Building a child friendly community conference, Logan QLD
How are Australian kids going?
Dr Lance Emerson, CEO
The Australian Research Alliance for Children & Youth (ARACY)
www.aracy.org.au
ARACY: pioneering preventive action to progress
the health and wellbeing of children and young people
What we do:
1. Advocacy to improve child wellbeing
2. Support evidence based practice & policy
3. Progress systems change initiatives
Our guiding principles:
Researchers
Community &
business
• focus on prevention & life-pathways
• work across sectors and disciplines
• provide a neutral space for organisational
collaboration
• value add to our members work
• progress sustainable, evidence-based action
Policy
collaborative hub
of 1,800 members
Children &
youth
Practitioners
& professions
www.aracy.org.au
.... recent achievements of ARACY
Australia’s first
international
comparative report
on child wellbeing
Advocacy &
research: Australia's
Early Childhood
Agenda
COAG
partnership on
4 site trial:
Prevention of
child abuse at
the system level
Instigating a middle
years agenda for
Australia children aged
9-14 (&social and
emotional learning)
www.aracy.org.au
Today:
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How are Australian kids going?
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What are some of the reasons for current wellbeing
status?
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Key concepts in children's development
Measures of wellbeing (e.g ARACY report card)
The concept of equality and equity
Broader societal influencers on children's wellbeing
How can we improve children's wellbeing?
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Address only the needs of the ‘vulnerable’?
Proportional universalism ?
www.aracy.org.au
Some key concepts in children's
development
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Sensitivity of the developing brain
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What happens in the early years has a lasting impact
Early advantages accumulate, as do early disadvantages
The concepts of life course, pathways, risks & protective factors
An ‘ecological’ model of children's wellbeing
The best investments are early investments
–
Investing in early years pays off
www.aracy.org.au
Sensitivity of the developing brain: Stress
Positive stress
– necessary aspect of
healthy development
– occurs in the context of
stable, supportive
relationships.
– brief increases in heart
rate and mild changes in
stress hormone levels
www.aracy.org.au
Sensitivity of the developing brain: Stress
Tolerable stress
– Stress responses that could
disrupt brain architecture,
but are buffered by
supportive relationships.
– Allows the brain an
opportunity to recover
from potentially damaging
effects.
www.aracy.org.au
Sensitivity of the developing brain: Stress
Toxic stress
• Strong, prolonged activation of the body’s
stress response systems in the absence of
the buffering protection of adult support.
.
• Can damage developing brain architecture
& create a short fuse for the body’s stress
response systems, leading to lifelong
problems in learning, behavior, and both
physical and mental health.
www.aracy.org.au
Institutionalization and Neglect of Young
Children Disrupts Their Body Chemistry
35%
Percent of
Children
with
Abnormal
Stress
Hormone
Levels
(Cortisol)
30%
25%
20%
15%
10%
5%
Middle Class US Toddlers
in Birth Families
Neglected/Maltreated Toddlers
Arriving from Orphanages Overseas
Source: Gunnar & Fisher (2006)
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Sensitivity of the developing brain
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The concept of risks & protective factors (AIFS 2010)
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What happens in the early years has a lasting impact
Acute response to trauma
www.aracy.org.au
What happens in the early years has a lasting impact
www.aracy.org.au
What happens in the early years has a lasting impact
5
Odds Ratio
4
3
2
1
0
1
2
3
ACEs
4
5+
Source: Chapman et al, 2004
Risk Factors for Adult Depression are Embedded in Adverse Childhood Experiences
www.aracy.org.au
What happens in the early years has a lasting impact
Odds Ratio
3.5
3
2.5
2
1.5
1
0.5
0
1
2
3
4
ACEs
5,6
7,8
Source: Dong et al, 2004
Risk Factors for Adult Heart Disease are Embedded in Adverse Childhood Experiences
www.aracy.org.au
The concept of pathways
Violence
& Crime
Drug
availability,
norms
Developmental model
School &
learning
difficulties
Adverse
parenting
Genetic
factors
Drug use in
pregnancy
Drug
misuse
Low selfesteem
(modifed from Silburn, 2002)
Suicidal
behaviour
Peer
problems
Self-regulation of emotion,
attention &
social interaction
Depression
Increasing
psychosocial
difficulties
Acute stress
significant loss
Negative
thinking
patterns
Poor
problem
solving skills
Early brain
development
Low
SES
Diet &
nutrition
Time
www.aracy.org.au
Ecological Systems Theory of child development
(from Bronfenbrenner, 1979, Comer et al., 2004 and Nairn 2011)
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The best investments are early investments
Heckman: investment in the
early years
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The best investments are early investments
Average public social spending per child by intervention as a proportion
of median working-age household income (Adema 2008: OECD)
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With these key concepts in mind – how do we
measure children's wellbeing?
