Physical Health


This is the first aim in the Be Healthy outcome. This section examines the physical health of Bristol children.

Birth rate
Infant mortality
Life expectancy
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

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Birth rate

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[1]. 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
Bristol 5023 54.1 6203 57.4 23.5% 6.1%
South-West 51476 54.2 58338 60.3 13.3% 11.3%
England 589851 56.9 671058 63.8 13.8% 12.1%

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Infant mortality

In recent years, according to National Perinatal Epidemiology Unit, University of Oxford[2], 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.

Locally:

 

  • 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
South West 4.4 4.2 4.1
England 5.0 4.9 4.8

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’.

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Life Expectancy

 

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

Source: NHS Bristol

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.

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Early Years: Weight at birth

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[3] 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)

Source: Office for National Statistics

Figure 3: Percentage of Underweight Live Births (Bristol and its Statistical Neighbours)

Source: Office for National Statistics

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Early Years: Breastfeeding

According to the Department of Health[4], 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)

Source: NHS Bristol

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)

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Early Years: Immunisation

 

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
Diphtheria Tetanus Polio Pertussis Hib MMR MenC
England 94 94 93 93 93 81 93
AWP 95 95 95 94 94 80 94
South-West 95 95 95 95 95 81 95
Bristol North 92 92 92 92 92 75 91
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[5] 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[6] 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[7] 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.

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Early Years: Antenatal care

 

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.

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Early Years: Smoking during pregnancy

 

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

Source: Office for National Statistics

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

 

Source: Office for National Statistics

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Early and Later Years: Disability and Special Educational Needs

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

 

Source: Office for National Statistics

Figure 8: Parental experience of Services for Disabled Children – Statistical Neighbours

Source: Office for National Statistics

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.

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Later Years: Healthy weight

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

 

Source: Office for National Statistics

Figure 10: Obesity in Reception Children – Statistical Neighbours

 

Source: Office for National Statistics

 

Figures 11: Obesity in Year 6 Children – Core Cities

 

Source: Office for National Statistics

Figures 12: Obesity in Year 6 Children – Statistical Neighbours

 

Source: Office for National Statistics

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Later Years: Healthy eating

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.

Source: Bristol City Council Quality of Life Survey 2009

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[8], 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[9]. 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.

Source: Bristol City Council

Figures 15: Take up of School Lunches in Bristol Secondary Schools.

Source: Bristol City Council

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Later Years: Physical activity

 

According to the most recent ECM Survey [10], 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

Source: Office for National Statistics

 

Figure 17: Participation by Year 10 Pupils in Physical Activity – Statistical Neighbours

Source: Office for National Statistics

 

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Later Years: Young carers

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[11] 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.

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[1] http://www.statistics.gov.uk/downloads/theme_population/FAQbirthsfertility.pdf

[2] https://www.npeu.ox.ac.uk/downloads/infant-mortality/Infant-Mortality-Antenatal-Care-Report.pdf

[3] http://www.data4nr.net/resources/524/

[4] http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_118525.pdf

[5] http://www.bmj.com/content/333/7574/890.full

[6] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC557899/?tool=pmcentrez

[7] http://www.bristol.ac.uk/infectious-diseases/mumps/

[8] http://www.food.gov.uk/multimedia/pdfs/publication/ndnsreport0809.pdf

[9] http://www.schoolfoodtrust.org.uk/school-cooks-caterers/reports/statistical-release-take-up-of-school-lunches-in-england-2009-2010

[10] http://publications.education.gov.uk/eOrderingDownload/DCSF-RR218.pdf

[11] http://www.youngcarer.com/pdfs/Young%20Carers%20Report%20-%202004.pdf

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2 Responses to Physical Health

  1. Dave Tuffery says:

    Your section on health eating contains some factual inaccuracies. The quality of life survey DOES NOT cover all ages. People are selected from the electoral register and so, by definition, does not include children. The 2005 figure for eating 5+ portions of fruit and veg a day was 48.3% +/- 1.3% and not 39% as you have written. You have also stated the average in 2009 was 55.3% The city wide figure was 55.6%. You appear to have calculated an average of 35 ward percentages to obtain the 55.3 figure which is different.
    There is nothing questionable about the quality of life survey methodology. It is clearly different from the National Diet and Nutrition survey as it is a simple question “How many portions of fruit and veg did you eat yesterday”. Although not as sophisticated as the NDNS, which involved a four day diet diary, the Quality of Life methodology has remained the same since 2005. This enables trends to be seen. The NDNS report points out that their methodology has changed and so cannot be compared with previous years. Each survey method has its own merits and variations. You cannot compare apples with pears (forgive the pun). Read the full report at http://www.bristol.gov.uk/qualityoflife .

  2. Anne James says:

    Early and Later Years: Disability and Special Educational Needs
    ‘The characterization of disabled is not straightforward, but a “limiting long-standing illness” is often used as a definition. You should be using the definition from the Equality Act 2010. LLTI is a census definition. This should be clarified in your introduction. I don’t think disability should be in the health section – as a disability is often not a health issue. this could be in the SEN and disability section.
    I think it is useful to publish gender as it has a significance for SEN. These were figs from CYPS for 2010. These do not correlate to disability and gender figures, so it is interesting to note that SEN picks up needs of boys more than needs of girls
    LD PSI ASD All SEN
    Year 6 SATs Cohort (Boys) 61 19 24 230
    Cohort (Girls) 24 8 2 78
    Year 11 GCSE cohort Cohort (Boys) 138 44 57 456
    Cohort (Girls) 67 25 8 186

    The ‘later years’ doesn’t apply to disability or SEN, only to obesity etc. Maybe a section is missing? or maybe it just needs titling differently

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