Sunday 20 July 2014

Investing in Children and Families


Investing in Children and Families
International Forum for Child Welfare 2014 

Thank you for the opportunity to present at this WorldForum.  Along with climate change, the future of the world’s children and their families remains the greatest challenge facing the global community.  While the recent Millennium Development Goals report highlight some progress there is still much left undone and the number of children in protective custody, prisons, and mental health institutions are a constant reminder of the pain and suffering still inflicted on children by people in authority.  Day by day we hear regular horrendous stories about the treatment of children and the seeming powerlessness of the world community to prevent and to respond to their exploitation and abuse. There are still enormous barriers to overcome and the solutions are not only the need for more financial resources but also a change in attitudes as to how we treat children.  The welfare of children and their families is our prime focus at this WorldForum and the challenge is to raise the profile of children and to demand of governments, corporations, institutions and the wider community that they invest in the health and wellbeing of children, not only with rhetoric but in service provision, as advocates and as a voice for their future. Healthy children need healthy families. Nurture, protection and safety of children are the hallmarks of a civilized society, and healthy communities and those institutions or organizations committed to the care of children and families must ensure their wellbeing. We know from bitter experience that this has not always been the case and still is a challenge.  An environment that continues to punish the poorest, blame victims, allows tribal rivalries, hatred and intolerance to continue, should be totally unacceptable in a civilized community whether rich or poor and as a place in which to nurture and raise children. As a global community we have the research and knowledge to protect children and build stronger families, yet we fail at times even to use common sense, and often rationalize why we do not more on the basis of ideological, free market economics or political grounds and ideology, rather than human need. International research unanimously affirming that investment in the first two years of life will not only ensure the best possible chance for children in the future but also makes economic sense. Disappointingly, in recent times the Australian government has implemented policies that incarcerate children of asylum seekers and refugees in detention and has reduced funding for health and education services that impact disproportionately on the poor.  Currently there are 4000 children held in detention. I refuse to describe these children as illegals as the Australian government encouraged and promoted.  This seems even more outrageous when only a few years ago the Australian government with the then opposition apologized to Australia’s indigenous children and also the Forgotten Australians.

 In this presentation I would like to begin with a few reflections and comments on the need for greater investment of the world’s resources in children and the outcomes that can be achieved, and then secondly, to speak about Australia’s challenges in meeting and responding to the needs of our indigenous people.


A recent report in the British Medical Journal the Lancet noted that substantial reductions in maternal child health deaths have been achieved worldwide over the past two decades.  This study demonstrated how investment in women and children’s health can bring about significant health, social, and economic change enabling greater participation and engagement in community life. The report went on to speak about greater change if countries invested more in the health needs of both children and their families, thereby preventing the deaths of 147 million children, 32 million stillborn and 5 million women by 2035.

 The report in the Lancet noted that the global maternal mortality rate was reduced over the period, 1990-2010 by 47%, and under 5 mortality by a similar percentage. However these improvements fall far short of the Millennium Development Goals set by the United Nations in 2000:
·      Goal 4: reduce the under 5 child mortality rate by two- thirds between 1990 and 2015
·      Goal 5: reduce by three- quarters between 1990 and 2015 the maternal mortality rate and to achieve universal access to reproductive health that aims to decrease child and maternal deaths worldwide by 2015.

The most recent MCD reports indicate substantial challenges ahead.  Six and half million children died in 2012.   This is 19000 deaths each day.  The leading causes of death in children under 5 are pneumonia, pre- term birth complications, diarrheoa and malaria.  Nearly 45% of deaths are linked to malnutrition. Children in the sub-Saharan Africa are 16 times more likely to die before age 5 than in developing countries.
Nearly 300,000 women die from treatable complications of pregnancy and childbirth. Alongside these figures sit 1 billion people who continue to live in extreme poverty. Fifty-seven million children do not attend school and over half the developing world lacks sanitation.
The report further highlights that despite economic growth in many Asian countries, South Asia still accounts for one- third of child and maternal mortality while sub- Saharan Africa accounts for 25% of deaths. While global and regional efforts are being made to accelerate improvements, much more needs to be done. The report highlights, as does both common sense and other research , what is required if we are to successfully reduce the level of infant mortality and improve the mother’s health. The simple answers are political will and resources. The leading causes of maternal mortality are in many cases preventable when well- equipped health services are present alongside education, parenting services, sanitation and fresh water, housing and an adequate income to ensure healthy eating, clean water and caring and nurturing families.

