Local authority child health profile reports 2023: indicator guide
Updated 3 May 2023
Applies to England
© Crown copyright 2023
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This publication is available at https://www.gov.uk/government/statistics/2023-child-health-profiles/local-authority-child-health-profile-reports-2023-indicator-guide
The child health profile reports on the Fingertips data website, now in HTML format, provide a snapshot summary of child health in upper-tier local authority areas. Individual reports can be found by searching for the relevant local authority in the search box at the top of this page. The snapshot reports should be differentiated from the interactive versions of the child health profiles, which are updated regularly whenever new data is available.
Intended for use by local government and NHS professionals, the reports have been published since 2011 and give a snapshot overview of child health and wellbeing in each local area in England, providing indicators across different topics.
Published annually in PDF format between 2011 and 2021, they have been produced on alternate years by the Office for Health Improvement and Disparities (OHID) since 2021, after Public Health England (PHE) was replaced by the UK Health Security Agency (UKHSA) and OHID. As well as being able to view the individual reports in HTML, users can also still print them in the pre-2023 format as a concise 4-page PDF.
The child health profiles can be used to:
- understand the needs of local communities
- improve the health and wellbeing of children and young people
- reduce health inequalities
Methods used to generate the reports
2021 mid-year population estimates
In December 2022, the Office for National Statistics (ONS) released population mid-year estimates (MYEs) for 2021. Based on the 2021 census, these estimates do not align with MYEs for earlier years, based on the 2011 census. This means that it is not possible to compare metrics produced using the 2021 MYEs with earlier versions of the same metric.
For this reason, analysis of some trends has been removed from the 2023 child health profiles. It has also not been possible to calculate metrics that use pooled years of data that would include 2021 MYEs – for example, hospital admissions of children and young people for conditions wholly related to alcohol. Within each report, these indicators have been updated to financial years 2018 to 2019 to 2020 to 2021 figures.
ONS plans to release updated MYEs for years 2012 to 2020, to align with the 2021 census and 2021 MYE, in November 2023. It will then be possible for us to re-calculate metrics for years prior to 2021 and re-instate the analysis of trends. We will also be able to calculate metrics for pooled years using aligned population estimates.
Geographical areas
The regional comparators shown in the profiles now follow the Nomenclature of Territorial Units for Statistics (Nomenclature des Unités territoriales statistiques – NUTS) system. This classification system came into force following the UK’s withdrawal from the EU on 31 December 2020, replacing the Eurostat geographical classification system. The statistical regions of England form part of NUTS 1. More details can be found on the Office for National Statistics website.
Statistical neighbours
Local authorities that are deemed to have similar characteristics can be designated as statistical neighbours, and provide a way of measuring progress. Any local authority may compare its performance (as measured by various indicators) against its statistical neighbours to provide an initial guide as to whether their performance is above or below the level that might be expected.
The statistical neighbours used have been drawn from the ‘children’s services statistical neighbour benchmarking tool’ created by the Department for Education (DfE), which was last updated in April 2021. While the tool defines 10 neighbours, this has been limited to the 4 closest statistical neighbours in the profiles, as space on the charts is limited.
Further information is available in the local authority interactive tool (LAIT) publication.
Confidence intervals
A confidence interval is a range of values used to quantify the imprecision in the estimate of a particular value that results from random variation in the estimation of the value.
In public health, many indicators are based on complete datasets and not samples. For example, mortality rates are based on death registers. In these instances, imprecision arises not as a result of sampling variation but of ‘natural’ variation. Generally, in public health, it is the underlying circumstances or process that is of interest and the actual value observed gives only an imprecise estimate of this ‘underlying risk’.
The width of the confidence interval depends on 3 things:
- the sample or population size from which the estimate is derived – larger samples give more precise estimates with smaller confidence intervals
- the degree of variability in the phenomenon being measured
- the required level of confidence – this is an arbitrary value and conventional practice is to use 95% confidence
For the purpose of these profiles, we have used 95% confidence limits, which are denoted by a horizontal line on the bar charts with minimum and maximum ranges showing as small vertical lines at either end.
