Chapter 4 Physical health

Key statistics at a glance

Infant health

  • In 2008, 5.6% of live-born infants in NSW did not have a healthy weight at birth (less than 2,500 grams).
  • Over the 15 years to 2008 the proportion of live-born infants who did not have a healthy weight at birth had shown little change.

General health

  • In 2007-2008, 90.4% of 5–15 year olds had excellent, very good or good health.
    • A higher proportion of children in the North Coast Area Health Service[1] had their health rated positively, than the population of 5-15 year olds in NSW.
  • In the eight years to 2007-2008 there was a significant decrease in the proportion of children aged 5–15 years that had excellent, very good or good health.

Immunisation

  • In 2010, the proportion of children aged two years immunised in NSW was above that required to interrupt the spread of vaccine preventable illnesses within communities.[2]
    • The immunisation target was not achieved in the Richmond-Tweed area or in the Eastern Suburbs of Sydney.

Communicable diseases

  • In 2010, among 0–17 year olds 4.0 in every 1,000 had a vaccine preventable illness, 2.4 in every 1,000 had other infectious diseases and 1.1 in every 1,000 had a sexually transmitted infection.
    • A greater proportion of children aged 5–10 years had a vaccine preventable illness.
    • A greater proportion of older children than younger children and female children than male children had a sexually transmitted infection.[3]

Infant mortality (less than 1 year)

  • In the 14 years to 2009, 4.4 in every 1,000 infants died.
    • Male infants were more likely to die than female infants, Aboriginal infants were more likely to die than non-Aboriginal infants, and infants living in outer regional areas were more likely to die than infants living in major cities.
  • In the same period the mortality rate for infants has fluctuated, with a recent notable decrease between 2008 and 2009.

Child mortality (1-17 years)

  • In the 14 years to 2009 among 1–17 year olds 0.094 in every 1,000 died with a disease or morbid condition.
    • Younger children were more likely to die in these circumstances than older children, and male children were more likely to die than female children.
  • In the same period there was a decline in the death rate for 1–17 year olds from a disease or morbid condition.

Oral health

  • In 2007, 51.8% of children aged 5–12 years examined in NSW primary schools had no past tooth decay.
    • A smaller proportion of Aboriginal children than non-Aboriginal children had no past decay.
    • A greater proportion of children living in major cities than those living in inner and outer regional areas or remote and very remote areas had no past decay.
  • Children aged 11–12 years had less unmet need for dental treatment than 5–6 year olds.

Chronic health conditions

  • In 2009, an estimated 15.9 per cent of children aged 0–17 years had a long-term health condition.
    • Half these children had a disability.
    • A greater proportion of older children than younger children had a chronic health condition.

Access to health care

  • In 2007-2008, one in five parents had difficulty getting health care for their children.
    • The most common difficulty was the waiting time for a GP appointment.
    • A lower proportion of parents of 0–4 year olds had difficulties in accessing health care than parents of 5–8 year olds.
    • A greater proportion of children living in rural areas than those living in urban areas had difficulty getting health care when needed.
    • A lower proportion of children living in the least and second socioeconomically disadvantaged areas[4] had difficulty getting health care when needed than the population of 0–15 year olds in NSW.
    • A greater proportion of children in the NSW Health Areas[5] of Hunter & New England, North Coast, Greater Southern, and Greater Western, had difficulty getting health care when needed than the population of 0–15 year olds in NSW.
  • Over the four years to 2007-2008 there was a significant increase in the proportion of parents of children who had difficulty getting health care for their children when needed.

Introduction

The physical health of children is critical, as childhood is the time when the foundations of future health are laid down which influence long-term health outcomes (AIHW, 2007).

Over recent decades there have been substantial improvements in living conditions, education, medical care and immunisation in Australia (AIHW 2006).

This chapter explores infant health; children's general health, including communicable diseases and immunisation; child mortality; dental health; chronic health conditions; and access to health care.

The data presented is drawn from existing collections, and established state, national or international measures are reported. Some additional information is presented to fill data gaps identified through the work of the NSW Commission for Children and Young People.

The information is provided as a resource for policy and research professionals working in both government and non-government settings who may or may not have detailed knowledge about children's physical health. Since the purpose of reporting on this data is to help inform the development of policy and service delivery responses, a number of deficit measures are included. While deficit measures miss the positive aspects of children's lives, such reporting is intended to assist policy makers to target their efforts at addressing both equity and efficiency concerns.

