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.