Main findings: the spine chart
The main health and wellbeing findings are summarised by the report’s spine chart (a visualisation that shows, at a glance, how one area compares with others across a range of indicators). See below for how to use these.
Full details of how the indicators included in the 2023 child health profiles spine chart have been calculated, and the sources of this data, are included in the interactive version of the profiles on OHID’s Fingertips tool. For help using the interactive tool or for further advice, please contact the local knowledge and intelligence service in your area; contact details are listed at the bottom of this page.
The main findings section provides a single statement of whether the area is ‘better than’, ‘worse than’, ‘similar to’ or ‘mixed compared with’ the England averages in respect to the selected indicator(s).
An area is classed as ‘better than’ the England average if any of the following are true:
- most (60% or more) indicators are green (they are significantly better than the England average)
- green indicators make up 40% or more and only up to 20% are red (they are significantly worse than the England average)
- green indicators make up 30% or more and there are no red indicators
An area is classed as ‘worse than’ the England average if any of the following are true:
- most (60% or more) indicators are red
- red indicators make up 40% or more and only up to 20% are green
- red indicators make up 30% or more and there are no green indicators
An area is classed as ‘similar to’ the England average if most (53% or more) of the indicators are amber. Otherwise, the area is classed as ‘mixed’.
Information on infant and child mortality is given for all local authorities. Statistics are also given for all local authorities on 7 topics where public health interventions can improve child health at a local level. These include:
-
childhood obesity
-
breastfeeding
-
dental health
-
MMR immunisation
-
teenage pregnancy
-
smoking in pregnancy
-
mental health
Two additional main findings are selected to highlight areas of particular interest. Topics could include any of the following:
- immunisation against childhood diseases such as diphtheria, pertussis (whooping cough) and tetanus (DTap), Haemophilus influenzae type b (Hib – an important cause of childhood meningitis and pneumonia) and polio
- immunisations for children in care
- babies born with low birthweight
- child poverty and homelessness
- alcohol and substance misuse
- road traffic accidents, injuries and A&E attendance
- hospital admissions for asthma
- young people not in education or employment, children entering the youth justice system
- school readiness
If an area is generally performing well, these 2 additional findings will be selected to highlight where the area does worse, and vice versa. Comparing local to national data also highlights potential inequalities which areas may wish to consider further.
Many of the main findings describe whether an area is better or worse than the England average for a particular indicator. This relates to a statistically significant difference, using the methodology described in the section above on confidence intervals.
Using the spine chart
The spine chart shows a summary of performance for all indicators.
The trend arrow in the spine chart shows the recent trend consistent with the method used in OHID’s Fingertips tool. The meaning of the colours is as follows:
- amber horizontal arrow – shows no significant change
- green up arrow – shows increasing and getting better
- green down arrow – shows decreasing and getting better
- red up arrow – shows increasing and getting worse
- red down arrow – shows decreasing and getting worse
- black dash – shows trend cannot be calculated
Local number per year: the number of occurrences in the local authority (a per-year average is calculated where the indicator presents multiple pooled years). The exact definition of ‘occurrences’ depends on the indicator definition. Examples could include children, hospital admissions or diagnoses.
Local value: the value of the indicator for the local authority.
England average: the value of the indicator for England.
England worst: the highest or lowest of all local authority values, depending on the indicator definition.
England best: the lowest or highest of all local authority values, depending on the indicator definition.
Spine: the coloured dot shows how the area is performing compared to the England average (shown as the red line on the chart):
- red dot – with the exception of the immunisations indicators noted above, this means that the selected area is performing significantly worse than the England average
- green dot – with the exception of the immunisations indicators noted above, this means that the selected area is performing significantly better than the England average
- yellow dot – with the exception of the immunisations indicators noted above, this means that the selected area is not significantly different from the England average
- white or grey dot – the selected area could not be compared to the England average
- grey diamond – this shows the regional average
- the grey boxes on the spine chart represent the area between the maximum or minimum value of all local authorities in England, shown as light grey shading, with the area between the 25th and 75th percentile shown in dark grey shading
Topic charts
The profile reports include more detailed analysis of children and young people’s health in local areas in the horizontal bar charts for individual topics.
