National Child and Maternal Health Intelligence Network (Public Health)
Improving young people’s health and wellbeing: A framework for public health - Cornwall
Introduction
Adolescence is the fastest changing period of development after infancy1. It can represent a crossroads in life and a time of setting new and positive norms. It is an important life stage for intervention.
The Young People’s Health and Wellbeing Framework, published in 2015 (www.chimat.org.uk/resource/view.aspx?RID=227214) addresses the request by the Chief Medical Officer in her 2012 Annual Report2 that Public Health England (PHE) should consider the specific needs of this age group. It is designed to give practical support to Councillors, Health and Wellbeing Boards, commissioners and service providers.
It sets out at a high level a way of thinking about young people’s health, taking an asset based approach, and focusing on wellbeing and resilience. It describes six core principles which will promote a more effective, integrated response to needs.
Developed alongside the Framework, the Young People's Profiles (atlas.chimat.org.uk/IAS/dataviews/youngpeopleprofile) allow areas to see how they perform against the national average and against other areas when considering the key public health outcomes for young people. They also present trends against the benchmark year.
This report presents relevant data at a local level, where available to supplement the Framework.
Improving the wider determinants of health
The Framework identifies the following key public health outcomes for young people in the context of wider determinants:
· Reduce the number of young people living in poverty: ensure that young people who are unemployed and not in education get the support they need to avoid poverty. In Cornwall 4.2% of young people aged 16 to 18 years were not in education, employment or training in 2014 (5.0% in 2010), which compares to 4.5% regionally and 4.7% nationally. In general, those not in education, employment or training are more likely to be young people who are disabled, were eligible for free school meals or had a baby5. In addition, 14.4% of children aged 11 to 15 years were living in low income families in Cornwall in 2012, which compares to 12.3% regionally and 16.4% nationally.
·
Provide targeted support for vulnerable groups, e.g. those in local authority care6, youth custody, care leavers (70 young people aged 16 years or over left care in Cornwall in 2012 (figure rounded)), young carers, homeless young people, asylum seekers, young people excluded from education and teenage parents. It has been estimated that more than 40% of young people on community service orders have emotional and mental health needs and the prevalence of mental illness among children in custody and in care is higher7.
The tables below show information on vulnerable groups in the area.
Looked after children and young people, rate per 10,000 population
/ Aged 10 to 15 years (2013) / Aged 16 years and over (2013) /Cornwall / 63.5 / 77.4
South West / 60.8 / 102.8
England / 67.8 / 105.8
Source: Department for Education
Children and young people formally entering the youth justice system, rate per 1,000 population
/ Aged 10 to 14 years (2013/14) / Aged 15 years (2013/14) / Aged 16 years (2013/14) / Aged 17 to 18 years (2013/14) /Cornwall / 2.6 / 9.7 / 11.2 / 16.2
South West / 2.8 / 10.9 / 14.9 / 19.0
England / 2.9 / 11.8 / 15.5 / 19.8
Source: Ministry of Justice
Homeless households headed by a young person aged 16-24 years, rate per 1,000 households
/ Homeless households headed by a young person aged 16-24 years (2011/12) / Homeless households headed by a young person aged 16-24 years (2012/13) / Homeless households headed by a young person aged 16-24 years (2013/14) /Cornwall / 1.16 / 0.84 / 0.36
South West / 0.58 / 0.53 / 0.42
England / 0.79 / 0.75 / 0.64
Source: Department for Communities and Local Government
In 2013/14, there were 84 homeless households in Cornwall headed by a young person aged 16 to 24 years. As shown above, this equates to a rate of .36 households per 1,000 total households; in 2010, this rate was .95.
The Department for Communities and Local Government also publishes statistics on households that have been accepted as in priority need because they are headed by a young person aged 16 or 17 years. In Cornwall there were 7 such households in 2013/14. Homelessness has a serious impact on both the young people affected and the wider society. Homeless young people have higher chances of poor physical and mental health, are more likely to have a disability, be admitted to hospital, smoke and have a poor diet. In general, they find it harder to achieve their goals and ensure their wellbeing. They are at higher risk of becoming involved in crime and themselves becoming victims of crime8.
