Are we really a caring society? in the light of woeful child health statistics and continuing inequity, New Zealanders need to ask ourselves "what kind of society are we?".
Social classes (Influence)
Child care services (Research)
Children (Health aspects)
|Publication:||Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New Zealand Nurses' Organisation ISSN: 1173-2032|
|Issue:||Date: Oct, 2011 Source Volume: 17 Source Issue: 9|
|Topic:||Event Code: 680 Labor Distribution by Employer; 310 Science & research|
|Product:||Product Code: 9105260 Family Planning & Child Care NAICS Code: 92312 Administration of Public Health Programs SIC Code: 8322 Individual and family services; 8351 Child day care services|
|Geographic:||Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand|
The New Zealand Children's Social Health Monitor's latest
report released in August shows slight improvements in some areas of
children's health amid continuing woeful statistics that define the
poor health of too many of our children. (1) But that glimmer of hope
requires a much greater commitment and a concerted, collaborative effort
from our political leaders--wherever they stand--if we want to ensure
all of our precious children thrive and succeed to their full potential.
We need to ask ourselves the question "What kind of society are we?" We kill and maim children at higher rates when they are under one-year-old and during adolescence. These are precisely the periods where the science teLLs us their greatest deveLopmentaL opportunities are.
Horror then inertia
We do poorly in comparison to our Organisation for Economic Co-operation and Development (OECD) colleagues. What is disturbing is that news of these comparisons is reguLarLy greeted at first with horror, but often followed by inertia when it comes to identifying and properly resourcing workable solutions.
These results are a poignant contradiction of how we as a nation Like to see ourselves when it comes to championing the well-being of children. They reflect the policy choices we make and the economic priorities we have. The fact we invest so Little in comparison to other OECD countries in early childhood suggests we make decisions based Less on the scientific evidence and more on ideological grounds. The truth is that despite our rhetoric around children, we actually don't value them as much.
In New ZeaLand, children and young people living in more deprived areas experience significantly worse health outcomes across a range of measures, such as infant mortality, hospital admissions for infectious and respiratory diseases, and non-accidental injuries. Each year, these measures are updated and presented through the New ZeaLand Children's Social Health Monitor.
Previous updates described worsening figures for hospital admissions for infectious and respiratory diseases since the onset of the recession. This most recent update, however, indicates that while these admissions are still increasing--with just under 5000 extra hospital admissions each year--the rate of increase appears to be slowing, with possible early signs of improvement for some groups, such as Pacific children. (1)
There is a strong consensus about the impact of socio-economic determinants on children's health and around the effectiveness of early interventions and of focusing efforts on the first few years of Life. We understand a Lot more about these, such as the effects of poverty on child health through both the material effects such as cold, damp, overcrowded housing, and access to health services.
Having good quality housing that is warm, insulated, and toxin-free is critical for health improvements. Access to affordable, good quality primary health care makes a difference too.
The strong social gradient in health means certain children remain disadvantaged--namely those Living in poverty, those who are in sustained poverty (over a longer period of time) and those who are Maori and Pacific or who have a disability.
The importance of early attachment, paid parental leave, maternal nutrition, breastfeeding, enrolrnent and regular visits with a Well ChiLd provider and quality parenting, along with the determinants of safe, secure and affordable warm housing and a viable income from a job have been highlighted relentLessly. The question is, why is this not happening?
Policy by stealth
We should be careful not just to Look at the big policy shifts, but aLso to consider the ways in which policy occurs at the margins or by stealth. An example of this is the removal of "Maori" and "Pacific" as a definition for high-needs funding in after-hours care at Auckland's primary health accident and emergency providers. We need to be vigilant about how these kind of changes will impact those who are already most vulnerable, bearing in mind that children are a higher proportion of the Maori population and that a greater proportion of children are Maori.
"Proportionate universalism" is a term we need to embrace if we are to make real progress. It is the idea that we all receive the entitlement (education, health services, adequate housing and nutrition), provided according to need. Those with greater needs have the greater amount given. The Medical Association's health equity position statement states "Proportional universalism ... is action that benefits all members of society, but preferentially benefits those who experience more suffering. (2)
The other concept that is hugely important is that of "cumulative risk" This is the idea that some individuals and families (and arguably, communities) carry so many risks that, after a while, their natural resilience is worn down by dealing with these. If, for example, you are Maori or Pacific, poor, live in a deprived neighbourhood with fewer community resources, become unemployed or experience a major illness, then you will struggle even more to cope.
What is required, ultimately, is stronger leadership and political will to invest in the needs of children as a social priority.
We have to remind ourselves that we really are a society that cares, in deed and word, one that truly Lives up to its mantra "isn't this a great place to raise children" We must strive to be a society which doesn't just respond to the plight of starving African children, but is prepared to respond to the needs of our own children--whether they be Maori, Pacific, Asian, European or other ethnicities.
These are issues all voters should consider when casting their votes in the general election next month.
(1) The New Zealand Children's Social Health Monitor. (2011) The New Zealand Children's Social Health Monitor 2011 Update. Palmerston North: Massey University.
(2) New Zealand Medical Association, (2011) Health Equity Position Statement. Wellington: The Author.
Cindy Kiro is an associate professor and head of Massey University's School of Public Health, a member of the Te Tuia Well Child Network (Massey, Auckland, Otago and AUT universities) and a former Children's Commissioner.
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