1. Before the Bough Breaks
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

2. OUTLINE Trends in child & youth outcomes.
Possible explanations - impact of early child development.
What does Australia need to do?

3. Trends in child & youth outcomes.

4. INDICATORS OF HEALTH AND WELLBEING
Health Outcomes
Death
Low birth weight
Complex diseases ( asthma, diabetes, obesity)
Mental Health problems
Lifestyle risk factors
Child abuse/neglect/domestic violence
Behavioural problems, substance abuse
Others
Juvenile crime
Youth unemployment

5. Infant Mortality Indigenous vs. All Australian infants
Source: AIHW Australian Health Trends 2001

6. Neonatal & postneonatal mortality by Indigenous status, WA 1980-1998.
Source: WA MCHRDB : Jane Freemantle Unpublished data

7. Infant Mortality Rate Comparison between USA, NZ & Australia
Per 1000 lives births
(1997)
(1995-7)
(1995)
Sources: “Trends in Indian Health” Indian Health Services, New Zealand Now ; ‘Children’ 1998 Edition, AIHW 2002

8. Infant Mortality Rate by Age
Comparison between USA & Australia
Per 1000 lives births
Sources: “Trends in Indian Health” Indian Health Services, New Zealand Now ; ‘Children’ 1998 Edition, AIHW 2002

9. Low Birth Weight Australia 1991 - 1998 (% of all births < 2,500g)
Source: AIHW National Perinatal Statistics Unit Database

10. Trends in cumulative lifetime wheeze prevalence
in primary school children
Source: Year Book Australia. Canberra: Australian Bureau of Statistics,
ABS Catalogue No , pages

11. Number of Patients with Type 1 Diabetes Princess Margaret Hospital for Children 1990-1999

12. Prevalence of overweight/obesity 1985-1997
Booth et al. Change in prevalence of overweight and obesity among young Australians, AmJ Clin Nutrition (In press)

13. Intellectual disability by severity Western Australia 1983-1992
ALL ID
Mild/
Moderate
Prevalence per 1000
Unspecified
Severe/
Profound
Year of birth
Leonard et al, 2002

14. Down syndrome

15. The Western Australian Child Health Survey: Children with Mental Health* Problems
Number (‘000) Per cent
Males
Females
4 to 11 year olds
12 to 16 year olds
All children
* as determined by caregiver and teacher using the Child Behavioural Checklist
Zubrick et al 1995

16. International Study on Psychosocial Disorders in Young People M
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.

17. Suicide rates in males, by age - 1907 to 1998

18. Mental Health Age specific suicide rates 1996-98 (WA, SA & NT)
Source: Sven Silburn

19. Increase in Child Abuse
Across Australia:
Reported cases of child abuse rose from to during the period
1995/6-2000/01
Number of children placed in out of home care rose from to during the period

20. New physical and sexual abuse cases seen at PMH 1982-94
Source: Child Protection Unit PMH, 1997

21. Child abuse

22. 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 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)

23. 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

24. Alcohol use
Hill 2000

25. Alcohol use
Hill 2000

26. Illicit Drug Use Proportion of the population 14 years and over
Source: AIHW : Statistics on drug use in Australia 2000

28. 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

29. Juvenile Crime - Violent Assaults
Males Adult : juvenile arrests
: 1
: 1
Females Adult : juvenile arrests
: 1
: 1.9
Juvenile Boys : girls arrested
: 1
: 1
Homel pc 2001

30. Juvenile crime
Source: Statistics on Juvenile Detention in Australia: AIC Technical & Background Paper Series No1

31. Secondary Education completion rates
SOURCE : P38 Department Education WA Annual Report

33. Source : Keating & Hertzman (1999)
Modernity’s Paradox
Increasing wealth, opportunity….
Increasing social disparity…
Increasing problems in children & youth
Source : Keating & Hertzman (1999)

34. 2. Possible Explanations Relate to the impact of Early Childhood Development

35. Pathways to resilience (Silburn, 2003)
Personal achievement, social competence and emotional resilience
Opportunities for achievement and recognition of accomplishments
Sense of self-efficacy & self-worth
Sense of social connected- ness
Healthy beliefs
and clear standards
Academic success & other achievements
Responsive Parenting
(i.e. appropriate care
stimulation and monitoring)
Positive
interaction with peers
Reduced exposure
to harmful drugs
Effective learning, communication & problem solving skills
Positive
interaction with adults
Optimal brain development in utero and early childhood
Genetic
factors
Effective self regulation of emotion, attention
& social interaction
Availability of +ve adult
role models & engaging community activities
Healthy pregnancy, reduced maternal smoking, alcohol & drug misuse
Social and economic environments supportive to child rearing – especially absence of poverty and exposure to violence
Time
Healthy nutrition in utero & throughout childhood & adolescence

38. Ecological contexts shaping child development
The Larger
Social-Structural
Community
School
Child
Political
Economic
Family
Cultural
Environment
From Bronfenbrenner

39. 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

40. Decreasing: Community cohesion & participation Neighbourhood trust
Children’s services & facilities

41. Impact of white colonisation on Aboriginal health today
Cultural genocide
Stolen children
Loss of hunter-gatherer
Lifestyle, loss of culture
Fixed settlements
Fringe camps
Urban ghettoes
Marginalisation from
white society, poor
communication and
discrimination
Poor nutrition
Poor housing,
Poor hygiene,
Overcrowding and
Infectious disease
Unemployment,
Poverty,
Poor education
Alcohol and
Substance abuse
Respiratory disease,
Ear disease,
Rheumatic heart dis.
Renal disease
Low birthweight,
Diabetes mellitus
Hypertension
Cardiovasc. disease
Domestic violence,
Accidents, deaths
in custody
From Matthews 1997

42. Policy developed in silos
Research done in silos
Education
Epidemiology
Economics
Sociology
Genetics
Criminology
Individual good research output
Policy developed in silos
Health
Employment
Education
Police
Housing
FaServices
Justice
Finance
Individual good policy development

44. 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

45. 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

46. AUSTRALIAN RESEARCH
ALLIANCE FOR
CHILDREN AND YOUTH

47. 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

48. 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.

49. ALLIANCE GOALS To promote collaborative research and agenda setting
The application of research to policy and practice for children and young people

50. 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

51. Death Due to all Causes, by age of child

52. 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)