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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 04-April-2008, Vol 121 No 1271

Children in New Zealand: their health and human rights
Nikki Turner, Karen J Hoare, Tony Dowell
...Many things we need can wait. The child cannot. Now is the time his bones are being formed; his blood is being made; his mind is being developed. To him we cannot say tomorrow. His name is today. (Gabriela Mistral)
Eighteen years ago, World leaders gathered at the United Nations to attend the World Summit for children. The meeting culminated in the launch of the United Nations Convention on the Rights of the Child (UNCROC)—the World’s most widespread human rights treaty.
Of the World’s 193 nation states, only Somalia and the USA did not commit to its ratification. New Zealand’s ratification committed the country to enshrine the 54 articles in the UNCROC in all of its policies. The convention enshrines for children, the right to life, survival and development, the right to an opinion and for that opinion to be heard in all contexts, protection from discrimination, and that the best interests of the child should be the primary consideration in all matters.
In 2003 the United Nations Committee met to consider how well New Zealand had implemented UNCROC.1 Several comments and recommendations were made by the Committee including the need to prioritise children in the Government budget and improve the health of children and young people by taking action in a range of health initiatives. They emphasised the need to focus on children from poor families and address the disparities between ethnic groups, in particular Māori.
What is the status of New Zealand children 18 years on from UNCROC?
Despite the 2003 United Nations Committee recommendations, in 2007 UNICEF drew the World’s attention to New Zealand’s poor performance in the health of our children: more children die from injuries than any other of the 24 OECD countries providing statistics, along with comparatively high infant mortality rates and low immunisation rates.2
The recent report by the New Zealand Child and Youth Epidemiology Service3 highlighted a broad range of areas with poor child health outcomes. The outstanding feature of this report is the significant socioeconomic and ethnic disparities observed in the outcomes across almost every health indicator.
For example, the relative risk of dying from sudden infant death syndrome is 10.6 times higher for an infant in NZDep Index decile 9–10 over decile 1–2;3 the relative risk of being hospitalised for a serious skin infection is 5.2 times higher in children from decile 10 compared to those from decile 1.
For many child health measures there has been a consistent pattern of significant increases in hospitalisations since the early 1990s,3 which although levelling off in the past few years, remains at higher levels than prior to the 1990s. This has occurred at a time when New Zealand has been showing increasing inequities4 and a rise in relative and absolute child poverty.5
Moreover, in youth and adolescence, high levels of psychological disorders, suicide, teenage pregnancy, and substance abuse are creating a context in which many young people are unable to reach adult life with security and confidence.
The Ministry of Social Development has been producing research since 2000 focusing on living standards for all New Zealanders. The outstanding feature of this research is the fact that children are disproportionately more likely to be living in severe or significant hardship than any other sector of New Zealand society.

Table 1. Percentage of the New Zealand population living in severe/significant hardship as measured by the Living Standards Reports 2000 and 2004

Variables
% in severe/significant hardship
2000
% in severe/ significant hardship
2004
Children
18%
26%
Adults
25-44 yrs
12%
15%
Adults
45–64 yrs
8%
10%
Adults
65+ yrs
2%
4%
Source: Summarised data from Figure 44, The Living Standards Report, MSD 2004.6

