Australian childrens wellbeing in 2034 closing the gap

Australian children's wellbeing in 2034: closing the gap between our aspirations and our effort Fiona Stanley Annual Forum 28 th March 2014 aracy. org. au

Welcome to country Warren Daley Ngunnawal elder aracy. org. au

Australian children's wellbeing in 2034: closing the gap between our aspirations and our effort Professor Fiona Stanley, AC, FAA, FASSA Patron, Telethon Kids Institute Distinguished Research Professor, The University of Western Australia Vice Chancellor’s Fellow, The University of Melbourne aracy. org. au

Overview 1. What should child wellbeing in 2034 “look like”? 2. Early childhood brain development: • • why it is so critical? what makes a difference and how do we scale up & measure success? 3. What effort is needed? Some priority actions: • • Investment in a comprehensive early years system Parent empowerment and engagement Proportionate universalism Aboriginal led and controlled solutions 4. Practical actions in moving forward: • • Aligning our collective effort toward a common vision Investing in a longer term, collaborative research agenda Need more evidence-based and prevention focused interventions Helping grass roots service agencies make an immediate difference. . aracy. org. au

Starting with the end in mind … a vision for the next 20 years An Australia where: ‘. . all young people are loved and safe, have material basics, are healthy, are learning and participating and have a positive sense of identity and culture. ’ (The Nest Action Agenda 2013) We need to see ensure Australian children and youth rank in the top third of OECD for 50% of indicators by 2034, as reported in the ARACY Report Card (current level is ~25%) aracy. org. au

We have made progress over last 100 years, however: § Alarming rise in some complex chronic conditions § e. g around 25% of 5 -14 yr olds are overweight or obese, increase in harmful drinking etc. . § Aboriginal children's wellbeing disparity across multiple domains § Increasing income disparity overall § very closely linked with poor health & wellbeing § around half a million children born into poverty § Other worrying trends: § FASD on the rise § Low birth-weight / pre-term birth on the rise. aracy. org. au

~75% of child wellbeing indicators in middle or bottom third of OECD ARACY Report Card on the Wellbeing of Young Australians (# 2) aracy. org. au

The focus of our current efforts Our current efforts are not positioning us well to close the gap and reach our goals. Most critically: §the importance of the early years is being missed in many debates (e. g. PC: Inquiry into Childcare and Early Childhood Learning is fine – but what happens before pre-school is far more important to child outcomes) §evidence on what works not collected or used wisely to make ‘best buy’ decisions (where is the national database of evidence informed interventions? ) §individual efforts are not well aligned - collective effort not harnessed §inequalities continue to grow, we are challenged in how we address it §implementing solutions for closing the gap for Indigenous Australians continues to be a huge challenge. aracy. org. au

The early years “Early child development. . . strongly influences wellbeing, obesity / stunting, mental health, heart disease, competence in literacy and numeracy, criminality, and economic participation throughout life. What happens to the child in the early years is critical for the child’s developmental trajectory and life course. ” World Health Organization (2014). aracy. org. au

Why is Child Health & Development Crucial for Australia’s Future? Intellectually Competent & Emotionally Capable Workforce Most Young People Participating to their Full Potential National Economic Prosperity Health & Welfare Budgets Not Draining Australia’s Capacity Next Generation of Parents Socially & Emotionally Competent Most Children Mentally & Physically Healthy, Reaching their Educational and Social Potential Cycles of Economic Prosperity & National Capacity Most Children Commence their Lives in Environments which Enable Full Opportunities for Healthy Child Development BUILDING BLOCKS aracy. org. au

Early adversity has lifelong impacts § Leads to changes in DNA (methylation) § ‘Biological embedding of environmental events’ (Hertzmann) § Affects the development of biological systems § Immune § Cardiovascular § Metabolic regulatory § What appears to be a social situation is likely to be a neurochemical situation - intergenerational nature of disadvantage and social exclusion aracy. org. au

How Adverse Childhood Experiences impair a child’s brain development Early childhood home environment predicts frontal and temporal cortical thickness in the young adult brain Wednesday, Oct 17, 2012 Society for Neuroscience Meeting, New Orleans Casey, S. (2013). “The High Cost of Child Poverty, ” Take 5, First Five: Contra Costa Blog. [www. firstfivecc. org/blog] aracy. org. au

Pathways to Resilience (Silburn, 2003) aracy. org. au

Pathways to Vulnerability (Silburn, 2001 aracy. org. au

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Australia's Heckman curve? Average public social spending per child in Australia by intervention as a proportion of median working-age household income (Adema 2008: OECD) aracy. org. au www. aracy. org. au

