Children and Young People Joint Strategic Needs Assessment

Poverty is not having enough money to get by on whereas deprivation refers to a more general lack of resources and opportunities. Unemployment, poor housing, lack of qualifications, debt, low income, fuel poverty, crime and many other social and environmental factors all indirectly affect the health of the population. Increased deprivation means that there is poorer health, but this is compounded as poor health also affects other measures such as employment and motivation to improve employment, education and the person’s environment such as housing. People in more deprived areas also tend to have lower health expectations and potentially fewer GPs per population so there are more likely to be delays in diagnosis and treatment which will influence survival. People living in more affluent areas tend to be among the first to initiate positive health changes whereas people living in more deprived areas find it more difficult to change due to the stress of poverty and increased pressures of life. Consequently, those who live in the most deprived areas are more likely to have individual risk factors for ill health such as smoking, poor diet and lack of exercise. There may also be more barriers in relation to access to health improvement services such as financial barriers, transport issues, access to local cheap good quality fresh fruit and vegetables, and safe access to parks.

Poverty and deprivation affect everyone who is affected but the effects are high for children and young people as they have even less control in relation to these influential factors.

Children living in more deprived areas are more likely to grow up thinking that poverty, poor housing, and unemployment are the norm, which could result in cyclic behaviours with these children behaving as their parents do as they reach adulthood. 

High levels of inequalities exist in children and young people when comparing those living in the most deprived areas of England and those living in the least deprived areas of Hull. Some of the health inequalities are illustrated by Public Health England below, although inequalities are not restricted to health alone and occur in all aspects of a child’s life.

Hull has high levels of both poverty and deprivation. In general, in relation to national averages, Hull has a higher unemployment rate, more poor housing, residents qualified to a lower level and higher levels of crime.

Based on the Index of Multiple Deprivation 2019 score, Hull is the fourth most deprived local authority in England (out of 317) which is in the most 2% of local authorities in England. Nationally an IMD score is calculated for each lower layer super output area (LSOA) in England which is a geographical area of around 1,500 residents and there are 166 such areas in Hull. More than half (54%) of Hull’s LSOAs are amongst the most deprived 20% nationally. Only four of Hull’s 166 LSOAs were in the least deprived fifth of LSOAs nationally. Hull has the fourth highest percentage of LSOAs within the most deprived 10% within England.

As Hull has so few geographical areas in the least deprived fifth nationally, local analyses generally use the local deprivation fifths. Hull’s 166 geographical areas are divided into five groups (approximately 33 areas each) from most deprived fifth to least deprived fifth.

Child poverty measured as a family having claimed one or more of Universal Credit, Tax Credits or Housing Benefit at any point in the year to be classed as low income using income before housing costs and equivalised to adjust for family size and composition. Based on this definition, in 2018/19, there were 15,872 children aged under 16 years representing 30.7% of children who were defined to be in living in relative low income. Using this definition, the rate has increased in Hull since 2014/15.

The number of children aged under 16 years living in relatively low income households is also available for each ward in Hull. For the latest period 2018/19, the percentage vary from 9.4% in Kingswood to 48.7% in St Andrew’s and Docklands. There are 7,428 wards in England, and it is possible to rank the wards in order of percentage of relatively low income households. Almost half of Hull’s wards (ten out of 21) are in the top 5% nationally for having the highest percentage of under 16s living in relatively low income households. Given that Hull is in the most deprived 2% of local authorities nationally, it is not surprising that the percentage of under 16s living in households with a relatively low income is so high.

The following map illustrates the percentages of under 16s living in relative low income households for 2018/19 for each ward in Hull.

Another measure of child poverty relates to the number children aged 0-15 years who are living in households with below 60% median income before housing costs. Based on this definition, the percentage of children in low income households is even higher at 36.8% with 19,026 children aged 0-15 living in low income households using this definition. Hull is ranked 47 out of 379 local authorities in the UK (bottom 12%), and ranked 45 out of 314 local authorities in England (bottom 14%). The rate has increased over time using this definition by more than one-fifth from 30.0% in 2014/15.

