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Child Health, Health Services and Systems in UK and other European countries
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. (Folkhälsa)
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

This work in child population medicine describes child health problems, increases knowledge of health services, systems, and wider determinants, and makes recommendations for improvements.

Aims

To explore trends in UK child health and health service quality and highlight policy lessons from the UK and other European countries

To study child health and health services in western Europe and derive lessons from different approaches to common challenges

To enhance knowledge on child to adult transition care

To describe trends in UK and EU15+ child and adolescent mortality and seek explanations for deteriorating UK health system performance, and make recommendations for improving survival

Methods

Population level measures of health status and system performance; primary and secondary research on policies and practice for health system assessments. Quantitative: mortality rate trends, excess deaths, DALYs, healthcare processes Qualitative: case reports, system descriptions, analyses 

Results

European child survival has improved, but variably between countries. The UK has not matched recent EU mortality gains. There are 6,000 excess deaths annually in children under 15 years in EU14 countries.

There are child survival inequities; countries investing in social protection have lower mortality. Children in the UK, compared with other EU countries, are more likely to be poor than adults.

Non-communicable diseases are now dominant causes of child death, disease, and disability.

Mortality, processes, and outcomes of healthcare amenable conditions varies between countries. Better outcomes seem to be associated with flexible health care models promoting cooperation, team working, and transition.

Conclusions

Child health in Europe is improving, but unevenly. Child health systems are not adapting sufficiently to meet needs. Recommendations are made for improving health systems and services.

Abstract [en]

How do European countries compare when it comes to child health statistics? How do different child health services, systems, and wider determinants impact long term influences for good or harm? Why do some countries seem to do better than others in safeguarding their children’s and young people’s health and wellbeing? And what can we  do to make things better for children?

This thesis explores some of these difficult but important issues, and despite describing some serious signals of concern about child health, offers recommendations and clear ways forward for countries to ensure healthier futures for children.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2015. , 157 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2015:24
Keyword [en]
child health, public health, health services and Systems assessment, UK, Europe
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
URN: urn:nbn:se:kau:diva-35856ISBN: 978-91-7063-637-0 (print)OAI: oai:DiVA.org:kau-35856DiVA: diva2:805680
Public defence
2015-05-29, Fryxellsalen, Karlstad, 09:00 (English)
Opponent
Supervisors
Available from: 2015-05-07 Created: 2015-04-15 Last updated: 2017-08-15Bibliographically approved
List of papers
1. How can we improve child health services?
Open this publication in new window or tab >>How can we improve child health services?
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2011 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 342, 901-904 p.Article in journal (Refereed) Published
Abstract [en]

Western European health systems are not keeping pace with changes in child health needs. Non-communicable diseases are increasingly common causes of childhood illness and death. Countries are responding to changing needs by adapting child health services in different ways and useful insights can be gained through comparison, especially because some have better outcomes, or have made more progress, than others. Although overall child health has improved throughout Europe, wide inequities remain. Health services and social and cultural determinants contribute to differences in health outcomes. Improvement of child health and reduction of suffering are achievable goals. Development of systems more responsive to evolving child health needs is likely to necessitate reconfiguring of health services as part of a whole-systems approach to improvement of health. Chronic care services and first-contact care systems are important aspects. The Swedish and Dutch experiences of development of integrated systems emphasise the importance of supportive policies backed by adequate funding. France, the UK, Italy, and Germany offer further insights into chronic care services in different health systems. First-contact care models and the outcomes they deliver are highly variable. Comparisons between systems are challenging. Important issues emerging include the organisation of first-contact models, professional training, arrangements for provision of out-of-hours services, and task-sharing between doctors and nurses. Flexible first-contact models in which child health professionals work closely together could offer a way to balance the need to provide expertise with ready access. Strategies to improve child health and health services in Europe necessitate a whole-systems approach in three interdependent systems—practice (chronic care models, first-contact care, competency standards for child health professionals), plans (child health indicator sets, reliable systems for capture and analysis of data, scale-up of child health research, anticipation of future child health needs), and policy (translation of high-level goals into actionable policies, open and transparent accountability structures, political commitment to delivery of improvements in child health and equity throughout Europe).