Australia, while having a national health service accessible to all Australians and supported by a robust and growing private health sector, is experiencing a range of challenges including an ageing population, rising obesity and high costs associated with advances in technology, longer waiting periods for elective and non- life threatening surgery and a growing demand for ante- natal and post- natal services. These challenges, alongside claims of financial unsustainability by those who advocate choice and free markets, will require a strong community and political will to ensure health care is available to all in the future. In Australia today we are beginning to see attempts at eroding a national and universal free health care system and welfare for all, from vested interests and powerful elites. The voices of the sick and the needy are shouted down by powerful lobby groups arguing for a free market approach to service provision instead of community well--being and need.   Investing in children and families is a political issue as much as a policy and best practice matter. And professionals working in the field of children’s services need to be advocates and voices for those who are unable to be heard in the market place. Research and common sense tells us that global priorities need to change if the future of millions of children are to be protected.

I want to now shift my focus in this presentation to how Australia has sought in more recent times, to address the health and well-being needs of our indigenous people, in particular children and families. The past is not one the nation can be proud of and it is only in recent times that greater attention has been given to their needs, partly driven by a stronger indigenous voice, and by the nation’s guilt and moral failure in the area with a growing awareness that more needs to be done, sooner rather than later. It has only been in the last 8 years that the lives of the nation’s indigenous communities have been recognised as an urgent priority and attention focused on addressing their health and welfare needs. Since the arrival of the British in 1788, the past 230 years have seen indigenous Australians decimated and abused, and annihilated would not be too strong a word, in some parts of the country. Today there remains a crisis in the delivery and provision of health, education and welfare services for our aboriginal and Torres Strait islander communities. Many were massacred for their land. And had their health adversely affected by European diseases, and the availability of alcohol, while thousands of children were “stolen”, removed from their families on account of being mixed race children . The decline of the indigenous population continued well into the twentieth century. Today they represent about 3% of Australia’s population numbering 600000. They were first recognised in the Australian constitution in 1967, although many fought alongside other Australians in the two World Wars, yet they still remain in many places on the margins, struggling for identity and awaiting full recognition. In February 2008 the then Prime Minister of Australia made a formal apology on behalf of the people of Australia to the “StolenGenerations” for the hurt and pain of the past inflicted on indigenous people by previous governments and the general population vowing to do everything possible to enable reconciliation and to ensure their future health and well-being. In 2009 a further apology was made to the Forgotten Australians, those children and young people, many British children sent to Australia during and after the Second World War and those of indigenous descent, who had experienced institutional care. Both occasions have been recognised as significant steps in the healing process and provided the background and motivation for greater investment in services for children and families to improve health services, schools, employment, housing and a voice in the formulation of public policy on indigenous issues. Outcomes have been mixed and not always successful. Voices have differed on needs and how they should be met even among Indigenous communities themselves.  When government leaders across the country met in 2008 to agree to a set of policies and objectives to be achieved, they set ambitious targets to address priority areas for change. The initiative is called “Closing the Gap”, a strategy of the Australian government in partnership with the States .The report outlines a level of investment unprecedented in the area of indigenous well-being, underpinned by a series of indigenous -specific and mainstream partnerships. The “Closing the Gap” strategy aims to reduce disadvantage in respect of life expectancy, access to education, employment, health matters and identity. How well this is achieved will depend on implementation, skills, listening and commitment not only by governments, but also by all Australians and the range on non-government and faith- based agencies willing to assist. Listening to and engaging the indigenous communities themselves will also be crucial. Perhaps the greatest risk or fear in achieving outcomes that reflect resource allocation is a belief that it is possible to move forward. The challenge is great. Compared with non–aboriginal Australians, Australia’s indigenous child population is:
·      More likely to be stillborn, to be pre-term, to have low birth weight, or die in the first month of life
·      Two to three times more likely to die in the first 12 months of life.
·      Bear a disproportionate 2.5 times the burden of disease, 5 times diabetes, 4.5 times cardiovascular disease and 4 times intentional injuries, such as suicide or harm from violence. They are more likely to have infection of the middle ear leading to cognitive deafness and blindness with implications for education and hospitalisation.
·      Many live in communities that do not have sanitation or clean drinking water.
·      Disproportionally represented in Out of Home and residential care programs

The impact of the removal of children from their families continues to affect health outcomes. It is estimated that 38% of children 15 and over were removed from their families and these children still suffer from a variety of emotional issues including loss of family and identity. This prevents many indigenous adolescents from participating fully in the community while suffering depression and other related illness. Twenty years ago one in 20 suicides in Australia were of aboriginal descent. Given they make up only 3% of Australia’s population that was far to high. Today half of deaths by suicide in northern Australia are those of indigenous people.  Figures from the Australian Bureau of Statistics show, that indigenous men, die 4 times and women 5 times higher, from suicide, than non-indigenous people. The group most at risk today is children mostly boys between the age of 10-14. These young men account for 4 out of 5 of all indigenous deaths,


“Closing the Gap” targets for Indigenous Australians are to:
1.   Close the life expectancy gap between indigenous and non-indigenous Australians within a generation, currently approximately 10-12 years less for indigenous Australians of both sexes
2.   Halve mortality rates for children under 5 within a decade by 2018
3.   Ensure all children in remote communities have access to early childhood learning by 2013
4.   Halve the gap for students in reading, writing and numeracy within a decade;
5.   Halve the gap for those in year 12, the final year in secondary schooling;
6.   Halve the gap in employment outcomes.

