European Society for Social Pediatrics and Child Health (ESSOP)* Position Statement: Social inequalities in child health - towards equity and social justice in child health outcomes

Systematic review: Effects of sustained nurse home visiting programs for disadvantaged mothers and children

AIMS

To systematically evaluate published experimental studies of sustained nurse home visiting (SNHV) programs. This review summarizes the evidence and identifies gaps in the literature to inform practice, policy, and future research.

DESIGN

Restricted systematic review with narrative summary.

DATA SOURCES

Databases searched were Medline, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 to the date of search (13 February 2018, with supplementary searches conducted to identify more recent publications (up to 2019). Several reputable evidence clearinghouses were also searched.

REVIEW METHODS

Studies were included if they used a randomized or cluster-randomized controlled trial to evaluate a home visiting program that: (a) targeted disadvantaged mothers; (b) commenced during pregnancy or prior to the child's first birthday; (c) had an intended duration of at least 12 months from the time of enrolment; and (d) was substantively delivered by nurses or midwives. Meta-analyses and reviews of studies meeting these criteria were also included. A quality appraisal was conducted for all studies.

RESULTS

Of 1,393 total articles, 30 met inclusion criteria. Seven specific SNHV programs were identified. Each demonstrated evidence of a positive statistical effect on at least one child or maternal outcome.

CONCLUSION

Sustained nurse home visiting programs benefit disadvantaged families, though effects vary across outcomes and subgroups. Further research is needed to discern the critical components of effective programs.

IMPACT

As SNHV programs have gained policy appeal, the need to evaluate the evidence-base supporting such interventions has become imperative. The findings of this review will assist policy-makers and practitioners in high-income countries to make evidence-informed decisions about which programs are best suited to addressing specific maternal and child outcomes for disadvantaged families. This should in turn ameliorate some of the inequalities in child development that have significant social and economic costs.

The Rights of Children for Optimal Development and Nurturing Care

Millions of children are subjected to abuse, neglect, and displacement, and millions more are at risk for not achieving their developmental potential. Although there is a global movement to change this, driven by children's rights, progress is slow and impeded by political considerations. The United Nations Convention on the Rights of the Child, a global comprehensive commitment to children's rights ratified by all countries in the world except the United States (because of concerns about impingement on sovereignty and parental authority), has a special General Comment on "Implementing Child Rights in Early Childhood." More recently, the World Health Organization and United Nations Children's Fund have launched the Nurturing Care Framework for Early Childhood Development (ECD), which calls for public policies that promote nurturing care interventions and addresses 5 interrelated components that are necessary for optimal ECD. This move is also complemented by the Human Capital Project of the World Bank, providing a focus on the need for investments in child health and nutrition and their long-term benefits. In this article, we outline children's rights under international law, the underlying scientific evidence supporting attention to ECD, and the philosophy of nurturing care that ensures that children's rights are respected, protected, and fulfilled. We also provide pediatricians anywhere with the policy and rights-based frameworks that are essential for them to care for and advocate for children and families to ensure optimal developmental, health, and socioemotional outcomes. These recommendations do not necessarily reflect American Academy of Pediatrics policy.

How universal are universal preschool health checks? An observational study using routine data from New Zealand's B4 School Check

OBJECTIVES

We aimed to estimate how many children were attending a universal preschool health screen and to identify characteristics associated with non-participation.

DESIGN

Analysis of population-level linked administrative data.

PARTICIPANTS

Children were considered eligible for a B4 School Check for a given year if:(1) they were ever resident in New Zealand (NZ),(2) lived in NZ for at least 6 months during the reference year, (3) were alive at the end of the reference year, (4) either appeared in any hospital (including emergency) admissions, community pharmaceutical dispensing or general practitioner enrolment datasets during the reference year or (5) had a registered birth in NZ. We analysed 252 273 records over 4 years, from 1 July 2011 to 30 June 2015.