Infant health

Infant[6] health at birth is a strong predictor of their health and well-being in later life. Measures of infant health also tell us about the quality and access of effective health care available to pregnant women and infants (ARACY, 2008).

Two areas of infant health are reported here: birth weight and infant mortality. Both are key national and international indicators of infant health. The NSW 2021–A Plan to Make NSW Number One sets a target to halve the gap between Aboriginal and non-Aboriginal infant mortality rates by 2018.

The NSW Midwives Data Collection (MDC) is used as the key source of information on pregnancy and childbirth in NSW, including perinatal deaths. It contains the most reliable information of infant health in NSW. The MDC covers all births in NSW public and private hospitals, as well as home births. The NSW Child Death Review Team (CDRT) collection holds the best source of information on infant mortality from 1996. The CDRT collection covers the deaths of children who are usually resident in NSW.

The MDC and the CDRT, as with any administrative data collection, are subject to error. The limitations of these collections include item non-response, transcription errors, coding errors, clerical and editing errors, and data conversion errors. In addition, when reporting on deaths the MDC is limited to those deaths that occur prior to discharge or transfer of the baby, deaths that occur after this time may not be reported. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

Birth weight

The international standard of a healthy birth weight is 2,500 grams or more. Children born too early or too small are at increased risk of a range of poor outcomes. Low birth weight is associated with increased risk of infant death and long-term disability and health conditions (Laws and Sullivan, 2009). Risk factors associated with low birth weight include socioeconomic status, age of mother, mother's nutritional status, smoking and alcohol intake and illness during pregnancy (Ashdown-Lambert, 2005; Mohsin, Wong, Bauman, and Bai, 2003).

In 2008, the MDC recorded 94.4 per cent of live-born infants in NSW as weighing at least 2,500 grams (Table A4. 1 (XLSX 259.7KB)).

Since 2004, the proportion of Aboriginal infants born with a low birth weight has been over 10 per cent. In 2008, 11.5 per cent of Aboriginal infants had a low birth weight (Table A4. 2) (XLSX 259.7KB). This is about twice the rate for non-Aboriginal infants (6.0%) (Centre for Epidemiology and Research, 2008: 81).

The proportion of infants born with a low birth weight varies across the former NSW Area Health Services.[7] In 2008 the proportion of infants born with a low birth weight varied from a high of 7.1 per cent in the Greater Western Area Health Service to a low of 5.1 per cent in the Greater Southern Area Health Service (Table A4. 3) (XLSX 259.7KB).

While birth weights in NSW have shown some variation over the period 1994-2008 on average 1 in 20 live-born infants have a low birth weight (Figure 4.1) (Table A4. 1) (XLSX 259.7KB).

Figure 4.1 Live-born infants with a birth weight below 2,500 grams by year, NSW, 1994-2008

Source: NSW Midwives Data Collection (MDC). Centre for Epidemiology and Research, NSW Department of Health (Table A4.1) (XLSX 259.7KB).

Infant mortality

Results from the Midwives Data Collection

Deaths occurring in the neonatal period (birth to less than 28 days) and stillbirths are classified as perinatal deaths.

In 2008, the MDC recorded 840 perinatal deaths (8.8 per 1,000 births). Over the period 1994-2008 the perinatal mortality rate has fluctuated from a low of 8.8 per 1,000 live births (in the years 1995, 2002, 2005 and 2008) to a high of 9.7 in 2000 (Table A4. 4) (XLSX 259.7KB).

Results from the Child Death Review Team Collection

In 2009, the CDRT reported 352 infants (a child less than 1 year of age) died or 3.60 per 1,000 infants (Table A4. 5) (XLSX 259.7KB).

From 1996-2009 there were 5,705 infant deaths with nearly 60 per cent of these infants dying within the first week of life, 35.7 per cent in the first 24 hours of life and 21.8 per cent between one day and one week (Table A4. 6) (XLSX 259.7KB). The infant mortality rate over this period was 4.43 per 1,000 infants.

When the statistical significance of sex, Aboriginal identity and geographic location are considered:

Male infants were 1.2 times more likely to die compared with female infants.

Aboriginal infants were 2.2 times more likely to die compared with non-Aboriginal infants.

Infants living in outer regional and remote areas were 1.2 times more likely to die than infants living in major cities (Table A4. 7) (XLSX 259.7KB).

