It's Time To 'Gonski' Health Care For Children
When it comes to our children’s education, needs-based funding for schools is well supported and understood.
It’s a concept that we need to see more of in child health services because inequities in educational outcomes are replicated in health outcomes and the gap in health and development is getting worse.
There are groups of children who are particularly at risk, including Indigenous children, children of refugee families and children with disabilities. Wealth has a powerful influence. For example, Aboriginal and Torres Strait Islander people with higher incomes experience better health than those on lower incomes.
Increasingly, wealth is determining health for Australian children, despite our relatively robust overall healthcare system.
Our healthcare system, like our schools, is an incredible piece of infrastructure. It has the power to dramatically decrease inequity in children’s health, if we use it wisely.
For a disadvantaged child, a visit to a GP can be life changing. It’s an important meeting of child, family and healthcare system. While a child might come in with a cold, a GP may detect other symptoms that could have otherwise gone unnoticed.
We know from recent research that children are visiting GPs at similar rates regardless of whether they are from a wealthy or disadvantaged area.
While this seems equitable, it’s not when we take into account the adverse impact of disadvantage.
Poor children get sick far more often so to be genuinely equitable, we should be seeing these kids in GP clinics more often.
Many child health concerns need the attention of a specialist, such as a paediatrician, so that they can be fully dealt with before growing into much bigger problems in adulthood.
Despite public funding, disadvantaged children are far less likely to see a specialist than those from wealthier families.
Thus, children from disadvantaged families are less likely to fully access our health care system at the primary health care and specialist level.
Our health system can’t just be there for those who come looking. We need to reach out to families and children in need and deliver this system at the right dose and intensity that is likely to make a difference.
The onus must shift from the family to the health system in determining when a child gets the right health care, if we are to close the growing inequity in child health.
We have plenty of evidence that shows the most cost effective to way to deal with adult health inequity as a nation is to tackle it in childhood.
Our current, growing gap in child health is going to become a much bigger, more expensive problem if we don’t act now.
So what can we do?
For more than a year, we’ve been working together as a group of paediatricians, public health experts and policy experts to develop The Royal Australasian College of Physicians’ position statement on inequity in children’s health. Inequities in health are inequalities that are unfair, unnecessary, systematic and preventable. They reflect the adverse impact of socioeconomic disadvantage on health and access to health care.
This is a systemic problem. The community, health care professionals, the Federal Government and state and territory governments all have a role to play in solving it.
We know the federal government is committed to children’s health – the last budget included a $77.9 million funding package for infant and maternal health, with a focus on the first 2,000 days of a child’s life.
We’re calling on the federal government to expand on its commitment to children’s health by appointing a national, clinical leader – a chief paediatrician – with a mandate to end the growing inequity in children’s health.
Not only do we need national clinical leadership dedicated to solving this problem, we also need more transparency.
We’re recommending the federal government require all governments to report annually on action taken against the Australian Institute of Health and Welfare’s established set of headline indicators on children’s health, including obesity, development, wellbeing, dental health and infant mortality.
With this leadership and transparency in place, we can work towards achieving needs-based health funding for all Australian children.
We’d be taking a leaf out of the Gonksi education book, but we also have some fantastic examples of success in our own field. For example, the health system has successfully reached out to disadvantaged children to ensure that they are properly immunised. Similarly, when a child is diagnosed with leukaemia, the health system makes sure that regardless of who they are and where they live, they get the right treatment. As a result, we don’t see socio-economic disadvantage in children’s leukaemia survival rate or immunisation rates.
We know that we can achieve truly equitable healthcare for our children and paediatricians are passionate about making sure we do.