Help needs to reach the kids missing out

There is an encouraging finding from this week’s Herald series on children’s health that hasn’t had much prominence: Most Kiwi kids are doing okay. Among the reports on hearing and vision problems, preventable illnesses, obesity and behavioural difficulties, it is important to acknowledge that the system works for probably 80 to 90 per cent of children.

However, helping the 10 to 20 per cent who are aren’t being properly served is a challenge we can’t shy away from. The themes emerging from the “Health check for Kiwi kids” series shed light on what needs to be addressed.

Today’s feature on behavioural difficulties reveals that parents are able to detect if their child has autism at around 2 or 3 years old, but most are not diagnosed until after they start school — or even longer for girls. Then there are delays as the child is referred to district health boards. Child psychiatrist Hiran Thabrew explains how the earlier a child can be diagnosed and helped to communicate and manage behaviour, the better she or he will cope with school life.

The need for early detection and intervention is also an issue for the one of the country’s biggest health initiatives: The B4 School Check. Our story this week reported that a number of concerning eye and ear problems are not included in screening, and about 20 per cent of kids are screened six months after they are meant to be.

The B4 School Check, which is due for a revamp, highlights another theme: Institutional bias. The programme has been found to favour middle-class white families, often at the expense of poorer Ma¯ ori and Pacific kids. This was partly because disadvantaged families were more likely to to say their child was okay because their development was typical for their community.

Bias also rears its head in the treatment of breathing problems. Our series found when Ma¯ ori kids walk into a GP clinic, they are treated differently. Children are less likely to be given prescriptions or an asthma-prevention plan. Encouragingly, DHBs and medical schools have introduced training to combat racial bias.

Underpinning many of the illnesses and shortcomings in treatment is poverty. It is sometimes assumed that cultural factors are the big influence on our high child obesity rates, but the biggest single factor is deprivation. Families on low incomes are less likely to be able to afford fruit and vegetable and more likely to buy fast food.

In terms of housing, damp, cold and overcrowded homes are mostly to blame for our high rates of bronchiectasis and hospitalisations.

One of the sad — but perhaps also hopeful — findings from the Herald’s stories is that much of the medical hardship faced by our kids is preventable. Delayed intervention, poverty, shoddy housing, institutional bias. In a way these healthcare handbrakes mirror the challenges facing the wider NZ society. They are entrenched problems. But if we can make some progress tackling them, we will improve more than just the health of our kids.