Transcript Presentation title

Australian children's wellbeing in
2034: closing the gap between our
aspirations and our effort
Fiona Stanley Annual Forum
28th March 2014
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Welcome to country
Warren Daley
Ngunnawal elder
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Australian children's wellbeing in
2034: closing the gap between our
aspirations and our effort
Professor Fiona Stanley, AC, FAA, FASSA
Patron, Telethon Kids Institute
Distinguished Research Professor, The University of Western Australia
Vice Chancellor’s Fellow, The University of Melbourne
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Overview
1. What should child wellbeing in 2034 “look like”?
2. Early childhood brain development:
•
why it is so critical?
•
what makes a difference and how do we scale up & measure success?
3. What effort is needed? Some priority actions:
•
Investment in a comprehensive early years system
•
Parent empowerment and engagement
•
Proportionate universalism
•
Aboriginal led and controlled solutions
4. Practical actions in moving forward:
•
Aligning our collective effort toward a common vision
•
Investing in a longer term, collaborative research agenda
•
Need more evidence-based and prevention focused interventions
•
Helping grass roots service agencies make an immediate difference ..
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Starting with the end in mind
… a vision for the next 20 years
An Australia where: ‘..all young people are loved and
safe, have material basics, are healthy, are learning
and participating and have a positive sense of
identity and culture.’
(The Nest Action Agenda 2013)
We need to see ensure Australian children and youth rank in the top third of
OECD for 50% of indicators by 2034, as reported in the ARACY Report Card
(current level is ~25%)
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We have made progress over last 100 years, however:
 Alarming rise in some complex chronic conditions
 e.g around 25% of 5-14 yr olds are overweight or obese, increase in
harmful drinking etc..
 Aboriginal children's wellbeing disparity across multiple domains
 Increasing income disparity overall
 very closely linked with poor health & wellbeing
 around half a million children born into poverty
 Other worrying trends:
 FASD on the rise
 Low birth-weight / pre-term birth on the rise.
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~75% of child wellbeing
indicators in middle or
bottom third of OECD
ARACY Report Card on the Wellbeing of Young Australians (# 2)
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The focus of our current efforts
Our current efforts are not positioning us well to close the gap and reach
our goals. Most critically:
the importance of the early years is being missed in many debates (e.g. PC:
Inquiry into Childcare and Early Childhood Learning is fine – but what happens before pre-school is far more important to
child outcomes)
evidence on what works not collected or used wisely to make ‘best buy’
decisions (where is the national database of evidence informed interventions?)
individual efforts are not well aligned - collective effort not harnessed
inequalities continue to grow, we are challenged in how we address it
implementing solutions for closing the gap for Indigenous Australians
continues to be a huge challenge.
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The early years
“Early child development . . . strongly influences
wellbeing, obesity / stunting, mental health, heart
disease, competence in literacy and numeracy,
criminality, and economic participation throughout life.
What happens to the child in the early years is critical
for the child’s developmental trajectory and life
course.”
World Health Organization (2014).
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Why is Child Health & Development Crucial
for Australia’s Future?
Intellectually Competent &
Emotionally Capable Workforce
Most Young People Participating
to their Full Potential
National Economic Prosperity
Health & Welfare Budgets Not
Draining Australia’s Capacity
Next Generation of Parents
Socially & Emotionally Competent
Most Children Mentally &
Physically Healthy, Reaching their
Educational and Social Potential
Cycles of Economic Prosperity
& National Capacity
Most Children Commence their Lives in
Environments which Enable Full
Opportunities for Healthy Child Development
BUILDING BLOCKS
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Early adversity has lifelong impacts
 Leads to changes in DNA (methylation)
 ‘Biological embedding of environmental events’ (Hertzmann)
 Affects the development of biological systems

Immune

Cardiovascular

Metabolic regulatory
 What appears to be a social situation is likely to be a
neurochemical situation - intergenerational nature of
disadvantage and social exclusion
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How Adverse Childhood Experiences impair a child’s brain development
Early childhood home environment predicts frontal and temporal
cortical thickness in the young adult brain
Wednesday, Oct 17, 2012
2012 Society for Neuroscience Meeting, New Orleans
Casey, S. (2013). “The High Cost of Child Poverty,” Take 5, First Five: Contra Costa Blog. [www.firstfivecc.org/blog]
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Pathways to Resilience (Silburn, 2003)
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Pathways to Vulnerability
(Silburn, 2001
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Australia's Heckman curve?
Average public social spending per child in Australia by
intervention as a proportion of median working-age household
income (Adema 2008: OECD)
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We need to address our “early
childhood vulnerability debt”
“Evidence from Canada shows that reducing the costs of early childhood
vulnerability from their current rate of 29% to a projected rate of 20% (by
2020) would result in an increase in GDP of more than 20% over 60 years.
The benefits to society associated with this reduction would outweigh the
costs that are needed to bring it about by a ratio of more than 6:1.
In Australia, it is estimated that reducing Australia’s early childhood
vulnerability from 22% to 15% (by 2020), as proposed in this action
agenda, would lead to an increase in Australian GDP of 7.35% over 60
years.”