We need to address our “early childhood vulnerability debt” “Evidence from Canada shows that reducing the costs of early childhood vulnerability from their current rate of 29% to a projected rate of 20% (by 2020) would result in an increase in GDP of more than 20% over 60 years. The benefits to society associated with this reduction would outweigh the costs that are needed to bring it about by a ratio of more than 6: 1. In Australia, it is estimated that reducing Australia’s early childhood vulnerability from 22% to 15% (by 2020), as proposed in this action agenda, would lead to an increase in Australian GDP of 7. 35% over 60 years. ” ARACY (2013). The Nest action agenda. aracy. org. au

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Priority areas for action The ‘best buys’ need to be better targeted at influencing the 0 -3 yrs. 1. 2. 3. 4. Investment in a comprehensive early years system Parent empowerment and engagement Proportionate universalism Aboriginal led and controlled solutions aracy. org. au

1. A comprehensive early years system We need: § investment that matches the importance of the early years § further development of a world-class perinatal and early years, health, education and social care system for all children aged 0 -5 years § a coordinated and comprehensive policy and service framework § a more holistic and integrated platform focused on all aspects of early child development aracy. org. au

1. A comprehensive early years system (cont. ) § UK research indicates that one year of preschool has almost as much impact on academic outcomes at age 11 as the first 5 years of school. § A high-quality and universally accessed early years system can yield population-level benefits. § Australia’s universal early years system? Largely limited to 2 interventions: § Quality early childhood education / preschool § Maternal and Child Heath (MCH) services in each state § Jurisdictional differences in preschool participation and MCH can be linked with levels of child vulnerability in Australia aracy. org. au

AEDI Results and preschool participation

2. Parent empowerment and engagement Both poverty and parenting quality are important in affecting child development outcomes, however: § poor parenting has nearly twice the impact of persistent poverty § positive parenting and a strong home learning environment can mediate its impacts. (UK Millennium Cohort Study) “what parents do is ultimately more important than who parents are. . ”. Paterson, C. (2011). Parenting Matters: Early Years and Social Mobility, Centre. Forum, UK. aracy. org. au

2. Parent empowerment and engagement (cont. ) International research over the past 40 years shows: § Parental engagement in learning led to better test scores, higher grades, better attendance, higher graduation rates, lower drop-out rates, greater likelihood of higher education attainment and improved behaviour, personal competence and a life-long love of learning. § Family participation in education was twice as predictive of students' academic success as socioeconomic status § Parental engagement was equivalent to $1000 in extra funding a student a year § Students whose parents regularly read and talk with them scored an average 25 points higher on the Program for International Student Assessment (PISA), or six months of a school year. aracy. org. au

aracy. org. au OECD (2012), Let’s read them a story! The Parent Factor in Education, OECD www. aracy. org. au

aracy. org. au OECD (2012), Let’s read them a story! The Parent Factor in Education, OECD www. aracy. org. au

2. Parent empowerment and engagement (cont. ) How do we promote parental engagement? The ‘best buys’: §holistic, sustained nurse home visiting programs - embedded within the universal system (Australia far from international best practice. . ) §parenting programs and early start programs for 0 -3 years that enhance the home learning environment and target in-home activities §parenting programs which include centre-based activities for parent and child §high quality preschool programs §Large scale primary prevention- a national campaign to empower parents with options to provide the very best start to life for their children and ultimately improve social mobility. (From The Nest action agenda) aracy. org. au

Need to increase FREQUENCY of positive parental behaviours that make a difference Overarching message to parents: Most of a child's brain development occurs in the first five years. How the brain develops depends on the quality and frequency of positive activities, including parenting (From ARACY: Engaging Families in the early years story project 2013) • Playing with your children • Encouraging your child to play • Reading to your child • Counting with your child aracy. org. au Play Care Learn Talk • Being consistent • Usingestablishedroutinesaroundmeals, play and sleep times • * Setting clear limits for your children • * Being physically active • and eating healthily with your • children • Being attentive to your children and responding to their needs • Spending time talking and listening to your children

3. Proportionate universalism Disadvantage and inequality are key influences on child health and wellbeing outcomes… But targeting only disadvantaged families will miss the mark. aracy. org. au

3. Proportionate universalism (cont. ) Child vocabulary development by parent income Hart, B. , and Risley, T. (2003). “The early catastrophe: The 30 million word gap, ” American Educator 27, pp. 4– 9. aracy. org. au

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16 60000 14 50000 12 40000 10 8 30000 6 20000 4 10000 2 0 Most disadvantaged Quintile 2 Quintile 3 Quintile 4 Least disadvantaged 0 # children with 1+ developmental vulnability % chidlren with developmental vulnerability Incidence and total numbers of developmental vulnerability (as measured by the AEDI) and by socio-economic status (as measured by SEIFA) Socio-economic status Total number of children Physical health Social competence Emotional maturity Language and cognitive Communication skills Centre for Community Child Health and Telethon Institute for Child Health Research. (2009). A Snapshot of Early Childhood Development in Australia – AEDI National Report 2009 aracy. org. au