Across the period 1996-2009 the crude mortality rate for infants has fluctuated with a recent notable decrease between 2008 and 2009 (4.11 per 1,000 infants to 3.60 per 1,000) (Figure 4.2) (Table A4. 5) (XLSX 259.7KB).

Figure 4.2: Infant mortality by year and sex, NSW, 1996-2009

Notes: Rates have been standardised against the Australian population, 2001. Only crude rates are reported for infants.

Source: NSW Child Death Review Team, Annual Report 2009 (Table A4.5) (XLSX 259.7KB).

Children's physical health

Good health is about more than the absence of illness. The World Health Organisation (WHO) for example, defines health as: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1946). Immunisation against vaccine preventable diseases is an effective public health intervention. Immunisation of children is not only important for individual health, but also to minimise the spread of disease (Raising Children Network, 2006a).

Two areas of physical health are reported here: general health and immunisation at age two years. These are key national and international indicators of children's physical health.

The NSW Population Health Survey (PHS) is used as the key source of information on children's general health in NSW and the demographic characteristics of the children. Characteristics of ongoing interest include Aboriginal children and children with a disability. The PHS does not collect information on children with a disability. While it collects information on Aboriginal children the small sample size limits regular reporting of Aboriginal children separately to non-Aboriginal children.

The Australian Childhood Immunisation Register (ACIR) provides information on immunisation in Australia. Both provide the most reliable information of the indicators covered in this section.

The PHS and the ACIR, as with any data collection, are subject to error. The limitations of the PHS include non-sampling and sampling errors, and reporting by parents and not the child concerned. The limitations of the ACIR include item non-response, transcription errors, coding errors, clerical and editing errors, and data conversion errors. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

General health

How an individual feels about their health has been demonstrated to be a powerful predictor of their future health (AIHW, 2010:34).

The PHS asked parents of children in the 5-15 year age group the following question: 'Overall, how would you rate your child's health during the last four weeks: excellent, very good, good, fair, poor or very poor?'

In 2007-2008, the health of most 5–15 year olds was as excellent, very good or good (90.4%).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location are considered:

  • No difference was found between age group; males and females; among the socioeconomically disadvantaged groups; or between urban and rural NSW health areas (Centre for Epidemiology and Research, 2010:123) (Table A4. 8 and Table A4. 9) (XLSX 259.7KB).
  • A higher proportion of children in the North Coast Area Health Service[8] had their health rated positively, compared with the population of 5-15 year olds in NSW (93.3% and 90.4%) (Centre for Epidemiology and Research, 2010:123).

Between 2001 and 2007-2008 there has been a significant decrease in the proportion of children aged 5-15 years with excellent, very good or good health (92.0% to 90.4%). The decrease has been most significant in children aged 5–8 years (92.7% to 89.3%) (Centre for Epidemiology and Research, 2010:123) (Table A4. 9) (XLSX 259.7KB).

Immunisation

It is generally recommended that children are immunised against a range of common diseases for which vaccinations are available. Some of these common diseases can cause serious illnesses and sometimes death or permanent disabilities.

Australia has a National Immunisation Program which outlines the recommended vaccines by age group, however immunisation is not compulsory. Source:  www.immunise.health.gov.au.

 

Children are considered fully immunised when they have received the standard immunisations appropriate for their age. For children up to 2 years of age this includes vaccination against diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type B (Hib), hepatitis B, polio and measles, mumps and rubella. Other vaccines available as part of the National Immunisation Program include meningococcal C (Men C), pneumococcal conjugate, varicella (chickenpox) and rotavirus. A pneumococcal polysaccharide is also provided for children with underlying medical conditions. However, these vaccines are not included in the assessment of vaccination status.

In 2011, 92.9 per cent of children in NSW had been fully immunised by 2 years of age compared to 96.2 per cent of children in Australia (Medicare, 2011). This is above the 90 per cent required to interrupt the spread of vaccine preventable illness within communities (Lister, McIntyre, Burgess, and O'Brien, 1999).

In 2010, the proportion of Aboriginal children that had been immunised by two years of age was similar to non-Aboriginal children in NSW (91.9% and 92.4%) (Table A4. 10) (XLSX 259.7KB).

Although overall immunisation rates of 2 year old children are high, the proportion varies by geographic area. The Hunter (95.1%) and Murrumbidgee (94.1%) areas of NSW had the highest proportion of children immunised. The Richmond-Tweed area did not reach the 90 per cent target (87.2%) due to the high rate of conscientious objection to vaccination in that area (Figure 4.3) (Table A4. 11) (XLSX 259.7KB).