Full details of how the indicators on these pages have been calculated and the sources for this data are included in the interactive version of the profiles. For help using the interactive tool or for further advice, please contact the local knowledge and intelligence service in your area; contact details are listed at the bottom of this page.
Obesity charts
The charts compare the local authority featured in the profile with its 4 closest statistical neighbours and the England value, together with confidence limits. The confidence limits on the smaller bars are for children classified as obese, while the confidence limits on the longer bars are for those classified as obese or overweight.
A significant difference is said to occur where the confidence intervals for the local authority do not overlap with the reference value. For example, where both confidence limits for the local authority exceed the value for England, the area is significantly higher than England for that indicator. Where the confidence interval straddles the England value, there is said to be no significant difference.
Trend information in the alcohol and mental health charts
The trend calculation uses a test which considers data over the most recent 5 years, and tests for differences over time. The test produces 2 statistics each time it is run, one which determines significance at 95% and the other which describes whether the trend is increasing or decreasing. Outliers are taken into account as part of determining the significance.
Young people’s sexual and reproductive health, breastfeeding and child development aged 2 to 2-and-a-half
The charts compare the local authority featured in the profile with its 4 closest statistical neighbours and regional and England values, together with confidence limits. A significant difference is said to occur where the confidence intervals for the local authority do not overlap with the reference value. For example, where both confidence limits for the local authority exceed the value for England the area is significantly higher than England. Where the confidence interval straddles the reference value (England or region), there is said to be no significant difference.
Breastfeeding and child development data have not been published where data for the area has not passed our validation. Further information is available in the Breastfeeding at 6 to 8 weeks after birth: annual data 2021 to 2022 data spreadsheet and Child development outcomes at 2 to 2 and a half years: annual data 2021 to 2022 data spreadsheet.
The chlamydia detection rate amongst under 25-year-olds is a measure of chlamydia control activities. It represents infections identified (reducing risk of sequelae in those patients and interrupting transmission onto others). Increasing detection rates indicate increased control activity: it is not a measure of morbidity.
The text for chlamydia describes whether the area’s detection rate for females is higher or lower than the recommended rate of 3,250, effective from January 2022. Rates of 2,400 to less than 3,250 are described as ‘approaching’, to reflect the fact that areas with detection rates in this range are only just failing to meet recommended levels.
Immunisation chart
The chart shows the local authority featured in the profile with its 4 closest statistical neighbours and regional and England values, together with confidence limits. The vertical black line on the chart represents the minimum recommended vaccination coverage of 95% – so the chart shows whether the area’s coverage is higher than recommended (95% or above) or lower than recommended. The shaded area on the graph shows 90 to 95% coverage and illustrates where local authorities are approaching the recommended coverage. Areas are described as ‘slightly less’ than 95% if the value falls between 90 and 95%. The confidence intervals are shown to highlight the inherent variation in this indicator (as is the case with all indicators) but are not used for the purpose of comparison.
Population statistics
The tables below describe the methods used to calculate data for the population information, which is included on the first page of each of the snapshot reports.