• Across multiple domains
• Mix of developmental and ‘symptom’ indicators
• Need for a benchmark?
– We should aim to be worlds best
• Trend data?
www.aracy.org.au
The ARACY Report Card
on the Wellbeing of Young Australians
• “ What is to be gained by
measuring and comparing child
well-being in different countries?
The answer lies in the maxim ‘to
improve something, first
measure it” UNICEF 2007, p.3
• First internationally comparable
child wellbeing report
• Allows evidence based dialogue
on need
• Allows prioritisation of effort
www.aracy.org.au
Main objective
• To use available data to present a picture of
how Australia’s children and young people (024 years) are faring in comparison with the
‘best’ international comparator
– Australian general population
– Australian Indigenous population
– Best international
www.aracy.org.au
How?
Report Card Framework
www.aracy.org.au
Eight Domains
1.
2.
3.
4.
5.
6.
7.
8.
Material wellbeing
Health and safety
Educational wellbeing
Family and peer relationships
Behaviour and risks
Subjective wellbeing
Participation
Environment
www.aracy.org.au
23 data sources used for Report Card measures
• Sample surveys
– ABS (adult literacy and life skills,
GSS, NATSISS,NHS)
– AIHW (National drug strategy
household survey)
– Australian Early Development
Index
– International Assoc for the
Evaluation of Educational
Achievement (CIVED)
– European school survey project
(ESPAD)
– OECD (PISA, Income and
Distribution survey)
– WHO (health survey, HBSC)
• Admin datasets/reports
– ABS (births)
– ABS/AIHW (Health and Welfare
of Australia’s Aboriginal and
Torres Strait Islander Peoples
– AIHW (Juvenile justice minimum
dataset, mothers and babies)
– OECD (Education at a glance,
Environmental indicatos, Health
database)
– WHO (SURF, mortality database)
– World Bank (HNP statistics,
Development indicators)
Challenges
• Numerous gaps in data
– Indigenous data missing or unavailable for a significant number of
measures
– Limited measures for several indicators (especially in the peer and
family relationships and subjective wellbeing domains)
– Lack of consistency in frequency of data collection (numerous ‘one-off’
collections and out of date data)
– Undeveloped indicators/measures (child abuse, breastfeeding, child
care)
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Inconsistency in definitions
Inconsistency in age groupings
Different data collection standards
Inconsistency in data collected around similar topics
www.aracy.org.au
Reported deprivation: % of children having fewer than 11 books in their home
(Australia 10/30, Indigenous 29/31)
www.aracy.org.au
Family relationships: % of children who report eating the main meal of the day with parents several
times per week (Aust 21/27, Indigenous 24/28)
Family relationships: % of children (15 y.o) who report that parents spend time ‘just talking to them’
more than once per week (Aust 18/27, Indigenous 17/28)
www.aracy.org.au
Teenage fertility: age specific fertility rates for females 15-19 years
(Australia 21/30, Indigenous 31/31)
www.aracy.org.au
Low Birthweight rate: rate per 1,000 live births
Australia: 7/18 Indigenous Australia: 19/19
Intentional self-injury death rate for young people aged 15-24 years
(rate per 100,000 children)
Australia: 13/23 Indigenous Australia: 23/24
Measure
Australia Rank
Indigenous Rank
Injury death rate 0-4 years
7/8
NA
School achievement (reading)
6 / 29
29 / 30
School achievement (maths)
8 / 30
29 / 31
School achievement (science)
5 / 30
29 / 31
% young people (15-19) not in education,
training or employment
17 / 25
NA
% children reporting eating main meal of
day with parents
21 / 27
24 / 28
% children reporting parents spend time
‘just talking’
18 / 27
17 / 28
Findings of the ARACY Report Card
• Overall - Australian children doing well but
consistently not as well as the ‘best’ international
• Australia was not ‘best’ for any chosen indicator
(exception AEDI - only two countries: Aus and Canada)
• Indigenous children do not fare as well as nonIndigenous children in Australia
• Indigenous children fare substantially less well than
the ‘best’ international
www.aracy.org.au
Summary of how Australian kids are going
Good news in some areas
Increase in complex conditions:
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Greater immunisation rates
Lower Infant mortality
Less accidental injuries
Lower child smoking / illicit drug use
Improved school achievement
Lower teenage births
Education scores
Lower alcohol use during pregnancy
Parent joblessness improving
Health of Aboriginal kids
Obesity, Asthma, Diabetes
Psychological problems (depression, anxiety..)
