17 Countries Ø 15 Member States (EU 15) Ø + Norway, Iceland Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project CHILD Philosophy • Health Status, Outcome Ø Death, illness, etc. - important; too late • Health Determinants Ø Preventive, more important • Burden of Illhealth Ø Illness, social cost, loss of education Ø Determining Priority Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Core Principles of CHILD 1. 2. 3. 4. 5. Topics must be important health issues Must be underlying scientific evidence Comparability between countries Routine data sources preferable Ability for continuity and time series Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Breadth of Determinants Lack of day-care Harmful environment Deficient law Negative market forces Day-care School Unemployment Lack of influence and participation Social services Health care Social life Socially isolated living Financial support to families Child-oriented culture Disease and injury Negative media Adverse cultural development Poverty Uncertain future prospects Adapted by Gunnlaugsson G and Rigby M from Skolhälsovården 1998. Underlag för egen kontroll och tillsyn. Stockholm: Socialstyrelsen, 1998. Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Structure of CHILD Health Determinants • Demographic and Socio-economic • Health Status and Well-being • Determinants of Health, Risk, and Protective Factors • Health Systems and Policy Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Topics · · · · Demography Socio-Economic Marginalised Children Well-being, Quality of Life Mental Health Lifestyles Nutrition and Physical Growth Development (inc. Intellectual and Social Mortality, Morbidity, Injuries Environment Health Promoting Policies Professor Michael Rigby Keele University, UK Access and Utilisation of Services

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Short-Listing Criteria 1. 2. 3. 4. 5. 6. 7. 8. 9. Significance of Burden to Society Significance of Burden to Family Significance of Burden to Individual Objective, based on research Representative of Large Population Groups Regularity and Repeatability (trend analysis) Amenable to Effective Action Data Availability Understandable to broad audience Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project CHILD Results 38 indicators - some traditional some novel thematic spread 17 areas need research - current evidence not adequate Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Spread of CHILD Indicators Outcome : Process : Determinants Aspects Measured Environmental Determinants C 12 D 7, D 8, D 9, D 10 A 1, A 2, A 3, A 4, A 5, D 5 Social Determinants Family Determinants C 9 C 2 Prevention D 1 2 o Prevention D 2 1 o 3 o Prevention Personal Behaviour C 1 D 6 C 11 C 3 D 4 B 8, B 9, B 10 B 11 Well-being Illness B 3, B 4, B 5, B 6 C 5, C 7 C 4 C 8 B 7 C 6 B 7 C 10 Disability Death B 1, B 2 (Birth) 6 months 5 years 1 year 1 week Professor Michael Rigby 10 years 15 18 years Keele University, years UK Age

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project CHILD Indicators A. Demographic & Socio-Economic C. Health Determinants, Risk, D. Child Health Systems & Policy A 1 Socio-economic Circumstances and Protective Factors Health Systems Policy A 2 Children in Poverty Parental Determinants D 1 Marginalised Children’s Health Care A 3 Parental Educational Attainment C 1 Breastfeeding D 2 Parental Inpatient Accompaniment A 4 Child in Single Parent Households C 2 Household Environmental Tobacco A 5 Asylum Seekers C 3 Parental Support Health System Quality D 3 Immunisation Coverage B. Child Health Status, Well-being Child Lifestyle Determinants D 4 Leukaemia 5 -year Survival Child Mortality C 4 Physical Activity B 1 Child Mortality Rates C 5 Tobacco Smoking Social Policy Indicators B 2 Selected Cause-specific Mortality C 6 Alcohol Abuse D 5 Physical Punishment C 7 Substance Misuse D 6 Anti-bullying policies in schools Child Morbidity B 3 Cancer Other Factors Physical Protection Policy B 4 Diabetes C 8 Overweight and Obesity D 7 Child Transportation Safety B 5 Asthma C 9 Children in Care D 8 Exposure to Lead B 6 Infectious Diseases C 10 Early School Leavers D 9 Exposure to Hazardous Noise B 7 Dental Morbidity C 11 Educational Enrolment D 10 Environmental Tobacco Smoke C 12 Air Pollution Exposure Injuries to Children B 8 Burns Necessitating Admission B 9 Poisoning Necessitating Admission B 10 Fracture of Long-bones Mental Health of Children Professor Michael Rigby Keele University, UK B 11 Attempted Suicide

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project CHILD Further Research Areas Child Abuse Childhood Behaviour Disorders Learning Disorders/Intellectual Disability Educational Development Perceived Well-being, Quality of Life and Positive Mental Health Children with Permanent or Severe Disability Family Cohesion and Social Cohesion Nutritional Habits Health Care Access Inpatient Service Quality Health Service Access for Socially Restricted Children Medication Play and Leisure Assessment of Children with Special Needs Integration of Children with Special Needs Professor Michael Rigby Keele University, UK Healthy Parenting Mental Health Education

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Application of CHILD Indicators • EU ECHIM data set Ø Small use except mortality and other published items • Countries Ø Not coordinated; use through literature Ø Hungary; Sweden; NOMESCO; Ireland; UK; etc. • WHO Ø European Health Report 2005 Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project WHO Compilation of CHILD Data Hospital admissions for burns, per 100 000, 5 -9 years olds <= 50 <= 40 <= 30 2000 EUROPE No data Professor Michael Rigby Keele <= 20 <= 10 No data Min = 0 UK University,

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Burns and scalds necessitating hospital admission in 2000: HUNGARY by County Professor Michael Rigby Incidence per 100. 000 individuals 50. 0 -74. 9 UK 75. 0 -99. 9 >=100 Keele University, 25. 0 -49. 9

100, 00 75, 00 50, 00 25, 00 Incidence of burns and scalds Child Health Indicators in the Context of Child Wellbeing – the CHILD Project A A A A A 1000 Professor Michael Rigby National Institute of Child Health A 1500 2000 GDP UK Keele University, 2500

100, 00 75, 00 50, 00 25, 00 Incidence of burns and scalds Child Health Indicators in the Context of Child Wellbeing – the CHILD Project A A A A A 1000 Professor Michael Rigby National Institute of Child Health A 1500 2000 GDP UK Keele University, 2500

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Other European Health Indicators • Perinatal Health (PERISTAT) • Child Safety (CSAP) • Children and Environment (CEHAPE) • Nutrition and Exercise Behaviour • Inter-personal Violence Professor Michael Rigby Keele University, UK

Child Health Indicators in the Context of Child Wellbeing – the CHILD Project Contact and References m. j. rigby@keele. ac. uk • Rigby M, Köhler L (editors). Child Health Indicators of Life and Development (CHILD): Report to the European Commission; Centre for Health Planning and Management, Keele, UK, for European Commission Health and Consumer Protection Directorate; 2002 (98 pp). (also available on http: //www. europa. eu. int/comm/health/ph/programmes/monitor/fp _monitoring_2000_frep_08_en. pdf ) • Rigby MJ, Köhler LI, Blair ME, Mechtler R. Child Health Indicators for Europe – A Priority for a Caring Society; European Journal of Public Health, 2003, 13, 3, Supplement, 38 -46. Professor Michael Rigby Keele University, UK