Politicians Kill Children?

Politicians kill children. That appears to be the message of the latest report from the Children’s Commission. Consider it Cindy Kiro’s parting gift.

“Kiwi kids are dying in accidents and from abuse and Third World diseases due to political apathy, doctors and child welfare experts say.”

Not sure about the “Third World diseases” bit. It is my experience that diseases don’t come with labels. You get malnutrition even in America, the wealthiest country on earth. We do have a relatively large number of un-immunised children who get these preventable diseases, but that hardly makes them “Third World”.

Child abuse, however, is another matter. Our statistics in this regard are nothing short of catastophe. Unfortunately, all the evidence suggests that the solution does not lie in politics, but in zero tolerance towards the factors that cause abuse, namely, absent fathers, alcoholism and drug abuse.

The report suggests that we “educate parents about the dangers of shaking babies”. This assumes that parents don’t know that shaking a fragile newborn is dangerous. I think this is highly unlikely. No amount of education will stop the shaking of babies, only the elimination of the precipitating factors – young parents with inadequate support groups, alcohol and drug abuse, absent or multiple fathers and the like.

Poverty is cited in the report as being the most important thing to eliminate. Yet poverty does not explain why the incidence of child abuse is three times higher in the Maori population than it is in the Pakeha population. Sure, there are proportionally more Maori in poverty than Pakeha, but it is certainly not three times as many. Clearly there are other things going on that are more important than poverty alone.

Statistically, there are many other markers that are more closely correlated with child abuse than poverty itself. Those mentioned in the preceding paragraph are some of them, but the strongest correlation by far is a history of abuse as a child. Such a history is also strongly related to dysfunctional relationships and a failure to succeed. It is also strongly related to poverty. It is this cycle that needs to be broken, not simply poverty. 

Government legislation is almost entirely useless here. There is value in supportive roles such as Plunket, but educational and punitive roles are virtually useless and may even be counterproductive. The repeal of section 59 is an example of this – it has made no difference to child abuse statistics and the backlash from parents dealing with ill-disciplined children may result in an increase in such statistics in future years.

In addition to the Children’s Commission report, paediatricians also made some suggestions for government intervention for child health reasons. They were:

• More Paediatric ICUs – While it is true that a child is twice as likely to die in a adult ICU than a paediatric one, this is entirely dictated by the number of potential cases for such an ICU. If there is inadequate throughput, it is not possible to maintain the skill set of the nurses and doctors, rendering the ICU non-viable.
• 20kmh zones around schools and busy pedestrian areas – Not a bad idea, but likely to play havoc in rush-hour traffic. The real problem around schools is not the speed of cars, it is the massive congestion of poorly parked cars, buses and school children that makes the area so deadly for children. Staggering school start times and class schedules would go a long way to stopping this.
• Booster seats for all children till they turn nine or are at least 148cm tall – Good idea. Hard to police.
• Teaching new mums about accidents in the home and child skin infections. – Almost everything about preventing accidents is common sense. In my experience, you can’t teach anyone common sense. This might work if the accidents chosen are two or three of the most common and the take-home message does not contain more than five ideas.
• Establishing child rehabilitation services – See the remarks on Paediatric ICUs
• Removing charges for after-hours medical care for children – The only one I utterly disagree with. There is absolutely no evidence at all that financial considerations play any part in the decision making of parents with sick children, especially after hours. Emergency Departments are free and everyone knows it. Every parent of a late-presenting, sick child I have met in the past decade have either not recognised their child was sick (sometimes code for too drunk to notice) or “didn’t want to bother the doctor” (sometimes code for couldn’t be bothered to come). Subsidising the GPs and A&M after hours services will simply spread normal consultations over a longer part of the day and be of most assistance to those wealthier people who normally use such services for convenience.

I find it interesting that, as usual, the hallmark of the Children’s Commission is to harp on things like poverty and children’s rights, while ignoring the realities of cycles of violence in communities that are unrelated to these things. Likewise the medical fraternity once more puts forward suggestions without thinking out their social ramifications. These are the stock responses that again reveal that the very people we are relying on to produce solutions are not able to think laterally, but only in the same old grooves. Most of these ideas are tired, or simply not doable.

My advice to Tony Ryall would be to give these reports to some innovative thinkers with a reputation for off-the-wall ideas and see if they can come up with something that might actually work.

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