Tony Waterston

Child public health

Introduction - Why child public health? 1. Child Health in the UK and Europe 2. Child Health in developing countries/the majority world 3. Determinants of Child Health 4. Child public health: lessons from the past 5. Key concepts and definitions 6. Child health and adult health 7. Techniques and resources for child public health practice 8. Child Public Health in practice: case scenarios

Who is speaking for children and adolescents and for their health at the policy level

Personal view p 249 The Bristol inquiry has put children at the heart of the publics agenda on health. This contrasts with the seemingly low position of children on the Westminster governments own health agenda. This status is exemplified by the current consultation exercise to draw up a national plan for health. Although this, together with the increase in funding for the NHS, is welcome, paediatricians are dismayed at the inadequate voice for children and adolescents in the modernisation action teams that are taking forward the definition of the plan.1 Only one registered childrens nurse and a health visitor have been appointed to be custodians of the interests of all children and young people. This reinforces a widely held perception by childrens doctors and nurses that the government is not committed to ensure that the interests of children and adolescents—whose needs are different from those of adults—are spoken for as a client group in the health service. We argue that there is an urgent need for children and adolescents to be explicitly represented at all levels of health policy. Furthermore, measures need to be implemented to deliver not only a coherent strategy for childrens health in England, but also more effective responsibility for integrating service delivery at the local level. #### Summary points Children and young people are a nations most precious resource, and their health is vital for the future success of our society Despite this, improving the health of English children is not a key government target Children are not young adults: their special health needs should be acknowledged A strategy needs to be defined for children and young people, with responsibility allocated for integrating care within the health service and between sectors It needs to be recognised that children have fundamental human rights for which protection is needed These …

Social capital: a key factor in child health inequalities

The widening gap in health outcomes between rich and poor is particularly evident among children and social inequalities in health are therefore of great concern to readers of this journal. Reducing inequalities in health is an important component of UK health policy.

Why children’s rights are central to international child health

The UN Convention on the Rights of the Child provides a framework for improving childrens lives around the world. It covers both individual child health practice and public health and provides a unique and child-centred approach to paediatric problems. The Convention applies to most child health problems and the articles are grouped into protection, provision and participation. Examples of the first are the right to protection from abuse, from economic exploitation and from illicit drugs. We examine one particular problem in each of these categories, specifically child labour, services for children with a disability and violence against children. The role of the paedialrician in applying a childrens rights approach is discussed. Children’s rights are increasingly being accepted around the world but still there is much more rhetoric paid to their value than genuine enforcement. Paediatricians can make a difference to the status of children worldwide by adopting a rights-based approach.

Teaching and learning about advocacy

Advocacy is an essential skill in the practice of paediatrics, where much of the work covers aspects of health as well as disease and where cross-agency work is common. Educationally, advocacy is best taught using a competency based approach and the key knowledge, skills and attitudes are defined. Central to the knowledge field is the evidence base for advocacy, and the UN Convention on the Rights of the Child. It is desirable for advocacy skills to be learned through experiential learning and examples are offered including letter writing campaigns, an advocacy journal club and keeping a diary of cases seen in the clinic. Means are suggested for including advocacy training in the core teaching of paediatricians, through a combination of theoretical teaching and practical experience. It will be necessary also to include advocacy topics in examinations, if there is to be genuine prioritisation of this area of practice.

Sustainable development, human induced global climate change, and the health of children

In this short article we introduce the concept of sustainable development and its significance to child health using climate change as an example. Environmental issues, in the long term, are as important to childrens health as smoking, accidents, and poor parenting are in the short term, yet have hitherto had little publicity or discussion within paediatric circles. What is happening to childrens health in the world? In the developed world cardiovascular disease, diabetes, cancer, and dental disease are all on the increase, while in the developing world malnutrition, infectious disease, and injuries are still rife. At present, inequalities of health and wealth—both within and between nations—appear to be increasing,1 with an adverse impact on childrens health. The Ottawa charter for health promotion states that the fundamental conditions for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.2 The evidence for the connections among the environment, the economy, and social change are compelling and any change within one inevitably affects the others. For the first time in history, the economic activity of the human population has become so vast that it is beginning to change the gaseous composition of the lower and middle atmospheres. This is now called human induced global climate change (HIGCC), which in turn will have a significant impact on a future generation of children. There seems no doubt that climate change is a genuine phenomenon.3 The main cause of climate change is the greenhouse effect, which is related to the massive increase in use of fossil fuels with consequent liberation of CO2 into the atmosphere. Before man started burning oil and coal and gas, the atmosphere contained about 280 parts CO2 per million—now the figure is about 360 ppm. Methane concentrations are now more than …

