Resource material to support primary health organisations in addressing social determinants of health Information for the PHO Alliance March 2016 version Equity for children’s access to health

Resource for PHOs to use and share, outlining: 1.The Case for Action: Evidence about the effects of poverty on child health and other outcomes Poverty as a determinant of health and long-term poor outcomes for children Evidence of size of problem for New Zealand children Wider costs of childhood poverty 2. What can PHOs do: Evidence-based mitigation measures that improve outcomes for children in poverty Six broad areas that children need support How each affects childhood outcomes Possible actions for PHOs

Part 1: The Case for Action Evidence about the effects of poverty on child health and other outcomes

Goal for NZ: All children thrive We want a New Zealand where all children can thrive because they… have enough resources to meet their needs live in safe, healthy homes do not suffer preventable illnesses go to school ready to learn and achieve grow up emotionally supported and loved But now many children are growing up without access to the things they need to thrive

Growing up in poverty is a real limitation to children’s health and wellbeing Children are growing up without access to the things needed to thrive: Healthy homes Nurturing families free of stress Engaging fully in school Part of a community with play and skills opportunities Full access to health care Adequate income to have basic needs met

What are the impacts of child poverty?

Part 2: What can PHOs do? Evidence-based mitigation measures that improve outcomes for children in poverty

What children need for health and wellbeing A safe, healthy home Stable, nurturing family A supportive community Having basic needs met Engaging in education Access to health services Ensuring good health despite poverty needs action across all these

Accessible health services PHOs have a role to ensure all children access their free health care services Govt provides core health services Communities are called on to reduce the barriers to accessing health services. What to do or get partners to do: Work in schools to assess and treat children, and teach parents about illness Appointment times that work for families; reminders, in-person calls Ensure child health care despite family debt Help pregnant women enroll with LMC Transport to appointments Care for other siblings Work with LMCs to enroll all newborns with PHOs Ensure new mother’s plans for contraception are followed-up post-birth

Affordable, safe, healthy homes Housing is major determinant of health Private rentals and state housing can be low quality Partner with community organisations to provide material housing needs (e.g. curtains, carpets) What to do or get partners to do: Advocate for DHB involvement in healthy housing initiatives Assess home status and safety on each home visit (WCTO, nurses, LMCs) Advocate to help patients access healthier homes (private rental or state housing) Advocate in tenant tribunals Inform about healthier sleeping arrangements (in crowded housing) Partner with community organisations to provide material housing needs: insulation, curtains, carpets, and quality, efficient heating.

Stable, nurturing family What to do or get partners to do: Follow up all referrals for parenting programmes, or secondary health care Home visits and family/environment checks Health advice - breast-feeding support, health-line Address parent mental health issues Address relationship issues / family violence WCTO – parenting supports (promote play with, talking to, and focus on child – giving attention, positive reinforcement, reading to children - even very young toddlers, tools for dealing with child behaviour etc) PHOs fundamentally help families /parents through direct health care provision or referrals: Secondary health care Mental health care Brief interventions e.g. on alcohol use Relationship counselling Wellbeing checks Safety checks

Supportive community What to do or get partners to do: Understand importance of community infrastructure (asset mapping) e.g. child care centres, kohanga reo, kindergartens, schools, churches, Marae, sports clubs, community halls Foster, and engage collaboratively with, potential partner community organisations and key people Advocate for play, sport and recreation facilities for children Advocate for youth mentoring organisations Connect families with community charities – to volunteer, or to benefit from their services Advocate for community empathy of those in poverty PHOs sit within communities providing a core service. Community organisations do a lot to help families access those core services, and are partners in health care provision and supporting child wellbeing. Communities create safe places for children’s play and recreation. PHOs can foster these.

Adequate income to meet needs Ultimate cause of child poverty is low parental income. This is a key determinant of health and is not entirely outside a PHOs realm of influence. PHOs have key role to play in advocating for children in poverty Health and other community organisations can fill gaps in families’ material needs. What to do or get partners to do: Advocate for progressive tax and living wages Give training and job opportunities to help people ‘move up’ Help families have their material needs met by supporting or referring to: Health Promoting Schools, Food in Schools Microfinance Collection and distribution of second-hand goods, food banks, children’s books and clothing Negotiate discounted energy/ install pay-as- you go options for home heating

Supportive education sector Education itself mitigates effect of poverty; but poverty creates unequal education opportunities. PHOs have a core role to help children’s education through: Keeping children well Counselling for transient children (referrals) Supporting social workers in schools PHOs can also work across communities to create an education sector that is more supportive of child health and wellbeing. What to do or get partners to do: Health hubs in schools– DHB nurses in schools Be aware of, and support, programmes in schools: Health Promotion Agency activities Health Promoting Schools External providers for curriculum learning modules, e.g. health, safety, relationships, bullying, drug or alcohol, nutrition, diet etc. School food programmes, garden to plate Homework clubs / before and after school care

Where should we focus? Greatest need for external support Greatest harm incurred Greatest inequalities Greatest return on investment Very young children (Pre-birth to age 6) Māori and Pasifika children Children in sole- parent families Children in severe and persistent poverty In all cases, the voices of children should be sought to ensure child-centred thinking