Transcript DIFFERENCE BETWEEN BOYS AND GIRLS

Building Healthy Development
in South Australia
Associate Professor Victor Nossar
Senior Paediatric Consultant
Child and Youth Health
Children, Youth and Women’s Health Service
Importance of
the early years
Evidence from human and animal studies
reveals that nutrition and experience in the
early years of a child’s life influence the
infant’s brain development.
Body functions (such as competence, coping
skills, behaviour, and health later in life) are
then affected through pathways that involve
the endocrine systems, the immune system,
and mental processes.
While remediable risk factors affecting health
occur throughout the life course, childhood is a
critical and vulnerable stage where poor
socioeconomic circumstances have lasting
effects.
Follow up through life of successive
samples of births has pointed to the crucial
influence of early life on subsequent mental and
physical health and development.
Independent Inquiring into Inequalities in Health Report. London, The
Stationary Office, November 1998.
Kauai Longitudinal Study:
Emmy E. Werner, Jessie M. Bierman, Fern E. French, Ruth S. Smith
•Complete cohort of 698 infants born in 1955.
•Followed development of these individuals at 1, 2, 10, 18 &
31/32 years of age.
•422 infants born without complications, after uneventful
pregnancies and grew up in supportive environments.
•116 children had physical or intellectual handicaps of
perinatal or neonatal origin (diagnosed before 2 years of
age).
•142 children developed serious learning or behavioural
problems (before 10 years of age).
•55% of cohort grew up in chronic poverty.
Kauai Longitudinal Study
Predicting Resilience – Protective Factors
• Individual
independent, sociable, affectionate,
adept at recruiting adult carers
• Family
four or less children, > 2 years apart, no
prolonged separations in the first year
• Community informal support at home/work/church,
substitute carers
Ref: Emmy E. Werner, Jessie M. Bierman, Fern E. French, Ruth S. Smith
Determinants of Health
Upstream Factors
Government
Policies
Determinants
Global of health
forces (social,
physical
economic
environmental)
Culture
Midstream Factors
Downstream
Health system Physiological
H
E
A
L
T
H
Psychosocial
Health behaviours
Culture
Biological
Socioeconomic determinants of health. Turrell G et al. QU T. April 1999. Commonwealth Dept
Health & Aged Care, Canberra
Key Initiatives For Health Improvement
Population Parenting
Programs
Immunisation
Smoking
Prevention/
Cessation
Home Visiting
School Connectedness
Early Educational
Infant Day-care
Maternal
Education
Breastfeeding
Community Development
Conception
Birth
2 years
5 years
12 years
Advocacy - enhance social, political, economic and physical environment;
legislation (eg. seatbelts), structural changes (eg housing design)
18 years
At the population-level there
is only very weak correlation
between traditional health
inputs and significant
improvement of outcomes for
children.
Inequality of outcomes:
• Families, whose children are
most likely to have health
problems or illnesses, are often
those least likely to be accessed
by (or to access) healthcare
services.
• Services
can
make
inequalities greater.
the
Cutler DM, Meara E. Changes in the age distribution of mortality
over the 20th century. NBER Working Paper 8556. MA, USA, 2001.
Marshall M, Leatherman S, Mattke S et al. Selecting indicators for the quality of
health promotion, prevention and primary care at the health systems level in OECD
countries. OECD Health Technical Papers No.16 OECD, Paris October 2004.
Programs to improve health
outcomes
for
populations
differ markedly from those
designed to assist with the
health problems of individuals.
Health Outcomes Achieved by Health Services
Population
Health
Outcomes
Health Promotion/Health Protection
Population
Care
Individual
Care
Individual
Health
Outcomes
Response to health problem or issue
Ref: Nossar V. Integrated model of Children’s Health: Better Definition of Health Outcomes for
Children and Training Requirements for Professionals. Association for Paediatric Education in
Europe/European Society for Social Paediatrics. Bordeaux, France, 1998.