Poor health outcomes for children have significant short-term and long-term consequences. There is abundant evidence that experiences in utero and early childhood can have profound effects on long-term health and social outcomes. To focus on achieving good health for children is a sensible societal and economic decision and complies with New Zealand’s obligation to implement the UNCROC.
While the challenges to improving child health may appear formidable, there are feasible solutions. Economic disparities, the strongest driver for poor child health outcomes, have been tackled in many countries through a range of macro-economic solutions.
The recent leveling off of hospitalisation rates in this country is likely to be related in part to current strong economic growth and higher employment rates. Also the effects of recent government policies focusing on supporting those on lower incomes particularly the Working for Families package will be expected to have a positive contribution,7 although it offers little to the children of beneficiary parents, who are likely to be disproportionately more represented in poor health outcomes.
To enhance these economic contributions to improving child health, the restoration of a universal child benefit could be the greatest single preventive health measure we could devise.
All complex health issues have complex and multi-factorial underlying aetiology and child health is no exception. Beyond macro-economics it is important that we acknowledge other challenges and paradoxes that may contribute to our poor child health outcomes.
There is increasing evidence that ill-health and other social problems are linked to relative deprivation and income inequality rather than absolute levels of income.8 There is no obvious strong relationship between Gross Domestic Product (GDP) per capita and child well-being; poorer countries than us (Cuba is a good example) have much better child health statistics.
Appreciation of relative deprivation, rather than absolute, and the corrosive impact of increasing income inequality means that we must all engage in the debate about our children’s future.
This debate should include a fundamental question about how we, as individuals, communities, and society in New Zealand view children.
There continues to be widespread belief that New Zealand is a child-focused and "child-friendly" society. The reality, however, is that for many children it is a harsh and brutal environment with high levels of stress, illness, anger, and violence. In addition many New Zealand institutions, and traditions, are tolerant of children rather than engaging directly with them.9
We need to confront the paradox that while New Zealand is an enviable physical environment for children there are few indications of a truly positive child centred society.
At a broad policy level, working together more effectively across sectors is achievable and effective. For instance, the UK has shown improvements in child outcomes with top-level commitment to children, with strategy and funding integrated across education, welfare, health, housing, and local government.10
There are also a wide range of health and education specific initiatives known to help improve children’s’ health. These include initiatives such as improving access to quality primary health care, resourcing to early childhood programmes, parenting programmes, and home visiting to families in need.10 However a number of current New Zealand health policies affecting young people, such as those affecting alcohol consumption and tolerance of morbidity and mortality caused by immature road use, are increasingly out of step with other OECD countries.
The Ministry of Health’s Primary Health Care Strategy, with a greater focus on population health, could further resource systems able to enhance enrolment and tracking of children. There are many children who are still not enrolled with a regular provider, despite evidence that early enrolment and regular relationships with primary care providers do improve health outcomes such as immunisation coverage rates.11
There is evidence to show that a systematic approach to child health in primary care can produce positive change.12 Good enrolment and tracking systems have worked to protect children in other OECD countries,10 and well organised primary health care compensates for substantial social disadvantage.13
In summary, while one-third of New Zealand’s population is made up of children, and while children are disproportionately more likely to be living in hardship than other members of our society, our child health statistics will remain a shameful fact of life in this country, and New Zealand will continue to fail its international commitment to UNCROC. However there are known, effective strategies that can affect these statistics.
To achieve change requires individual and community-wide acceptance that we have a significant problem, and a willingness to make the necessary economic and societal efforts to bring about change.
New Zealand has both the tools and ability to improve child health; we have taken some effective steps in this direction. However if there is a genuine commitment to improving the future of our children now is the time for bigger bolder action.
...An aging society that does not take care of its young has a death wish. (Dame Anne Salmond, Knowledge Wave conference, 2003)
Competing interests: None known.
Author information: Dr Nikki Turner, Senior Lecturer, Department General Practice and Primary Health Care, School of Population Health, University of Auckland; Karen J Hoare, Lecturer, Goodfellow Unit, Department of General Practice and Primary Health Care, School of Population Health and School of Nursing, University of Auckland; Tony Dowell, Professor, Department of Primary Health Care and General Practice, Wellington School of Medicine and Health Sciences, University of Otago, Wellington
Correspondence: Dr Nikki Turner, Senior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, Private Bag 92019, Auckland, New Zealand. Email: n.turner@auckland.ac.nz
References:
  1. United Nations Committee. Concluding observations of the UN committee on the rights of the child: New Zealand. 2003. [website] http://www.acya.org.nz/site_resources/library/Documents/UNRecommendations/NC_Concl_Obs_unedited_2003.rtf
  2. UNICEF. An overview of child wellbeing in rich countries. Florence: Innocenti Research Centre; 2007 February. http://news.bbc.co.uk/nol/shared/bsp/hi/pdfs/13_02_07_nn_unicef.pdf [large file: 1.52MB]
  3. Craig E, Jackson C, Han DY. Monitoring the Health of New Zealand Children and Young People: Indicator Handbook. Auckland: University of Auckland; 2007.
  4. Blakely T, Tobias M. Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies. BMJ, doi:10.1136/bmj.39455.596181.25 (published 24 January 2008). http://www.bmj.com/cgi/content/full/bmj.39455.596181.25v1?rss=1
  5. Our Children: The Priority for Policy (2nd edition). Auckland; 2003.
  6. Ministry of Social Policy. The Social Report 2004 Te pūrongo oranga tangata 2004: indicators of social well-being in New Zealand. Wellington, New Zealand: Ministry of Social Policy. 2004.
  7. Work and Income. Increasing Working for Families Tax Credits. [website] http://www.workingforfamilies.govt.nz/tax-credits/
  8. Wilkinson RG, Pickett KE. The problems of relative deprivation: why some societies do better than others. Social Science & Medicine. 2007;65:1965–78.
  9. Dowell AC, Turner N. New Zealand: The urgent need to focus on child health. New Zealand Family Physician. 2007;35:152–7.
  10. Hoare K, Wilson D. The place for Children's Centres for New Zealand children. Australian Health Review. 2007;31(1):123–31.
  11. Grant C, Petousis-Harris H, Turner N, et al. General Practice and Health Professional Determinants of Immunisation Coverage: Final Report for the Ministry of Health and Health Research Council. Auckland: The University of Auckland; 2007.
  12. Tracey J, Cooke A. Focus on child health: A quality improvement initiative. New Zealand Family Physician. 2005;32(4):279–82.
  13. Ashworth M, Seed P, Armstrong D, et al. The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework . British Journal of General Practice. 2007;57:441–8.
     
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