Shelter, the housing and homelessness charity, notes that homeless households accommodated outside their local area can face practical disruption relating to employment, education and support from services, family and friends. Households housed out of their usual district report feeling isolated, and a negative impact on their mental health. In many local areas there are too few of these households to report, as is the case in Cornwall (this relates to all homeless households, not restricted to those which contain a young person).
Further information on vulnerable groups is shown below:
School exclusions as a percentage of pupils in secondary school
/ Fixed period exclusions (2012/13) / Permanent exclusions (2012/13) /Cornwall / 3.8% / 0.08%
South West / 5.6% / 0.10%
England / 6.8% / 0.12%
Source: Department for Education
Denominator uses pupil headcount. Dually registered pupils are excluded.
Teenage mothers: deliveries to teenagers living in this area, percentage of all deliveries
/ Teenage mothers (2014/15) /Cornwall / 1.1%
South West / 0.9%
England / 1.0%
Source: Hospital Episode Statistics (HES). Health & Social Care Information Centre
Further key outcomes for young people relating to the wider determinants of their health include:
· Provide young people in further education and training who have special educational needs or disabilities (SEND) the same rights and protections to those for children with SEND under 169.
· Target support for parents and families to those who need most help, recognising their critical role in young people’s outcomes, and linking with the Troubled Families programme10.
· Improve safety: young people consulted while developing the Framework listed safety among their most important concerns11. This includes freedom from sexual exploitation, domestic and interpersonal violence, accidents and psychological safety (including managing social media, bullying and homophobic bullying). There were 774 emergency hospital admissions from accidental or deliberate injuries of young people aged 15 to 24 years in Cornwall in 2014/15, which equates to a rate of 125.4 per 1,000 population. This compares to 145 regionally and 131.7 nationally.
Health improvement
The Framework identifies the following outcomes relating to health improvement:
· Reduce smoking, drinking and drug use: evidence suggests that some groups of young people facing disadvantage or under particular stress continue to have higher rates of poor health relating to these risk factors than the general youth population12.
In Cornwall: There were approximately 176 hospital admissions per year of young people aged 15 to 24 years as a result of substance misuse in the period 2012/13 - 2014/15. This equates to a rate of 96.9 per 100,000 population; the regional rate is 91.8 and the national rate is 88.8.
· In 2010/11 - 2012/13, on average 55 children and young people aged under 18 years were admitted to hospital each year as a result of alcohol, this equates to a rate of 52.9 per 100,000 population. Nationally the rate is 42.7, and regionally 51.2.
· Unfortunately nationally derived local area data on smoking in children and young people is not available. Trends are available from national surveys, and smoking in young people on the whole is decreasing.
Proportion of pupils aged 11-15 years who smoke regularly - EnglandSource: Smoking, Drinking and Drug Use Among Young People in England - 2012. Health & Social Care Information Centre
Prevalence of cigarette smoking among young adults - England
Source: Statistics on Smoking, England 2013. Health & Social Care Information Centre. Table 2.1.
Further key outcomes for young people relating to health improvement include:
· Continue to reduce under-18 conceptions: there are significant variations in conception rates across the country. In Cornwall 242 girls aged under 18 years became pregnant in 2012, more information on teenage conception rates is shown below.
Under 18 conceptions, rate per 1,000 population
Under-18 conception rate
Cornwall / 32.8 / 33.4 / 35.9 / 30.5 / 32.9 / 30.3 / 26.1 / 21.3
South West / 33.1 / 36.2 / 34.9 / 32.4 / 29.9 / 27.3 / 24.8 / 21.2
England / 40.6 / 41.4 / 39.7 / 37.1 / 34.2 / 30.7 / 27.7 / 24.3
Under 18 conceptions leading to abortion, percentage
/ 2006 / 2007 / 2008 / 2009 / 2010 / 2011 / 2012 / 2013 /Under-18 conceptions leading to abortion
Cornwall / 46% / 55.3% / 48.3% / 42.1% / 44% / 44.8% / 44.6% / 48.2%
South West / 50.2% / 48.9% / 50.6% / 48.7% / 49.9% / 47.9% / 48.9% / 50.3%
England / 48.8% / 50.5% / 49.7% / 49.1% / 50.3% / 49.3% / 49.1% / 51.1%
Under 16 conceptions, rate per 1,000 population
/ 2009 / 2010 / 2011 / 2012 / 2013 /Under-16 conception rate
Cornwall / 5 / 5.9 / 5.4 / 4.6 / 3.9
South West / 6.3 / 5.7 / 5.1 / 4.9 / 3.8
England / 7.5 / 7 / 6.1 / 5.6 / 4.8
Under 16 conceptions leading to abortion, percentage
Under-16 conceptions leading to abortion
Cornwall / 60.9% / 66.7% / 52% / 57.1% / 71.4%
South West / 62.8% / 65.1% / 60% / 62.2% / 66%
England / 60.2% / 62.8% / 60.5% / 60.1% / 61.8%
Source for all conception and abortion rates: Office for National Statistics
Values may be blank where small numbers have been suppressed.
