Advocating for Children

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Advocating for Children

• Tony Waterston
• Newcastle upon Tyne

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Sweden - Child Heaven?
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Newcastle- not child heaven?
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outline

• The meaning of advocacy
• Advocacy in history
• Why advocacy is needed now
• Principles behind advocacy
• Training for advocacy
• Some examples

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The meaning of advocacy

• Speaking out on behalf of a particular issue,
  idea or person
• Children require advocacy as they are vulnerable
  and cannot usually speak out for themselves
• Paediatricians are effective advocates as they
  are objective and carry influence

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Levels of advocacy

• The child in front of you- required by every
  clinician
• Public policy advocacy - required by those who
  want to bring about change

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Advocacy in History the American Academy of
Pediatrics

• 1929 conflict between the paediatricians and the
  AMA leadership over a federal health programme in
  Maternal and Child Health
• Paediatricians met and concluded that a national
  paediatric society was needed
• A united front to influence paediatrics in its
  various phases sociologic, hygienic,
  educational, investigative, and clinical".
• Since then, advocacy has been an important part
  of the work of the AAP

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An American paediatrician

• Murray Katcher in 1980s, decided that he had
  taken care of too many children with hot water
  burns
• He found that, by simply lowering the temperature
  at which hot water heaters are set, less children
  would suffer serious water burns
• With the help of the AAP he developed model
  legislation that would mandate lowering water
  heater temperature settings
• Eventually a public education campaign was
  launched to lower the setting of older water
  heater

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A British paediatrician

• In the 1960s, Hugh Jackson encountered a child
  who had taken 10 imipramine tablets prescribed
  for his mother's depression
• The child developed severe fits and arrhythmia,
  and died within 24 hours.
• The mother said, "nobody told me it could do any
  harm"
• Jackson, shocked over this failure, conducted a
  survey into the circumstances of accidental
  poisoning, published in 1968
• He later became a member of the national
  committee on poisoning, which set up a test team
  for developing childproof medication containers.

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Other examples

• Parents staying in hospital in UK Sir James
  Spence
• Banning corporal punishment in Sweden?
• Nuclear weapons - IPPNW and the Nobel Peace Prize
  1985

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Why advocacy is needed for children now

• They cannot vote
• They rarely have access to the courts
• They are not members of trades unions or
  professional associations
• They have little or no access to the media
• They do not have powerful lobbies acting on their
  behalf to counter the well-resourced and
  sophisticated corporate lobbies that increasingly
  influence governments

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The Impact of Public Policy on Childrens Rights
to the Best Possible Health

• Child poverty has a profound impact on childrens
  physical, mental, emotional and psychological
  well-being.
•  
• Childhood accidents can be exacerbated by the
  priority given to road users over pedestrians, by
  failure to invest in road safety programs, and
  lack of attention to safety in design of public
  spaces.
•  
• Environmental pollution is damaging the health of
  millions of children, for example, through toxic
  emissions, the widespread use of chemical
  pesticides, exposure to lead in older homes and
  in soil, etc.

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The Impact of Public Policy on Childrens Rights
to the Best Possible Health

• The fashion industry is encouraging increasing
  numbers of young girls to aspire to images of
  thinness which cannot be attained while eating a
  normal diet, resulting in a significant rise in
  the incidence of bulimia and anorexia.
•  
• Food advertising targeted at children encourages
  a desire for foods that are high in fat, sugar
  and salt, leading to greater incidence of obesity
  and other chronic diseases.

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The Impact of Public Policy on Childrens Rights
to the Best Possible Health

• Violence. Children in many countries in the
  world are the only group of people not protected
  in law from all forms of violence.  
• Discriminatory laws and practices can and do
  cause profound damage to childrens health and
  well being increasing the likelihood of mental
  illness and low self-esteem and depression, as
  well as poorer physical health.

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silence is the voice of complicity
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Principles behind advocacy

• UN Convention on the Rights of the Child
• Other human rights legislation
• National legislation (in UK, the Children Act)
• General Medical Council, UKGuidance 0-18yr

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The basis of advocacy The UN Convention on the
Rights of the Child
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UNCRC 1989

• Promotion
• Protection
• Participation

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Protection 2 discrimination 16 privacy 19
violence 22 refugee 32 economic
exploitation 34 sexual abuse
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General Medical Council The regulator of the
medical profession in the UK
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Training for advocacy

• A competency-based approach
• A training course with American Academy of
  Pediatrics

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Comparing advocacy with communication skills

• Communication
• Knowledge of psychology
• Understanding the needs of children
• Empathy with parents and children
• Understanding problems of poor communication
• Skills of listening

• Advocacy
• Knowledge of how systems work
• Understanding childrens rights
• Empathy with children
• Understanding the problems of children in society
• Skills of finding the source of the problem

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RCPCH Competencies in relation to advocacy

• Understand the responsibility of paediatricians
  to consider all aspects of a childs well-being
  including biological, psychological and social
  factors
• Develop a commitment to a policy of advocacy for
  a healthy lifestyle in children and young people
  and for the protection of their rights
• Know the principles of the UN Convention on the
  Rights of the Child, apply these in their own
  practice and work for the protection of these
  rights
• Be aware of child health exploitation issues
  including child prostitution, child labour and
  children in combat

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A training course

• Available at www.essop.org
• RCPCH, ESSOP and AAP
• Currently developing a toolkit for training
  paediatricians - assistance needed!

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Encouraging advocacy by paediatricians

• USA AAP CATCH programme
• UK RCPCH Advocacy Committee and Advocacy award

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Examples of advocacy 1. Alican an asylum seeker

• Learning difficulties child, 8yrs
• Harassed by local children
• Housing very poor
• Mother at risk of deportation
• Action letters to housing, councillor, home
  office, meeting with housing
• Result deportation prevented

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2. Corporal punishment

• Campaigning to change the law in the UK to ban
  corporal punishment in the home
• Children are Unbeatable Alliance
• RCPCH joins the lobbyists
• Joint letter to Ministry by seven childrens
  organisations re changing the law

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3. Childrens rights in RCPCH

• Motion at annual meeting that childrens rights
  should be incorporated in all work of College
• Annual training day and a representative on each
  committee
• Appointment of participation officer
• Consultation exercise on work of the College

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4. Elsevier and the arms trade

• Arms sales and children a holocaust
• The arms trade a function of rich nations
• The arms trade links with health
• Reed Elsevier, the Lancet and arms

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Lancet 10th Sept 2005 p.868
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1996-7

• RCPCH and Elsevier
• Lobbying by health professionals
• Petition on line and letter writing, threat of
  boycott of Elsevier journals
• RCPCH writes to Chief Executive to warn of
  possible withdrawal

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The Lancet 9th June 2007
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Other current issues

• Climate change - the RCPCH has a target to become
  carbon neutral
• A TV programme on parenting

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The future

• In a child-centred society there should be little
  need for advocacy
• However there will always be a need for
  paediatricians to speak out on behalf of their
  patients
• There are trends in Western society which are not
  in the interests of all children - we must stand
  together

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The true measure of a nations
standing is how well it attends to its children
their health and safety, their material
security, their education and socialization, and
their sense of being loved, valued, and
included in the families and societies into
which they are born. UNICEF 2007, Wellbeing
report
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Goodbye, and good luck!