Feeding infants for their future health - how can we make it happen in Tayside?

1. Feeding infants for their future health - how can we make it happen in Tayside? Joyce ThompsonDietetic Consultant – Public Health Nutrition Tayside NHS

2. Aim • To consider the current status and explore what the future might hold for feeding infants in Tayside Tayside Public Health Network

3. Objectives • Tayside’s infant population • Key drivers • Key issues relating to infant nutrition • What is and is not in place • Priorities and opportunities Tayside Public Health Network

4. Tayside’s population - area Tayside Public Health Network

5. Tayside’s population – age group Tayside Public Health Network

6. Deprivation Category Angus Dundee City Perth & Kinross 1 & 2 (affluent)           3            4 & 5         6 & 7 (deprived)        Tayside’s population – deprivation Data Source: “Carstairs scores for Scottish postcode sectors from the 2001 Census” Philip McLoone, MRC Social & Public Health Sciences Unit, March 2004 Tayside Public Health Network

7. % of children living in workless households Source: Health Scotland Community profiles 2004 Data source: Census Tayside Public Health Network

8. Key drivers – Scottish documents • Improving Health in Scotland – The Challenge (2003) • Early years strategy (2003) • HALL 4 (2003) Tayside Public Health Network

9. Scottish Diet Report 1993 Eating for Health: A Diet Action Plan for Scotland 1996 Eating for health: Meeting the Challenge 2004 Nutritional Guidance for Early Years 2005 (consultation doc) Key drivers – policies and plans Tayside Public Health Network

10. Premature morbidity and mortality Coronary Heart Disease Stroke Cancer Life span Children Adults Older people Vulnerable groups Social deprivation Behaviours and circumstances Food and health – the evidence Tayside Public Health Network

11. ‘The real challenge is to plan and provide for the future of Scotland’s health, to get upstream of these potential problems by a concentrated effort to promote positive health.’ Source: Dr E.M. Armstrong, Chief Medical Officer, 2001. Tayside Public Health Network

12. Key health issues for children • Obesity • Dental caries • Faltering growth ………. etc Tayside Public Health Network

13. Overweight • Increasing in adults and children • Prevalence in 1984 in boys and girls in Scotland was 6.4% and 10.4% • Prevalence in 1994 was 10% and 15.8% Tayside Public Health Network

14. Dental caries % of 5 yr old children with no obvious dental decay Source: National Dental Inspection Programme 2003 Tayside Public Health Network

15. Faltering growth ……etc • Prevalence of faltering growth • Incidence of iron deficiency anaemia in young children • Incidence of asthma in boys and girls aged 2-15 yrs is 19% and 16% • Incidence of type I Diabetes mellitus has tripled over the last 20 years Tayside Public Health Network

16. Key feeding issues for children Breastfeeding at 6-8 wk review in Tayside 2000-2002 Tayside Public Health Network

17. Infant Feeding Survey 2000 % babies given solid food • 4% by 6 weeks of age • 7% by 8 weeks • 28% by 3 months • 83% by 4 months 50% of babies given solids before 4 to 6 months Early introduction associated with: • heavier birth weight, lower social class, mothers with lower educational levels, and white mothers Tayside Public Health Network

18. Infant Feeding Survey 2000 – Solids • 4 to 5 months - more likely commercially prepared (62%) than home made baby food (38%) • 8 to 9 months - 70% gave homemade food compared to 52% • 10% encountered difficulties in weaning onto solid foods • 50% said it was due to baby only accepting certain types of food Tayside Public Health Network

19. % consumers Non-Manual Manual Wholemeal bread 38 19 HF Breakfast cereal 67 57 High PUFA spreads 50 40 Non-fried fish 13 7 Citrus fruit 31 22 Eating habits of children aged 1- 4 yrs in the UK Food Intake g/week From: Gregory et al (1995) National Diet & Nutrition Survey 11/2 to 41/2 years Tayside Public Health Network Source: CPHNR, Dundee.

20. Tayside Public Health Network Source: Mike Nelson, Kings.

21. From: Dowler and Calvert (1995). Nutrition and diet in lone-parent families in London. Tayside Public Health Network Source: Mike Nelson, Kings.

22. Fewer car owners Poorer housing Less education Unemployment Lower social class of father Access to healthy food Food storage Awareness Affordability Acceptability Determinants of food choice in low income households Tayside Public Health Network

23. NATIONAL/ REGIONAL COMMUNITY LOCALITY INTERNATIONALFACTORS INDIVIDUAL POPULATION WORK/SCHOOL/HOME Leisure Activity/ Facilities Public Transport Transport Energy Expenditure Globalization of markets Urbanization Public Safety Labour % Over or under nourished Infections Health Care Health Development Worksite Food & Activity Social security Sanitation Food intake : Nutrient density Media & Culture Media programs & advertising Family & Home Manufactured/ Imported Food Education School Food & Activity Agriculture/ Gardens/ Local markets Food & Nutrition National perspective Societal policies and processes influencing food intake Source: Professor WPT James, IOTF, London. Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org

24. Children are vulnerable to nutritional problems • High nutritional needs • Dependent on others • Limited resources • Ethnic minority communities Tayside Public Health Network

25. Shaping food preferences through early experience and exposure is critical Tayside Public Health Network

26. What is or is not in place? The stages • Pregnancy • Infancy • Breast feeding • Weaning • Under fives • Primary school • Adolescence Tayside Public Health Network

27. The framework • Strategic – whole system & tactical approach • Population – programmes & priorities • Individual – addressing knowledge, skills and behaviour change • Monitoring and evaluation – what works? Tayside Public Health Network

28. What is or is not in place? Strategy, policy, guidelines & structures • Food and Nutrition Policy 1996 • Nutrition Guidelines for Under Fives 2001 • NHST Health Plan and JHIPs • Healthy Weight Strategy 2005 • Breastfeeding Strategy 2005 • Best Value Review on Nutrition 2005-2006 • Tayside Infant Feeding Strategy Group • TDCN PHN and Paediatric Groups Tayside Public Health Network

29. What is or is not in place? Population and programmes • Sure Start • Toothnology • Unmet Needs Project • Weaning Groups • What else? Tayside Public Health Network

30. What is or is not in place? Individual level • Fun First Foods published - 2005 • Programmes & services - advice, practical skills • What else? Fun First Foods An easy guide to introducing solid foods Tayside Public Health Network

31. What is or is not in place? Monitoring and evaluation • How do we know what impact we are having at individual, programme and strategic level? Tayside Public Health Network

32. And lastly…..how my post fits in! • Co-ordinated approach to improving nutrition in the Tayside population • Public health, clinical and institutional nutrition Tayside Public Health Network

33. Priorities What are the priorities that need to be addressed to improve infant feeding in Tayside? • Training for carers ? • Practical support? • What do you think? Tayside Public Health Network

34. Opportunities What opportunities are available to help address these priorities? • Healthy Start – Food Welfare Scheme • Best Value Review exercise • What do you think? Tayside Public Health Network

35. Questions for you • What else is in place at strategic, programme and individual level? • What else needs to be in place at these levels? • Which do you think are the top three priorities? • What opportunities exist to address these? Tayside Public Health Network

36. Thank you! Tayside Public Health Network