Behavioural problems (ADHD, hyperactivity..)
Violent & anti-social behaviour
Some Risk behaviours (earlier drinking..)
Young people not in employment /
education increasing
• Child abuse and neglect?
• Parental stress?
x
35
www.aracy.org.au
“…life expectancy for Australian children alive today will fall two years by the time
they are 20 years old. After centuries of rising life expectancy, we are now staring
down the barrel of a decline... ”
High child &
youth wellbeing
Low child &
youth wellbeing
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3
4
5
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10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Relative OECD country ranking for child and youth wellbeing (red bar= Australia)
www.aracy.org.au
www.aracy.org.au
What are the reasons for poor child wellbeing?
Inequality plays a big factor
‘ Ability gaps between advantaged and other children open up early
before schooling begins. Conventional school based policies start too
late to completely remedy early deficits, although they can do some
good.
Children who start ahead keep accelerating past their peers, widening
the gap…Early advantages accumulate, so do early disadvantages
- Heckman J. & Masterov DV, 2005
www.aracy.org.au
Inequality & inequity?
• Health inequalities - differences in health status or in the
distribution of health determinants between different
population groups. … Some health inequalities are
attributable to biological variations or free choice and others
are attributable to the external environment and conditions
mainly outside the control of the individuals concerned.. ..the
uneven distribution may be unnecessary and avoidable as
well as unjust and unfair, so that the resulting health
inequalities also lead to inequity in health
WORLD HEALTH ORGANISATION
www.aracy.org.au
Antenatal
Youth / young adulthood
Middle years
The ‘inequality cycle’ and
its impact on child
wellbeing
Birth / pre-school
Kindergarten
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What are the reasons for poor child wellbeing?
Inequality accounts for a lot …. but not all
– poor wellbeing is not just limited to poor kids
www.aracy.org.au
The ‘inconvenient truth’?
Greater incidence of poor wellbeing in higher SES children in some areas, e.g:
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Mental health: Prevalence of high or very high levels of psychological distress in youth
Illicit drug use
Alcohol or drug-related violence
Antisocial behaviours in children
Teenage pregnancy
Asthma
Meeting the dietary guidelines & daily recommended serves for fruit & veg
... these are seen as qualifications NOT refutation of the current story
www.aracy.org.au
www.aracy.org.au
ALAN HAYES (2011)
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Risk is not destiny
Vulnerability is not unchangeable
Protection is no guarantee
Resilience is built on personal and social
foundations
• that can be significantly strengthened through
public policy
• Building resilience involves enhancing individual,
family and community strengths
www.aracy.org.au
How to address needs?
Address the needs of the ‘vulnerable’
PLUS
… improve the wellbeing of the whole
population by addressing ‘upstream’
issues as much as possible
(= prevention)
www.aracy.org.au
Prevention continuum
www.aracy.org.au
We need a whole of society change ..
