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Source: WA MCHRDB : Jane Freemantle Unpublished data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
INFANT MORTALITY RATE
8
Per 1000 lives births
6
4
2
0
American
Maori
Indians &
(1997)
Alaska natives
(1995)
Indigenous
Australians
(1995-7)
Sources: “Trends in Indian Health” 1998-99 Indian Health Services, New Zealand Now ;
‘Children’ 1998 Edition, AIHW 2002
Infant Mortality Rate by Age
Comparison between USA & Australia
12
10
8
Ne onatal
6
Post Ne onatal
Per 1000 lives
births
4
2
0
Ame rican
USA: All Race s
Indians &
Alaska native s
Indige nous
Australians
Aust: All race s
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
900
800
700
600
Total
500
patients 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
Prevalence per 1000
ALL ID
Mild/
Moderate
Unspecified
Severe/
Profound
Year of birth
Leonard et al, 2002
Down syndrome 1980-2000
The Western Australian Child Health Survey:
Children with Mental Health* Problems
Males
Females
Number (‘000)
30.0
23.5
Per cent
20.0
15.4
4 to 11 year olds
12 to 16 year olds
30.8
22.7
16.0
20.6
All children
53.5
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
NAI
CSA
Total
1985
1988
1991
1994
Source: Child Protection Unit PMH, 1997
Child abuse
Care & Protection
Rate per 1,000 Children
25
Indigenous Australians
Other Australians
20
15
10
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
% hazardous drinkers
60
50
40
30
20
10
0
12
16
Age (years)
1983
1986
1989
1992
1996
Hill 2000
Alcohol use
Girls
% hazardous drinkers
60
50
40
30
20
10
0
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
Secondary Completion Rates (Students who commenced Year 11
in 2000 and achieved secondary graduation in 2001)
56%
60%
50%
40%
30%
20%
18%
10%
0%
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
Pathways to resilience
Personal achievement,
social competence and
emotional resilience
(Silburn, 2003)
Opportunities for achievement and
recognition of accomplishments
Responsive Parenting
(i.e. appropriate care
stimulation and
monitoring)
Genetic
factors
Optimal brain
development
in utero and
early childhood
Healthy pregnancy,
reduced maternal
smoking, alcohol
& drug misuse
Sense of selfefficacy &
self-worth
Academic
success & other
achievements
Effective learning,
communication &
problem solving skills
Effective self regulation
of emotion, attention
& social interaction
Sense of
social
connectedness
Healthy
beliefs
and clear
standards
Positive
interaction
with peers
Positive
interaction
with adults
Reduced
exposure
to
harmful
drugs
Availability of +ve adult
role models & engaging
community activities
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
Political
Cultural
Environment
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
COLONISATION
Loss of hunter-gatherer
Lifestyle, loss of culture
Poor nutrition
Poor housing,
Poor hygiene,
Overcrowding and
Infectious disease
Unemployment,
Poverty,
Poor education
Alcohol and
Substance abuse
Domestic violence,
Accidents, deaths
in custody
Fixed settlements
Fringe camps
Urban ghettoes
Low birthweight,
Diabetes mellitus
Hypertension
Cardiovasc. disease
Respiratory disease,
Ear disease,
Rheumatic heart dis.
Renal disease
From Matthews 1997
Research done in silos
Epidemiology
Economics
Genetics
Sociology
Education
Criminology
Individual good research output
Policy developed in silos
Health
Housing
Education
FaServices
Employment
Police
Justice
Individual good policy development
Finance
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)