Solutions to Child Poverty:
Our Initial Proposals:
Health
Nikki Turner
Expert Advisory Group
September 2012
The Challenge
Mandate: to advise the Children’s
Commissioner on how to reduce child
poverty and mitigate its effects
Health and poverty
• Living in poverty (usually by economic measures)
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Higher infectious disease rates
Higher hospitalisation rates
Higher rates of assault/neglect/maltreatment
Poorer nutrition
Poor long term outcomes in adulthood: heart disease, alcohol and
drug addiction, mental health, poor oral health
– Higher rates of disability short and long term
– Higher risk of dying
– Inequalities for all even greater for Maori and Pasifika children
• 2007- 2010 approx. an extra 5000 socioeconomically sensitive
admissions per year in NZ
• Early years particularly important!
Key questions for feedback
We are particularly interested to know your views on:
1. Which proposals will be effective in reducing child poverty?
2. Which proposals are less likely to be effective?
3. What are the most important proposals to reduce child
poverty? (i.e. what should the main priorities be?)
4. What needs to be done first and why?
5. What is missing from our proposed package of proposals?
Guiding principles
• Be child-centred and family –focused
• Support child health and wellbeing by
ensuring sufficient resources
• Be evidence-based
• Support children from before birth
• Promote equality of early development
opportunities for all children
• Ensure that effective Maori and Pasifika
models that improve child outcomes are
available , evaluated and utilised
Recommendation 1
Fund child health using the principle of ‘proportionate
universalism’
The government to develop a maternity and child health
funding strategy based on the principle of proportionate
universalism, providing universal services and targeted extra
services based on assessment of need
Combined with a re-configuration of government expenditure
for children to increase spending during the early years,
starting with antenatal and early postnatal services.
Recommendation 2
Connect more pregnant women with maternity services earlier
The EAG recommends that the government direct health
services, using District Health Boards as one mechanism, to
increase the update and early engagement with maternity
services (by 10 weeks of pregnancy) particularly for women
from low socioeconomic backgrounds, especially teenagers,
Maori and Pasifika.
Recommendation 3
Develop a common assessment pathway
The government to develop, implement, and evaluate a
common assessment pathway for all children, service planning
and delivery approach starting antenatally and continuing
through to age 5 yrs.
• One assessment tool is applied and shared by all practitioners.
• An assessment plan is used to identify needs and vulnerabilities,
develop a service plan and monitor progress
Recommendation 4
Develop a national plan to improve child nutrition
- Including a food in schools programme (under education recs)
Recommendation 5
Free primary health care for all children
Short term:
The Ministry of Health to continue to implement the current
national initiative to establish free primary care visits for all
children from 0-6, 24 hours/7 days a week and set a specific
target to make timely progress towards 100 % coverage
Long term:
Extend free primary health care for all children under 18 years
of age.
The government to gradually reduce parent co-payments forth care
children older than six years of age until access to free primary care visits
24 hours/7 days a week can be achieved for all children to age 18
Recommendation 6
Secure funding for youth-friendly school-based health and
social services
The government to establish additional sustained funding for
youth-friendly health and socials services in all decile 1 – 3
secondary schools.
Recommendation 7
Streamline information systems across health and social
services
We recommend the development of a single enrolment system,
combining information collected by the National Health Index,
NIR, Well Child/Tamariki Ora, and the Shared Maternity
Record of Care , through to age 18.
Short term action: enrol all children at birth with a primary health care
provider (NHI assigned at that time), the NIR and with Well-Child/Tamariki
Ora (WCTO) providers.
Medium term action: expand the current IT Health Board's Shared Maternity
Record of Care project to include the child health shared record through to
age 18.
Long term: progress the development of a single enrolment information
system for all child health and social services.
Recommendation 8
Evaluate community-based services across
health and social services
We recommend the government to evaluate existing
community-based services that incorporate health
and social services in high deprivation communities
(e.g. integrated and co-located models of service
delivery), systematically piloting, conducting
effectiveness trials, and ,based on the results ,
implementing the effective approaches in additional
high deprivation communities
Recommendation 9
Prevent problem gambling and smoking
Support the objectives of the Ministry of Health’s (2010) Preventing and
Minimising Gambling Harm: Six-year strategic plan, especially targeting
prevention efforts for low income families
http://www.health.govt.nz/publication/preventing-and-minimising-gambling-harmsix-year-strategic-plan-2010-11-2015-16
Support health targets of expanding smoking prevention and reduction
initiatives
Gaps?
Disability Services strategy….
Others ?