| Indicator or measure | Live births |
|---|---|
| Definition | Number of live births registered to mothers resident in area |
| Rationale | Understanding the demography of the area will help with planning of appropriate services |
| Numerator | Number of live birth registrations |
| Source of numerator | Office for National Statistics (ONS) |
| Denominator | Not applicable |
| Source of denominator | Not applicable |
| Age range | 0 years |
| Time period | Calendar year 2021 |
| Geographical level | Unitary authority, metropolitan borough council, London borough council, county council |
| Method | Number |
| Limitations | None |
| Further information | ONS – Births in England and Wales: summary tables (table 3) |
| Indicator or measure | Children (aged 0 to 4 years and 0 to 19 years) |
|---|---|
| Definition | Number and percentage of children aged 0 to 4 years and 0 to 19 years resident within the area |
| Rationale | Understanding the demography of the area will help with planning of appropriate services |
| Numerator | Mid-2021 population estimates for local authorities in England (persons aged 0 to 4 years and 0 to 19 years) |
| Source of numerator | ONS |
| Denominator | Mid-2021 population estimates for local authorities in England (total population: persons of all ages) |
| Source of denominator | ONS |
| Age range | 0 to 4 years, 0 to 19 years |
| Time period | Calendar year 2021 |
| Geographical level | Unitary authority, metropolitan borough council, London borough council, county council |
| Method | Population estimate (number and percentage). Published figures are rounded to the nearest hundred persons. However, the percentages are calculated on unrounded data. |
| Limitations | None |
| Further information | ONS – Estimates of the population for the UK: England and Wales, Scotland and Northern Ireland (table MYE2 – Persons) |
| Indicator or measure | Children (aged 0 to 19 years) in 2031 (projected) |
|---|---|
| Definition | Projected number and percentage of children aged 0 to 19 years resident within the area in 2031 |
| Rationale | Understanding how the demography of the area is projected to change will help with planning of appropriate services. |
| Numerator | 2018-based subnational population projections for local authorities in England (ages 0 to 19 years) |
| Source of numerator | ONS |
| Denominator | 2018-based subnational population projections for local authorities in England (total population, persons of all ages) |
| Source of denominator | ONS |
| Age range | 0 to 19 years |
| Time period | Calendar year 2031 |
| Geographical level | Unitary authority, metropolitan borough council, London borough council, county council |
| Method | Population projections (number and percentage). Published figures are rounded to the nearest hundred persons. However, the percentages are calculated on unrounded data |
| Limitations | Long-term subnational population projections are an indication of the future trends in population by age and sex over the next 25 years. As they are trend-led projections, assumptions for future levels of births, deaths and migration are based on observed levels mainly over the previous 5 years and show what the population will be if these trends continue. The projected resident population of an area includes all people who usually live there, whatever their nationality. People moving into or out of the country are only included in the resident population if their total stay in that area is for 12 months or more, thus visitors and short-term migrants are not included. Armed forces stationed abroad are not included, but armed forces stationed within an area are included. Students are taken to be resident at their term-time address. The projections do not take into account any policy changes that have not yet occurred, nor those that have not yet had an impact on observed trends. These projections were published on 24 March 2020 and are based on 2018 mid-year population estimates published on 26 June 2018 |
| Further information | ONS – Population projections for local authorities (table 2). ONS – Future plans for national population projections |
| Indicator or measure | School children from minority ethnic groups |
|---|---|
| Definition | Number and percentage of children at state-funded primary and secondary schools classed as ‘minority ethnic pupils’. These are all pupils classified as belonging to an ethnic group other than white British |
| Rationale | Understanding the demography of the area helps with the planning of appropriate services |
| Numerator | Number of children at state-funded primary and secondary schools classed as ‘minority ethnic pupils’ |
| Source of numerator | Department for Education (DfE) |
| Denominator | Total number of children at state-funded primary and secondary schools whose ethnic group was classified |
| Source of denominator | DfE |
| Age range | School pupils of all ages |
| Time period | 2022 |
| Geographical level | Unitary authority, metropolitan borough council, London borough council, county council |
| Method | Number and percentage |
| Limitations | Includes middle and all through schools. Includes all primary academies, including free schools. Includes city technology colleges and all secondary academies, including secondary free schools, university technical colleges and studio schools. Pupils were classified according to their ethnic group. Includes pupils who were sole or dual main registrations. Excludes pupils from special schools due to small numbers |
| Further information | DfE – Schools, pupils and their characteristics: January 2022 –- underlying data for pupil characteristics |
| Indicator or measure | School pupils with social, emotional and mental health needs |
|---|---|
| Definition | See definition for School pupils with social, emotional and mental health needs: % of school pupils with social, emotional and mental health needs (School age) in OHID’s Fingertips tool |
| Indicator or measure | Children in relative low income families (under-16s) |
|---|---|
| Definition | See definition for Children in relative low income families (under-16s) in OHID’s Fingertips tool |
| Indicator or measure | Life expectancy at birth |
|---|---|
| Definition | See definition for Life expectancy at birth (male or female, 3 year range) in OHID’s Fingertips tool |