Area	2014/15	2015/16	2016/17	2017/18	2018/19
Hull (numbers)	14,873	16,387	17,020	17,884	19,026
Hull (%)	30.0	32.8	33.5	34.8	36.5
Y&H (%)	28	29	30	30	32
England (%)	29	29	30	31	31

Unsurprisingly, the percentage of children eligible for free school meals is high in Hull compared to England.

The rate in Hull is highest in the Yorkshire and Humber region.

The percentage uptake of free school meals has decreased in Hull, although it is possible that percentages will have increased in 2020 with the COVID-19 pandemic and its impact on employment.

Information relating to food insecurity (concerns over being able to provide food for the family) can be found under Financial Resilience both under Health and Wellbeing Influences.

Maternity services cover care for the women from when they become pregnant and access care until they are signed off by the midwife (around 10 days after the birth) and care formally handed over to health visitors.

Good antenatal care and support can identify potential problems early, and provide information to aid informed choice. Poor care during the birth can increase the risks to both mother and baby. Good maternity services should respond to the physical, psychological, emotional and social needs of women and their family in a structured and systematic way.

There is a higher risk of adverse events in pregnancy and during the birth for women who are teenagers, who are older, who smoke, who are overweight and who have other risk factors such as diabetes. The proportion of births to older women and women who are overweight has increased giving rise to an increase in the likelihood of adverse events. This, together with the higher number of births overall, has placed additional pressure on already stretched maternity services nationally.

Women who lack social support have been found to be at increased risk of antenatal and postnatal depression, and having a poor relationship with a partner is also a risk factor for postnatal depression. As well as having a profound effect on the individual affected (often the mother but could be the father), poor perinatal mental health has a strong effect on the whole family and can influence the bond established between parent and child, which can have long-lasting implications.

There are a number of screening programmes in place in the UK relating to antenatal and newborn. Tests in pregnancy and in the newborn after birth are designed to help make the pregnancy safer, check and assess the development and wellbeing of the women and her baby, and screen for particular conditions. Nationally there are several screening programmes for pregnant women, although most are only for specific women at increased risk. Uptake of screening for HIV, syphilis, hepatitis B, and sickle cell and thalassaemia for pregnant women and fetal anomaly screening is available for England and Yorkshire and Humber at Public Health England Fingertips, although this information is not available at local authority level.

Women in Hull are much less likely to take folic acid supplements before becoming pregnant, and are more likely to be obese or smoke in early pregnancy. The percentages are presented below.

The NHS provide information the risks of smoking during pregnancy:

“The risks of smoking during pregnancy are serious from premature delivery to increased risk of miscarriage, stillbirth or sudden infant death. Quitting smoking is one of the best things you and your partner can do to help your baby develop healthily during pregnancy and beyond.

When you smoke you breathe in more than 4,000 chemicals from the cigarette. The smoke goes from your lungs into your bloodstream. That blood flows to your placenta and umbilical cord, right into your baby’s tiny body. This causes your baby to struggle for oxygen. One of the chemicals found in cigarettes is carbon monoxide, a dangerous chemical that gets into your bloodstream. This restricts the supply of oxygen that’s essential for your baby’s healthy growth and development. This causes your baby’s tiny heart to pump even harder.

Your baby’s tiny body is completely dependent on yours, so if you smoke throughout your pregnancy, your baby will go through nicotine withdrawal once it is born. This can make your baby stressed and irritable and it may be difficult to stop them crying. Smoking while you are pregnant also increases the risk of your baby dying from cot death by at least 25%.

