Manifesto on improving systems to help children
The Healthy Children and Adolescents Manifesto was released last week at the 2019 Swiss Public Health Conference (#SPHC19), with the goal of motivating action. By whom? Politicians and bureaucrats at the national, cantonal and local level, advocacy organizations and professionals who work with children.
Some highlights of the Manifesto, along with my thoughts:
· Parental leave / Elternzeit: Switzerland needs better parental leave laws, in particular shared parental leave (flexible time off for both parents) and leave for fathers (who currently may only get a single day off when their child is born—the same amount of time as for moving or getting married). Paternal leave builds a long-term bond between father and child; reduces maternal stress and postpartum depression[1], improves more equal sharing of care by both parents; and may be associated with higher child cognitive test scores[2]. Hopefully the National Council (Nationalrat) will take up this issue when they come into session next week, either passing the 2 weeks of paid paternity leave approved by the Swiss Council of States (St?nderat), or, more hopefully, supporting the initiative for 4 weeks of leave (#vaterschaftsurlaub).
· Voluntary home visits / freiwilliges Hausbesuchsprogramm: Community Health Workers (CHWs), also called outreach workers or promotores, provide vital outreach (Gesundheitsf?rderung) to families, including hard-to-reach populations such as immigrants and underprivileged households, via visits to homes, schools, and other community locations. Coming from the communities and cultures they serve, CHWs are able to build strong bonds with clients and guide them through disease care management. CHWs are particular effective in achieving outcomes for patients with diabetes, asthma, and blood pressure/cardiovascular disease.[3] A financial Return on Investment (ROI), as well as a Social ROI, can be calculated using this handy tool. (Full disclosure: my former employer, the Health Law & Policy Center at the University of Massachusetts Medical School, developed this tool.)
· Health education / Gesundheitsf?rderung: Health education in schools can be taught in many subject areas, to all ages: science (nutrition, how the body works), math (incidence of sexually-transmitted diseases), reading (novel about young person with mental illness), even history (domestic violence laws / legal rights of women). See https://www.schulnetz21.ch/ for lesson plan resources for teachers about diverse health topics.
· Psychological health / psychischen Gesundheit: Better mental health services are needed. According to the WHO, approximately 1 (0.9) out of every 100,000 children in Switzerland 10-14 years of age commits suicide, while 7.1 out of 100,000 youth ages 15-19 do so. In western Europe, only Iceland, Ireland, Finland and Austria have higher suicide rates among youth.[4]
· Disease prevention / Pr?vention: More uniform access to dental care at school across cantons and communities will improve students’ school performance—and futures. Students with oral health problems are almost four times more likely to have lower grades[5], have more absences, and have lower feelings of self-worth[6]. Cavities and dental pain can thus negatively impact students’ schooling, as well as their subsequent career chances and future wages.
· Data for Deeds / Daten für Taten: We still know so little about how diseases develop. I4C (#I4C), the International Childhood Cancer Cohort Consortium[7], pools data from around the world to secure a large enough sample size to effectively study causes and risk factors for developing cancer. Similarly, the creation of a cohort of Swiss children would enable researchers to study risk and protection factors for other diseases and conditions by following the children into adulthood and old age.
What concrete steps can we take to promote the ideas in this Manifesto? How can we make these goals a reality in Switzerland?
[1] https://www.nber.org/papers/w25902
[2] https://www.oecd-ilibrary.org/social-issues-migration-health/fathers-leave-fathers-involvement-and-child-development_5k4dlw9w6czq-en
[3] https://icer-review.org/material/chw-final-report/
[4] https://apps.who.int/gho/data/node.main.MHSUICIDE
[5]https://www.researchgate.net/publication/229425479_The_Impact_of_Oral_Health_on_the_Academic_Performance_of_Disadvantaged_Children
[6] https://www.childrenshealthfund.org/hbl-literature-review/
[7] https://www.georgeinstitute.org/projects/international-childhood-cancer-cohort-consortium-i4c