The Born in Bradford Study: An Imperative to Act

Yesterday, I went to a presentation on the Born in Bradford research.  It was the second presentation I have seen and shorter than the last one and so I am able to report it with greater ease and hopefully accuracy.

 

Born in Bradford is a cohort study following about 13, 400 babies born in Bradford between the years 2007-2011.  This represents about half of the babies born in Bradford over that period and largely represents the demographics of the city. The women were recruited when attending a routine hospital appointment between 26-28 weeks.  This study is about health and the results will inform health social policy and changes in policy over the coming years.

 

Neil Small, Professor of Research at the School of Health Studies at the University of Bradford says of the study: “Born in Bradford wants to chart and understand the interactions between poverty, ethnicity, environment, behaviours, genetics and the way services are provided to the people of the city.  It is understanding the whole picture that gives us clues about improving health.”

 

Indeed, we must understand the complexity of factors contributing to ill health – poverty ethnicity, social class, migration – also, access to health services and quality of information.  Housing air and water quality, food, whether people smoke drink alcohol, their mental wellbeing, their physiology and metabolism their genetic inheritance.  All these and the interactions between them and how they are layered within people’s lives, homes and communities affect people’s health and the health of their children.

 

The data collected from women at 26-28 weeks included demographic and social economic, family history including migration history, lifestyle and diet factors (food, alcohol, smoking, exercise, etc), mental wellbeing, obstetric and medical histories, blood samples etc.  Where possible the Dad’s were also recruited with 6000 Dads being included in the research.  Smaller in depth studies have been done on such matters as Infant Growth and Asthma where a selection of the cohort have had more in depth work.

 

The context, which makes this study particularly interesting and useful, is that, Bradford has a high number of people of childbearing age and a high birth rate.  We also have a dichotomous population with a white British population almost balanced by a South Asian population mostly originating from Pakistan (40-50%).  This makes for a useful comparator.

 

Some interesting comparators between the two populations are the following:

 

Item

Percentage of white population

Percentage Pakistani population

Mothers who have been in regular employment

92

51.9

Married

33.4

97.9

Co-habits with Father

72.4

94.1

Ever smoked

57.57.6

 

Alcohol drunk in pregnancy

72.2

0.4

Deprivation indicator: lack of 2 or more essential material items in the home

36.2

35.3

Subjective poor (‘Yes I am poor’)

7.2

8.0

 

Interesting:

  • The high number of British women who are employed, the high levels of two parent families in both communities, the difference in lifestyle/culture of marriage, smoking and alcohol.
  • the fact that the majority of children born in Bradford are born into poor homes – when you see the infant mortality figures you see how big an impact this has on the life expectancy of a baby.

 

Those women do not see themselves or speak of themselves as being poor (although the objective label maybe that they are).

 

When the researchers looked at migration they found that the majority of mothers migrated between the ages of 18-24 and often were married and had children within a relatively short period of arrival.

 

Generally research has shown that migrants tend to do better healthwise than the resident population of the places they migrate to.  But in this case, for these mothers, it is not the case.  Why?

 

Infant Mortality

 

Bradford (since the rate has slightly dropped) has nearly double the infant mortality rate of the UK national average.  We had a person in the room whose job it is to know these things and she said the latest figures were 2007-2010 – 7.9 per 1000 live births better than the previous 3 year figures: 2006-9 – 8.3 per 1000 live births.

 

When Bradford compares herself with other towns and cities with similar demographics and poverty levels we come off slightly worse than most but significantly worse than some such as Mansfield.  We need to know why.

 

Infant Mortality and Health Inequality.

 

What was shocking listening to both the previous presentation and this one was the distribution of this high rate of infant mortality WITHIN our population.  Basically you are five/six times more likely to lose your baby if you are in the poorest two fifths of the population than you are if you are in the richest fifth of the population.  This distribution of deaths can be seen geographically as well as the poorest areas of Radford have the highest infant mortality.

 

Overlaying the clear poverty link to infant death there is an ethnic link remembering that Bradford’s average is 7.9 per 1000 live births, if you are a first generation migrant from Pakistan that rises to 15 per 1000 live births and if you are second generation Pakistan/South Asian 14 per 1000 live births.  This information hurts.

 

Why is this happening?  What is happening here?  We don’t know – there were no answers in the presentation.  Indeed there was an admission of a sense of a missing link here in the processing of the data, of finding the right questions or information, to understand why this is happening.

 

But there was more which linked into this shocking information. 

 

Developmental Origins of Adult Disease: Diabetes

 

The problem: 

20% of adults of South Asian origin have diabetes (this can be true of migrants of other poor areas but this Bradford).

Another 20% have impaired glucose tolerance – indicator for future diabetes – especially Type II

If you look at the age profile of the Bradford S. Asian population then we have a ticking time bomb of ill health here:

I.e. 40% of our births are South Asian origin in a population of 40% South Asian.  The fore cast for increased diabetes in South Asian population over next 20 and 40 years is scary.

 

The origins of Diabetes in this population:

 

The Barker hypothesis – 1986 The Lancet and later verified in Helsinki Cohort Study 1997 BMJ

Barkers study of native British people in Northamptonshire (if I remember correctly).