The building blocks to achieve these goals are:
1.   Early childhood services
2.   Schooling
3.   Health, including sanitation and access to fresh drinking water
4.   Healthy homes
5.   Economic participation
6.   Safe communities
7.   Governance and leadership.

The process for the implementation of the “Closing the Gap” framework involves financial investment in a range of partnerships to address lifestyles, health issues, truancy, poor schools, inadequate housing and easy access to alcohol. As well as government policies and agencies, non-government, charitable and faith-based agencies are also engaged in service provision, advocacy and research designed to enhance the well-being and opportunities for indigenous children and families.

The key elements of the “Closing the Gap” initiative are :
1.   Sexual health- sexual disease and infections continue to be reported at alarming and much higher rates compared to the non- indigenous population
2.   Mental health-$2.2 billion is to be spent over 5 years for suicide prevention, alcohol and drug addiction, preventative care, addressing past abuse
3.   Provision of culturally sensitive services and accommodation for older people
4.   Housing management and safe families especially for children and women as violence resulting from alcohol and drug abuse remains high
5.   Road safety
6.   Outlawing discrimination particularly in the sporting arena.

Having outlined the policy directions and key components of the program there is no cause for complacency. A great deal still needs to be done and many mistakes have occurred. Undoing 200 years of mistreatment cannot be achieved overnight or even in a single generation. It will require a continuing strong political will, community support and advocacy, as well as a reordering of priorities. Along the way respect for and the preservation of indigenous culture must be a priority. Self- esteem and participation by indigenous people must be taken seriously and accepted as a priority. Decisions cannot be left to government bureaucrats no matter how well intentioned or motivated. On a recent trip to a settlement in Arnhem Land in Northern Australia I saw new housing in a remote and isolated community being built while young people sat around smoking, drinking and bored. There were no jobs and schools. The complexity of the challenge in investing in the future is not easy. While housing needs to be addressed, the immediate goals remain to be addressed:
·      Getting children to school
·      Getting adults into work
·      Ensuring safe communities .


Progress so far:
1.   Only a small improvement in life expectancy has occurred since 2007
2.   The target to halve the gap in child mortality is on track although no actual figures seem to be available
3.   By 2012, 88% of indigenous children in remote communities were enrolled in pre-schools
4.   Progress to halve gaps in writing, reading, and numeracy have been disappointing and have not reached projected targets with only 2 regions out of 8 showing significant improvement
5.   Little progress has been made to halve the employment gap
6.   Improvements have been achieved to increase participation rates a year 12 level.


Investing in children and families requires more than best practice. It requires more than financial resources. It requires a full understanding of what it means to be human in a world where 80% of the world’s wealth is in the hands of 20% of the global population. Investing in children is a global concern and requires a political solution where more than lip service is given to the challenges. It requires a political will driven by a community belief that all children and families have a right to education; freedom from abuse and discrimination; access to clean water and sanitation, to shelter, and employment. These principles are at the centre of the UN Declaration of Children’s Rights and we all have a responsibility to speak with and on behalf of children and their families to prevent or correct failure.  Investing in children and families makes good economic sense, as does the opportunity for ensuring that all children and families are able to reach their potential.
The future of Australia’s indigenous children and their families is Australia’s  challenge in a rapidly expanding urban context. This challenge sits alongside the high level of service already achieved for the rest of the community. This shows that it can be done . Respecting human dignity and promoting the rights of the child are fundamental to any civilized society. Children are more at risk  of poverty and less likely to succeed when adults fail in their obligation to provide services and to protect young people from exploitation.
Finally it does not matter who you are, or your status or experience. The future of our children is the responsibility of each of us. It is not someone else’s problem, and we in our attitudes and values may in fact be part of the problem as we are the solution. As citizens of the world we need to continue to challenge and expose hypocrisy and self-interest that prevents children from reaching their potential and demand that international and national priorities in spending  be directed first and foremost to the needs of the most vulnerable children and families in our own communities  thereby raising the profile of political action as well as high quality service delivery.

References;
1.   Closing the Gap, Prime Minister’s Report on progress on addressing indigenous disadvantage, April 2014.
2.   Unnamed paper presented by Associate Professor Jane Fremantle at an oral presentation in St Paul’s Cathedral Melbourne April 2014.
3.   www.thelancet.com.journals/Lancet/article/PH140-6736{13}62231-X/fulltext. This was a report entitled, Advancing social and children’s health.

Ray Cleary
8th June  2014.