Alarm over Oldham’s child health outcomes
CULTURAL PRACTICES ADD TO INFANT MORTALITY, SAY EXPERTS
CHILDREN in Oldham are more likely to die as babies, five-yearolds have rotting teeth and a quarter of youngsters are obese by their final year of primary school, writes Charlotte Green.
A series of reports presented to councillors at a health scrutiny meeting has painted a grim picture of the challenges faced by children growing up in Oldham.
The borough’s most recent three-year infant mortality rate, from 2018 to the end of 2020, was 6.2 per 1,000 people. This is significantly higher than the national rate of 3.9. Councillors were told that the trend had been getting “slightly worse”.
Health chiefs said the situation was unlikely to substantially change for the better unless more families were lifted out of poverty and deprivation.
The borough’s infant mortality rate, where a child dies under the age of one, has been higher than the England rate “consistently” for more than a decade.
Oldham now has the worst rate of infant mortality in the northwest of the country. And it’s not just babies’ health that suffers in the borough.
More than one in 10 receptionaged children, and 26 per cent of children in year six of primary school are obese, while nearly half of five-year-olds have experience of “dental decay”.
Councillors described hearing the reports as “depressing” – and there were warnings that the pandemic could have made issues even worse.
When questioned by a panel member, councillor Riaz Ahmad, on the impact of austerity on health, Rebecca Fletcher, a consultant in public health at Oldham council, said: “The national evidence is that in terms of causes of deaths of children, poverty is associated with almost all deaths of children.”
Oldham ranks as the 19th most deprived area out of 317 local authorities in 2019 indices of deprivation data.
Fletcher added: “The most recent report from the national child mortality database did highlight that infant mortality is sadly more common in areas of deprivation. So that’s one of the key risks.”
The report found that nationally, if the mortality risk in the most deprived areas was brought in line with the areas with least risk, a fifth of all child deaths would be prevented, she explained.
“Key contributing causes of these deaths are, in particular, congenital abnormalities, babies born really small for gestational age, and also extremely premature births,” she told councillors.
“The prevention of these particular causes are the ones where we can make some of that difference. Some of the support is around the risk factors for those – smoking in pregnancy is a key risk factor, maternal obesity is another one.
“But also around better engagement with our services – so how do we get our services to do better with engaging with pregnant women and families with small children? And also focusing on how we mitigate the impact of poverty on families so we can stop that risk factor.”
The meeting was told there were wider issues that also impacted infant mortality, such as overcrowded housing and a lack of access to interpreters.
All deaths of children in Oldham are reviewed by the Child Death Overview panel which covers Oldham, Bury and Rochdale.
Another major risk to babies in Oldham is genetic or congenital abnormalities, which can be increased by consanguineous relationships – those between blood relatives. Typically these relationships are marriages between cousins or first cousins, and are more common within certain south Asian communities, chiefly people of Pakistani heritage.
A report published in 2018 estimated there were around 20 births annually in Oldham that were affected by consanguinityrelated disorders.
Since 2015, the council has commissioned a genetic outreach service which aims to support individuals and families affected by autosomal recessive gene disorders which are more likely to occur within cousin marriages.
Fletcher said: “They look at working with culturally appropriate conversations around raising the risk of recessive conditions.
“It is a small service and it works with smaller numbers of individuals in parts of the community. But it’s about having very complex conversations.”
Katrina Stephens, the director of public health, said: “One of the big aims for us really is to narrow that gap between Oldham and England as our first target.
“We would hope to see reduction of smoking in pregnancy filtering through to our infant mortality data, similarly improvements in maternity services.
“And then we get into a situation where there are things that are more difficult to shift and change because it’s about housing and about poverty, those bigger picture issues.
“Every baby death we prevent is really important, that’s a massive impact on that family.”