RESULTS

We found that participation rates varied for each component of the B4 School Check (in 2014/2015 91.8% for vision and hearing tests (VHTs), 87.2% for nurse checks (including height, weight, oral health, Strengths and Difficulties Questionnaire [SDQ] and parental evaluation of development status) and 62.1% for SDQ - Teacher [SDQ-T]), but participation rates for all components increased over time. Māori and Pacific children were less likely to complete the checks than non-Māori and non-Pacific children (for VHTs: Māori: OR=0.60[95% CI 0.61 to 0.58], Pacific: OR=0.58[95% CI 0.60 to 0.56], for nurse checks: Māori: OR=0.63[95% CI 0.64 to 0.61], Pacific: OR=0.67[95% CI 0.69 to0.65] and for SDQ-T: Māori: OR=0.76[95% CI 0.78 to 0.75], Pacific: OR=0.37[95% CI 0.38 to 0.36]). Children from socioeconomically deprived areas, with younger mothers, from rented homes, residing in larger households, with worse health status and with higher rates of residential mobility were less likely to participate in the B4 School Check than other children.

CONCLUSION

The patterns of non-participation suggest a reinforcing of existing disparities, whereby the children most in need are not getting the services they potentially require. There needs to be an increased effort by public health organisations, community and whānau/family to ensure that all children are tested and screened.

Children's health in Europe - challenges for the next decades

These reflections from a Child Public Health perspective underline the dramatic changes in children's conditions in Europe over this last century, including a considerable improvement in health. However, we still face problems, disturbing facts and alarming signs. There are important gaps in our knowledge about essential areas of children's health panorama and about particularly vulnerable sub-groups of children, which are less healthy, less well cared for and not enjoying the good conditions of life. We also see an evident lack of the child's perspective, implying acknowledgement and action on the views of the children themselves. Moreover, in spite of the generally improving standard, societal inequity in economy, education and health is increasing and the recent economic crises have struck hard on families with children. There are many good signs implying continuing progress for children and their conditions and also an improved respect for their rights. But with the increasing segregation in our societies, the risk is imminent that the health problems will increase, and that some groups get left far behind. Although actions on this field are primarily a political responsibility, people working with children can make a difference. There are also many examples of projects, particularly on local levels, where professionals act to promote children's health, prevent their ill-health and facilitate their health behaviour, rather than to repair their diseases. Children's particular needs and protection is now generally accepted, and the growing concern for their rights opens a window to the future for a more powerful child health advocacy.

Child health in Iceland before and after the economic collapse in 2008

After rapid economic growth, more than 90% of the Icelandic banking system collapsed within 2 weeks in October 2008. A severe economic crisis of historic proportion ensued from which Iceland is still recovering. To protect those most vulnerable, governmental response included policy measures aimed to address the needs of children, families, the elderly, those on social benefits and the unemployed. By the maintenance of free universal healthcare for pregnant women and children, child health has been preserved. Six years later, there is little notable impact of the crisis on key child health indicators. Yet, the proportion of children born small-for-gestational age increased from 2.0% to 3.4%. One important pillar for the outcome is the good coverage and easy access to universal healthcare, educational and social services with highly qualified professionals. Iceland has shown that, by protecting the most vulnerable and maintaining universal access to healthcare, children's health and well-being can be maintained during an economic crisis.

Family-related predictors of body weight and weight-related behaviours among children and adolescents: a systematic umbrella review

