Early Years: Weight at birth
Early Years: Breastfeeding
Early Years: Immunisation
Early Years: Antenatal care
Early Years: Smoking during pregnancy
Early and Later Years: Disability and Special Educational Needs
Later Years: Healthy weight
Later Years: Healthy eating
Later Years: Physical activity
Later Years: Young carers
Throughout the 1990s there was a general decline in the birth rate in the UK. This was followed by a period in the 2000s which witnessed seven consecutive annual increases, driven by higher fertility rates and by changes in the size and age structure of the female population. Women are having more children than at any time in the past 35 years. Increased birth rates, together with greater longevity are now a more significant factor in population growth than net migration. This will have obvious repercussions on services such as education, transport and housing.
The general fertility rate measures the number of live births per 1000 women aged 15-44 years. In 2009 the general fertility rate was 57.4 in Bristol which was lower than the average for the South-West (60.3 per 1000) and the National average (63.8 per 1000). Furthermore the rate in Bristol has risen slower than in the South-West and England (see following table). Between 2003 and 2009 the number of live births in Bristol increased from 5023 to 6203 (23.5%).
Table 1: General Fertility Rates (2003 – 2009)
|2003||2009||% increase in Live Births||% increase in GFR|
|Live Births||GFR||Live Births||GFR|
In recent years, according to National Perinatal Epidemiology Unit, University of Oxford, infant mortality in England and Wales has shown a steady decline from around 12 deaths per 1000 live births in 1980 to 4.7 deaths per 1000 live births in 2007. But throughout this period infant mortality has shown a marked and persistent socioeconomic gradient with the highest rates occurring in the most socio-economically disadvantaged groups.
- Bristol has an infant mortality rate above that of both the SW and the Infant England equivalent and the gap between Bristol and the SW region is widening.
- Since 2002-04 the rate decreased (as have those of the SW and England), however the latest data for Bristol shows this trend reversing.
- Bristol has the highest infant mortality rate for the last three years of all the SW Primary Care Trusts.
Table 2: Mortality (all causes) in infants under the age of 1
|Mortality all causes – Infants < 1 year|
|Deaths/1000 live births||2004-06||2005-07||2006-08|
|Bristol Primary Care Trust||4.9||4.6||5.0|
National Centre for Health Outcomes Development 3-yr rolling average 2006-08
There are a number of key areas that together improve infant mortality rates, e.g. the reduction of maternal smoking, increasing breast-feeding initiation and duration rates, and the early booking of ante-natal care. These protective factors will be discussed separately in the section ‘Early years’.
A Bristol child born today could expect to live until the age of:
- 76.9 if they are a boy, a figure that is lower than that for the South-West (79) and for England (77.9).
- 81.7 if they are a girl, which is also lower than that of the South-West (83.1) and England (82).
ONS Life Expectancy at Birth 3-year rolling average 2006-08
However, variations across the city are substantial, where life expectancy is strongly related to poverty levels. Figure 1 gives a stark demonstration of this
Figure 1: Ward level life expectancy at birth: Bristol 2002 – 2006
For the first time Lawrence Hill is no longer the ward with the lowest life expectancy (it now has the 6th lowest), and the gap between the highest and lowest wards has reduced from 10.2 in 2001-2005 to 9.3. In 2002-6 Southmead had the lowest life expectancy (75.3) and Henleaze, as per previous years, had the highest (84.6). From 2001-2005 the overall life expectancy for Bristol has increased from 78.3 to 78.6.
Confidence intervals suggest significant increases from 1998-2002 to 2002-6 for 5 wards: Ashley (3.5 years), Brislington East (2.4 years), Clifton East (3.6 years), Cotham (3.4 years) and Lawrence Hill (2.6 years).
Life expectancy has decreased in 9 wards in 2002-6 compared to 1998-2002, although these decreases are not statistically significantly different. Lockleaze and Hartcliffe had the largest life expectancy decreases over the 4 year period; 1.3 years and 1.2 years respectively.
According to National Institute for Health and Clinical Excellence (NICE), low birth weight is an enduring aspect of childhood morbidity, a major factor in infant mortality and has serious consequences for health in later life. Low birth weight displayed in the following graphs shows Bristol has a higher percentage of underweight live births (less than 2500 grams) than the South-West as a whole. Unlike in the South-West, which is showing a downward trend, there is no clear pattern in Bristol’s figures.
Figure 2: Percentage of Underweight Live Births (1999 – 2007)
Figure 3: Percentage of Underweight Live Births (Bristol and its Statistical Neighbours)
According to the Department of Health, breastfeeding is a priority for improving children’s health: research continues to emphasise the importance of breast milk as the best nourishment for babies aged up to six months. Breastfeeding can play an important role in reducing health inequalities.
