Australia's children

In a national study of Australian young people’s perspectives, health ranked as the second most important domain for having a good life (Redmond et al. 2016). In addition to their own health, young people also reported that the health of family members (for example, a parent or grandparent) was important for their wellbeing (Redmond et al. 2016).

Health is influenced by factors such as individual and psychological make-up, lifestyle, environmental and cultural influences, socioeconomic conditions and access to quality health care programs and services (AIHW 2018a). The World Health Organization (WHO) defines health as a multidimensional construct that incorporates physical, mental and social wellbeing and so is more than just the absence of disease or infirmity (WHO 1946).

While the WHO’s definition of health is widely accepted, there can be variation across cultures. Aboriginal and Torres Strait Islander people take a broader perspective of health and view it not just as the physical wellbeing of the individual, but the social, emotional and cultural wellbeing of the whole community (AIHW 2016).

Why is child health important?

Good health influences how children feel and go about their everyday lives because health can affect participation in family life, schooling, social and sporting activities. This chapter includes information on a number of topics considered important to children’s health, development and/or overall wellbeing.

The foundations for good health start during the antenatal period, and the first years of life. Maintaining a healthy lifestyle during pregnancy contributes to better outcomes for the baby and the mother. Smoking during pregnancy is associated with poorer perinatal outcomes such as low birthweight, perinatal death and sudden infant death syndrome (SIDS). Teenage mothers are also more likely to have low birthweight babies and are themselves a vulnerable population who may experience a greater risk of socioeconomic disadvantage.

The health of a baby at birth is a key determinant of subsequent health and wellbeing. Low birthweight has been associated with increased risk of coronary heart disease, diabetes, hypertension and stroke in adulthood. Following birth, breastfeeding is a protective factor by reducing infant mortality, protecting against illnesses, and helping develop the baby’s microbiome (COAG Health Council 2019). As children grow, immunisation protects them from harmful, and potentially fatal diseases.

Chronic conditions that particularly affect children, such as asthma and diabetes, cancer, mental illness, and disability have a substantial impact on a child’s overall quality of life. They can require considerable disease management and affect physical, social and emotional development, schooling attendance and education outcomes. There may also be an impact on family life, parental health and employment if time off work is needed for caring responsibilities, with a potential flow-on effect for household finance. This illustrates the inter-relationship of health with other domains of wellbeing.

Poor oral health is also associated with increased risk of chronic disease later in life, including stroke and cardiovascular disease (AIHW 2019). Children with poor oral health are also more likely to miss school and perform poorly in school (Jackson et al. 2011).

Children’s social and emotional wellbeing – how they think and feel about themselves and others, and deal with daily challenges – is 1 component of mental health and wellbeing. Socially and emotionally competent children:

• are confident
• have good relationships
• communicate well
• do better at school
• take on and persist with challenging tasks
• develop the necessary relationships to succeed in life.

While rates of infant and child deaths are decreasing, and survival rates for certain cancers are increasing, perinatal conditions, injuries and cancer remain leading causes of death for children.

Good health in childhood also has a long-term impact, as problems that become more apparent in old age can have their origins in childhood. Children who smoke and drink at risky levels often continue to do so into adolescence and adulthood, putting them at risk of chronic conditions and premature death. Poor nutrition and sedentary lifestyles have been linked with obesity, and children who are overweight or obese are also more likely to become obese adults, putting them at risk of chronic conditions such as type 2 diabetes and cardiovascular disease at younger ages (Sahoo et al. 2015).

Many topics included in this health domain also reflect what Australian adults see as the key health issues for children. A survey of Australian adults on how much of a problem they considered 29 child and adolescent health issues, identified these top 10 child health problems:

• excessive screen time
• obesity
• not enough physical activity
• unhealthy diet
• bullying
• illegal drug use
• family and domestic violence
• internet safety
• child abuse and neglect
• suicide (Rhodes 2015).

Some of these topics are included in other domains (for example, bullying, family and domestic violence and child abuse) reinforcing the interrelation between health and other domains.

The governance supporting children’s health

While parents have the primary caring role for their children, ensuring that children get the best possible start in life is a responsibility shared with the wider community and governments.

From a governance perspective, responsibility for supporting children’s health is shared by the Australian and state and territory governments, as they are for the population as a whole

Australian Government responsibilities

The Australian Government is responsible for:

• leading the development of national health policy
• administering Medicare
• funding state and territory public hospital services
• funding and providing oversight of Primary Health Networks
• funding medicines (through the Pharmaceutical Benefits Scheme)
• regulating private health insurance
• funding community-controlled Indigenous primary health care and some prevention programs (for example, cancer screening)
• health and medical research.

