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Source: WA MCHRDB : Jane Freemantle Unpublished data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)