The current and future state of child health and wellbeing in Aotearoa New Zealand: part 1

Childhood and young adulthood are important stages of growing, learning and development. Yet, there are increasing pressures and challenges that children and young people face. These factors may adversely impact upon their health and wellbeing, and thereupon have long-lasting effects on our society as a whole.

Factors include public health issues such as poverty and household overcrowding, food security, persistent and pervasive health inequities (especially for tamariki and rangatahi Māori and Pasifika children and young people), the rights of children and young people, impacts of technology, climate change, changing patterns of disease and many others. These factors impact on education, nutrition, development, health (physical, mental or dental) and also have long-term impacts beyond childhood and adolescence. In addition, these factors often impact more on specific social groups within Aotearoa New Zealand including tamariki and rangatahi Māori and Pasfika children and young people, as well as others, for instance children and young people who identify as Rainbow.

Our vision is for all children and young people in Aotearoa New Zealand to thrive and flourish as our leaders of today, through the full realisation of their rights to health and wellbeing. Yet we know this does not happen for all. The links between colonisation and significant health inequities that occur for Indigenous peoples compared with non-Indigenous is well described internationally and in Aotearoa New Zealand. The stark health inequities that are experienced by pēpi, tamariki and rangatahi Māori in Aotearoa New Zealand are described elsewhere in the literature as the ‘manifest symptomatology of colonisation, coloniality and racism’ (King et al. 2018, p. 187). Further, as highlighted by Cormack and King (2022) colonisation ‘fundamentally disrupted Indigenous knowledge systems, establishing epistemic hierarchies that privilege Eurocentric colonial epistemologies and methodologies’ (p. 1).

Pēpi, tamariki and rangatahi Māori have specific rights to health and wellbeing under Te Tiriti o Waitangi (Te Tiriti) (King et al. 2018), which forms the foundation of the contractual relationship between two sovereign nations–Māori, as tāngata whenua of Aotearoa, and the Crown (Jackson 1985). Te Tiriti articulates tāngata whenua rights to health and wellbeing for pēpi, tamariki and rangatahi Māori under all four articles collectively with the intent of Te Tiriti as expressed through the phrasing and words of the text (King et al. 2018). Yet as a country we have failed to respect, protect and fulfil these rights for all pēpi, tamariki and rangatahi Māori.

In order to highlight the pressures and challenges experienced by children and young people growing up in Aotearoa New Zealand, this special issue of the Journal of the Royal Society of New Zealand is the first of two volumes bringing together manuscripts focusing on aspects of health and welfare/wellbeing relevant to children and young people.

In pursuit of wellbeing for all children and young people, and equity within health, welfare and beyond, it is vital to make space for children and young people to have their voices heard. As part of this, we have ensured that there is rangatahi Māori representation on the guest editorial team for this special issue, as well as inclusion of rangatahi Māori and other young people as authors of its constituent manuscripts. The voices and expertise of children and young people must not be underestimated, particularly if we adults are professing to act in their best interests.

The manuscripts in this issue focus on the critical importance of the first 1000 days, oral health and food security, mokopuna Māori perspectives of well-being, and adolescent health and well-being. Together they highlight critical issues, including inequities, and provide a clear challenge to us all to enact transformative changes for current and future generations of children and young people. For transformational change to occur, we must honour the voices and experiences of children and young people in Aotearoa New Zealand and uphold their individual and collective rights.

A focus on early events that influence child health and wellbeing

The first 1000 days refers to the time from conception until the child’s second birthday (Cusick and Georgieff 2016). This is a time of significant vulnerability, massive change and also huge potential. Optimisation of all relevant opportunities for all children within this time is integral to short-term and long-term health and wellbeing (Barker 2003). Furthermore, the intragenerational effects of deprivation and inequity across the life course will feed into adverse outcomes for subsequent generations facing the challenges of their first 1000 days.

In their critique of the adverse impacts on hauora Māori of the delegitimization of Māori ways of being, knowing and doing, Edmonds et al. (2022) present an extensive body of Kaupapa Māori and Māori led translational research to inform transformational changes that achieve tino rangatiratanga and health equity for pēpi and whānau Māori. The research they present focuses on approaches to preconception, Hapū Ora and the first 1000 days. The authors lay down their wero (challenge) to all of us to decolonise our current systems and approaches to improve hauora Māori, especially regarding the first 1000 days.

Oral health and food security: two determinants of child well-being

One of the manuscripts published focuses on aspects of oral health in Aotearoa New Zealand whilst a second reports on aspects of food security. These are two key determinants of the outcomes of individual children and young people, and of our society as a whole.

Boyd et al. (2022) review aspects of oral health in young people in Aotearoa New Zealand. Dental caries is the foremost non-communicable disease in Aotearoa New Zealand. This condition is more marked in tamariki Māori and Pasfika children, those living in lower socio-economic conditions and those residing in areas without fluoridated water. The authors highlight the many issues that lead to high rates of dental caries and provide a guide to how Aotearoa New Zealand might overcome this challenge.