Inappropriately focussing on individual
level determinants of health while
ignoring more important macrolevel
determinants is tantamount to
obtaining the right answer to the wrong
question.
(Schwartz & Carpenter. Am J Public Health 1999; 89: 1175 - 80.)
Linkage of health outcomes in later life to
multiple, interacting early-life influences has
resulted in a paradigm shift in population
health research, away from simple models of
proximal causality and notions of “nature vs.
nurture”.
Life course epidemiology examines the
complex, often cumulative, interplay
between the characteristics of the
individual (including biological factors,
genetic susceptibilities and intrauterine exposures) and their broader
family, social, economic and physical
environments.
Life course perspectives on health are
based on three key conceptual models of
human health and development:
• The notion of critical or sensitive periods
during which certain exposures or
environmental conditions are necessary for
optimal subsequent growth and development.
• Pathways or cumulative exposures
emphasises the accumulation of life
circumstances that determine subsequent
health outcomes.
• The importance of the ecological contexts in
which individuals develop, and the changing
role of these contexts over the lifespan.
What can
research
contribute to
healthier
development?
“Science is just like sex, there
may be a practical outcome
but that’s not why we do it!”
Richard Feynman
There seems to be an assumption
that a lack of information or
evidence constrains our ability to
improve health and wellbeing.
With the conclusion that more
information and more evidence
will lead to improved health and
developmental outcomes.
Concerns:
• Much evidence already exists
confirming that most of the principal
determinants of health are well known.
• Most health research dollars continue
to be focussed not on the principal
determinants of morbidity and
mortality of Australians.
Concerns:
• The principal focus of health
research is still on better
treatments for affected
individuals, on basic science or on
more epidemiological
descriptions.
• Comparatively little research
money (or research effort) is
expended on trialing ( and
evaluating the efficacy of)
population-level interventions.
High variance apparently “ explained” by
individual-level risk indicators ….does
not mean that they are important
determinants of the population level of
any outcome.
(Rose G. Sick individuals and sick populations. Int J
Epidemiol 1985; 14:32-8.)
Despite occasional rhetorical interest
in wider determinants of health,
evidence based assessments are
largely restricted to individualised
interventions.
(Smith, Ebrahim and Frankel. Editorial. BMJ 2001: 322:
184-5.)
Obesity in children
• Rapid growth in prevalence rates in many
developed countries.
• Predisposes children to additional risks of
disease eg. diabetes mellitus type II.
• Correlates with greater risk of adverse
health in adulthood.
• Social factors appear to play an important
role.
“The Canadian Institute for Advanced
Research … by bringing together the
most distinguished thinkers from across
Canada and around the world, and
providing them with the research time
and networking opportunities they need
to respond to the scientific and social
challenges of tomorrow.”
CIAR: The Canadian Institute for Advanced Research. http://www.ciar.ca/
“Teaming up the best researchers
across geographic, institutional, and
disciplinary boundaries, and by
providing this group with leadership
and the advice of experts, CIAR creates
an arena for exploration and discovery.”
CIAR: The Canadian Institute for Advanced Research. http://www.ciar.ca/
Experience-based Brain & Biological
Development Program
Program Director: Ronald G. Barr, University of
British Columbia
Investigating the functional linkages between
the social and cultural influences experienced
by infants and their subsequent biological
development ... to discover exactly how, when
and under what circumstances differential
societal exposures early in life give rise to
changes in the neural, endocrine and
immunological systems.
CIAR: The Canadian Institute for Advanced Research. http://www.ciar.ca/
The unique
contribution that
South Australia
can make.
South Australia:
• Mainly metropolitan population.
• Manageable birth cohort.
• Population broadly representative of
much of Australia.
• Strong tertiary sector.
• Unique community-wide child health
service – Child and Youth Health.
• Unique datasets.
Good research is an essential prerequisite
of achieving improvements in health and
wellbeing, but of itself is insufficient.
To get the greatest possible benefit, that
knowledge must be applied effectively in
programs that focus on improving the
health and wellbeing of communities.
Where to from here?