There can be no keener revelation of a society's soul than the way in which it treats its children. Nelson Mandela, Pretoria, 1995

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1 There can be no keener revelation of a society's soul than the way in which it treats its children Nelson Mandela, Pretoria, 1995

2 How New Zealand can achieve equity from the start Amanda D Souza Gay Keating PHA Conference September 2010

3 Overview A glimpse at where we are at WHO Commission on social determinants of health & PHAC report The importance of early childhood development What actions can be taken by people in public health? Discussion Feedback

4 Sudden Infant Death Syndrome rates by ethnicity Fetal and Infant Deaths 2006, Ministry of Health 2010

5 Rate per 1,000 Hospitalisation for bronchiolitis by deprivation, infants <1 yr, Series NZDep quintile Craig E et al. Monitoring the health of New Zealand children and young people: Indicator handbook Paediatric Society; NZ Child & Youth Epidemiology Service.

6

7 WHO CSDH: A new global agenda for health equity Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity. Putting right these inequities the huge and remediable differences in health between and within countries is a matter of social justice. Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative. Social injustice is killing people on a grand scale

8 WHO CSDH Three interrelated recommendations for civil society, governments and global institutions: 1. Improve daily living conditions 2. Tackle the inequitable distribution of power, money, and resources 3. Measure and understand the problem and assess the impact of action

9 Equity from the start Action areas Commit to and implement a comprehensive approach to early life, building on existing child survival programmes and extending interventions in early life to include social/emotional and language/cognitive development. Set up an interagency mechanism to ensure policy coherence for early child development such that, across agencies, a comprehensive approach to early child development is acted on. Make sure that all children, mothers, and other caregivers are covered by a comprehensive package of quality early child development programmes and services, regardless of ability to pay. Expand the provision and scope of education to include the principles of early child development (physical, social/emotional, and language/cognitive development). Provide quality compulsory primary and secondary education for all boys and girls, regardless of ability to pay. Identify and address the barriers to girls and boys enrolling and staying in school and abolish user fees for primary school.

10 Why early child development? Better understanding of human development Evidence of effective interventions Positive economic returns Key intervention period for increasing social equity International obligations e.g UNCROC Moral and ethical obligations

11 Early child development-key points 1. Ecological model of human development: shaped by many different factors at different levels family/whanau, community, national, & global Complex, interactive, lifelong Risk and protective/resiliance factors both important

12 Influences on early child development Irwin L, Siddiqi A, et al Early Child Development: A Powerful Equalizer. Final Report for the Commission on Social Determinants of Health. Geneva, WHO.

13 Early child development 2. Rapid brain development during early years Billions of sets of neural circuits form wiring of the brain is influenced by genetics, early experiences/environments Simple neural circuits provide base for more complex learning and development Relationships are key loving, secure, responsive Brain development can be disrupted by toxic stress

14 Brain development

15 Early child development 3. Early environments shape longterm physical and mental health (e.g. obesity, diabetes, cardiovascular disease, mental illness) and many social outcomes (eg social skills, educational achievement, economic productivity, criminality).

16 Early child development 4. There are opportunities for prevention and early intervention: Evidence of effective interventions Evidence of cost-effectiveness Need for multi-faceted interventions Implementation so as to reduce inequalities and to be most effective for those with greatest need Universal platforms maternity services, Well- Child Tamariki Ora programme, primary health care, early childhood education

17 PHAC: Best Start in Life Identified the following key issues: Increasing pressure on families/whānau Widening socioeconomic disparities Comparatively low government investment in early childhood Uncoordinated services A lack of information for policy decisions and service delivery

18 PHAC: Best Start in Life Recommended 4 key areas for action: Strengthen leadership to champion child health and wellbeing Develop an effective whole-of-government approach for children Establish an integrated approach to service delivery for children Monitor child health and wellbeing using an agreed set of indicators

19 PHAC Cross-Agency Policy Set for child health and wellbeing From: The Best Start in Life: Achieving effective action on child health and wellbeing (Public Health Advisory Committee 2010)

20 Next steps?

21 Acheiving a focus on equity and early child development The healthy development of all young children benefits all of society Jack Shonkoff, Centre on the Developing child, Harvard University

22 Action on equity from the start the basics Leadership political will community action Comprehensive and sustained action across sectors mechanisms required Information monitoring progress, evidence

23 What actions can be taken by people in public health? Incorporate a focus on equity from the start as part of routine public health practice 2. Encourage wider action on achieving equity from the start across the health system, wider public sector, and community.

24 For discussion/brainstorming Select one of the following topics for small-group discussion: 1. What resources, tools, knowledge do you need for your workplace to incorporate an equity from the start focus? 2. What resources, tools, knowledge do you need to help build leadership, political will and community action on equity from the start? For each group consider: What opportunities are there to build on existing platforms? What are the barriers and how can these be overcome? What else is needed? List your top 5 actions

25 Further information For further information or if you wish to participate please or

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