Number of children
Secondary and Primary prevention
Tertiary
prevention
(targeted)
Hertzman, 2004
vulnerability threshold
Low
High
Outcome measure (e.g child wellbeing)
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www.aracy.org.au
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Michael Marmot (UK)
“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”
www.aracy.org.au
Proportionate universalism: How?
Some starting principles (for local & national)…
1. Understand local needs
2. Use of evidence based programs, practices and
policies
– Only around 200 evidence based programs for kids
3. Use best evidence in implementing programs,
practices and policies
– Australia’s Implementation Deficit Disorder
4. Need to focus much earlier
5. Placing kids needs and rights on the agenda
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Australian Early Development Index (AEDI)
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2. Use best evidence in implementing ‘interventions’
• Around 50-200 evidence based programs to improve child
wellbeing
however
• very few children ‘experience’ an evidence based program:
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Some researchers better at ‘selling’ programs than others
Localised attempts hampered by national funding constraints
Little attention to the ‘science’ of implementation
Little focus on better fitting evidence based programs into existing
systems
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3. Need to focus much earlier
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Its costing us a motza by not starting earlier ..
Annual costs (AUS$M) of preventable diseases, illnesses and injuries, by scenario
(Source: ARACY / Access Economics 2009)
www.aracy.org.au
The cost of doing nothing
Cost of
problems
2030 = $40B
Child abuse and
neglect, Obesity,
Mental illness,
Human Capital,
Crime and
Delinquency,
Bullying,
Adolescent,
Pregnancy, Binge
drinking
$22B
but will be reduced by
$10-15B if we start now
Time
risk factors
Relationship between risk factors and protective factors. Shaded area: cost of doing nothing.
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Developmental vulnerability today will
contribute to a potential 20% loss to
GDP growth in the next 60 years
Kershaw et al (15 by 15: A comprehensive policy framework for Early human capital investment in BC. 2009)
www.aracy.org.au
4. Placing kids needs and rights on the agenda
Nordic countries:
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No such thing as ‘child protection’ system
Youth violence = wellbeing issue,
addressed through numerous ‘systems’
The most economically efficient &
competitive nations in the world (World
Economic Forum)
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World’s highest labour force
participation rates for women
Work fewer hours than Aussies, with
national incomes a little higher than ours
77
www.aracy.org.au
A long term (primary prevention) behaviour change agenda
Public information &
behaviour change
Social connectivity &
coherence of services
Development &
transfer of evidence
Policy & legislative change
www.aracy.org.au
www.aracy.org.au
Example: focusing on early years & emotional needs of children
Very strong evidence:
• Warm parenting
• Lack of coercive parenting
• Consistency
AND
• Parents level of knowledge on these issues, with appropriate
expectations on development, leads to:
– Higher cognitive skills in children
– Fewer emotional & behavioral problems
– Better self regulation
www.aracy.org.au
Other countries have cottoned-on
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“Simply calling for a more comprehensive
approach to the challenges facing
disadvantaged young children and their parents,
however, offers nothing new ..”. (U.S Shonkoff
2010)
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“.. the world in which most children grow up is
more difficult than it should be .. ” (U.K
Children's Society 2009)
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“The need for a social marketing strategy as the
“crown jewel’ in UK’s Big Society project … via an
alliance of interested groups, charities and
foundations to ensure the public, parents, health
professionals and especially newly pregnant
women are aware of the importance of
developing social and emotional capability in
the first years of life..”. (Graham Allen MP
entitled “Early Intervention: The Next Steps”
2011)
www.aracy.org.au
www.aracy.org.au
Summary:
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How are Australian kids going? ?
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•
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What are some of the reasons for current wellbeing
status?
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OK in some areas, but not all – worrying trends
Average internationally
Inequity a huge factor, but does not explain everything
Broader societal influences having an increasing role?
How can we improve children's wellbeing?
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Continue to target ‘vulnerability’ (need early years targeted EBPP!!)
Need to strengthen universal approaches, particularly parental &
community engagement in meeting development needs
www.aracy.org.au
ARACY MEMBERSHIP:
www.aracy.org.au
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Keynote - How are Australian kids going