Tracey Oorschot and Jane Frawley
Child, youth, Indigenous and social policy advocates have campaigned for improved health and wellbeing of Australian children and young people for years. Despite these efforts, Australia continues to underperform in a range of key benchmarks. Statistics reveal that 1 in 6 Australian children and young people live in poverty; and youth mental health issues are worsening (up from 11.8% to 15.4% for 18-24 year olds). Additionally, Australia ranks in the bottom third of OECD countries for child obesity and early years education participation; increasing the likelihood that children are developmentally vulnerable once at school (1 in 5 children are developmentally vulnerable at age five in Australia).
The statistics for First Nations Peoples in Australia continue to be very worrying, with up to a third of Aboriginal and Torres Strait Islander youth aged 15-19 estimated to have a mental health illness; together with being at much higher risk of suicide. Indigenous children and young people also have poorer educational participation and numeracy and literacy rates than their non-Indigenous counterparts. Of most concern is the continued over-representation of Aboriginal and Torres Strait Islander children and youth in the child protection and youth justice systems.
Preventive action can greatly reduce these types of health and wellbeing issues, so will the National Preventive Health Strategy (NPHS) currently being developed make a difference?
The Productivity Commission’s Draft Report on Mental Health states our health and wellbeing conundrum plainly; even though mental health has a significant policy agenda through billions of dollars of investment, improvements in child and youth mental health have been minimal. In response to this, the Final Report recommends a range of prevention and early intervention initiatives, along with systemic changes to our health system. Key areas targeted for improvement can be broadly grouped into workforce, intervention, health system fragmentation and research, with similar findings also presented in the National Action Plan for the Health of Children and Young People (2020-2030). The Report supports what our health workforce continues to advocate for; that public health responses like the NPHS take a life course approach, and look beyond healthcare workers to include the community-based workforce.
A national strategy with a focus on preventive health that can explicitly incorporate life course specific requirements is a step in the right direction. However, if the NPHS is to succeed, we have to re-think how we develop and implement national strategies.
According to Rittel and Webber’s seminal paper on public policy issues being “wicked problems”, we must find a way to deal with the intrusion of politics upon public policy creation. Australians will not have “the best start in life” as the NPHS seeks to achieve, if there is inadequate, poorly targeted, or short-term investment in preventive health initiatives for children and youth. Presently, we fall well short of other comparable OECD countries when it comes to preventive health investment; with widespread calls to increase our current preventive health budget from under 2% to at least 5%.
Adequate preventive health investment also means funding interventions, programmes and services that support the social, cultural and economic determinants of health across the life course, as stated in the NPHS. The public health workforces that provide implementation, ongoing execution and governance for preventive health initiatives must also receive sufficient, secure and sustained funding.
An example of a necessary child and youth health and wellbeing initiative is universal funding for child care and kindergarten programmes to help address child poverty and low rates of participation in early education. Coordinated wellbeing responses for primary and high school educators are also needed; as well as the provision of tertiary education to support child and youth mental health.
To enhance Aboriginal and Torres Strait Islander child and youth health outcomes, self-determined responses led by Indigenous communities should be the principle approach. Culturally informed responses guided by peak bodies such as the National Aboriginal Community Controlled Health Organisation are vital. An example of this would be the reinstatement of the defunded Koori Courts that provided culturally appropriate justice responses for Aboriginal and Torres Strait Islander youth.
The provision of these programmes and services are influenced by politics, and keeping or funding a new programme or service largely rests on a politician’s personal assessment of alignment with party politics or electability.
An idea has been put forward that could achieve the goal of improved child and youth health and wellbeing: the creation of an Australian equivalent of the Center for Disease Control (CDC) that exists in the United States. The establishment of such a centre in Australia has been raised before, and requires an ambitious National Preventive Health Strategy to succeed. Terry Slevin sums up how an Australian CDC would resolve current issues concerning the public health workforce, service provision, health system fragmentation, and research.
A national centre for disease control can coordinate local, state, and federal responses; which will help to reduce health system fragmentation, and also subsequent health inequities created by unequal funding and disparities in service provision. Distinct departments can also be created to focus on specific cohorts; such as children, youth or Aboriginal and Torres Strait Islander people. These departments could create evidence-based interventions and programmes at the national level, and support both the healthcare workforce and public health workforce through mentorship, training programmes, and knowledge dissemination. They could also undertake research to reduce issues concerning the lack of data or nationally representative data (as per the CDC’s Child and Maternal Health, Division of Adolescent and School Health and Tribal Health departments).
PHAA CEO Terry Slevin asserts that the development process to create a national centre will engender “non-partisan policy and collaboration between all parties”. This is our best chance of neutralising political barriers and elevating the public health platform to remedy existing health and wellbeing gaps for our children and youth.
We need our own CDC to implement the National Preventive Health Strategy if we want to see real improvements in the health and wellbeing of children and young people in Australia.
Dr Jane Frawley is Co-Convenor of the PHAA Child & Youth Health Special Interest Group. She is a National Health and Medical Research Council (NHMRC) Early Career Fellow. Dr Frawley is a member of the Australian Centre of Public and Population Health Research within the Faculty of Health at UTS. Dr Frawley’s research program applies rigorous public health and health services research methods to the areas of maternal and child health.
Tracey Oorschot is an emerging public health researcher with multidisciplinary training in human services/social work, counselling and psychology. Tracey’s interests include chronic disease, mental health, complementary medicine and integrative health care, and public policy. She is currently a doctoral student of public health at the Australian Research Centre in Complementary and Integrative Medicine within the Faculty of Health, University of Technology Sydney.