Solutions to Child Poverty: Our Initial Proposals: Health Nikki Turner Expert Advisory Group September 2012

The Challenge Mandate: to advise the Children’s Commissioner on how to reduce child poverty and mitigate its effects

Health and poverty Living in poverty (usually by economic measures) – Higher infectious disease rates – Higher hospitalisation rates – Higher rates of assault/neglect/maltreatment – Poorer nutrition – Poor long term outcomes in adulthood: heart disease, alcohol and drug addiction, mental health, poor oral health – Higher rates of disability short and long term – Higher risk of dying – Inequalities for all even greater for Maori and Pasifika children approx. an extra 5000 socioeconomically sensitive admissions per year in NZ Early years particularly important!

Key questions for feedback We are particularly interested to know your views on: 1.Which proposals will be effective in reducing child poverty? 2.Which proposals are less likely to be effective? 3.What are the most important proposals to reduce child poverty? (i.e. what should the main priorities be?) 4.What needs to be done first and why? 5.What is missing from our proposed package of proposals?

Guiding principles Be child-centred and family –focused Support child health and wellbeing by ensuring sufficient resources Be evidence-based Support children from before birth Promote equality of early development opportunities for all children Ensure that effective Maori and Pasifika models that improve child outcomes are available, evaluated and utilised

Recommendation 1 Fund child health using the principle of ‘proportionate universalism’ The government to develop a maternity and child health funding strategy based on the principle of proportionate universalism, providing universal services and targeted extra services based on assessment of need Combined with a re-configuration of government expenditure for children to increase spending during the early years, starting with antenatal and early postnatal services.

Recommendation 2 Connect more pregnant women with maternity services earlier The EAG recommends that the government direct health services, using District Health Boards as one mechanism, to increase the update and early engagement with maternity services (by 10 weeks of pregnancy) particularly for women from low socioeconomic backgrounds, especially teenagers, Maori and Pasifika.

Recommendation 3 Develop a common assessment pathway The government to develop, implement, and evaluate a common assessment pathway for all children, service planning and delivery approach starting antenatally and continuing through to age 5 yrs. One assessment tool is applied and shared by all practitioners. An assessment plan is used to identify needs and vulnerabilities, develop a service plan and monitor progress

Recommendation 4 Develop a national plan to improve child nutrition - Including a food in schools programme (under education recs)

Recommendation 5 Free primary health care for all children Short term: The Ministry of Health to continue to implement the current national initiative to establish free primary care visits for all children from 0-6, 24 hours/7 days a week and set a specific target to make timely progress towards 100 % coverage Long term: Extend free primary health care for all children under 18 years of age. The government to gradually reduce parent co-payments forth care children older than six years of age until access to free primary care visits 24 hours/7 days a week can be achieved for all children to age 18

Recommendation 6 Secure funding for youth-friendly school-based health and social services The government to establish additional sustained funding for youth-friendly health and socials services in all decile 1 – 3 secondary schools.

Recommendation 7 Streamline information systems across health and social services We recommend the development of a single enrolment system, combining information collected by the National Health Index, NIR, Well Child/Tamariki Ora, and the Shared Maternity Record of Care, through to age 18. Short term action: enrol all children at birth with a primary health care provider (NHI assigned at that time), the NIR and with Well-Child/Tamariki Ora (WCTO) providers. Medium term action: expand the current IT Health Board's Shared Maternity Record of Care project to include the child health shared record through to age 18. Long term: progress the development of a single enrolment information system for all child health and social services.

Recommendation 8 Evaluate community-based services across health and social services We recommend the government to evaluate existing community-based services that incorporate health and social services in high deprivation communities (e.g. integrated and co-located models of service delivery), systematically piloting, conducting effectiveness trials, and,based on the results, implementing the effective approaches in additional high deprivation communities

Recommendation 9 Prevent problem gambling and smoking Support the objectives of the Ministry of Health’s (2010) Preventing and Minimising Gambling Harm: Six-year strategic plan, especially targeting prevention efforts for low income families six-year-strategic-plan Support health targets of expanding smoking prevention and reduction initiatives

Gaps? Disability Services strategy…. Others ?