The Kenneth Myer Lecture
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Transcript of The Kenneth Myer Lecture
The Kenneth Myer Lecture
PROF. FIONA STANLEY ACTELETHON INSTITUTE FOR CHILD HEALTH
RESEARCH
Before the Bough BreaksCHILDREN IN CONTEMPORARY AUSTRALIA
NATIONAL LIBRARY, 2003
OUTLINE
1. Trends in child & youth outcomes.
2. Possible explanations - impact of early child
development.
3. What does Australia need to do?
1. Trends in child & youth outcomes.
INDICATORS OF HEALTH AND WELLBEING
1. Health Outcomes• Death• Low birth weight• Complex diseases ( asthma, diabetes, obesity)• Mental Health problems
2. Lifestyle risk factors• Child abuse/neglect/domestic violence• Behavioural problems, substance abuse
3. Others• Juvenile crime• Youth unemployment
Infant Mortality Indigenous vs. All Australian infants
Source: AIHW Australian Health Trends 2001
Neonatal & postneonatal mortality by Indigenous status, WA 1980-1998.
Source: WA MCHRDB : Jane Freemantle Unpublished data
Infant Mortality Rate Comparison between USA, NZ & Australia
INFANT MORTALITY RATE
0
2
4
6
8
10
12
14
16
18
AmericanIndians &
Alaska natives
Maori IndigenousAustralians
INFANT MORTALITY RATE
Per 1000 lives births
(1995)
(1997)
(1995-7)
Sources: “Trends in Indian Health” 1998-99 Indian Health Services, New Zealand Now ; ‘Children’ 1998 Edition, AIHW 2002
0
2
4
6
8
10
12
AmericanIndians &
Alaska natives
USA: All Races IndigenousAustralians
Aust: All races
Neonatal
Post Neonatal
Per 1000 lives births
Infant Mortality Rate by Age Comparison between USA & Australia
Sources: “Trends in Indian Health” 1998-99 Indian Health Services, New Zealand Now ; ‘Children’ 1998 Edition, AIHW 2002
Low Birth WeightAustralia 1991 - 1998 (% of all births < 2,500g)
Source: AIHW National Perinatal Statistics Unit Database
Source: 2001 Year Book Australia. Canberra: Australian Bureau of Statistics,
ABS Catalogue No. 1301.0, pages 368-400.
Trends in cumulative lifetime wheeze prevalence in primary school children
Number of Patients with Type 1 Diabetes Princess Margaret Hospital for Children
1990-1999
0
100
200
300
400
500
600
700
800
900
Total patients
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Prevalence of overweight/obesity1985-1997
Booth et al. Change in prevalence of overweight and obesity among young Australians, 1969-1997. AmJ Clin Nutrition (In press)
Intellectual disability by severityWestern Australia 1983-1992
Year of birth
Pre
vale
nce
per
100
0
Severe/Profound
Unspecified
Mild/Moderate
ALL ID
Leonard et al, 2002
Figure 8 : Down synd rome 1980-2000
0
0.5
1
1.5
2
2.5
3
3.5
80 82 84 86 88 90 92 94 96 98 2000
Year
per
1000
bir
ths
Total Down syndrome Terminations only livebirths
Down syndrome 1980-2000
The Western Australian Child Health Survey: Children with Mental Health* Problems
Number (‘000) Per centMales 30.0 20.0Females 23.5 15.4
4 to 11 year olds 30.8 16.012 to 16 year olds 22.7 20.6
All children 53.5 17.7
* as determined by caregiver and teacher using the Child Behavioural Checklist
Zubrick et al 1995
International Study on Psychosocial Disorders in Young People M. Rutter & D. Smith (1995)
•Crime, suicide & self harm, depression, eating disorders, use of alcohol & drugs
•As these are associated with disadvantage, the expectation was that they should have reduced as living conditions improved.
•Clear substantial & sudden increases in these disorders since 1950’s in most developed countries.
Suicide rates in males, by age - 1907 to 1998
Mental HealthAge specific suicide rates 1996-98 (WA, SA & NT)
Source: Sven Silburn
Increase in Child Abuse
Across Australia:
• Reported cases of child abuse rose from 91734 to 115471 during the period
1995/6-2000/01
• Number of children placed in out of home care rose from 14078 to 18241 during the period 1997 - 2001
New physical and sexual abuse cases seen at PMH 1982-94
0100200300400500600700800
1982 1985 1988 1991 1994
NAICSATotal
Source: Child Protection Unit PMH, 1997
Child abuse
Care & Protection
Substantiations Orders
Rate per 1,000 Children
Indigenous AustraliansOther Australians
25
20
15
10
5
Source : AIHW Child protection data collection & AIHW children on care & protection orders data collection (Table A19.6)
Rates of Aboriginal & Torres Strait Islander and other Australian children aged 0-14 years in substantiations in 1999-00 and on care and protection orders, 30 June 2000
Substance Abuse• Dramatic increase in females smoking
and drinking over the last 50 years
• Smoking rates for girls higher than boys
• Drinking rates for girls equal to those of boys
• Major social change
• Major public health concern
Alcohol useBoys
0
10
20
30
40
50
60
12 16
Age (years)
% h
azar
do
us
dri
nk
ers
1983 1986 1989 1992 1996
Hill 2000
Alcohol useGirls
0
10
20
30
40
50
60
12 16
Age (years)
% h
azar
do
us
dri
nk
ers
1983 1986 1989 1992 1996
Hill 2000
Illicit Drug Use Proportion of the population 14 years and over
Source: AIHW : Statistics on drug use in Australia 2000
Increase in Juvenile Crime“Difficult to explain why juvenile crime has increased so much in most developed countries in the post war period. Changes in family functioning, increased mobility and associated declines in cohesiveness of local communities along with changes in the pattern of crime opportunities…are the most likely explanations”
Rutter & Smith 1995
Juvenile Crime - Violent AssaultsMales Adult : juvenile arrests
1973-74 2.1 : 1
1993-94 1.2 : 1
Females Adult : juvenile arrests
1973-74 3.4 : 1
1993-94 1 : 1.9
Juvenile Boys : girls arrested
1973-74 24 : 1
1993-94 4.4 : 1
Homel pc 2001
Juvenile crime
Source: Statistics on Juvenile Detention in Australia: 1981 - 2001 AIC Technical & Background Paper Series No1
Secondary Completion Rates (Students who commenced Year 11 in 2000 and achieved secondary graduation in 2001)
18%
56%
0%
10%
20%
30%
40%
50%
60%
Indigenous Students Non-Indigenous Students
Secondary Education completion rates
SOURCE : P38 Department Education WA Annual Report 2001-2002
Modernity’s Paradox
• Increasing wealth, opportunity….
