The current and future state of child health and wellbeing in Aotearoa New Zealand: Part 2

KEYWORDS:

• Children
• tamariki, adolescents
• rangatahi
• youth
• health
• hauora
• mental health
• wellbeing
• nutrition
• health equity
• oral health, Kaupapa Māori
• indigenous

Optimizing maximal health and wellbeing outcomes for all children and young people in Aotearoa New Zealand is a societal responsibility. The implications of ignoring poor health and wellbeing outcomes are manyfold, with compromised quality of life and increased costs in the short term, compounded by adverse effects across the life course that have intergenerational impacts.

This special issue of the Journal of the Royal Society of New Zealand is the second of two volumes bringing together manuscripts highlighting issues relevant to the health and welfare/wellbeing of children and young people in Aotearoa New Zealand. The first part of this special issue covered some important aspects of life from conception to adolescence (Materoa Moton et al. 2022). In particular, the manuscripts focused on the critical importance of the first 1000 days, oral health and food security, honouring mokopuna Māori views and experiences around wellbeing, and issues in adolescent health and wellbeing including for Rainbow populations. This second part of the special issue comprises a further nine manuscripts that highlight a number of social determinants and impacts on health and wellbeing outcomes for children and young people, and their families and whānau in Aotearoa New Zealand.

Together this special issue of 18 manuscripts call our attention to the various challenges that children and young people in Aotearoa New Zealand face now, and into the coming years. They place further emphasis on the importance of situating such challenges within the broader context of colonization, coloniality and racism and impacts on the health and wellbeing outcomes of all children and young people in Aotearoa New Zealand.

Social determinants of health and wellbeing for children and young people

Health and wellbeing outcomes for children and young people are heavily influenced by the conditions into which they are born, grow, live, work and age, and those broader systems (such as political systems, economic policies and societal norms) that shape the conditions of their daily lives (World Health Organization [date unknown]). Several of the manuscripts collated within this special issue place emphasis on social determinants of health and wellbeing, and their impacts on equitable outcomes for children and young people in Aotearoa New Zealand.

Access to nutritious food is essential for health and wellbeing of children and young people – influencing weight gain, linear growth, development and learning amongst other outcomes. Macaulay et al. (2023) provide critical insights into food insecurity for families and whānau in Aotearoa New Zealand. The first component of their study comprised face-to-face interviews with six female solo-parents. Participants highlighted the impact of low household income relative to essential household outgoings, and the consequent balance between being able to access food to feed their households within the context of paying the rest of the household expenses. The second component of the study utilized data from two large-scale surveys demonstrating high prevalence of food insecurity for households with considerable inequities reported by ethnicity and by disability status.

A study undertaken by Muller et al. (2023) examined associations between poor sleep and impacts on child health equity. The study used data from a longitudinal programme of research on maternal and child sleep and health from a nationwide pregnancy and birth cohort that included 340 tamariki Māori and 570 non-Māori children (approximately 3 years of age) which demonstrated associations between sleep and socioeconomic or physical health outcomes, with ethnic inequities occurring whereby tamariki Māori had higher odds of poor health for all of the health measures. The study findings highlight the role of poor sleep health in the pathway between social disadvantage and ethnic inequities in health and wellbeing outcomes for young children. The authors challenge the readers to address systemic drivers of racism, and social and sleep inequities, in order to achieve health equity in early childhood.

The manuscript by Russell et al. (2022) also focuses on the impacts of social determinants of health equity in early childhood, undertaking a latent profile analysis of developmental health status in a cohort of more than 6000 preschool children, and its relationship with socioeconomic factors. Overall, young children were more likely to be classified with suboptimal developmental health (early learning skills difficulties, physical health difficulties, and developmental difficulties) if they experienced unmet healthcare needs, faced socioeconomic disadvantage or were of Māori or Pacific ethnicity. One in four children were classified as having suboptimal developmental health. The study reiterates how eliminating barriers to optimal developmental health for children is critical to improving health and wellbeing over the life course.

Kokaua et al. (2023) draws attention to access to continuing education and impacts on health and wellbeing for Pacific families in Aotearoa New Zealand. Using linked population data, the authors examined the association between parental education levels and potentially avoidable hospitalizations for children and young people under 20 years of age who are Pacific and non-Māori non-Pacific (nMnP). Higher parental education was protective for Pacific children and young people, associated with a reduction in the risk of potentially avoidable hospital admissions. The authors highlight the importance of Pacific-focused initiatives that support continuing education that meets the needs of Pacific learners, as an investment for the health and wellbeing of Pacific families.

