Blackpool’s integrated Children’s Oral Health Improvement System
Case study synopsis (100 words):
Blackpool, has been developing an integrated approach to improving children’s oral health. This is linked to the focus on the work of the Blackpool Better Start and a recognition that a range of interventions focused on population and individual approaches is required to achieve better life chances for the children of Blackpool. Additionally Blackpool and the Fylde Coast are one of 10 integrated care systems leading the development of new ways of working across health and social care. This case study shows how a range of interventions and collaborations across organisations can be used to tackle the issue of poor oral health in children.
The health of people in Blackpool is worse than the England average and Blackpool is the most deprived local authority in England, based on both the average Lower Super Output Area (LSOA) score and concentration of deprivation measures. Priorities in Blackpool include housing, tackling substance misuse, building community resilience, reducing social isolation, and early intervention.
In 2015, in Blackpool, about 28% of children were living in low income families and the oral health of 5 year old children was poor with a significantly higher experience of tooth decay in comparison with levels in England as a whole. Children living in the Blackpool Better Start wards had higher levels of tooth decay, although the levels of decay are also high in the remaining wards
Working together, Blackpool Council, Blackpool Better Start, NHS England and Blackpool Teaching Hospitals NHS Foundation Trust have, over recent years, put in place a range of interventions that now provide an oral health improvement system rather than single isolated approaches. The system includes interventions that may be described as upstream midstream and downstream. Figure 1 illustrates the types of interventions ranging from public policy, for example the sugar tax, through to clinical prevention, for example fluoride varnish application in a dental practice.
Source: Watt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiology 2007;35: 1-11
Upstream measures include
Blackpool Council’s Free School breakfast scheme which includes the offer of milk which is fluoridated. In excess of 11,000 breakfasts have been delivered daily in 33 schools since the start of the scheme, with children having the opportunity to enjoy a variety of healthy breakfast products. Fluoridated milk is offered as part of the scheme and now accounts for 70% of the consumption.
Supervised toothbrushing at childcare settings, where the Blackpool Better Start advised by Public Health England, is supplying nurseries and child minders with training and the necessary equipment for supervised tooth brushing. They are investing over £12,000 annually to help develop oral health skills in children aged 2-4 and to date over 1000 children a day are brushing their teeth.
Midstream measures include
An advertising campaign on local busses with the slogan “Sandgrown children, Don’t rinse your mouth after brushing!” The campaign focused on Public Health England’s evidence based toothbrushing advice.
‘The Sandgrown Family Brush Their Teeth’ book, which has embedded evidence based advice on toothbrushing was also developed. This was published as part of a campaign to promote key oral health messages, and family cohesion through encouraging fathers to read to their children.