The origins of diabetes and indeed heart disease are in rapid weight gain in early infancy where adipose tissue is laid down around the vital organs of the body.

 

Basically, in resource poor areas of our country and of our world, babies have a slower metabolism and their growth is slower so their growth can keep pace with the limited resources available to them.  Move them into a resource rich area (e.g. from rural Pakistan to Bradford UK) or significant increases in affluence within the area (Northamptonshire since early last century), mean that babies with a resource poor metabolism are given a resource rich diet.  The superfluous resource is deposited as fat around the vital organs.  It is believed that it takes three generations to change the metabolism of babies.

 

This in the view of the Bradford researchers is what is happening to our Bradford South Asian Population – babies are being fed beyond their requirements and it is detrimental to their future health.

 

Two clear policy imperatives arrive from this information (and were followed up in our group discussions:

  1. BREASTMILK is the ultimate appropriate food and feeding mechanism for South Asian Babies for a significant part of their first year, because this ensures food at the appropriate levels for the baby’s metabolism – preventing the depositing of adipose fat.  We therefore need to put policies in place to ensure South Asian Babies get this appropriate food – including and especially babies whose Mums cannot breastfeed or breastfeed adequately for clinical reasons.

 

  1. The current growth charts need to change.  The charts given to South Asian Mums are based on the growth of Western babies – or a significant proportion of such babies.  Midwives and Health Visitors will be putting pressure on Mums to supplement feeds if the babies are not growing at the rate these charts predict is normal and healthy.  Also families will be proud to show that their babies are well fed and healthy by being seen to have babies average or above in terms of weight gain and growth.  Ironically, these charts could be reducing the life and health expectancy of South Asian children not ensuring it because they will encourage inappropriate weight gain (and therefore supplementing of breastfeeding to ensure weight gain).  The Handheld ‘Redbook’ growth charts need to be changed for South Asian parents, to charts specifically representing the norm for their baby’s slower metabolism/growth.  It needs to be done now – and the intervention evaluated.

 

I would like to note that only recently in Bradford have the charts actually represented breastfed babies – 5 years ago and even much more recently, a breastfeeding baby’s growth was measured on charts depicted the more rapid pattern of growth of formula fed babies – leading to pressure on breastfeeding Mums of all nationalities to supplement.

 

 

This is the big message I want to record in my blog but there is one more message from the research which was highlighted by Professor Small and I will put it briefly.

 

The occurrence of a recessive gene in a child causing ill health or disability in the normal population is 1 in 40.

If you marry a first cousin it is halved to 1 in 20

If you are in a community or culture where marriage of cousins is a regular occurrence over generations, then the occurrence in 1 in 11.

 

In the UK the South Asian population represents 3.4 per cent of the UK population

And 30% of the recessive genetic disorder population in the UK.

 

Me: This is not about condemning people for their choices – within communities and groups there have been sound reasons or pressing circumstances that has made this happen, but with this information and the impact on the life and wellbeing of their children, South Asian communities need to evaluate and review this practice and the reasons for it.  They need appropriate support to do so.

 

Some Qualifications

There is more to the research than this summary.

Any mistakes, inaccuracies, misinterpretations are mine not the research team’s.  I would recommend getting the findings direct from the website: www.borninbradford.nhs.uk or book yourself in to hear a presentation from Professor Neil Small of the School of Health Studies at the University of Bradford.

 

Some final thoughts and observations of mine:

 

The policy discussion after the presentation was very interesting.  At the meeting we had a cross section of policymakers across the district – including several key commissioners and project leaders in the PCT, and in the Local Authority. 

 

Conspicuous by their absence were the new GP Commissioners: the GP chair of the Maternity Newborn Programme (resourced by the PCT) and another GP who left before the discussion, were the only representatives of the GPs soon to be charged with carrying forward the research and policies we were talking about. GPs, are going to be given so much money and so much power to deliver health care – why are they not joining the cross sector partnerships seeking to tackle health inequalities, infant mortality and diabetes etc?  It worries me that though they will be taking over the commissioning next year they are not here at key strategy meetings where it matters.

 

 The key things I heard in the policy discussion groups (mine and the feedback) were:

  • The imperative to change the charts for South Asian babies soon – and monitor and evaluate the intervention. 
  • The importance of breastfeeding as the appropriate food and therefore the imperative for this to be a priority for the well being of our population. 
  • Thirdly, the importance of partner ship across sectors for effectiveness and for gathering data to evaluate and further the data now amassed and proving so useful ( where were the GP commissioners?), and
  • The tension between short term funding and the long term goals/actions that responding effectively to this research demands.

 

This study has the potential to be turned into strategies that implemented will save lives.  It will maintain health and could stop the diabetes time bomb in our city.  This study is a wakeup call, learning for action to change and save lives.  We need to take up the challenge that this research presents and use whatever influence we have to ensure the wellbeing of our communities, families, friends and neighbours – especially in Bradford.

 

P.S. can you give your GP that message as well because how else are they going to hear it?

 

 

 

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