There are two National Indicators which examine the prevalence and coverage of breastfeeding at 6-8 weeks from birth. Prevalence is defined as the percentage of infants being breastfed at 6-8 weeks; coverage is defined as the percentage of infants for whom breastfeeding status is recorded. Bristol’s performance is displayed in the following graph:
Figure 4: Quarterly Breastfeeding Data (Bristol – 2008 to 2010)
Number of women breastfeeding at 6 – 8 weeks after delivery as a percentage of all mothers attending 6-8 week check. Breastfeeding includes both exclusively breastfed, and mixed breastfeeding and bottle. Source: NHS Bristol (PCT)
A crucial factor in the reduction of infectious diseases and associated morbidity and mortality has been the development of childhood vaccination programmes. Nearly all children in the United Kingdom are now immunised against tetanus, diphtheria, polio, whooping cough, haemophilus influenzae b, meningitis C and measles, mumps and rubella. Current government immunisation targets are for 95 per cent of children to be immunised against these diseases by the age of two. The measles /mumps /rubella (MMR) vaccine, which was introduced in 1988, resulted in notifications of measles dropping to their lowest recorded annual total of under 3,000 in 2001. However, following now discredited concerns by some over the safety of the MMR combined vaccine there was a fall in the proportion of children receiving this vaccine.
Table 3: Percentage of children immunised by their 2nd birthday, by primary care organisation, 2004-05
|Percentage immunised by their 2nd birthday|
|Bristol South and West||95||95||94||94||94||80||94|
The stand-out column is the MMR immunisation take-up, which is clearly lower than for all other vaccines. However, by 2007/2008, the Bristol PCT reported a significant rise in MMR immunisation (90%), out-performing both the South-West (88%) and England as a whole (85%).
Low MMR vaccine uptake has had clear implications. According to the British Medical Journal measles has reappeared in the United Kingdom, with 449 confirmed cases to the end of May 2006 compared with 77 in 2005, and the first death since 1992. Cases are occurring in inadequately vaccinated children and in young adults, leading to concerns that endemic measles could re-emerge. The BMJ also reveals the effects of non-vaccination: mumps cases began rising in 1999 after years of very few cases, and by 2005 the United Kingdom was in a mumps epidemic with almost 5000 notifications in the first month of 2005 alone. The University of Bristol states that in recent years there has been an increase in the level of mumps cases in the Bristol area. Particularly high numbers of cases have been seen in the 16-24 age group.
It is important that women book antenatal care with their local hospital to ensure that they are given appropriate advice and care at an early stage to avoid complications during the pregnancy. It is recommended that women book before they are 12 weeks pregnant.
There is very little data available that is specific to this area.
Smoking is the major modifiable risk factor contributing to low birth weight. Babies born to women who smoke weigh on average 200g less than babies born to non-smokers. The incidence of low birth weight is twice as high among smokers as non-smokers (Messecar, 2001).
Babies from deprived backgrounds are more likely to be born to mothers who smoke, and to have much greater exposure to second-hand smoke in childhood. Smoking remains one of the few modifiable risk factors in pregnancy. It can cause a range of serious health problems, including lower birth weight, pre-term birth, placental complications and perinatal mortality.
In Bristol, the percentage of mothers smoking during pregnancy has declined significantly during the previous decade, from 18.8% in 2003 to 11.5% in 2008:
Figure 5: Percentage of Mothers Smoking in Pregnancy, Bristol 2003 – 2008
The following chart shows that the encouraging reduction in mothers’ smoking in pregnancy has happened in all Bristol wards. However, it also shows that it remains most prevalent in wards of higher deprivation (e.g. Filwood and Hartcliffe have the highest percentages of all the wards). Furthermore, there is little evidence to show that the rate of reduction is slower in the more deprived wards.
Figure 6: Change in the Percentage of Mothers Smoking in Pregnancy by Bristol Ward
The characterization of disabled is not straightforward, but a “limiting long-standing illness” is often used as a definition. A sub-set of this group is the group of people claiming disability benefit (Disability Living Allowance), for which data is collected annually. The number of under-16s claiming DLA has risen gradually over the last decade, generally in line with population increase. In August 2002 there were 2010 under-16 claimants (13.1% of all claimants); in August 2009 there were 2340 under-16 claimants (11.1% of the total number of claimants). Conversely, for the cohort of claimants in the 16 to 24 age range, the share of the total number of claimants has risen from 5.3% to 6.7%.
A national sample survey of parents of disabled children in England was conducted between July and November 2009 on the DfE’s behalf, the primary purpose of which was to measure parental experience of services for disabled children and provide a 2009-10 score for the national performance indicator.