• Increasing social disparity…
• Increasing problems in children & youth
Source : Keating & Hertzman (1999)
2. Possible Explanations Relate to the impact of Early Childhood Development
Pathways to resilience(Silburn, 2003)
Healthy pregnancy,reduced maternal smoking, alcohol & drug misuse
Genetic factors
Responsive Parenting(i.e. appropriate care
stimulation and monitoring)
Optimal brain development in utero and
early childhood
Effective self regulation of emotion, attention
& social interaction
Effective learning, communication &
problem solving skills
Positiveinteraction with peers
Healthy beliefs
and clear standards
Personal achievement, social competence and
emotional resilience
TimeHealthy nutrition in utero & throughout childhood & adolescence
Availability of +ve adult role models & engaging
community activities
Reduced exposure
to harmful drugs
Sense of self-efficacy & self-worth
Opportunities for achievement and recognition of accomplishments
Social and economic environments supportive to child rearing – especially absence of poverty and exposure to violence
Academicsuccess & other
achievements
Sense of social
connected-ness
Positiveinteraction with adults
Institute for Child Health, PerthWestern Australia
From Bronfenbrenner
Child
CommunitySchool
Family
Ecological contexts shaping child development
CulturalEnvironment
Economic Political
The LargerSocial-Structural
Multiplicity of factors influencing the declines in development, health & wellbeing in
Australian children since the 1950’s:
Increasing:•Wealth•Working hours •Women working outside the home•Unemployment•Family discord & breakdowns•Violence•Youth alienation &adolescent dependence•Media influence•Drug & alcohol availability
Decreasing:
•Community cohesion & participation
•Neighbourhood trust
•Children’s services & facilities
Impact of white colonisation onAboriginal health today
From Matthews 1997
COLONISATIONCultural genocideStolen children
Loss of hunter-gathererLifestyle, loss of culture
Fixed settlementsFringe camps
Urban ghettoes
Poor housing,Poor hygiene,
Overcrowding andInfectious disease
Respiratory disease,Ear disease,
Rheumatic heart dis.Renal disease
Poor nutrition
Low birthweight,Diabetes mellitus
HypertensionCardiovasc. disease
Domestic violence,Accidents, deaths
in custody
Marginalisation fromwhite society, poorcommunication and
discrimination
Unemployment,Poverty,
Poor education
Alcohol andSubstance abuse
Research done in silos
Individual good research output
Economics SociologyEpidemiology Education
Genetics Criminology
Policy developed in silos
Health EmploymentEducation Police
Housing FaServices Justice Finance
Individual good policy development
Effects of Criminal Justice System on Crime Rates
• Complex• Strong evidence that imprisonment
increases likelihood of re offending• No evidence that increasing the rate of
detention and conviction reduces crime rates
• Punishment should be justified on grounds other that crime reduction.
Rutter & Smith 1995
Reducing Juvenile Crime
“Crime reduction policy must concentrate on pursuing objectives that are indubitably good in themselves. ie Improving family functioning and school socialisation, improving the effectiveness of formal social controls, especially in local communities, and reducing the opportunities for crime.”
Rutter & Smith 1995
AUSTRALIAN RESEARCH
ALLIANCE FOR
CHILDREN AND YOUTH
SUMMARY OF RATIONALE FOR IMPROVED COLLABORATION
• Increases in many childhood diseases, disabilities and problems
• Causal pathways many and varied but often have common antecedents
• Research in silos: Policy in silos
• Policy not evidence based
• Fragmented databases
PURPOSE OF ALLIANCE
A national collaboration established to facilitate, coordinate and support the development of knowledge and its effective use to enhance the well-being and life chances of children and young people.
ALLIANCE GOALS
• To promote collaborative
research and agenda setting
AND
• The application of research to
policy and practice for
children and young people
KEY ACTIVITIES OF ALLIANCE
• A consensus national research agenda - this will frame:
• Establishment of collaborative research nodes
• Supported by a national data network, a clearing house of effective interventions, and a communication strategy for turning knowledge into action
Death Due to all Causes, by age of child
We need to place social and environmental sustainability and population health ahead of
economic growth as a national goal, and develop social policies that enhance equity,
social stability and trust. Our response must extend beyond conventional frameworks for
social and economic policy.
Butler, Douglas & McMichael (2001)