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Healthy kids healthy nation

ARTICLE: Based on a presentation by Ian Hassall for the Starship Paediatric Update,  23 April, 2014.

Why do other countries do better for children?

 

Here’s a photo of the Irish Deputy Prime Minister, Prime Minister and Minister for Children launching a new national framework for children and young people. Here’s how the accompanying article[1] began;

“We’ve liked to think of ourselves as a child-centred country, even if reality has often proved very different.

A legacy of indifference contributed to society ignoring the plight of tens of thousands of poor, illegitimate, abused children who were forced to endure the brutalising experience of industrial schools.

The same legacy was to blame much more recently for a new generation of vulnerable children who slipped through the cracks of the State’s child protection system.

Our laws were insufficient to protect our most vulnerable children, while our services were often too chaotic or poorly organised to be able to protect those most at risk.

A new national policy framework for children and young people, Better Outcomes, Brighter Futures , seeks to draw a line in the sand over this past legacy of failure.”

Ireland has a quarter of New Zealand’s child maltreatment deaths and was fourth best in the OECD compared with New Zealand’s ranking of 22nd[2]. It has seen fit to place children at the centre of its policy-making and make them a priority consideration in the deliberations of its Cabinet and Government.

[1] Irish Times (17/4/14)

[2] UNICEF (2003) A league table of child maltreatment deaths in rich nations. Innocenti report card No. 5. Florence: UNICEF Innocenti Research centre.

Why are Ireland and a number of countries around the world doing this? Because they are realising attention to children is key to adaptation to the rapidly changing economic and environmental circumstances of this century. So must we. It is not only that we need to foster our children’s creativity and enterprise to hold on to our economic prosperity but that caring for and about them will maintain the sense of common purpose and mutual trust that is needed for our nation to stick together.  

What causes Ill-health?

Health and well-being are dependent on more than an effective healthcare system[3].

Negative Socio-economic Determinants of Child Health

  • Socio-economic disadvantage
  • Parental impairment
  • Social isolation
  • Child-rearing attitudes and practices including maltreatment.

Adversity affecting children’s well-being and future prospects comes in diverse forms. The three New Zealand cohort studies have shed light on what the most important adversities are, how they operate and to a degree how they might be ameliorated.

Negative Socio-Economic Determinants of Adult Health

  • Social status, inequality
  • “Anomie”, social disconnection
  • Stress in early childhood
  • Material deprivation

http://dunedinstudy.otago.ac.nz/publications

  http://www.otago.ac.nz/christchurch/research/healthdevelopment/publications

  http://www.growingup.co.nz/reports.shtml

Adversity in childhood is to a large extent mediated through parental adversity[1][2][3][4]. The headings in the above box represent diverse pathways which include cultural dispossession, disability, poverty, unemployment and educational deprivation.

It is crucial to understand that it is multiple and cumulative adverse conditions in childhood that give rise to multiple adverse outcomes in adulthood. Association between a single adverse condition and a single adverse outcome is likely to be statistically weak. As the Christchurch cohort study found[8]:

“ it is…important for research into childhood and social background to move away from an emphasis on the role of social conditions in the aetiology of specific problem and towards a greater concern with the impact of social conditions on the quality and nature of childhood…” Fergusson, Horwood, 1990

Taking Action

As health practitioners we can take action at three levels. We can:

  • work toward more equal outcomes in our personal healthcare practice,
  • transform our healthcare systems and the institutions that support them and  
  • make changes through the civil society and our political institutions 

Dr Jones in an earlier lecture covered the first two. My subject is the third.

We have a history now of co-ordinated campaigns for children involving a wide range of child and family organisations, professional bodies and interested people from diverse walks of life, together constituting a children’s movement. It has been associated with the development in New Zealand and overseas of:

  • children’s interests studies in universities
  • Commissioners/ombudsmen for children
  • Ministries for children
  • Specialist statutory processes and courts for children
  • Integrated policies for children 

[4] Wilkinson, R., Pickett, K. (2010) The spirit level. London: Penguin, p.75.