Second-hand smoke is very dangerous for anyone exposed to it, but it is particularly dangerous for children. Children exposed to second-hand smoke are at risk of ear infections, bronchitis, pneumonia, asthma attacks and meningitis. Last year in the UK, 300,000 GP visits and 9,500 hospital admissions were caused by children breathing in other people’s cigarette smoke. Furthermore, nearly three quarters of children worry that their mum or dad will die because they smoke. Not only that, but if you smoke, your children are three times more likely to smoke when they grow up. By quitting, your children will be less likely to take up smoking. Children exposed to a smoky atmosphere are more likely to suffer from breathing problems, allergies and chest infections. By not smoking, you protect the health of those close to you.”

The percentage of women who continue to smoke throughout their entire pregnancy is high. The percentage of women known to be current smokers at the time of their delivery is around twice as high in Hull compared to England.

The percentage of smoking throughout pregnancy has reduced slightly over the last decade but the reduction has been relatively slow, although comparable to reductions in England and the Yorkshire and Humber region.

There are a number of screening programmes in place in the UK relating to antenatal and newborn. Tests in pregnancy and in the newborn after birth are designed to help make the pregnancy safer, check and assess the development and wellbeing of the woman and her baby, and screen for particular conditions. However, uptake rates for screening of pregnant women are only available for England and for each region and not available at local authority level. Uptake rates are also not available at local authority level for the physical examination of infants after birth or the infant ‘blood spot’ screening, although information is available for the infant hearing test.

Hull has a relatively low percentage of deliveries to mothers from Black, Asian and Minority Ethnic groups. Further information such as the trends over time is given within Birth and Infant Health under Pregnancy, Infants and Early Years under Children and Young People.

The percentage of caesarean sections is slightly lower in Hull compared to England. There are more births among under 18s in Hull and fewer among women aged 35+ years in Hull compared to England.

The information below gives the percentage of caesareans, the rate of under 18 conceptions per 1,000 women aged 15-17 years, the rate of under 16 conceptions per 1,000 women aged 13-15 years, the percentage of teenage mothers out of all deliveries, and the percentage of mothers aged 35+ years out of all deliveries.

Further information such as the trends over time is given within Birth and Infant Health under Pregnancy, Infants and Early Years under Children and Young People.

The percentage of women with multiple births in Hull is lower than England, but the rate of premature births and the percentage of babies born with a low birth weight are both higher in Hull compared to England.

The rate of multiple births figure is per 1,000 maternities. Premature births is the number of births with a gestational age between 24-36 weeks and all stillbirths (also 24+ weeks gestational age) also given as a rate per 1,000 live births and stillbirths.

The figures relating to low birth weight are all given as percentages. Low birth weight is the number of live births of full-term babies (at least a gestational age of 37 complete weeks) born with a low birth weight (under 2,500 grams) out of all live full-term births. The number of low birth weight (under 2,500 grams) and very low birth weight (under 1,500 grams) babies is also given for all live births and stillbirths (24+ weeks gestational age).

Further information such as the trends over time is given within Birth and Infant Health under Pregnancy, Infants and Early Years under Children and Young People.

Public Health England’s Fingertips presents data on the percentage uptake of the infant hearing screening test. The percentage uptake in Hull is generally high compared to England.

The percentage of new birth visits completed within the first 14 days and the percentage of 6-8 week visits completed within the time period are high in Hull, and are higher than England.

A&E attendances among those aged under 1 year and 0-4 years in Hull are considerably higher in Hull compared to England (per 1,000 population).

The rate in Hull was comparable to England in 2016/17, but has since increased markedly for both infants under one year and those aged 0-4 years. In 2018 there were 3,300 live birth and in 2019 there were 3,175 live births in Hull, and with almost 5,000 attendances at A&E for infants under one year of age during 2018/19, this means that significantly numbers are attending more than once. The Office for National Statistics estimate there are 16,883 children aged 0-4 years living in Hull in mid-year 2019, and with 18,110 attendances at A&E for children aged 0-4 years in Hull, this also means that significant numbers are attending more than once as it is likely that a high proportion of children will not attend at all in the year.