ARACY (2013). The Nest action agenda.
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Priority areas for action
The ‘best buys’ need to be better targeted at
influencing the 0-3 yrs.
1.
2.
3.
4.
Investment in a comprehensive early years system
Parent empowerment and engagement
Proportionate universalism
Aboriginal led and controlled solutions
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1. A comprehensive early years system
We need:
 investment that matches the importance of the early years
 further development of a world-class perinatal and early years,
health, education and social care system for all children aged 0-5
years
 a coordinated and comprehensive policy and service framework
 a more holistic and integrated platform focused on all aspects of early
child development
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1. A comprehensive early years system (cont.)
 UK research indicates that one year of preschool has almost as
much impact on academic outcomes at age 11 as the first 5 years of
school.
 A high-quality and universally accessed early years system can yield
population-level benefits.
 Australia’s universal early years system? Largely limited to 2
interventions:
 Quality early childhood education / preschool
 Maternal and Child Heath (MCH) services in each state
 Jurisdictional differences in preschool participation and MCH can be
linked with levels of child vulnerability in Australia
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AEDI Results and preschool participation
Developmentally vulnerable on one or more AEDI domain
45.0
39.1
40.0
35.0
30.0
34.3
32.2
31.9
29.1
28.6
Per cent
25.5
25.0
22.3
24.1
23.5
All children
20.5
20.0
20.3
17.7
15.0
16.2
14.5
Preschool or kindergarten program (incl in a
day care centre)
No preschool or kindergaren program
10.0
5.0
.0
1 Most
disadvantaged
2
3
SEIFA IRSD Quintile
4
5 Least
Disadvantaged
2. Parent empowerment and engagement
Both poverty and parenting quality are important in affecting child
development outcomes, however:
 poor parenting has nearly twice the impact of persistent poverty
 positive parenting and a strong home learning environment can
mediate its impacts.
(UK Millennium Cohort Study)
“what parents do is ultimately more important than who
parents are ....”.
Paterson, C. (2011). Parenting Matters: Early Years and Social Mobility, CentreForum, UK.
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2. Parent empowerment and engagement (cont.)
International research over the past 40 years shows:
 Parental engagement in learning led to better test scores, higher
grades, better attendance, higher graduation rates, lower drop-out
rates, greater likelihood of higher education attainment and improved
behaviour, personal competence and a life-long love of learning.
 Family participation in education was twice as predictive of students'
academic success as socioeconomic status
 Parental engagement was equivalent to $1000 in extra funding a student
a year
 Students whose parents regularly read and talk with them scored an
average 25 points higher on the Program for International Student
Assessment (PISA), or six months of a school year.
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OECD (2012),
Let’s read them a story! The Parent Factor in Education, OECD
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OECD (2012),
Let’s read them a story! The Parent Factor in Education, OECD
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2. Parent empowerment and engagement (cont.)
How do we promote parental engagement? The ‘best buys’:
holistic, sustained nurse home visiting programs - embedded within the
universal system (Australia far from international best practice..)
parenting programs and early start programs for 0-3 years that enhance
the home learning environment and target in-home activities
parenting programs which include centre-based activities for parent and
child
high quality preschool programs
Large scale primary prevention- a national campaign to empower
parents with options to provide the very best start to life for their children
and ultimately improve social mobility.
(From The Nest action agenda)
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Need to increase FREQUENCY of positive parental behaviours that make a difference
Overarching message to parents: Most of a child's brain development occurs in the
first five years. How the brain develops depends on the quality and frequency of
positive activities, including parenting (From ARACY: Engaging Families in the early years story project 2013)
• Playing with your
children
• Encouraging your child
to play
• Reading to your child
• Counting with your child
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Play
Care
Learn
Talk
• Being consistent
• Using established routines around meals,
play and sleep times
• * Setting clear limits for your children
•
* Being physically active
•
and eating healthily with your
•
children
• Being attentive to your children and
responding to their needs
• Spending time talking and listening to
your children
3. Proportionate universalism
Disadvantage and inequality are key
influences on child health and wellbeing
outcomes…
But targeting only disadvantaged families will
miss the mark.
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3. Proportionate universalism (cont.)
Child vocabulary development by parent income
Hart, B., and Risley, T. (2003). “The early catastrophe: The 30 million word
gap,” American Educator 27, pp. 4–9.
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16
60000
14
50000
12
40000
10
8
30000
6
20000
4
10000
2
0
0
Most
disadvantaged
Quintile 2
Quintile 3
Quintile 4
Least
disadvantaged
# children with 1+ developmental vulnability
% chidlren with developmental vulnerability
Incidence and total numbers of developmental vulnerability (as measured by
the AEDI) and by socio-economic status (as measured by SEIFA)
Socio-economic status
Total number of
children
Physical health
Social
competence
Emotional
maturity
Language and
cognitive
Communication
skills
Centre for Community Child Health and Telethon Institute for Child Health Research. (2009).
A Snapshot of Early Childhood Development in Australia – AEDI National Report 2009
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3. Proportionate universalism (cont.)
