Professor of Epidemiology and Health Data Science
We are using innovative research methods to understand and reduce inequalities in three key areas of child health: unhealthy weight, school food, and timely childhood immunisations.
Find out about our work in each area by expanding the sections below:
Our research is helping to build a picture of the circumstances and consequences of living with unhealthy weight in childhood.
Through our analyses, we have found that children living with unhealthy weight in North East London are:
Our research into child weight uses data linkage, where we link different sources of data so they can be analysed together, or where we link people sharing the same household to understand how health varies at the household level. Data processing agreements with NHS North East London and local authorities in the region give our research team approved access to de-identified data from GP patient health records and from the National Child Measurement Programme (NCMP) – a government initiative that measures and weighs children in schools to inform national and local strategies. We have linked data from these sources to uncover new insights, adhering to the ‘five safes’ framework to ensure that no individual can be identified through our research.
We use data from the National Child Measurement Programme to study child weight because this provides a more comprehensive source of information on children’s Body Mass Index (BMI) at the population level compared with GP patient health records. In 2021, we compared BMI data recorded in GP health records with data from the National Child Measurement Programme for 56,000 children in North East London. We found that relatively few children have BMI recorded in their GP health record, and those that do are more likely to be underweight or overweight. GP records are not suitable for estimating the population prevalence of unhealthy weight in childhood.
BMI is used as an indicator of body fat, but the definitions of unhealthy weight based on BMI were developed using data from a predominantly White population. This does not work well for some other ethnic groups. Other researchers have developed ways of adjusting BMI to avoid underestimating body fat in children from South Asian ethnic groups and overestimating it in those from Black ethnic groups, but these adjustments are not used routinely in the National Child Measurement Programme. We allow for ethnic differences in body fat in our research on unhealthy weight by applying these ethnic-specific BMI adjustments. In 2020, we applied these adjustments in a study to compare obesity prevalence with National Child Measurement Programme estimates in North East London. We showed that if the national programme had used ethnic adjustments, it would have changed the information about their child’s weight given to around one in five parents of children from South Asian and Black ethnic groups.
Our qualitative paper was the first to bring together current evidence on the experiences of children who were categorised as ‘overweight’ and ‘very overweight’ by the National Child Measurement Programme, and the views of their parents. Children who were told they were above a healthy weight reported anxiety and embarrassment. Parents expressed concerns about the potential for triggering eating disorders and unhealthy dieting behaviours in the future. We don’t know whether these concerns are borne out in the long term, but our study suggests policy makers should investigate whether the programme is causing harm and consider how this can be mitigated. Read our news story.
Visit our Published research page to view all our published papers relating to child health.
Lead: Carol Dezateux; CEG team: Nicola Firman, Meredith Hawking, Marta Wilk. The qualitative paper was written in collaboration with Queen Mary colleague Deborah Swinglehurst.
This work is funded by Barts Charity (REAL Child Health programme: MGU0419) and the Economic and Social Research Council - London Interdisciplinary Social Science Doctoral Training Partnership.
We are conducting two evaluations, using qualitative and quantitative methods, to build a rich picture of food provision in schools in Tower Hamlets.
We are working with Tower Hamlets Council to evaluate their ‘Fantastic Food in Schools’ programme in primary schools. The initiative promotes healthy eating throughout the school day, encompassing universal free school meals, breakfast clubs, training for catering staff, and activities like taster sessions and ‘Cook-a-thons’ for children and their parents.
We are using:
Tower Hamlets Council extended universal free school meals to all secondary schools in the borough in September 2023, and we are evaluating the impact:
Our qualitative research in primary and secondary schools uses observations, focus groups, interviews and projective techniques – asking participants to put themselves in the shoes of a fictional character to prompt discussion. In each setting, we have developed age-appropriate activities. We’ve used ‘Ziggy the alien’, who needs feeding a delicious and nutritious lunch; games like ‘pin the meal on the wheel’ that helps children to describe how much they like or dislike particular foods; and sensory metaphor activities that encourage children to try new foods and describe them in creative ways. We have eaten lunch with children and observed their responses to foods, and interviewed parents, carers, and school and kitchen staff.
Understanding the children’s experiences, and the context and choices faced by the adults who care for them, has revealed that in primary schools:
Leads: Meredith Hawking and Carol Dezateux; CEG team: Natalia Concha, Nicola Firman and Jakob Petersen, with Queen Mary colleagues Mathilda O'Donoghue and Pratima Singh, and collaborators at Tower Hamlets Council, ActEarly, University of York, University of Oxford, Newcastle University and Queens University Belfast.
The primary school evaluation (Food Improvement Goals in Schools, ‘FIGS I’) is funded by the UK Prevention Research Partnership via ActEarly, a programme bringing academics, local authorities and communities together in Tower Hamlets and Bradford to improve the health of children in areas of poverty. The quantitative aspect of this evaluation is funded by the National Institute for Health and Care Research award to the Tower Hamlets Health Determinants Research Collaboration. Both programmes benefit from funding for the REAL Child Health programme by Barts Charity (MGU0419).
The secondary school evaluation (‘FIGS II') is funded by NIHR School for Primary Care Research.
Through our research and related clinical effectiveness programmes, we are helping to ensure all children have an equal chance of protection against serious preventable illnesses.
The HPV (human papillomavirus) vaccine is now routinely administered in UK schools, to all children aged 12-13 years. The vaccine prevents infections from HPV, which is responsible for some cervical and other cancers. Our analysis in 2021, when this vaccine was only offered to girls, used data from a nationally representative sample of children participating in the Millennium Cohort Study. We found that girls were less likely to be vaccinated if they were:
London has the lowest rates of Measles, Mumps and Rubella (MMR) immunisation in the UK – a problem which predated the Covid-19 pandemic and has become worse since. Measles is highly infectious, with one infected person able to infect between 12 and 28 others. The World Health Organization recommends that 95% of children receive two MMR doses to avoid a measles outbreak.
In 2022 we published a longitudinal study about the effect of the pandemic on the timeliness of MMR immunisation using data from GP health records in North East London. We found that:
We developed a quality improvement programme to help GP practices navigate the complex childhood immunisation schedule. The programme is centred on a purpose-built software tool: the Active Patient Link for Childhood Immunisations (or ‘APL-Imms’) tool. This enables GP teams to use data from patient records to call and recall children for the right immunisation at the right time. We ae evaluating this programme: early findings indicate an increase in timely MMR immunisations following its introduction across North East London. We published a protocol for the evaluation in BMJ Open and expect to publish our results in 2024.
We ran a series of workshops with a small group of parents from Tower Hamlets to discuss MMR vaccination, our research, and to understand their views. From these conversations, we are producing a short video for dissemination within the local community. The video will be shared on social media platforms, within health centres, and among parents and local clinical staff networks.
Lead: Carol Dezateux; CEG team: Ana Gutierrez, Anna Billington, Meredith Hawking, Milena Marszalek and Nicola Firman, in collaboration with Helen Bedford at UCL.
Our programme to improve timeliness and equity of childhood immunisations was funded by Barts Charity (REAL Child Health programme: MGU0419), the NHS North East London Digital First programme, the OneLondon programme, and the London Health Data Strategy. Milena Marszalek and Meredith Hawking are funded by the NIHR School for Primary Care Research.
We are grateful to the Discovery Programme Board, general practitioners and patients for permission to use routinely collected health data for research, and to public health colleagues for approval to use data from the National Child Measurement Programme.