Hospital admissions are for babies aged under 14 days are much lower in Hull compared to England (admissions per 1,000 population). Further information can be found within Hospital Admissions Among Children and Young People under Health Factors under Children and Young People.

However, hospital admissions for gastroenteritis in infants is higher in Hull compared to England among those aged under two years with around 100 such admissions in total, but rates are lower in Hull among children aged 2-4 years with around 30 admissions. Rates are given as admissions per 10,000 population. Further information such as trends over time can be found within Hospital Admissions Among Children and Young People under Health Factors under Children and Young People.

Hospital admissions for lower respiratory tract infections in infants under one year is higher in Hull compared to England with over 250 admissions in Hull. However, admission rates in Hull are lower than England for children aged 1-4 years. Rates are given as admissions per 10,000 population. Further information such as trends over time can be found within Hospital Admissions Among Children and Young People under Health Factors under Children and Young People.

Emergency admissions among those aged 0-4 years caused by unintentional and deliberate injuries are higher in Hull compared to England. Rates are given as admissions per 10,000 population.

Whilst admissions caused by unintentional and deliberate injuries are higher in Hull, they have been decreasing in Hull.

Further information relating to hospital admissions as a result of unintentional and deliberate injuries such as the types of injury and causes of injury can be found within Accidents and Injuries Among Children and Young People under Health Factors under Children and Young People.

Hospital admissions among children aged 0-9 years were lower in Hull compared to England for asthma, diabetes and epilepsy compared to England (admissions per 100,000 population). Further information such as trends over time can be found within Hospital Admissions Among Children and Young People under Health Factors under Children and Young People.

Compared to England, young people aged 10-18 years living in Hull had fewer hospital admissions for asthma, but considerably more admissions for epilepsy and for diabetes (for the year 2018/19). The numbers of admissions were relatively low though and it is possible that there could be multiple admissions from the same young people, and that numbers could change markedly from year to year.

Admissions from diabetes have generally been similar to or higher than England, but increased in 2018/19 although decreased again in 2019/20.

The same is true for epilepsy with admissions generally been similar to or higher than England, but there was a peak in 2014/15 with rates having decreased since then. However, it is possible that one or two young people in 2014/15 could have had a number of admissions which inflated the figures that particular year. The admission rates for epilepsy have increased over the last couple of years, and are now significantly higher than England.

The number of attendences at A&E among those aged under 18 years is considerably higher in Hull compared to England. Rates are given as admissions per 1,000 population.

The number of A&E attendances per 1,000 children and young people in Hull aged under 18 years has consistently been higher than England, but there has been a dramatic increase in the rate of attendance in Hull recently.

Emergency hospital admissions among those aged under 18 years are higher in Hull compared to England. Rates are given as admissions per 1,000 population.

Whilst there has been relatively little change over the last decade, the difference in the rate between Hull and England has reduced, but this is mainly because the rate in England has increased slightly over time.

Admissions among all children and young people aged 0-18 years was lower in Hull compared to England for asthma, but higher for diabetes and epilepsy, although the numbers are relatively small and can be influenced by a relatively high number of admissions from a small number of children and young people. Rates are given as admissions per 100,000 population. Further information such as trends over time can be found within Hospital Admissions Among Children and Young People under Health Factors under Children and Young People.

Hospital admissions caused by unintentional and deliberate injuries in children have decreased in Hull recently and are now only slightly higher than England among children and young people aged 0-14 years, and rates in Hull are comparable to England among those aged 15-24 years. During 2019/20, there were 210, 315 and 445 admissions among children and young people aged 0-4, 5-14 and 15-24 years respectively.

Public Health England’s Fingertips gives the total number of admission rates for unintentional and deliberate injuries to children and young people per 10,000 population.

Further information relating to hospital admissions as a result of unintentional and deliberate injuries such as the types of injury and causes of injury among under fives can be found within Accidents and Injuries Among Children and Young People under Health Factors under Children and Young People.

The rate of admissions in Hull has decreased among those aged 0-4 years.