Figure 7: Parental experience of Services for Disabled Children – Core Cities
Figure 8: Parental experience of Services for Disabled Children – Statistical Neighbours
The survey scored Bristol favourably against the Core Cities and against its statistical neighbours. Nationally, the scores range from 55 to 68, and at 62 Bristol scores ahead of the median (61). This is a relatively new indicator, so no longitudinal data is available.
The results of the annual National Child Measurement Programme can be used to draw conclusions about the pervasiveness of overweight pupils in reception and Year 6. In Bristol, during 2008/09, 10.4% of all reception age children were classified as obese and 17.9% of all Year 6 pupils were similarly classified. In 2009/10 these figures were 10.5% and 18.4%. 2009/10 report.
Figure 9: Obesity in Reception Children – Core Cities
Figure 10: Obesity in Reception Children – Statistical Neighbours
Figures 11: Obesity in Year 6 Children – Core Cities
Figures 12: Obesity in Year 6 Children – Statistical Neighbours
The NHS recommends that as part of a healthy balanced diet everyone has at least five 80g portions of fruit and/or vegetables per day. Data from the Quality of Life in Bristol Survey (Bristol City Council, 2009) reveals the following picture:
Figure 13: Percentage of respondents who have five+ portions of fruit or veg per day.
The survey covered the full range of ages, not just children, but it is safe to assume that the diet of children in areas of deprivation is unhealthier than that of those living in wealthier areas. For example, in Stoke Bishop 70% of the respondents eat the 5 portions whereas in Filwood it is only 43%. The average of all wards in 2009 was 55.3%, whereas in 2005 that average was 39%; every ward with the exception of Windmill Hill witnessed an improvement during this period. According to the National Diet Nutrition Survey, nationally only a third of men and women are now eating the recommended ‘5-a-day’ fruit and veg. This suggests that either Bristol is significantly ahead of the rest of the country or calls into question the methodology of Bristol’s Quality of Life survey.
By monitoring take up of school lunches we can assess the increase in healthy eating among children and young people, particularly those children entitled to a Free School Meal. All school lunches are now required to meet tough nutritional standards that ensure that all the food provided by schools and local authorities in a school lunch is healthy and of good quality. Packed lunches provided by parents are not regulated and there are no mechanisms for establishing whether packed lunches meet the nutritional standards required for school lunches. Nationally, in 2009/10, 41.4% of primary and 35.8% of secondary pupils had school lunch, increases of 2.1 and 0.8 percentage points respectively from the previous year. 16% of primary and 13% of secondary pupils have known entitlement to FSM and 13% of primary pupils (81% of those registered) of primary and 9.5% of secondary pupils (73% of those registered) of secondary pupils take up that entitlement.
In Bristol take up of school lunches declined by 1.3 percentage points in Primary schools over the 2008/09 to 2009/10 period. In the same period there was an increase in take up in Secondary schools of 1.9 percentage points. Take up in Bristol out performs the South-West as a whole and its statistical neighbours for both sectors.
Figure 14: Take up of School Lunches in Bristol Primary Schools.
Figures 15: Take up of School Lunches in Bristol Secondary Schools.
According to the most recent ECM Survey , nationally:
- Children and young people who were active were more likely to say they ate healthily and vice versa
- Overall it appears that boys are more active than girls both within and after school, and this is particularly the case at break times within school.
- Children and young people who are in Year 10, those who say they receive free school meals, and those who describe themselves as Asian / Asian British are less likely to say that they have participated in activities (either structured or unstructured) than all children and young people.
The Tellus3 and Tellus4 surveys give us more local data, based on pupils in year 10 only. Figures 16 and 17 show how Bristol compares with the other Core Cities and with its statistical neighbours. Between 2008/09 and 2009/10 Bristol, like all the Core Cities saw a reduction in participation in physical activity. There was an overall reduction over the same period Bristol and its statistical neighbours (the average dropping from 66.7% to 63.9%).
Figure 16: Participation by Year 10 Pupils in Physical Activity – Core Cities
Figure 17: Participation by Year 10 Pupils in Physical Activity – Statistical Neighbours
It is notoriously difficult to find reliable data on this group of children. The 2001 census gives a figure of 175,000 nationally, but a recent survey conducted by the University of Nottingham on behalf of the BBC suggests that the census was flawed and that the number of carers in Britain is closer to 700,000. Figures for Bristol are not available, and it would be dangerous to extrapolate using national figures, so this represents a gap in our knowledge that needs filling.
A 2004 report suggests that a young carer is more likely to be a girl than a boy, and that typically they will be aged 11 to 15. The report also states that half of all young carers are caring for 10 hours or less per week; one third for 11-20 hours per week; and 16% for over 20 hours per week. Some (2%) are caring for more than 50 hours each week. Many carers are largely unrecognised and receive no support.