The Framework also identifies the following:
· Improve sexual health by de-stigmatising asking for advice: nationally, rates of sexually transmitted infections in those aged 15-24 are much higher than in all other age groups13. In Cornwall, there were 36.3 acute STI diagnoses per 1,000 population aged 15 to 24 years in 2012. This compares to 33.0 regionally and 34.4 nationally.
· Increase levels of physical activity and fitness: physical activity declines across adolescence, particularly for young women14.
·
Encourage healthy eating and weight, as well as positive body image: young people need support to improve nutrition (including cooking skills), reduce obesity and prevent eating disorders. In general, the prevalence of obesity and overweight in children aged 10-11 in the poorest households is double that of the most affluent15, and there is an association between poor diet and nutrition and obesity with deprivation. In Cornwall, 14.9% of children aged 10 to 11 years are overweight, and a further 17.1% obese. (Source: National Child Measurement Programme results for 2014/15).
·
Improve access to mental health services: this applies across the population but particular attention should be given to more vulnerable groups of young people.
· Reduce self-harm and suicide: surveys and research suggest that between 6%-20% of young people may have self-harmed16. Although suicide is rare and rates are decreasing, it remains a significant cause of death of young people17. Critically, certain groups of young people may be significantly more at risk of self-harm or suicide, including lesbian, gay, bisexual, transgender and questioning young people18. There were 380 admissions to hospital following self-harm for young people aged 10 to 24 years in Cornwall in 2012/13. This equates to a rate of 422.1 per 100,000 population. Regionally the rate is 442.5 and nationally 346.3.
·
Encourage health literacy: knowing where to go and how to ask for help will build resilience and mean that services are used more effectively.
· Promote positive self-image: adolescence is a time of identity development, so promoting positive self-esteem, healthy body image, confident health choices, and a sense of belonging will all contribute to wellbeing and resilience.
· Support young people with long term conditions to maintain their independence and good health, with the minimum disruption to their education and learning.
Health protection
The Framework identifies the following outcomes relating to health protection:
· Young people are supported to develop the confidence to protect their health, to self-manage wherever possible and seek help when necessary.
· Champion the recommended vaccination schedule for adolescents, particularly those from marginalised and vulnerable groups. Enlist carers’ support in encouraging 11-18 year olds to have the vaccinations, and design inoculation opportunities around adolescents’ use of other services. All girls aged 12 to 13 are offered HPV (human papilloma virus) vaccination, which protects against cervical cancer, as part of the NHS childhood vaccination programme. The vaccine is usually delivered through schools. In Cornwall, 57.3% of girls had the vaccine in 2013/14. Regionally the uptake was 83.2%, and nationally 86.7%.
Healthcare public health and preventing premature mortality
The Framework identifies the following outcomes relating to healthcare public health:
· Reduce depression and anxiety: mental ill health is the largest single cause of disability in the UK19. At any one time, around 5% of young people aged 11-15 in England have diagnosable emotional disorders such as depression and anxiety20.
· Manage long-term conditions, chronic disease and disability: in general, one in seven young people aged 11-15 has a long-term medical illness or disability affecting many aspects of their life21. The transition from child to adult services needs to be carefully planned with the young person. Cornwall had 52 emergency hospital admissions for asthma in young people aged 10 to 18 years in 2012/13, 26 for epilepsy and 44 for diabetes. More information about emergency hospital admissions for young people as a result of their long-term condition is shown below.