Within the Sydney area, young children in relatively wealthy areas such as the Eastern Suburbs (87.8%) and Inner Sydney (90.9%) had lower proportions of children immunised (Table A4. 12) (XLSX 259.7KB). Research suggests that the under-immunisation of children is significantly related to parental concerns about vaccine safety (Leask, et al., 2008). This is also consistent with evidence from the United Kingdom which found that some wealthy, highly educated parents are not immunising their children because of doubts about the usefulness, efficacy and perceived health risks of some vaccinations, for example the measles, mumps, and rubella (MMR) vaccinations (Begg, Ramsay, et al., 1998).

The General Practice Immunisation Incentive (GPII) is an Australian government initiative that provides financial incentives to general practices for monitoring, promoting and providing appropriate immunisation services to children under the age of seven years. The aim of the GPII is to encourage at least 90 per cent of practices to fully immunise at least 90 per cent of children under seven years of age attending their practices. Source: www.medicareaustralia.gov.au cited 09/06/2011.

Maternity Immunisation Allowance is a non-income tested payment to encourage parents to immunise their children. Source: www.centerlink.gov.au.

Figure 4.3: Children immunised at two years of age by Statistical Division, NSW, 2010

Source: Australian Childhood Immunisation Register, 2010 (Table A4.11) (XLSX 259.7KB).

Communicable diseases

Communicable diseases remain a significant public health priority both in Australia and internationally (Department of Health and Ageing, 2009). Despite public health measures and mass immunisation programs outbreaks of communicable diseases still occur, impacting the health of children (AIHW, 2011:47).

Certain communicable diseases must be notified to the NSW Department of Health under the Public Health Act, 1991.

The number of communicable diseases recorded in children is a key national and international indicator of children's physical health. Three areas of communicable disease are reported here:

  • Vaccine preventable illnesses (including Hib, influenza, measles, mumps, pertussis [whooping cough], pneumococcal diseases [invasive], and rubella).
  • Sexually transmitted infections (including chlamydia, gonorrhoea, and syphilis infection).[9]
  • Other infectious diseases (including adverse event after immunisation, cholera, cryptosporidiosis, giardiasis, haemolytic uraemic syndrome, hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, leptospirosis, malaria, meningococcal disease, meningococcal-conjunctivitis, Q fever, salmonella infection, shigellosis, tuberculosis, typhoid, verotoxin [producing Escherichia coli], and rotavirus).

The NSW Notifiable Conditions Information Management System (NCIMS) (formally known as the NSW Notifiable Diseases Database) is a population-based surveillance system. It provides the best source of information on communicable diseases recorded in children.[10]

The NCIMS, as with any administrative data, is subject to error. The limitations of this collection include item non-response, transcription errors, clerical and editing errors, errors relating to reporting by respondents, definition and classification errors, coding errors, and data conversion errors. Further, the collection is limited to information on notifications of positive tests under the Public Health Act, 1991 and represents only those cases where health care was sought and a diagnosis made that required a notification to health authorities. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

One characteristic of ongoing interest is the cultural background of children, particularly Aboriginal children. While the NCIMS records Aboriginal identity in 2010, this data was missing for 70 per cent of children. While some of these children will be Aboriginal and some will be non-Aboriginal, the exact proportions cannot be determined. The high level of missing data precludes any analysis of Aboriginal children separately from non-Aboriginal children.

In 2010, the NCIMS recorded 4.0 per 1,000 children aged 0-17 years with a vaccine preventable illness, 1.1 with a sexually transmitted infection (STI) and 2.4 with other infectious diseases (Table A4. 13) (XLSX 259.7KB).

Vaccine preventable illnesses

In 2010, vaccine preventable illnesses were most common among children aged 9-10 years (7.0 per 1,000) and children aged 5-8 years (6.2 per 1,000). Children in these age groups were more than five times more likely than 15-17 year olds to acquire a vaccine preventable illness (Table A4. 13) (XLSX 259.7KB).

From 2009 to 2010 the rate of vaccine preventable illnesses almost halved among children aged 0-4 year, 13-14 years and 15-17 years (Figure 4.4) (Table A4. 13) (XLSX 259.7KB).

