Report on the Contextual Determinants of Child Health Policy
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Report on the contextual determinants of child health policy 28 February 2017 Authors Kinga Zdunek, Peter Schröder-Bäck, Mitch Blair, Michael Rigby DRAFT Report on contextual determinants of child health policy in Europe Status Report on the contextual determinants of child health policy Third draft Origin Work Package 1: Identification of Models of Children’s Primary Health Care Task 7: National Health and Policy Culture Distribution All members of MOCHA via WP Leaders and website Context This report will provide MOCHA members with an overview on the contextual determinants of child health policy in Europe 2 DRAFT Report on contextual determinants of child health policy in Europe Contents 1. Introduction ....................................................................................................................... 6 1.1. Child-centric perspective ........................................................................................... 6 1.2. Aim of the study .......................................................................................................... 8 1.3. Theoretical background............................................................................................. 8 2. Methodology ......................................................................................................................10 3. Case studies of current child health issues in Europe ....................................................13 3.1. Anti-vaccination movement across Europe .............................................................13 3.2. Defending the rights of children with special needs ...............................................15 3.3. Child abuse. Infringement of children’s rights ........................................................17 3.4. Lifestyle changes – lifestyle challenges. Changes in behavioural patterns............20 3.5. Societal changes and children’s mental health........................................................24 3.6. Poverty in Europe, Europe in crisis. Child as a victim of economic crisis ..............26 3.7. Provision and access to care and services ...............................................................28 3.8. System functionality ..................................................................................................33 4. Contextual categories of child health policy ...................................................................41 4.1. Europe’s concerns about child health care. Main areas ..........................................41 4.2. Placing the child at the centre in Europe. Actors of child health policy .................42 4.2.1 Child as the central actor in the child health policy .....................................................42 4.2.2 The agents of the child. The children’s voice representation .......................................43 4.3. Contextual triggers of the child health policy changes ...........................................48 4.3.1 Human factors ............................................................................................................49 4.3.2 Non-human factors .....................................................................................................50 4.4. The nature of contextual determinants of child health policy ...............................53 4.4.1 Socio-cultural determinants........................................................................................54 4.4.2 Structural determinants..............................................................................................61 4.4.3 International determinants .........................................................................................70 4.4.4 Punctual event ............................................................................................................73 4.5. Vehicle of public expression .....................................................................................76 4.5.1 Actors .........................................................................................................................77 4.5.2 Actions........................................................................................................................78 4.5.3 Communication...........................................................................................................81 4.5.4 Information.................................................................................................................82 5. Conclusions........................................................................................................................84 6. Literature...........................................................................................................................87 3 DRAFT Report on contextual determinants of child health policy in Europe 7. Appendices ........................................................................................................................89 7.1. WP 1 questionnaire, round 6 ....................................................................................89 7.2. List of countries by case description ........................................................................94 7.3. List of cases by country system type ........................................................................96 Acknowledgements Acknowledgement is paid to the Country Agents of the MOCHA project as identified on the project website (http://www.childhealthservicemodels.eu/partners/). Their contributions ensured that the findings of this report are based on detailed and local indigenous knowledge. 4 DRAFT Report on contextual determinants of child health policy in Europe Figures Figure 1: Child-centric health policy......................................................................................................................... 11 Figure 2: Child as the central actor in the process of shaping child health policy................................ 43 Figure 3: Interdependence of the triggers of the child health policy change ......................................... 49 Figure 4: Interfaces between contextual determinants of child health policy ....................................... 54 Figure 5: Vehicles of public expression ................................................................................................................... 77 Tables Table 1: Main areas of public concerns of child health..................................................................................... 42 5 DRAFT Report on contextual determinants of child health policy in Europe 1. Introduction 1.1.Child-centric perspective Today nobody can deny the fact that children are the future of the nations as Jean-Jacques Rousseau said. Similarly, nobody can undermine the statement of Hans-Georg Gadamer who claimed that children are the most important value for humankind; they are the guarantee of development, stability, and reconstruction of society. Nowadays the awareness of children’s rights is stronger than ever in history. In ancient times the child did not enjoy the full rights which were entitled to others. The position of the child varied from different cultural and socio- economical contexts of history. Traditionally, a child yielded to its father’s will. In Sparta, children were considered as the property of the state, which was supposed to take care of their physical and military development (Rosa, Matysiuk 2013). Aristotle pointed out the need for care of the intellectual and physical development of children and their health (Rosa, Matysiuk 2013). Unfortunately, those who were suffering from disabilities, who were born in an extramarital relationship or orphaned very often were condemned to wandering and poverty. For centuries the father wielded the right of life and death. The change started with the development of Christianity. The child became an important family value, although the right to joyfulness and fun was significantly infringed by restricted religious rules. The Renaissance brought the reflection on the personality of the child and the Enlightenment attached great significance to the institutionalisation of care directed at those children who were excluded and marginalised. At the end of the 18th century, as a consequence of the French Revolution, children were given rights, and parents were obligated to look after them. The industrial era brought new problems such as high mortality amongst children, delinquency and inhuman mothers’ work conditions. Thanks to the development of charity and broad infrastructure of associations, the awareness of children’s rights and status increased. The law against child labour in industry and agricultural sectors was announced then. With the first decades of the 19th century, it was stressed that children had not only a right to their own mental life but also a right to be respected by adults (Jakubiak 2000). Even though the sociological literature reports that until the 70s and 80s the child was still not considered as an independent individual (Rosa, Matysiuk, 2013). The independence movement of empowering the child’s position was initiated by Abraham Maslov, Alice Miller, Aleksander Neill and Hubertus von Schoenbeck (Rosa, Matysiuk 2013) who were against child discrimination and called for the need of defining and respecting the child’s health. 6 DRAFT Report on contextual determinants of child health policy in Europe In the second decade of the 21st-century a child is considered as a ‘value end in itself’. Nowadays ‘children represent the future