Focusing solely on the most disadvantaged
will not reduce health inequalities sufficiently.
To reduce the steepness of the social
gradient in health, actions must be universal,
but with a scale and intensity that is
proportionate to the level of disadvantage.
We call this proportionate universalism.
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Tiered system of universal service delivery
Targeted high
intensity
High need
2-5%
10-15%
100%
Low need
Universal low
Intensity
4. Aboriginal led and controlled solutions
“It is important that we privilege Aboriginal and Torres Strait Islander
knowledge when developing agendas and delivering services relevant to
Aboriginal and Torres Strait Islander children and youth. We also need
to recognize that Aboriginal and Torres Strait Islander agencies are well
placed to meet the needs of Aboriginal and Torres Strait Islander
children and youth — such agencies need to be provided with
appropriate funding, accountability and authority to meet the needs of
their people.’
(Nest Operational Principle, Nest Action Agenda, 2013)
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Two different populations in one
country
Australian
population
Australian Aboriginal
population
Population
(fertility rate)
20,561,00
(1.8)
419,600
(2.15)
Median age
36.6 years
20.5 years
2.95
1.19
Life expectancy
78 years males
83 years females
59 years males
67 years females
Infant mortality
rate
5.3 per 1000
10.6 per 1000
Adult to child
ratio1
36
1Persons
aged 18+ for every 0-17 year old
Australia:
Growing old and growing young
37
Source: Australian Bureau of Statistics
Life expectancy
Indigenous and non Indigenous
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38
Source: Calma 2010
Two different populations in
one country
Australian
population
Australian Aboriginal
population
Population
(fertility rate)
20,561,00
(1.8)
419,600
(2.15)
Median age
36.6 years
20.5 years
2.95
1.19
Life expectancy
78 years males
83 years females
59 years males
67 years females
Infant mortality
rate
5.3 per 1000
10.6 per 1000
Adult to child
ratio1
1Persons
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aged 18+ for every 0-17 year old
39
…. continued
Australian
population
Australian Aboriginal
population
Fetal growth
restriction
11%
20%
Mental health
morbidity for
<18yo
17%
24%
Low academic
competence
20%
Retention to Year
12 school1
58%
75.7%
39.5%
1In
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Australia, 10 years of schooling has been compulsory
40
How to move forward?
1. Aligning our collective effort
toward a common vision
An independent national plan for the
next 20 years … with metrics and
accountability
….. need to move to next stage of
implementation (from 2014 onwards)
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How to move forward?
2. Investing in a longer term, collaborative research
agenda:
•
•
•
The big child & youth research questions have largely gone
unanswered for the last 20 years
No more “bitsy” research – need for large scale, long term collaborative
research – including more effectiveness trials
Need to align government, philanthropic and other funding to reward
collaborative research, with child wellbeing targets in mind (e.g from
The Nest)
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How to move forward?
3. Need more evidence-based and prevention focused
interventions
•
•
•
We know the conditions required for positive child development .......
... but we lack scalable evidence based and prevention focused solutions
Need to measure common outcomes (e.g in AEDI, ARACY Report Card)
to test scale up and innovation
Need to take stock of what works and stop reinventing the wheel
–
use of the ARACY database of evidence based interventions (developed for The Nest)
–
of around 200 interventions tested internationally, we deliver less than a dozen
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How to move forward?
4. Helping grass roots service agencies make an immediate
difference .. The Nest operational principles, if implemented by all service
agencies “on the ground” would have a profound impact. These principles are:
1. A commitment to the child at the centre
2. A commitment to privileging Indigenous knowledge
3. A commitment to a long-term, evidence-informed approach
4. A commitment to prevention and early intervention
5. A commitment to a life-stage approach
6. A commitment to systemic change using an outcomes approach, including
»
•
shared vision, shared outcomes framework, reforming funding arrangements, blended and braided funding models, harnessing the
energy and power of volunteers, evidence-based implementation science
ARACY plans to help agencies operationalize these principles from 2014 →
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CIVIL SOCIETY
Equality/diversity
Trust, care
Social determinants of
child and youth health
UNCIVIL SOCIETY
Inequalities
Fear, violence
Collective good
Priority for material
wealth
Valuing parents
Parents not valued
Valuing
childhoods
Fast tracking
childhoods
Prevention more than
cures
Cures more than
prevention
Protected
environments
Environmental
degradation
Safe places for all
Safe places for the
few
Effective use of helpful
technologies
Child needs as well as
adults
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Excessive use of
damaging
technologies
Adults needs more
than children’s
Measuring success
Population level measures
are critical
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QLD - no universal MCH & lowest preschool
attendance, also the state with the highest % of children
developmentally vulnerable in one domain (26%)
VIC – arguably the strongest universal MCH & high
preschool attendance, also the state with the lowest % of
children developmentally vulnerable in one domain (19%)
From Brinkman SA, Gialamas A, Rahman A, et al. BMJ Open 2012;2:e001075. doi:10.1136/bmjopen-2012-001075
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THANK YOU
Fiona Stanley Annual Forum
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