Figure 4.4: Children 0-17 years notified of a vaccine preventable illness by age, NSW, 2009-2010

Source: NSW Commission for Children and Young People calculations based on NSW Notifiable Conditions Information Management System (NCIMS), 2009 Surveillance Unit, Communicable Diseases Branch, NSW Department of Health and ABS Customised Report 2011 (ABS 2009 and 2010 Estimated Residential Population) (Table A4.13) (XLSX 259.7KB).

Sexually transmitted infections

Young people are at risk of unplanned pregnancies and sexually transmitted infections (STIs) (Rissel, Smith, Richters, Grulich, and De Visser, 2003). Preventing STIs is important because they can impact on health and fertility.

In 2010, the rate of STIs was highest in the 15-17 years age group (5.8 per 1,000) although infections were also evident in the 0-4 years old group[11] (0.2 per 1,000) and the 13-14 years age group (0.5 per 1,000).

STIs were four times higher for female children compared with male children (1.8 per 1,000 female children compared with 0.4 male children) (Table A4. 14) (XLSX 259.7KB).

The rate of STIs among children aged 0-17 years increased from 0.9 per 1,000 in 2009 to 1.1 per 1,000 in 2010 (Table A4. 14) (XLSX 259.7KB). The increase was evident in both male and female children.

Other infectious diseases

In 2010, other infectious diseases were most common among younger children (5.5 per 1,000 children aged 0-4 years compared with 2.4 per 1,000 children aged 0-17 years) (Table A4. 13) (XLSX 259.7KB). There was an increase in other infectious diseases among children 0-17 years from 2.1 per 1,000 in 2009 to 2.4 per 1,000 in 2010. This increase was most evident in male children.

Child mortality

Child mortality and cause of death are key pointers to the health of children. They reflect both the circumstances of children around the time of their death and provide information about the changes in social and environmental conditions, medical interventions, and lifestyles (AIHW, 2009).

Child mortality is a key national indicator of children's physical health.

The NSW Child Death Review Team (CDRT) collection holds the best source of information on child mortality. The CDRT collection is a population-based surveillance system covering the deaths of children who are usually resident in NSW.

The CDRT, as with any administrative data, is subject to error. The limitations of this collection include item non-response, transcription errors, coding errors, clerical and editing errors, and data conversion errors. In addition some causes of death are rarely coded as an underlying cause, yet play critical roles in the causal sequence that leads to death. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

In 2009, the CDRT reported 114 children aged 1-17 years in NSW died with a disease or morbid condition as their underlying cause of death. This equates to a mortality rate of 0.07 per 1,000 children 1-17 years (Table A4. 15) (XLSX 259.7KB).

The majority of these 114 children died as a result of a neoplasm including lymphoid and myeloid leukaemia (27), a congenital or chromosomal abnormality including malformation of the heart, congenital renal failure and congenital diaphragmatic hernia (24), or a disease of the nervous system including cerebral palsy, Werdnig-Hoffman and degenerative diseases (22) (Table A4. 16 and Table A4. 17) (XLSX 259.7KB).

From 1996-2009 there were 1,994 deaths from diseases and morbid conditions as the underlying causes of death or 0.09 per 1,000 1-17 year olds (Table A4. 17) (XLSX 259.7KB).

When the statistical significance of age, sex, Aboriginal identity and geographic location are considered:

  • When compared with 1 year olds, 2-4 year olds and 16-17 year olds were 50 per cent less likely to die with a disease or morbid condition; 14-15 years were 60 per cent less likely to die; and 5-9 year olds and 10-13 year olds were 70 per cent less likely to die.
  • Male children were 1.2 times more likely than females to die with a disease or morbid condition.
  • Aboriginal children were no more likely than non-Aboriginal children to die in these circumstances (Table A4. 17) (XLSX 259.7KB).

There has been a decline in the rate of deaths due to diseases and morbid conditions over the period 1996-2009. The lowest mortality rate was in 2009 at 0.074 per 1,000 1-17 year olds. This is the lowest seen since the CDRT collection commenced in 1996 (Figure 4.5) (Table A4. 15) (XLSX 259.7KB).

Figure 4.5: Children aged 1-17 years who died with diseases and morbid conditions by sex and year, NSW, 1996-2009

Notes: *DSMR = Directly Standardised Mortality Rat. DSMR is used to adjust for changes in the age profile of the population.

Source: NSW Child Death Review Team, Annual Report 2009, NSW Child Death Review Team, Annual Report 2008 and NSW Child Death Review Team, Annual Report 2007 (Table A4.15) (XLSX 259.7KB).

