Cephir June 27, 2012 Local strategies against inequalities in childhood health Dr. Onno de Zwart, MPH
Mar 31, 2015
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.