The Kenneth Myer Lecture

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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
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OUTLINE

• Trends in child youth outcomes.
• Possible explanations - impact of early child
  development.
• What does Australia need to do?

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Trends in child youth outcomes.
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INDICATORS OF HEALTH AND WELLBEING

• Health Outcomes
• Death
• Low birth weight
• Complex diseases ( asthma, diabetes, obesity)
• Mental Health problems
• Lifestyle risk factors
• Child abuse/neglect/domestic violence
• Behavioural problems, substance abuse
• Others
• Juvenile crime
• Youth unemployment

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Infant Mortality Indigenous vs. All Australian
infants
Source AIHW Australian Health Trends 2001
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Neonatal postneonatal mortality by Indigenous
status, WA 1980-1998.
Source WA MCHRDB Jane Freemantle Unpublished
data
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Infant Mortality Rate Comparison between USA, NZ
Australia
Per 1000 lives births
(1997)
(1995-7)
(1995)
Sources Trends in Indian Health 1998-99 Indian
Health Services, New Zealand Now Children
1998 Edition, AIHW 2002
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Infant Mortality Rate by Age Comparison between
USA Australia
Per 1000 lives births
Sources Trends in Indian Health 1998-99 Indian
Health Services, New Zealand Now Children
1998 Edition, AIHW 2002
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Low Birth WeightAustralia 1991 - 1998 ( of all
births lt 2,500g)
Source AIHW National Perinatal Statistics Unit
Database
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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.
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Number of Patients with Type 1 Diabetes Princess
Margaret Hospital for Children 1990-1999
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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)

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Intellectual disability by severityWestern
Australia 1983-1992
ALL ID
Mild/ Moderate
Prevalence per 1000
Unspecified
Severe/ Profound
Year of birth
Leonard et al, 2002
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Down syndrome 1980-2000
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The Western Australian Child Health Survey
Children with Mental Health Problems
Number (000) Per cent Males 30.0 20.0 Fem
ales 23.5 15.4 4 to 11 year
olds 30.8 16.0 12 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
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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 1950s in most developed
  countries.

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Suicide rates in males, by age - 1907 to 1998
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Mental Health
Age specific suicide rates 1996-98 (WA, SA NT)
Source Sven Silburn
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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

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New physical and sexual abuse cases seen at PMH
1982-94
Source Child Protection Unit PMH, 1997
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Child abuse
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Care Protection
Rate per 1,000 Children
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Indigenous Australians
Other Australians
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15
10
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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)
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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

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Alcohol use
Hill 2000
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Alcohol use
Hill 2000
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Illicit Drug Use Proportion of the population
14 years and over
Source AIHW Statistics on drug use in
Australia 2000
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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
opportunitiesare the most likely explanations
Rutter Smith 1995
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Juvenile Crime - Violent Assaults
Males 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
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Juvenile crime
Source Statistics on Juvenile Detention in
Australia 1981 - 2001 AIC Technical Background
Paper Series No1
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Secondary Education completion rates
SOURCE P38 Department Education WA Annual
Report 2001-2002
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Modernitys Paradox

• Increasing wealth, opportunity.
• Increasing social disparity
• Increasing problems in children youth

Source Keating Hertzman (1999)
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2. Possible Explanations Relate to the impact
of Early Childhood Development
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Pathways to resilience(Silburn, 2003)
Personal achievement, social competence and
emotional resilience
Healthy beliefs and clear standards
Sense of self-efficacy self-worth
Opportunities for achievement and recognition of
accomplishments
Sense of social connected-ness
Academicsuccess other achievements
Responsive Parenting (i.e. appropriate
care stimulation and monitoring)
Positive interaction with peers
Reduced exposure to harmful drugs
Effective learning, communication problem
solving skills
Positive interaction with adults
Optimal brain development in utero and early
childhood
Genetic factors
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
Time
Healthy nutrition in utero throughout
childhood adolescence
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Ecological contexts shaping child development
The Larger Social-Structural
Community
School
Child
Political
Family
Economic
Cultural Environment
From Bronfenbrenner
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Multiplicity of factors influencing the declines
in development, health wellbeing in Australian
children since the 1950s

• Increasing
• Wealth
• Working hours
• Women working outside the home
• Unemployment
• Family discord breakdowns
• Violence
• Youth alienation adolescent dependence
• Media influence
• Drug alcohol availability

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Decreasing

• Community cohesion participation
• Neighbourhood trust
• Childrens services facilities

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Impact of white colonisation on Aboriginal health
today
COLONISATION
Cultural genocide Stolen children
Loss of hunter-gatherer Lifestyle, loss of culture
Fixed settlements Fringe camps Urban ghettoes
Marginalisation from white society,
poor communication and discrimination
Poor nutrition
Poor housing, Poor hygiene, Overcrowding
and Infectious disease
Unemployment, Poverty, Poor education
Alcohol and Substance abuse
Respiratory disease, Ear disease, Rheumatic heart
dis. Renal disease
Low birthweight, Diabetes mellitus Hypertension Ca
rdiovasc. disease
Domestic violence, Accidents, deaths in custody
From Matthews 1997
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Research done in silos
Education
Economics
Sociology
Epidemiology
Genetics
Criminology
Individual good research output
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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
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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
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• AUSTRALIAN RESEARCH
• ALLIANCE FOR
• CHILDREN AND YOUTH

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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

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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.

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ALLIANCE GOALS

• To promote collaborative research and agenda
  setting
• AND
• The application of research topolicy and
  practice for children and young people

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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

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Death Due to all Causes, by age of child
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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)
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