Oral health

Good oral health practices should begin before a child's first teeth appear as these practices create the foundations for oral and physical health in later life (AIHW, 2009; Raising Children Network, 2009).

Oral health is a key national and international indicator for children's health. In this section oral health is reported for both deciduous and permanent teeth.

The Centre for Oral Health Strategy (COHS) NSW is responsible for planning and developing oral health policies that focus on oral health promotion, prevention, early intervention and treatment. This encompasses the State's responsibility for health protection and disease prevention embodied in legislation, including fluoridation of public water supplies, and extends to applying public health approaches to the control of oral diseases.

In 2007, The NSW Centre for Oral Health Strategy developed the Early Childhood Oral Health (ECOH) program to promote and improve the oral health and well-being of infants and young children through promotion, prevention and early intervention. The program focuses on effective partnerships between families, oral health professionals and general child health professionals to achieve optimal oral health for infants and young children. It is a community-based early intervention program that is based on integrated service delivery. The strategy is twofold: targeting both child health professionals as well as oral health professionals. Source: http://www.health.nsw.gov.au/cohs/.

The 2007 NSW Child Dental Health Survey (CDHS) provides the most up to date information on the dental health of children in NSW. The survey is conducted through oral examinations of NSW primary school students aged 5-12 years. The National Child Dental Health Survey also provides information on the dental health of children aged 4-15 years attending school dental services in Australia. The most recent data available for NSW children is for the year 2000.

The CDHS, as with any survey, is subject to error. The limitations of this survey include non-sampling and sampling errors, and the exclusion of children in the specified age group who are either not enrolled in school, absent on the day the survey is conducted, or children enrolled in special needs schools. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

Oral health is measured by the dmft/DMFT index.[12]  The index is derived from the number of decayed, missing and filled teeth the child has – the lower a child's dmft/DMFT the better their oral health. In 2007, the CDHS found that the mean dmft/DMFT value for 5-12 year olds was 1.61 (Table A4. 18) (XLSX 259.7KB).

In 2007, 51.8 per cent of children aged 5-12 years examined in NSW primary schools had no past tooth decay.

  • A greater proportion of Aboriginal children had tooth decay compared with non-Aboriginal children (63.8% compared with 47.2%) (Table A4. 18) (XLSX 259.7KB).
  • This finding is consistent with literature from the Northern Territory which found that Aboriginal children have worse dental health outcomes than non-Aboriginal children, regardless of socioeconomic status (Jamieson, Armfield, and Roberts-Thomson, 2006).
  • A greater proportion of children living in major cities than those living in inner and outer regional areas or remote and very remote areas had no past decay (Figure 4.6) (Table A4. 19) (XLSX 259.7KB).

Figure 4.6: Children aged 5-12 years with no past decay experience by location, NSW, 2007

Source: The NSW Child Dental Health Survey 2007, Centre for Oral Health Strategy NSW (Table A4.19) (XLSX 259.7KB).

In 2007, the mean dmft/DMFT values for deciduous teeth across 5-10 year olds in primary school fluctuated and was the lowest for children aged 10 years (1.2) (Table A4. 20) (XLSX 259.7KB). This fluctuation results from the loss of deciduous teeth and their replacement by permanent teeth (Centre for Oral Health Strategy NSW, 2009).

The mean dmft/DMFT values for permanent teeth across 6-12 year olds in primary school increased with age and was the highest for 12 year olds at (0.75) (Table A4. 20) (XLSX 259.7KB). This pattern is explained by the small number of permanent teeth present for children eight years and younger (Centre for Oral Health Strategy NSW, 2009).

Unmet need for dental treatment declines as children get older reducing from 78.1 per cent among five year olds to 55.9 per cent among eight year olds (Centre for Oral Health Strategy NSW, 2009: 12).

Chronic health conditions

A chronic health condition is a disease or disorder which has lasted or is likely to last for at least six months, or a disease, disorder or event (for example, an accident) which produces an impairment or restriction which has lasted or is likely to last for at least six months[13] (ABS, 2010). Conditions include loss of sight or hearing; speech difficulties; shortness of breath or breathing difficulties; chronic or recurrent pain or discomfort; blackouts, fits or loss of consciousness; difficulty learning or understanding; incomplete use of arms or fingers; difficulty gripping or holding things; incomplete use of feet or legs; nervous or emotional condition; restriction in physical activities or in doing physical work; disfigurement or deformity; mental illness or condition requiring help or supervision; long-term effects of head injury; stroke or other brain damage; receiving treatment or medication for any other long-term conditions or ailments and still restricted; or any other long-term condition resulting in a restriction.

