The Kenneth Myer Lecture

Before the Bough Breaks

CHILDREN IN CONTEMPORARY AUSTRALIA NATIONAL LIBRARY, 2003 PROF. FIONA STANLEY AC TELETHON INSTITUTE FOR CHILD HEALTH RESEARCH

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Source: WA MCHRDB : Jane Freemantle Unpublished data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 18 16 14 12 10 8 6 4 2 0 American Indians & Alaska natives (1995) Maori (1997) Indigenous Australians (1995-7) INFANT MORTALITY RATE Per 1000 lives births Sources: “Trends in Indian Health” 1998-99 Indian Health Services, New Zealand Now ; ‘Children’ 1998 Edition, AIHW 2002

12

Infant Mortality Rate by Age

Comparison between USA & Australia 10 8 6 4 Neonatal Post Neonatal Per 1000 lives births 2 0 American Indians & Alaska natives USA: All Races Indigenous Australians Aust: All races Sources: “Trends in Indian Health” 1998-99 Indian Health Services, New Zealand Now ; ‘Children’ 1998 Edition, AIHW 2002

Low Birth Weight

Australia 1991 - 1998 (% of all births < 2,500g) Source: AIHW National Perinatal Statistics Unit Database

Trends in cumulative lifetime wheeze prevalence in primary school children

Source: 2001 Year Book Australia. Canberra: Australian Bureau of Statistics, ABS Catalogue No. 1301.0, pages 368-400.

Number of Patients with Type 1 Diabetes Princess Margaret Hospital for Children 1990-1999 Total patients 900 800 700 600 500 400 300 200 100 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Prevalence of overweight/obesity 1985-1997

Booth et al.

Change in prevalence of overweight and obesity among young Australians, 1969-1997.

AmJ Clin Nutrition (In press)

Intellectual disability by severity Western Australia 1983-1992

Year of birth ALL ID Mild/ Moderate Unspecified Severe/ Profound Leonard et al, 2002

Down syndrome 1980-2000

The Western Australian Child Health Survey: Children with Mental Health* Problems Males Females

Number (‘000) Per cent

30.0

20.0

23.5

15.4

4 to 11 year olds 12 to 16 year olds All children 30.8

22.7

53.5

16.0

20.6

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 Health

Age 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

800 700 600 500 400 300 200 100 0 1982 1985 1988 1991 1994 NAI CSA Total

Source: Child Protection Unit PMH, 1997

Child abuse

Care & Protection Rate per 1,000 Children 25 20 15 10 Indigenous Australians Other Australians 5 Substantiations Orders 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 Source : AIHW Child protection data collection & AIHW children on care & protection orders data collection (Table A19.6)

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 use

Boys

60 50 40 30 20 10 0 12 16

Age (years)

1983 1986 1989 1992 1996 Hill 2000

30 20 10 0 60 50 40

Alcohol use

Girls 12 16 Age (years)

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 Assaults

Males 1973-74 1993-94 Females 1973-74 1993-94 Juvenile 1973-74 1993-94 Adult : juvenile arrests 2.1 : 1 1.2 : 1 Adult : juvenile arrests 3.4 : 1 1 : 1.9

Boys : girls arrested 24 : 1 4.4 : 1

Homel pc 2001

Juvenile crime

Source: Statistics on Juvenile Detention in Australia: 1981 - 2001 AIC Technical & Background Paper Series No1

Secondary Education completion rates 60%

Secondary Completion Rates (Students who commenced Year 11 in 2000 and achieved secondary graduation in 2001) 56%

50% 40% 30% 20% 10% 0%

18%

Indigenous Students Non-Indigenous Students 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

Genetic factors

Pathways to resilience

Personal achievement, social competence and emotional resilience

(Silburn, 2003)

Opportunities for achievement and recognition of accomplishments Sense of self efficacy & self-worth Sense of social connected ness Healthy beliefs and clear standards Academic success & other achievements Responsive Parenting (i.e. appropriate care stimulation and monitoring) Effective learning, communication & problem solving skills Positive interaction with peers Positive interaction with adults Reduced exposure to harmful drugs Optimal brain development in utero and early childhood Effective self regulation of emotion, attention & social interaction Availability of +ve adult role models & engaging community activities Healthy pregnancy, reduced maternal smoking, alcohol & drug misuse Social and economic environments supportive to child rearing – especially absence of poverty and exposure to violence Healthy nutrition in utero & throughout childhood & adolescence

Time

Institute for Child Health, Perth Western Australia

Ecological contexts shaping child development The Larger Social-Structural

Community School Child

Economic

Family

Cultural Environment Political From Bronfenbrenner

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 on Aboriginal health today

Cultural genocide Stolen children Marginalisation from white society, poor communication and discrimination Unemployment, Poverty, Poor education Alcohol and Substance abuse Domestic violence, Accidents, deaths in custody

COLONISATION

Loss of hunter-gatherer Lifestyle, loss of culture Poor nutrition Low birthweight, Diabetes mellitus Hypertension Cardiovasc. disease Fixed settlements Fringe camps Urban ghettoes Poor housing, Poor hygiene, Overcrowding and Infectious disease Respiratory disease, Ear disease, Rheumatic heart dis.

Renal disease From Matthews 1997

Epidemiology Research done in silos Education Economics Sociology Genetics Criminology Health Housing Individual good research output Policy developed in silos Police Education Employment Fa Services 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)