Place, publisher, year, edition, pages
BMJ Books, 2011
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-15651 (URN)10.1136/bmj.d1277 (DOI)
Available from: 2012-11-19 Created: 2012-11-19 Last updated: 2017-12-07Bibliographically approved
2. Health services for children in western Europe
Open this publication in new window or tab >>Health services for children in western Europe
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2013 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 381, no 9873, 1224-1234 p.Article in journal (Refereed) Published
Abstract [en]

Western European health systems are not keeping pace with changes in child health needs. Non-communicable diseases are increasingly common causes of childhood illness and death. Countries are responding to changing needs by adapting child health services in different ways and useful insights can be gained through comparison, especially because some have better outcomes, or have made more progress, than others. Although overall child health has improved throughout Europe, wide inequities remain. Health services and social and cultural determinants contribute to differences in health outcomes. Improvement of child health and reduction of suffering are achievable goals. Development of systems more responsive to evolving child health needs is likely to necessitate reconfiguring of health services as part of a whole-systems approach to improvement of health. Chronic care services and first-contact care systems are important aspects. The Swedish and Dutch experiences of development of integrated systems emphasise the importance of supportive policies backed by adequate funding. France, the UK, Italy, and Germany offer further insights into chronic care services in different health systems. First-contact care models and the outcomes they deliver are highly variable. Comparisons between systems are challenging. Important issues emerging include the organisation of first-contact models, professional training, arrangements for provision of out-of-hours services, and task-sharing between doctors and nurses. Flexible first-contact models in which child health professionals work closely together could offer a way to balance the need to provide expertise with ready access. Strategies to improve child health and health services in Europe necessitate a whole-systems approach in three interdependent systems—practice (chronic care models, first-contact care, competency standards for child health professionals), plans (child health indicator sets, reliable systems for capture and analysis of data, scale-up of child health research, anticipation of future child health needs), and policy (translation of high-level goals into actionable policies, open and transparent accountability structures, political commitment to delivery of improvements in child health and equity throughout Europe).

Place, publisher, year, edition, pages
Amsterdam: , 2013
Keyword
Western European health systems, child health services, child health, Non-communicable diseases, first-contact care
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-15661 (URN)10.1016/S0140-6736(12)62085-6 (DOI)000317350100033 ()23541056 (PubMedID)
Available from: 2012-11-20 Created: 2012-11-20 Last updated: 2017-12-07Bibliographically approved
3. Improving the transition between paediatric and adult healthcare: A systematic review.
Open this publication in new window or tab >>Improving the transition between paediatric and adult healthcare: A systematic review.
2011 (English)In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 96, no 6, 548-553 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The transition between paediatric and adult care for young people with chronic illness or disability is often poorly managed, with adverse consequences for health. Although many agree that adolescent services need to be improved, there is little empirical data on which policies can be based.

OBJECTIVES: To systematically review the evidence of effectiveness of transitional care programmes in young people aged 11-25 with chronic illness (physical or mental) or disability, and identify their successful components.

DESIGN: A systematic literature review in July 2010 of studies which consistently evaluated health outcomes following transition programmes, either by comparison with a control group or by measurement pre-intervention and post-intervention.

RESULTS: 10 studies met the inclusion criteria, six of which showed statistically significant improvements in outcomes. Descriptive analysis identified three broad categories of intervention, directed at: the patient (educational programmes, skills training); staffing (named transition co-ordinators, joint clinics run by paediatric and adult physicians); and service delivery (separate young adult clinics, out of hours phone support, enhanced follow-up). The conditions involved varied (eg, cystic fibrosis, diabetes mellitus), and outcome measures varied accordingly. All six interventions that resulted in significant improvements were in studies of patients with diabetes mellitus, with glycosylated haemoglobin level, acute and chronic complications, and rates of follow-up and screening used as outcome measures.

CONCLUSIONS: The most commonly used strategies in successful programmes were patient education and specific transition clinics (either jointly staffed by paediatric and adult physicians or dedicated young adult clinics within adult services). It is not clear how generalisable these successful studies in diabetes mellitus will be to other conditions.

Keyword
child health, transitional care programmes, paediatric care, chronic illness, transition clinics
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-35866 (URN)10.1136/adc.2010.202473 (DOI)21388969 (PubMedID)
Available from: 2015-04-16 Created: 2015-04-16 Last updated: 2017-12-04Bibliographically approved
4. UK child survival in a European context: Recommendations for a national Countdown Collaboration
Open this publication in new window or tab >>UK child survival in a European context: Recommendations for a national Countdown Collaboration
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2015 (English)In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 100, no 10, 907-914 p.Article in journal (Other academic) Epub ahead of print
Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-35867 (URN)10.1136/archdischild-2014-306752 (DOI)000361685000004 ()
Available from: 2015-04-16 Created: 2015-04-16 Last updated: 2017-07-03Bibliographically approved

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