Chronic health conditions can disrupt the normal growth and development of children, either directly or indirectly through treatment (AIHW, 2010:34). Chronic health conditions are a key national and international indicator of children's health.

The ABS Survey of Disability, Ageing and Carers (SDAC) collects information on a range of factors, including chronic health conditions, need for and receipt of assistance, use of aids and equipment such as wheelchairs and hearing aids, and participation in community activities. The survey is considered the most reliable source of information about chronic health conditions in children.

The SDAC, as with any survey, is subject the error. The limitations of this survey include non-sampling and sampling errors; the difficulty in measuring disability (it depends on a person's perception of their ability to perform a range of activities associated with daily life); information for children in some cases was provided by others which may differ from information that the child may provide; and under-reporting of certain conditions because of the sensitive nature of the condition, or the episodic or seasonal nature of the condition. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

In 2009, SDAC found that an estimated 15.9 per cent of children aged 1-17 years had a recognised chronic health condition. Half of these children had a disability (7.8%).

As children grow older a greater proportion have a recognised chronic health condition. Nearly 15 per cent (14.6%) of 1-8 year olds had a long-term health condition, compared with 16.9 per cent of 9-14 year olds, and 17.3 per cent of 15-17 year olds (Figure 7) (Table A4. 21) (XLSX 259.7KB).

Among 1-8 year olds and 9-14 year olds, a greater proportion of male children compared with female children had a chronic health condition (16.0% compared with 13.1% and 20.9% compared with 12.8%) (Figure 4.7) (Table A4. 21) (XLSX 259.7KB).

Figure 4.7: Children aged 1-17 years with a chronic health conditions by age and sex, NSW, 2009

Source: NSW Commission for Children and Young People calculations based on ABS 2011 Customised Report (Survey of Disability, Ageing and Carers 2009, Cat. No: 4430.0) (Table A4.21) (XLSX 259.7KB).

Access to health care

The ability to access appropriate health services when required is likely to have a major impact on children's health and well-being. Access to services depends on the adequate supply of services as well as affordability, physical accessibility and the social and cultural acceptability of services (Gulliford, et al., 2002).

The NSW Population Health Survey (PHS) is the most reliable source of information on access to health care services for children in NSW and the demographic characteristics of the children. Characteristics of ongoing interest include Aboriginal children and children with a disability. The PHS does not collect information on children with a disability. While it collects information on Aboriginal children the small sample size limits regular reporting of Aboriginal children separately to non-Aboriginal children.

The PHS, as with any survey, is subject to error. The limitations of this survey include non-sampling and sampling errors, and reporting by parents and not the child concerned. The reader should keep these limitations in mind when interpreting the data. More information is in Appendix 1: Key survey sources and data reports.

The PHS asked parents of 0-15 year olds: 'Do you have any difficulties getting health care when your child needs it?'

In 2007-2008, one in five parents or carers (22.3%) had difficulties in getting health care for their child when needed. (Table A4. 22) (XLSX 259.7KB).

Figure 4.8: Children aged 0-15 years where parents had difficulties getting them health care when they needed it by age and location, NSW, 2007-2008

Notes: Estimates are based on 5,101 respondents. Parents were asked: 'Do you have any difficulties getting health care when your child needs it?'. Includes parents or carers who had difficulties getting health care when their child needed it and excludes those who said that the child did not need health care.The 95 per cent confidence interval provides a range of values that should contain the actual value 95 per cent of the time. The width of the confidence interval relates to the differing sample size for each indicator. In general, a wider confidence interval reflects less certainty in the estimate for that indicator. If confidence intervals do not overlap then the observed estimates are significantly different. If confidence intervals overlap slightly the observed estimates may be significantly different and further testing is done to establish that significance. For a pairwise comparison of subgroup estimates, the p value for a two-tailed test was calculated using the t-test for differences in means from independent samples and a modified form of t-test, which accounts for the dependence of the estimates, to test for differences between sub-group estimates and total estimates.

Source: NSW Population Health Survey 2007–2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health (Table A4.22) (XLSX 259.7KB).