In a prospective assessment of 2,087 school students from the Hawkes Bay region of Aotearoa New Zealand, McKelvie-Sebileau et al. (2022) identified a number of concerns relating to food environment and nutritional outcomes. More than 16 percent of children and young people reported food insufficiency in their households. Few of the respondents reported having fruit and vegetable intake meeting recommended guidelines, however higher rates of vegetable intake were reported by children and young people from high-advantage (high decile) schools. Overall, this report highlights important issues in the food environment (food insufficiency and insecurity) with deprivation having a large impact. While specific to Hawkes Bay, many of these issues are relevant nationally. The authors highlighted some aspects of approaches that might ameliorate these concerns.

Privileging the views and experiences of mokopuna Māori

Two manuscripts highlight that discussion around the health, welfare and wellbeing of children and young people cannot happen without acknowledging the voices and experiences of children and young people themselves, including mokopuna Māori. King and Cormack (2022) share the findings from a Kaupapa Māori qualitative research study exploring mokopuna Māori concepts of wellbeing through the privileging of the worldviews and experiential knowledge of mokopuna Māori aged between 6 and 13 years. The authors reaffirm the critical importance of recognising mokopuna Māori as knowledge holders, creators, and makers of meaning to participate in, and articulate their views on their own wellbeing, and other matters of importance to them.

Moton et al. (2022) present their work about honouring the experiences of mokopuna Māori who have lived through the state care system. This Kaupapa Māori qualitative study focused on mokopuna Māori who have care experience, in relation to the conditions that exist and are needed to uphold wellbeing. The findings arising from this work highlight the importance of honouring their experiences and upholding their individual and collective rights, particularly within the highly politicised climate surrounding the state care sector. The authors state that for this to occur, the importance of identity, relationships and stability must be recognised and acknowledged within the context of affirming and maintaining a sense of belonging and whakapapa connections.

Adolescent health and well-being: the final steps towards adulthood

The World Health Organisation (WHO) defines adolescence as the period between childhood and adulthood, within the ages 10–19 years (WHO 2022). This is a critical period characterised by pubertal development, increasing maturity and increasing independence from parents or caregivers. During this time of considerable biological and social change, adolescents lay down the building blocks for their future lives. Some of these building blocks can set the scene for both future positive and negative trajectories, as illustrated by four of the reports in this issue.

Carlson et al. (2022) present the findings of an in-depth, collaborative qualitative research study exploring rangatahi hauora with 56 culturally diverse young people aged between 16 and 20 years. Structured around the Whakawhanaungatanga Conceptual Model, the study findings foreground the role of relationality in the narratives of young people, challenging predominant individualisation approaches to wellbeing for young people, and emphasising the strengths of young people and the contributions they have to make. The authors provide a broader context for approaches to the wellbeing of young people, and emphasise essential elements regarding connections and relationality that services and providers must consider.

Fleming et al. (2022) examined the patterns and progress of a number of key indicators of health for young people in Aotearoa New Zealand over two decades. Data were available from four national surveys of young people (the Youth2000 surveys): the first in 2001 and the last in 2019. Overall, the data reported in these surveys demonstrated improvements in several indicators (e.g. recent binge drinking and recent risky driving) but worsening in key mental health fields (such as depression and suicidal ideation). These surveys highlight the changes that have occurred in successive cohorts of young people, and this paper highlights the value of monitoring the health and wellbeing of young people over time. We cannot assume that the challenges faced by adolescents remain the same, as well exemplified by the COVID-19 pandemic.

Ball et al. (2022) have explored aspects of substance abuse by young people in Aotearoa New Zealand. The authors used data from five different surveys that have documented aspects of substance abuse over periods of up to 30 years. Overall, these data show declining rates of alcohol, tobacco and cannabis use. In contrast, more recent data alarmingly show increasing rates of vaping. The authors highlight that there are wide ethnic and socio-economic inequities within these patterns and call for ongoing monitoring of patterns and related policies.

Young people identifying as transgender, gender diverse, intersex or other (sometimes termed as Rainbow) are at increased risk of mental health concerns or other inequities (Connolly et al. 2016). Fraser et al. (2022) report data arising from a survey of 955 young people identifying as Rainbow. The survey respondents illustrated mixed experiences with mental health services. The authors provided practical suggestions for mental health services and providers that might enhance the support and outcomes for the Rainbow population in Aotearoa New Zealand.

Conclusions

Together these nine manuscripts emphasise a number of the challenges faced by children and young people in Aotearoa New Zealand. Several of the manuscripts included in this special issue demonstrate how positive transformative actions across policy and practice can influence the health and wellbeing outcomes of children and young people. Our wero as a society is for every one of us to take urgent action to address the issues raised and implement the solutions contained within this volume, so that all children and young people experience maximal health and wellbeing, allowing them the opportunity to claim their space as our leaders of today and the future of Aotearoa New Zealand.