[5] Durkheim, E. (2002) Suicide. London: Routledge, pp.201-239.

[6] Dew, K., Matheson, A., (Eds.) (2008) Understanding health inequalities in Aotearoa New Zealand. Dunedin: Otago University Press. 

[7] National Health Committee. (1998) The social, cultural and economic determinants of health in New Zealand. Wellington: National Health Committee.

[8] Fergusson, D., Horwood, L., Lawton, J. (1990) Vulnerability to childhood problems and family social background. Journal of child Psychology and Psychiatry, 31, 7, 1145-1160.

So, we are not starting from scratch. There is a long history in New Zealand of public policy development to advance children’s interests.

The children’s movement’s public policy aims can be placed in three categories:

  1. Recognition of the central place of children in the nation’s health and development. Creation of structures and policies that reflect this
  2. Commitment to resolving certain significant issues such as; reinstating the dispossessed, social and legislative attention and resource allocation to the early years, prevention of abuse and neglect, elimination of poverty and social isolation.
  3. Passage of narrower specific policy initiatives that are building blocks for 1. and 2. These include; child impact reporting on cabinet papers, extension of paid parental leave, a universal child benefit, a universal housing warrant of fitness, a Minister for Children with a senior place in Cabinet, a cross-party caucus on children.

In past election years these three categories and specific policies have been variously emphasised. This year we have the sense that children are on the agenda. Each of the three main political parties have based their opening addresses for the year on a child-related theme. Thanks to the good work of Child Poverty Action Group, the Children’s Commissioner and many others there is a widespread expectation that something, will be done about child poverty.

NGOs, professional bodies, agencies and individuals will pursue their own plans to influence public demands and party platforms in this election year. As has been the case for the last ten years there will also be programmes in which we join forces. Every Child Counts was set up in 2004 to advance children’s interests in the run up to the 2005 and subsequent general elections. It is a coalition of UNICEF New Zealand, Barnardos, Save the Children, Plunket, Kahui Mana Ririki and others.

This year a new collaborative initiative, Tick for Kids, with a broader base has taken up the cause of children

Tick for Kids aims to make the children’s movement more visible to the public, opinion-shapers and politicians. It has been joined by UNICEF New Zealand, ACYA, Amnesty, NZEI, IHC, Mana Ririki, Plunket, and others. It has mounted a campaign that will continue up to and beyond the election.   

Our strategy is to capitalise on and enhance the momentum for children. We cannot write a complete policy for children because that is the job of government and its advisors. We can, though, propose the shape of such a policy and specify some of its constituent parts.

Most importantly, we present a vision and a rights and values base that will drive the development of such a policy. That is how we have shaped this year’s campaign.

Conclusion

Politics has been defined as the art of the possible but this definition describes only the middle part of the process, the horse-race, game-playing part that is popular with the media. I prefer a longer and wider view of politics that has a beginning a middle and an end.

Politics is about standing for something and gaining enough support and influence to see that it prevails

Reconnecting the economic engine to a strategy for human development is an urgent matter. A focus on children can make that reconnection. It may be the only way. Our responsibility is to explain how this can be done, by describing and promoting a coherent ideology of children’s interests and how this matters to us all. For:

  • If we have a short-term view that ignores the damage of our end-of-year, bottom line market policies, it is children who teach us to look to the longer term
  • If we are unable to make common cause in solving the big problems of our age because of an overly individualistic view, it is children who teach us that we are interdependent
  • If we have become self-centred and callous in allowing the growth of poverty and inequality, it is children who teach us selflessness and compassion
  • If we have been beguiled into an unsatisfying consumer lifestyle, it is children who teach us what is important and what constitutes an agreeable and productive life.

 

Healthy kids healthy nation

 
 
 
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