The Australian Government also funds a range of mental health-related services through the Medicare Benefits Schedule (MBS), and the Pharmaceutical Benefits Scheme (PBS)/Repatriation Pharmaceutical Benefits Scheme (RPBS)

The Australian Government also funds a range of mainstream programs and services including:

• income support
• social and community support
• disability services
• workforce participation programs
• housing assistance.

State and territory government responsibilities

State and territory governments are responsible for:

• funding and managing public hospitals
• regulating and licensing private hospitals
• providing oversight of local health networks
• delivering public community-based and primary health care services
• delivering preventive services, such as cancer screening and immunisation programs
• delivering ambulance services
• managing health complaints services.

State and territory governments also fund and deliver public sector mental health services. These provide specialist care for people with severe mental illness in public acute and psychiatric hospital settings, state and territory specialised community mental health care services, and state and territory specialised residential mental health care services. In addition, states and territories provide other mental health-specific services in community settings such as supported accommodation and social housing programs.

Local governments, in some jurisdictions, are responsible for:

• environmental health-related services such as waste disposal and water fluoridation
• community and home-based health and support services
• delivery of health promotion activities.

All Australian health ministers are members of the Council of Australian Governments (COAG) Health Council – the forum for cooperation on health issues and the health system (COAG Health Council 2014).

National health strategies for children

A key objective of the COAG National Healthcare Agreement is that Australians are born healthy and remain healthy. This is also the vision of the Healthy, Safe and Thriving: National Strategic Framework for Child and Youth Health (the framework).

The framework was endorsed by the Australian Health Ministers’ Advisory Council (AHMAC) in 2015 and provides a 10-year overarching vision and set of priorities for child and youth health, which other targeted health policies at the national and/or state and territory level can build on. The framework’s priorities are to:

• equip children and young people with the foundations for a healthy life
• support children and young people to become strong and resilient adults
• support children and young people to live in healthy and safe homes, communities and environments
• ensure children and young people have equitable access to health care services and equitable health outcomes
• improve systems to optimise the health outcomes of children and young people.

Improvement of child health and wellbeing outcomes is also the goal of the Australian Government’s National Action Plan for the Health of Children and Young People: 2020–2030 (the action plan).

This plan builds on the framework. It has these 5 key priority areas:

• improve health equity across populations
• empower parents and caregivers to maximise healthy development
• tackle mental health and risky behaviours
• address chronic conditions and preventive health
• strengthen the workforce.

A number of national whole-of-population health policies are also relevant to children and to particular sections of Australia’s children. An overview is in Table 1 and a more detailed listing can be found in the Healthy, Safe and Thriving National Framework for Child and Youth Health and the Former COAG Health Council website.

While the Department of Health has responsibility for most health areas, some fall under the remit of other Australian government organisations. Disability, for example, falls under the remit of the Department of Social Services, and Indigenous health under the Department of Prime Minister and Cabinet.

People with disability, including children, are a focus of The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. The Royal Commission was announced on 5 April 2019 and is expected to run over 3 years. It will cover all forms of violence, abuse, neglect and exploitation, in all settings where they occur. As such, its recommendations will have implications for children with disability (see Justice and safety)

Table 1: National strategies relevant to health sections

Topic area	Strategy
Health	National Healthcare Agreement
Antenatal period	National Fetal Alcohol Spectrum Disorder Action Plan 2018–2028 National Strategic Approach to Maternity Services – emerging strategy
Breastfeeding	Australian National Breastfeeding Strategy: 2019 and beyond
Chronic conditions	National Strategic Framework for Chronic Conditions
Asthma	National Asthma Strategy (2018)
Diabetes	Australian National Diabetes Strategy 2016–2020
Mental health	Fifth National Mental Health and Suicide Prevention Plan (2017) Australia’s Long Term National Health Plan National Children’s Mental Health Strategy – announced in Australia’s Long Term National Health Plan, and under development as at 15 August 2019
Disability	National Disability Strategy 2010–2020
Oral health	Healthy Mouths, Healthy Lives: Australia’s national Oral Health Plan 2015–2024
Injuries	National Injury Prevention Strategy – emerging strategy
Physical activity	Sport 2030
Drugs and alcohol	National Drug Strategy 2017–2026 National Alcohol Strategy 2018–2026 (draft)
Preventive healthcare	National Preventive Health Strategy – announced in Australia’s Long Term National Health Plan, and under development as at 15 August 2019
Indigenous	National Aboriginal and Torres Strait Islander Health Plan 2013–2023 Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 National Framework for Health Services for Aboriginal and Torres Strait Islander Children and Families
Immunisation	National Immunisation Strategy for Australia 2019 to 2024

What is missing?