This umbrella review analysed the relationships between family variables and child/adolescent body weight, diet and physical activity. In line with theories of health behaviour change, it was assumed that behaviour-specific family variables (i.e. beliefs, perceptions and practices referring to food intake or physical activity) would have stronger support than more general family variables (i.e. socio-economic status or general parental practices). Data obtained from 18 systematic reviews (examining 375 quantitative studies) were analysed. Reviews of experimental trials generally supported the effectiveness of reward/positive reinforcement parental strategies, parental involvement in treatment or prevention programmes, and cognitive-behavioural treatment in reducing child/adolescent body mass and/or obesity. Results across reviews of correlational studies indicated that healthy nutrition of children/adolescents was related to only one parental practice (parental monitoring), but was associated with several behaviour-specific family variables (e.g. a lack of restrictive control over food choices, high intake of healthy foods and low intake of unhealthy foods by parents and siblings, low pressure to consume foods). With regard to adolescent physical activity, stronger support was also found for behaviour-specific variables (e.g. physical activity of siblings), and for certain socio-economic variables (e.g. parental education). Child and adolescent obesity prevention programmes should account for behaviour-specific family variables.

Trends in the coverage of 'universal' child health reviews: observational study using routinely available data

OBJECTIVES

Universally offered child health reviews form the backbone of the UK child health programme. The reviews assess children's health, development and well-being and facilitate access to additional support as required. The number of reviews offered per child has been reduced over recent years to allow more flexible provision of support to families in need: equitable coverage of the remaining reviews is therefore particularly important. This study assessed the coverage of universal child health reviews, with an emphasis on trends over time and inequalities in coverage by deprivation.

DESIGN

Assessment of the coverage of child health reviews by area-based deprivation using routinely available data. Supplementary audit of the quality of the routine data source used.

SETTING

Scotland.

PARTICIPANTS

Two cohorts of around 40 000 children each. The cohorts were born in 1998/1999 and 2007/2008 and eligible for the previous programme of five and the current programme of two preschool reviews, respectively.

OUTCOME MEASURES

Coverage of the specified child health reviews for the whole cohorts and by deprivation.

RESULTS

Coverage of the 10 day review is high (99%), but it progressively declines for reviews at older ages (86% for the 39-42 month review). Coverage is lower in children living in the most deprived areas for all reviews, and the discrepancy progressively increases for reviews at older ages (78% and 92% coverage for the 39-42 month review in most and least deprived groups). Coverage has been stable over time: it has not increased for the remaining reviews after reduction in the number of reviews provided.

CONCLUSIONS

The inverse care law continues to operate in relation to 'universal' child health reviews. Equitable uptake of reviews is important to ensure maximum likely impact on inequalities in children's outcomes.

Revised You're Welcome criteria and future developments in adolescent healthcare

In 2011, the Department of Health (England) will publish revised You're Welcome criteria. This is the first comprehensive attempt to define good quality health services for young people (11-19 years) and provide a self-assessment tool applicable to all adolescent health services. It builds on a growing understanding of the distinctiveness and importance of adolescent health, and the demands placed on adolescent health services. This article reviews changing understandings of the nature of adolescence, including physical, psychological and social transition, evolving patterns of morbidity and mortality, adolescence as part of a life-course approach to health and health behaviours, and the specific needs of young people when using health services. We describe key features of the You're Welcome criteria and discuss the views of young people and professionals involved in revising them, as well as relevant published literature. Lastly, we discuss how the perspective of social paediatrics may be useful in guiding professionals towards a more holistic approach to adolescent care in the future.

The enigma of the welfare state: excellent child health prerequisites--poor subjective health

The rate of subjective health complaints among Swedish children is increasing by age and over time, and more so than among children in other Scandinavian countries. In contrast, the somatic health and prerequisites for wellbeing are excellent. This paradoxical situation, The Enigma of the Welfare State, is the focus of this viewpoint. We argue that one important background factor may be late adverse effects of the welfare society itself and some of its inherent values. We have identified several possible pathways. We have given them names of diseases--on the society level--like health obsession, stress panic, welfare apathy and hyper-individualism. Together with other factors such as a dysfunctional school and an unsatisfactory labour market for youth, these diseases are involved in an interplay that is constantly inducing anxiety and low self-esteem.

CONCLUSION

The gradually deteriorating self-reported health among Swedish youth may, to some degree, be explained as a late adverse effect of the welfare society itself and its inherent values.