3. Proportionate universalism (cont. ) Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism. aracy. org. au

Tiered system of universal service delivery Targeted high intensity High need 2 -5% 10 -15% 100% Low need Universal low Intensity

4. Aboriginal led and controlled solutions “It is important that we privilege Aboriginal and Torres Strait Islander knowledge when developing agendas and delivering services relevant to Aboriginal and Torres Strait Islander children and youth. We also need to recognize that Aboriginal and Torres Strait Islander agencies are well placed to meet the needs of Aboriginal and Torres Strait Islander children and youth — such agencies need to be provided with appropriate funding, accountability and authority to meet the needs of their people. ’ (Nest Operational Principle, Nest Action Agenda, 2013) aracy. org. au

Two different populations in one country Australian population Australian Aboriginal population Population (fertility rate) 20, 561, 00 (1. 8) 419, 600 (2. 15) Median age 36. 6 years 20. 5 years 2. 95 1. 19 Life expectancy 78 years males 83 years females 59 years males 67 years females Infant mortality rate 5. 3 per 1000 10. 6 per 1000 Adult to child ratio 1 36 1 Persons aged 18+ for every 0 -17 year old

Australia: Growing old and growing young 37 Source: Australian Bureau of Statistics

Life expectancy Indigenous and non Indigenous aracy. org. au 38 Source: Calma 2010

Two different populations in one country Australian population Australian Aboriginal population Population (fertility rate) 20, 561, 00 (1. 8) 419, 600 (2. 15) Median age 36. 6 years 20. 5 years 2. 95 1. 19 Life expectancy 78 years males 83 years females 59 years males 67 years females Infant mortality rate 5. 3 per 1000 10. 6 per 1000 Adult to child ratio 1 1 Persons aracy. org. au aged 18+ for every 0 -17 year old 39

…. continued Australian population Australian Aboriginal population Fetal growth restriction 11% 20% Mental health morbidity for <18 yo 17% 24% Low academic competence 20% Retention to Year 12 school 1 58% 75. 7% 39. 5% 1 In aracy. org. au Australia, 10 years of schooling has been compulsory 40

How to move forward? 1. Aligning our collective effort toward a common vision An independent national plan for the next 20 years … with metrics and accountability …. . need to move to next stage of implementation (from 2014 onwards) aracy. org. au

How to move forward? 2. Investing in a longer term, collaborative research agenda: • • • The big child & youth research questions have largely gone unanswered for the last 20 years No more “bitsy” research – need for large scale, long term collaborative research – including more effectiveness trials Need to align government, philanthropic and other funding to reward collaborative research, with child wellbeing targets in mind (e. g from The Nest) aracy. org. au

How to move forward? 3. Need more evidence-based and prevention focused interventions • • • We know the conditions required for positive child development. . but we lack scalable evidence based and prevention focused solutions Need to measure common outcomes (e. g in AEDI, ARACY Report Card) to test scale up and innovation Need to take stock of what works and stop reinventing the wheel – use of the ARACY database of evidence based interventions (developed for The Nest) – of around 200 interventions tested internationally, we deliver less than a dozen aracy. org. au

How to move forward? 4. Helping grass roots service agencies make an immediate difference. . The Nest operational principles, if implemented by all service agencies “on the ground” would have a profound impact. These principles are: 1. 2. 3. 4. 5. 6. A commitment to the child at the centre A commitment to privileging Indigenous knowledge A commitment to a long-term, evidence-informed approach A commitment to prevention and early intervention A commitment to a life-stage approach A commitment to systemic change using an outcomes approach, including » • shared vision, shared outcomes framework, reforming funding arrangements, blended and braided funding models, harnessing the energy and power of volunteers, evidence-based implementation science ARACY plans to help agencies operationalize these principles from 2014 → aracy. org. au

CIVIL SOCIETY Equality/diversity Trust, care Social determinants of child and youth health UNCIVIL SOCIETY Inequalities Fear, violence Collective good Priority for material wealth Valuing parents Parents not valued Valuing childhoods Fast tracking childhoods Prevention more than cures Cures more than prevention Protected environments Environmental degradation Safe places for all Safe places for the few Effective use of helpful technologies Child needs as well as adults aracy. org. au Excessive use of damaging technologies Adults needs more than children’s

Measuring success Population level measures are critical aracy. org. au

QLD - no universal MCH & lowest preschool attendance, also the state with the highest % of children developmentally vulnerable in one domain (26%) VIC – arguably the strongest universal MCH & high preschool attendance, also the state with the lowest % of children developmentally vulnerable in one domain (19%) From Brinkman SA, Gialamas A, Rahman A, et al. BMJ Open 2012; 2: e 001075. doi: 10. 1136/bmjopen-2012 -001075 aracy. org. au

THANK YOU Fiona Stanley Annual Forum aracy. org. au