The sections in this domain include a number of established national indicators; however, consistent national reporting is not available in some areas due to lack of a suitable data source and/or indicator. For more information on national data gaps, see Data gaps.

A number of topics were not included for other reasons but could be considered for future updates.

Children's subjective view of health

National data on how children view their own health are limited. Of particular interest are the views of children living with disability and areas of social and emotional wellbeing. The Social-Emotional Wellbeing (SEW) Survey and Rumbles Quest, could offer opportunities.

Priority populations

Health data for a number of priority population groups are limited, including children:

• who are refugees
• with disability
• living in out-of-home-care
• involved in youth justice.

Data on some priority groups, for example children receiving child protection and care services, would be particularly valuable for further examination of topics, such as teenage mothers (AHRC 2017).

The Royal Commission and Board of Inquiry into the Protection and Detention of Children in the Northern Territory (Royal Commission) reported a lack of comprehensive data on the health of children and young people in detention in the Northern Territory (Royal Commission 2017a, 2017b).

A recent feasibility study by the Australian Institute of Health and Welfare (AIHW) identified significant gaps in the available national data and current knowledge about the health and risk behaviours of young people involved in youth justice and health services provided to them (AIHW 2018b).

In the future, data linkage between youth justice and health data, such as hospitalisations data, has the potential to improve the information available about this group of children.

More routine linkage of mortality data with other data collections, such as disability services, could also provide opportunities to examine variation in death rates across particular population groups.

Sleep

Sleep is essential to healthy brain development. Sleep, or a sleep deficit, has been associated with the development and severity of a range of physical, behavioural and other mental health issues.

Young children who do not get enough sleep are at increased risk of becoming overweight, even after adjustment for initial weight status and multiple confounding factors (AHMAC 2015). A study among Indigenous children, for example, confirmed that short sleep duration is associated with unhealthy body mass index, with sleep duration decreasing with the number of adults in the household increasing (Deacon-Crouch et al. 2017).

Research based on the Longitudinal Study of Australian Children (LSAC) found that sleep problems were associated with externalising and internalising difficulties in children (Quach et al. 2018). Difficulty sleeping was also reported as the most frequent health complaint, occurring almost every day for 12% to 16% of participants in years 4, 6, and 8 in the Australian Child Wellbeing Project (Redmond et al. 2016). National, regular, population-level reporting on children’s sleep is not available; however future updates could include a focus on available data.

Hearing

For children, hearing is critical to learning to speak, and subsequently performing academically, and engaging socially (WHO 2016). Early detection of profound permanent childhood hearing impairment, together with access to appropriate intervention, can minimise the impact of children with this condition. National neonatal hearing screening data are not currently available for reporting. However, a working group was established in 2013 to review the National Framework for Neonatal Hearing Screening and National Performance Indicators to Support Neonatal Hearing Screening in Australia. The review is expected to be completed in 2020.

Health service use

Future updates to this domain could include information on children’s health service use, for example use of hospitals, alcohol and other drug services mental health services, and prescription use.

While service use data are readily available for a number of health services see Australia’s Health, national data are not available for community health services, and medical technology and devices used by children with health conditions. There are also limited comprehensive and nationally representative data on allied health services and primary health care consultations. Developments are underway to establish a National Primary Health Care Data Asset to improve the completeness and use of primary care data, as should the use of My Health Record data for research and public health purposes once available.

The emergence of new national data assets, such as the National Integrated Health Services Information Analysis Asset, which contains de-identified data from hospitals, the MBS, PBS and the National Death Index, will provide opportunities for examine the service use patterns of children. Work is also underway to develop enduring linked assets related to cancer and diabetes data.

Specific areas related to domain topics

• While physical activity includes some data on children’s physical activity, trend data are not currently available. Under the Intergenerational Health and Mental Health Study, the ABS National Nutrition and Physical Activity Survey is scheduled to be conducted again in 2023. National data on the variety of physical activity children undertake, beyond organised sport, are also not available. Information on screen time that promotes physical activity, such as active video games, is also not available.
• Routine national data on children’s consumption of food, other than fruit and vegetables, is also limited. For example, the most recent data on children’s intake of grains, meat (and alternatives), dairy and discretionary foods comes from the 2011–12 Australian Health Survey (AIHW 2018c).
• This domain includes some data on mental illness and social and emotional wellbeing; however regular, national data and reporting on children’s overall mental health and wellbeing are not currently available. This reporting could include measurement of concepts such as overall life satisfaction or happiness, engagement in life and optimism.
• National data on the health of young fathers are limited. For example, there are limited data about the role of young fathers in parenting and the impact the birth of a child has on them (AHRC 2017).