ENSURE ALL CHILDREN ACCESS THE HEALTHCARE THEY NEED
The first 1000 days are the most important part of life’s trajectory, and must be prioritised more. Whānau who live with poverty are more commonly sick, with higher rates of physical and mental ill-health, than those who are not in poverty. Children living in the 40% poorest neighbourhoods consistently experience inequitably higher rates of potentially avoidable hospitalisations.. The leading cause overall of such hospitalisations for children is respiratory illnesses – often “diseases of poverty” which are worsened by cold, damp, crowded homes.
Serious pregnancy and childhood health conditions can potentially be avoided by: actions in the community (timely perinatal care and primary care); public health activities that improve and promote health of the population (eg immunisation, injury prevention); and social policy actions that address factors such as adequate incomes, healthy housing and underlying racism.
Adolescence (also developmentally important) should attract appropriate care, attention and resourcing.
RECOMMENDATIONS
1. Ensure every child can access healthcare to meet their needs, at all times
Ensure every infant is enrolled with an accessible general practice where the whānau feel welcomed, comfortable and supported, ideally with Lead Maternity Carers checking and supporting the enrolment of the pregnant parent pre-birth or, at the latest, at birth.
For families who move between areas, ensure that ease of shifting general practice enrolment is enabled for all children and whānau, using system navigators where necessary.
Address the shortage of midwives to enable ease of access for all low-income parents-to-be as early as possible in pregnancy by ameliorating their conditions and recruitment.
Ensure all Well Child Tamariki Ora checks and immunisations are made accessible and their approach is fit-for-purpose for every whānau wherever they live; if issues are found, ensure that appropriate follow-up of the child occurs using system navigators where necessary.
Increase resourcing to support primary care, after-hours and emergency department services to deliver safe, effective and timely services, particularly for children.
Increase resourcing in schools to support School-Based Health Services under Te Whatu Ora, involving students in the design and ensuring all healthcare occurs in a safe comfortable environment with practitioners whom students trust.
We note that rangatahi contributing to the Taitamariki Youth Declaration call for “educational programmes on how to recognise symptoms and support those with mental health issues” including via seminars in schools.
Te Whatu Ora and Te Aka Whai Ora need effective strategies to address racism and discrimination in the healthcare system. Develop, resource and implement strategies to address these issues, and in particular, support the development of Kahu Taurima to address the following issues identified: 1. Service delivery racism, discrimination and ableism; 2. Barriers to appropriate perinatal education; 3. Support for distress and bereavement during the first 2000 days; and 4. Better rural access to primary and specialist perinatal parental and early years care.[iv]
Substantively increase resourcing to child and youth mental health so that, at minimum, it has resourcing parity with adult mental health services per person in need.
2. Make all healthcare free for all children from pre-birth to 18 years, at all times
Make all General Practice visits (not just pregnancy-related GP visits) free during pregnancy, including for mental health.
Make dental care free for all pregnant people up until 6 weeks after birth.
Extend current free General Practice visits to all children up to 18 years; and to all people with Community Services Cards (in order to cover caregivers in low-income families).
·Make all after-hours healthcare services free for all children up until 18 years in all parts of the country.
Introduce fees-free visits to primary mental health support and perinatal parental mental healthcare.
IMPACTS AND INDICATORS
If implemented, these actions would be steps towards moving Aotearoa to be a nation where all children and families flourish free from poverty.
Meeting the health needs of every child will assist the Crown in addressing Te Tiriti o Waitangi obligations, including health equity, and assist New Zealand to meet:
· Targets for UN Sustainable Development Goal 3: “Ensure to ensure healthy lives and promote well-being for all at all ages”. This includes “3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
· Obligations under the UN Convention on the Rights of the Child, Article 24: “recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such healthcare services.”
And meeting the health needs of every child will help us all realise the national vision “that New Zealand be the best place in the world for children and young people”.
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