COMMUNITY CHILD HEALTH

SIR,-Dr Polnay argues (April 21, p 910) that the community paediatrician should not share hospital clinical duties. When working as a hospital-based paediatrician in developing countries, I always argued strongly for the need to combine hospital clinical .work with community care for the following reasons: (1) The doctor who cares for acutely ill children in hospital is in a good position to appreciate what are the most pressing problems in child health (this is less true in the UK). (2) Comprehensive health care means integrating the curative and preventive aspects. (3) The credibility of community work is enhanced in the eyes of hospital colleagues if the doctor doing it is seen to work also in an acute clinical situation. (4) Whilst training of health staff continues to take place mostly in hospital, there is a need for greater integration into the community by hospital doctors. Maybe these are arguments for a greater community orientation of hospital doctors, rather than a hospital commitment by community doctors. But the most effective community paediatrician I know combined his work in Zimbabwe as a hospital superintendent and surgeon with organising health worker training and the building of pit latrines. Is this only possible in the Third World? Perhaps. Certainly the commitment required to the community of an inner city area in Britain will take up much time and skill. But can one remain a paediatrician without looking after individual sick children and their families? Or can this care perhaps be given outside hospital? I hope that practical examples of successful integration of preventive and curative care can be provided from within the UK.

Violence against children: the UN Report

> Understand that one person can do something about violence but many people can stop violence. > > No violence against children is justifiable; all violence against children is preventable. In November 2006 the UN issued the Secretary-General’s Report1 on violence against children. In a joint initiative, the Office of the High Commissioner on Human Rights (OHCHR), the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) have led the first global attempt to describe the scale and impact of all forms of violence against children. It follows the previous study2 by Graca Machel (wife of Nelson Mandela) on violence against children in armed conflict. It is therefore relevant to the UK and to the work of paediatricians who see the results of this violence in children’s lives, and is essential reading both in its wealth of statistics and its global overview of how to prevent violence. We review the report to bring out its implications for UK paediatricians, who are much concerned with the impact of violence and have a central role to play in its prevention. Paediatricians are key players in the management of child abuse and in protecting children from harm. Can they also take a high profile role in the prevention of violence and the promotion of non-violent policies? The independent expert appointed to lead the study is Dr Paulo Pinheiro and his concept for the study outlines the objectives and methodology.3 The research covered the magnitude of violence, the causes both locally and nationally, and strategies for prevention. The methods used included information obtained from international and national organisations, regional consultations, field visits and wide discussion with children and young people. The last was a strong feature of the study and adds to its value; children’s comments are provided below. New research was …

Giving guidance on child discipline. Physical punishment works no better than other methods and has adverse effects.

The consultation document issued this month by the Department of Health on the physical punishment of children states clearly that “many parents would welcome support in learning effective measures of disciplining their child which do not involve physical punishment” while adding that “there may still be occasions when parents … may consider it appropriate to discipline a child through physical punishment.”1 Most British parents do use physical punishment2 and this fact is used by the government to justify continuing to allow some form of smacking in their proposals for new legislation. At a time when parenting has become a political issue and when child behaviour is causing difficulties both at home and in school, is there a consistent line which health professionals can follow in giving advice on discipline? Most research on child discipline has been done in the United States. The American Academy of Pediatrics consensus conference on corporal punishment3 and guidelines on effective discipline4 identified three essential elements: a learning environment characterised by positive supportive parent—child relationships; a strategy for systematic teaching and strengthening of desired behaviours; and a strategy of decreasing or eliminating undesired or ineffective behaviours. Each component needs to function adequately for discipline to result in improved child behaviour. Most of these principles have been developed over many years …

Children’s rights

A practice perspective The year 2004 marked the 15th anniversary of the UN Convention on the Rights of the Child, which has had a remarkable impact on the position of children in society both …