cephir june 27, 2012 local strategies against inequalities in childhood health dr. onno de zwart,...

Cephir June 27, 2012

Local strategies against inequalities in childhood

health

Dr. Onno de Zwart, MPH

Rotterdam youth demography

• 23% of today’s Rotterdam population is 0-20 yrs old

• 175 different nationalities

• 12% of non-western origin (mainly Turkish, Moroccan, Surinam, Dutch Antills)

• 53% of non-western origin in the age group 0-20 years

Disadvantaged areas (children at risk) and (% non-western youth 0-20 years

36 23 28

26%

7%56

28%37%

10%

20%12%

4%

7

6%

36

5% 7566

11%16%12%

62

7763

52

12%

29%

Risk inventarisation Municipal Health Office Rotterdam

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%acute risk (acute safety risk in development child)

high risk (seriously threat in child development)

increased risk in child development

no risk

Families

• About one third lives in a single-parent family

• Families with children have a lower income than families without: 20% minimum, 14% structural minimal

• About 25% lives in a house that is too small

Youth in G4 and the Netherlands: Potential unfavorable family situations

Number %

Children in families living on well-fare 2009 2009

Rotterdam 20.450 17,5%

Amsterdam 20.320 14,6%

Den Haag 10.480 10,5%

Utrecht 4.290 7,5%

The Netherlands 183.500 5,2%

One-parent family with children (0-25 yr) 2010 2010

Rotterdam 42.842 23,8%

Amsterdam 53.020 24,2%

Den Haag 29.161 20,0%

Utrecht 10.928 10,6%

The Netherlands 135.951 14,0%

Teenage mothers 2011 2010

Rotterdam 319 −

Amsterdam 185 −

Den Haag 141 −

Preventive health care

Rotterdam 2000-2007*

Landelijk2000-2007

First visit to preventive health care after 14 weeks of pregnancy

36,1% 20,7%

Bron: Rapportage Perinatale gezondheid in Rotterdam, nulmeting periode 2000-2007*Begin 2013 gegevens beschikbaar over 2008-2011

Solutions

.Youth Policy (incl. regional en local program Every

Child Gains)

.Educational policy

.Healthy School

.Ready for a Child

Youth policy Rotterdam

.Youth policy including Youth Health Care (Youth and Family

Centres): responsibility of the city of Rotterdam

.Youth care and child protection: responsibility of the region of

Rotterdam

.2015: youth healthcare, care and child protection: decentralisation

to municipalities

9

Every child gains!

. Regional program (2007-2010)

. Regional and local program

(2011 -2014)

. Result:

. Youth and Family Centres: provides advice on raising children and, when

needed, guides parents and children into other areas of the youth care

system.

. More than 90% of children is seen

. More focus on children at risk

Every child gains and decentralisation youth care

Common goal

More children in Rotterdam will grow up in a safe home

with possibility to develop their talents.

Three objectives:

.Strengthen the basic services and the educational

environment

.Strengthen the professional workers

.Strengthen the strategy on care (improving steering

conditions)

Rotterdam: educational facts and figures

. 90.000 pupils in compulsory education: 174 nationalities

. 250 primary schools, 75 secondary schools, 2 schools for

upper secondary vocational training (50 locations), 4

schools for higher vocational education, 1 university

. Private school boards govern the schools

. Majority of parents is low educated

. Language at home is often not Dutch

The Rotterdam school population:Ethnicity in compulsory Education

5%4%

12%

38%3%

10%

2%

12%

14%

Netherlands Antilles

Cape-Verdian

Maroc

Dutch

North Mediterran

Other poor countries

Other rich contries

Surinam

Turkish

Educational Policy Rotterdam 2011-2014

Two action programmes:

. Beter Presteren: raising education results

. Aanval op Uitval: tackling Early (or Unqualified) School

Leaving

Educational Policy Rotterdam 2011-2014

raising education results

more time for learning

professional schools

parents involvement

2 school arrangements: ISO and Topclasses

Tackling Early school leaving

main factors, interventions

- growing focus on truancy; early and complete reporting by schools; more personnel to find and pick up truant youngsters

- growing awareness in vocational education that Gripping & Binding is important to keep pupils in school

- more diversity in vocational trajectories, more different ways of learning/training

- possibilities for streaming into school at several moments during the year, following the process of tracking and leading back

And a non-planned, positive development: bad perspectives on the

labourmarket keeps the youngsters longer in education/training

Tackling Early school leaving

monitoring ESL since the Lisbon Agreements:

Bruto VSV, netto VSV, Lissabonlijn - 1999-2008 (17 t/m 22 jarigen)

24,0%22,9%

20,7% 20,3% 21,0%20,1%

17,9%

15,3%

12,0%

28,3%27,3%

24,9% 24,4% 24,2%22,6%

21,3%

18,1%

15,2%

0%

5%

10%

15%

20%

25%

30%

netto VSV

bruto VSV

Lissabonlijn

netto VSV 24,0% 22,9% 20,7% 20,3% 21,0% 20,1% 17,9% 15,3% 12,0%

bruto VSV 28,3% 27,3% 24,9% 24,4% 24,2% 22,6% 21,3% 18,1% 15,2%

Lissabonlijn 28,3% 26,9% 25,5% 24,1% 22,6% 21,2% 19,8% 18,4% 17,0%

1999/2000 2000/2001 2001/2002 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008

GGD Rotterdam-Rijnmond

Youth health care: Healthy City, Healthy Schools

. Gezonde School officially started in 2008

. In Rotterdam en region now more than

80 schools

Healthy Primary School

Primary School

secondary School

Healthy secondary school

Special education

Starting point

. ‘Maximize their potential’

. Using this message gets politicians at our side

. health, education and development are closely linked

Basic principles

Question/need of the school is central

No ad hoc activities, but a structural

approach

Integrated approach on four levels

Team with other partners: local &

regional organizations

Programma Klaar voor een KindErnie van der Weg

Program Ready for a Child

B

C

D

E

A

TOP 5 ongunstige wijken

A Waalhaven / rand Charlois 37

B Schieveen 34

C Pernis 24

D Delfshaven 23

E Nieuw Crooswijk 22

Gemiddelde Nederland: 10,3

A13A20 A16

A15

Babysterfte (foetale sterfte: vanaf 22 weken zwangerschapsduur + vroegneonatale sterfte: tot 7 dagen na de bevalling) in aantal per 1000 geboorten, naar wijk

Preconceptional care- Pregnancy Giving birth safely After birth care CJF (CJG)

Programstructure, education, information, research, monitoring & evaluation

Conclusions

.Rotterdam does have inequalities in youth health

. As in health among adults

.Health infrastructure is suited to all

. Youth health care more focus on groups at risk

. ‘Every child gains’ offers a chance for a new system

. Important to stimulate better educational results

.We need a more integrated postitively based youth

policy. With the restructuring of the city

organisation there’s a chance to reach that goal.