A study by Oben et al. (2023a) places renewed emphasis on addressing rheumatic fever, a critical public health issue in Aotearoa New Zealand potentially preventable through addressing social determinants of health equity and ensuring equitable access to primary healthcare. The authors present data on hospitalization rates for acute rheumatic fever in children aged 0–14 years over the period 2000–20, and during the earlier stage of the COVID-19 pandemic (to May 2021). Findings highlight the persistence of inequities over time by ethnicity (Pacific children and tamariki Māori) and for children living in the most deprived areas. Furthermore, the data delineated how incidence of acute rheumatic fever hospitalizations in children reduced overall during the five years of the Rheumatic Fever Prevention Programme (a government initiative to prevent rheumatic fever). However, the downwards trend was not sustained following government cessation of this programme in 2017. The study findings reiterate the urgent need for renewed efforts to implement innovative evidence-based strategies that address rheumatic fever and eliminate inequities in outcomes for children and young people.

A further study by Oben et al. (2023b) examined potentially avoidable hospital admissions over a 20-year period (2000–19) for tamariki and rangatahi Māori under 25 years of age compared with nMnP, focusing on magnitude of inequity by deprivation. Across the duration of the 20-year study period, higher rates of potentially avoidable hospitalizations for medical conditions persisted for Māori compared with nMnP. Absolute differences in potentially avoidable hospitalization rates between most and least deprived areas were higher for Māori compared with nMnP. Respiratory and skin infections accounted for almost two-thirds of admissions for tamariki and rangatahi Māori. The study findings place further emphasis on the urgent need to implement effective policies that eliminate deprivation-based inequities, whilst improving both access to, and high quality of care.

Fraser et al. (2023) draw our attention to the impacts of homelessness on young people in Aotearoa New Zealand. Using linked population data, the study examined outcomes for 69 previously homeless young people aged between 18 and 25 years who received housing and support from a ‘Housing First’ provider. Baseline and follow-up data on government service interactions and other outcomes were explored. The authors reported a significant increase in total income for the cohort of young people along with reduced episodes of hospitalizations and emergency department admissions following being housed. The findings of the study highlight how access to housing improves outcomes for young people and lends further support to the ‘Housing First’ programme.

Maessen et al. (2023) highlight the focus of the Better Start National Science Challenge upon aspects of the wellbeing of children in Aotearoa New Zealand. The authors identify significant gaps in the measurement of wellbeing and in ways that fully incorporate Māori perspectives. Through the themes of Big Data, Healthy Weight, Resilient Teens, and Successful Learning, the Better Start Challenge has promoted research that enables solutions. The authors further highlight future challenges to wellbeing, including technological advances and climate change.

The final manuscript in this special issue is co-authored by young people with care-experience, and reiterates the importance of prioritizing the voices of children and young people in Aotearoa New Zealand. Kemp et al. (2023) provide an overview of ‘Kia Tika, Kia Pono – Honouring Truths’, an ethical framework for engaging with children and young people who are care-experienced (that is, children and young people who currently or at some stage in their lives have been in foster or residential care). The authors provide valuable insights around the co-development of ‘Kia Tika, Kia Pono’ with young people who are care-experienced. They highlight the critical importance of ethical, reflexive and culturally safe participatory practices when working with, and for, children and young people who are care-experienced, upholding their mana and affirming them as knowledgeable experts of their own lives.

Conclusion

Building on the earlier manuscripts included in part 1 of this special issue, these nine manuscripts offer some clarity and vision to many of the problems and issues that children, young people and their families and whānau face in Aotearoa New Zealand. However, shining the torch on these urgent issues is only the first step.

As a society we must work together in demonstrating our commitment to achieving maximal health and wellbeing outcomes for all children and young people in Aotearoa New Zealand, through equity-based policy and system-level changes that overcome and eliminate the drivers of poor health and wellbeing outcomes. It is only through this collective commitment and accountability that transformative and lasting changes will occur for all children and young people to be afforded the opportunity to flourish, thrive and contribute to the fair and just world we envision.