When the statistical significance of age, sex, socioeconomic disadvantage and geographic location are considered:

  • A lower proportion of parent of 0–4 year olds had difficulties in accessing health care compared with 5–8 year olds. (Figure 8) (Table A4. 22) (XLSX 259.7KB).
  • Compared with the overall NSW population of children aged 0-15 years (22.3%), a lower proportion of children living in the least and second socioeconomically disadvantaged areas[14] had difficulty getting health care when they needed it (Centre for Epidemiology and Research, 2010:185).
  • A greater proportion of children living in NSW rural health areas compared with those living in urban health areas had difficulties in getting health care (33.5% compared with 16.9%) (Centre for Epidemiology and Research, 2010:185) (Figure 8) (Table A4. 22) (XLSX 259.7KB).
  • Previous research and research in other Australian states has also found that access to health care can be problematic in rural areas (see for example, DEECD, 2009; Kenyon, Sercombe, Black, and Lhuede, 2001).
  • Compared with the overall NSW population of children aged 0-15 years (22.3%), a lower proportion of children in the Area Health Services[15] of Sydney South West (14.5%), South Eastern Sydney & Illawarra (18.0%), and Sydney West (16.8%) had difficulty getting health care when needed.
  • A higher proportion of children in the Hunter & New England (35.3%), North Coast (32.1%), Greater Southern (33.2%), and Greater Western (31.1%), had difficulty getting health care when needed (Centre for Epidemiology and Research, 2010:185).

The most common difficulty reported was the waiting time for a GP appointment (Centre for Epidemiology and Research, 2010:185).

Between 2005-2006 and 2007-2008 there was a significant increase in the proportion of parents of children aged 0-15 years who had difficulty getting health care when their children needed it (15.6% and 22.3%) (Centre for Epidemiology and Research, 2010:185) (Table A4. 23) (XLSX 259.7KB).

References

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AIHW. (2011). Young Australians: their health and wellbeing 2011.Cat. no. PHE 140 Canberra: Australian Institute of Health and Welfare.

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Gulliford, M., Figueroa-Munoz, J., Morgan, M., Hughes, D., Gibson, B., Beech, R., et al. (2002). What does 'access to health care' mean? Journal of Health Services Research and Policy, 7(3), 186-188.

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Kenyon, P., Sercombe, H., Black, A., and Lhuede, D. (2001). Creating better educational and employment opportunities for rural young people. Hobart: Australian Clearing House for Youth Studies for the National Youth Affairs Research Scheme.

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Lister, S., McIntyre, P. B., Burgess, M. A. B., and O'Brien, E. D. (1999). Immunisation coverage in Australia children: a systematic review 1990-1998. Communicable Diseases Intelligence, 23(6), 145-170.

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[1]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas.
[2]Ninety per cent immunisation is considered necessary to interrupt the spread of vaccine preventable illness within communities (Lister, McIntyre, Burgess, and O'Brien, 1999).
[3]Gonorrhoea infections can result from contact with exudate from mucous membranes of infected people, as a result of sexual activity or during childbirth. Non-sexual transmission to infants and young children has been reported.
[4] Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles). The least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[5]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas.
[6]An infant is a child under one year of age.
[7]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas.
[8]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas.
[9]Gonorrhoea infections can result from contact with exudate from mucous membranes of infected people, as a result of sexual activity or during childbirth. Non-sexual transmission to infants and young children has been reported.
[10]As of April 2010 the Notifiable Conditions Information Management System has been operating in NSW.
[11]Gonorrhoea infections can result from contact with exudate from mucous membranes of infected people, as a result of sexual activity or during childbirth. Non-sexual transmission to infants and young children has been reported.
[12]This measure is used by the World Health Organisation and is determined through a clinical examination without radiographs (WHO, 2009).
[13]The ABS codes chronic health conditions to a classification based on the World Health Organisation's (WHO) International Classification of Diseases, version 10 (ICD-10). ABS (2004) Disability, Ageing and Carers, Australia 2003. (Cat. no: 4430.0) Canberra: Australian Bureau of Statistics.
[14]Certain socioeconomic characteristics of a geographic area can be used to determine its socioeconomic disadvantage (ABS, 2006). Areas can be ranked and then grouped according to their socioeconomic disadvantage. The NSW Department of Health uses five groupings (quintiles). The least disadvantaged areas are in the first group and the most disadvantaged areas are in the fifth group.
[15]On 1 January 2011 Local Health Districts (LHD) replaced Area Health Services (AHS) as the NSW Health geographic areas.