Doug Simkiss

Honorary Associate Professor in Child Health

The future of community child health

The clue is in the name

Jeff GoldhagenThe history of advances in child health is

a chronicle of the application of the principles of social justice, equity, and children's rights to practice, advocacy, and the development of public policy to improve the lives of children and families. The future of paediatrics lies, in part, in its historical roots, which are fully entwined with those of public health

Social justice – Marmot report• Estimated number of child deaths that could be avoided if all quintiles

had the same level of mortality as the least deprived (2005-6)

Social justice – Marmot report• Inequality in early cognitive development of children in the 1970

British Cohort Study, at ages 22 months to 10 years

Social justice – Marmot report• Child deaths by socio-economic class (NS-SEC), 2001-3

Equity – Marmot report• Conceptual framework for reducing health inequalities

Marmot review• Policy objectives

– Give every child the best start in life– Enable all children...to maximise their

capabilities and have control over their lives• Policy mechanisms

– Equality and health equity in all policies– Effective evidence based delivery systems

United Nations Convention on the Rights of the Child

• A legal document that asserts a full array of rights that are inherently due to children.

• Laws that protect rights are fundamentally different from those that extend privileges that can and are revoked by executive or legislative powers

United Nations Convention on the Rights of the Child

‘Among the most powerful tools available to respond to and increase the relevance of paediatrics to contemporary disparities and determinants of child health outcomes’

United Nations Convention on the Rights of the Child

• Article 6: ‘Children have the right to live. Governments should ensure that children survive and develop healthily’

• Article 23: ‘Children who have any kind of disability have the right to special care and support, as well as the rights in the Convention, so that they can live full and independent lives’

United Nations Convention on the Rights of the Child• Article 7: the child’s right to know and be

cared for by his or her parents• Article 8: the child’s right to preserve is or

her name, identity and family relations• Article 9: the child’s right not to be

separated from his or her parents, except when it is in his or her best interests; and to maintain contact with both parents

UNCRC – article 7

United Nations Convention on the Rights of the Child• Article 18: the principle that parents have

the prime responsibility for the upbring and development of the child.

• Article 20: the right of the child deprived of his or her family to special protection and assistance from the state.

United Nations Convention on the Rights of the Child• Article 21: the best interests of the child

should dominate all decisions about his or her adoption.

• Article 22: the right of the unaccompanied refugee child to protection and assistance in family tracing and reunification.

Jeff GoldhagenThe history of advances in child health is a

chronicle of the application of the principles of social justice, equity, and children's rights to practice, advocacy, and the development of public policy to improve the lives of children and families. The future of paediatrics lies, in part, in its historical roots, which are fully entwined with those of public health

ICF model of disability

Disorder or Disease

Body functions & structure Activity Participation

Environmentalfactors

Personalfactors

HEALTH CONDITION

CONTEXTUAL FACTORS

Advocacy

Ann E Dyson, Community Paediatric Training Initiative Curriculum Committee, American Academy of Pediatrics.

Advocacy• At the end of the last century the number of children dying from burns

and scalds in the homes of Merthyr Tydfil miners outnumbered the number of miners killed in accidents. The opening of the pithead head baths had a much more" dramatic impact on these mortality rates than could the opening of the most well equipped burns unit imaginable. Now, as then, health services play a minor role in determining the state of our children's health. Much more important are the environments in which children live-at home, in school, and in the wider world. Although we must argue for better and appropriate health services for children and young people, our biggest task in advocacy is to change the reality of children's lives.

• Elspeth Webb, Health Services; who are the best advocates for children Archives of Diseases in Childhood

Examples of advocacy by paediatricians

2010 NICE / SCIE guidance• Identified research on the

views, experiences and preferences of children and young people, their families and carers, about the care system.

• http://guidance.nice.org.uk/PH28

Findings from the qualitative reviewEvidence from 6 + studies and one ++ study revealed

LACYPs view that i) love and affection is desired by LACYP but often

lacking from their lives, ii) love, or the lack of it has a significant impact on their

emotional wellbeing, in particular their self esteem, iii) for some LACYP training and payment for foster

carers undermines the sense that they are wanted or loved and

iv) an unmet need for love and affection is perceived by some young people to have a profound and lasting effect on their future outcomes

CMO Annual report for England • Theme of wider determinants of child

health• Chapter on Looked after children

Jeff GoldhagenThe history of advances in child health is a

chronicle of the application of the principles of social justice, equity, and children's rights to practice, advocacy, and the development of public policy to improve the lives of children and families. The future of paediatrics lies, in part, in its historical roots, which are fully entwined with those of public health

The future of community child health• An interaction between clinical paediatrics

and public health• A concern for the health of all children,

focussed on the most vulnerable• First class research changing practice and

policy• Excellent care for the child in front of you

and a good understanding of the determinants of child health

The future of community child health

Clinical practice Research

Teaching Management

Remember the clue is in the name