Children's rights and child wellbeing: personal reflections on the role of the UNCRC within child public health work

1989 was the year Berlin Wall fell, protesters filled Tiananmen Square, and F W De Klerk took over as President of South Africa. It was also the year that I graduated from medical school, and that the United Nations Convention on the Rights of the Child (UNCRC) came into being (http://www.unicef.org.uk/UNICEFs-Work/UN-Convention/). I can’t imagine practicing as a paediatrician without it – the Royal College of Paediatrics and Child Health states in its core curriculum that, from their first level of training, every paediatrician in the UK must “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 “.

When you are faced with an individual child in front of you, their vulnerability is obvious, and you do not turn away. Each child has a right to be listened to, nurtured and protected. The responsibility for their care, protection and respect lies most immediately with their parents and other primary caregivers, but wider society also has responsibilities to each individual child – to provide healthcare, opportunities for education and play, protection from discrimination, violence and abuse, etc.  In Scotland, we have a national practice model under what we call Getting It Right For Every Child, aiming to systematize the practice of all those involved in the care of a child, to ensure that all children are supported appropriately in terms of what they need from the people who look after them, and from their wider world, to be Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible and Included (see http://www.scotland.gov.uk/Resource/0040/00408987-500.jpg). Those working outside Scotland will no doubt recognize similarities between this and their own models for assessment and planning for children. These models are absolutely consistent with the aim of upholding an individual child’s rights under the UNCRC. 

Those of us working in Child Public Health are challenged with how we deliver the same respect, nurture and protection at a population level.  Our new Children and Young People (Scotland) Act is increasing the responsibility on statutory bodies (including local Health Boards) to uphold children’s rights, with the prospect of individual cases being brought for investigation if children’s rights are infringed. Given that, and the fact that 2014 is the 25th anniversary of the UNCRC, this was a particularly appropriate year for BACAPH to hold a fringe session on Children’s Rights and Wellbeing at the Faculty of Public Health Scotland annual conference, held in Aviemore in early November. In the run up to that session, I prepared some observations and reflections on our current position and these are summarised here. (For more detail, I highly recommend the ISSOP position statement on Child Rights and Health Care, and particularly the commentary by Elspeth Webb, both linked to from here http://www.essop.org/index.php?option=com_content&view=category&layout=blog&id=33&Itemid=24)

UK paediatricians are generally more or less familiar with the principles of the UNCRC, although not usually good on the detail. I am unusual in always having with me at work a pocket summary, listing articles 2-42, so I can not only quote but also show them to people when relevant. I can think of very, very few occasions when I’ve heard anyone else quote it. On the positive side, we do:

  • have far more child and family-friendly health services in many ways than decades ago, eg design of buildings, access to play, acknowledging need for having a parent stay, etc
  • listen to individual patients, not just their parents/carers
  • include groups of children and young people when planning the design of some services (eg a new children’s hospital)
  • have a Youth Advisory Panel for the Royal College of Paediatrics and Child Health http://www.rcpch.ac.uk/child-health/voice-children-young-people-and-their-families/youth-advisory-panel/youth-advisory-pane
  • have children’s parliaments that facilitate children’s rights to participation in decision making processes http://www.childrensparliament.org.uk
  • manage many good practice examples eg communication passports for children with disability during inpatient stays

But on the negative side we:

  • frequently fail to recognize the child’s right to appropriate medical care (article 24) when developing “efficient” ways of increasing the proportion of outpatient appointments attended. Services offer ‘partial booking’ or ‘opt in’ schemes, whereby a referral is responded to by a letter being sent to the parents/carers, inviting them to telephone during office hours to arrange an appointment for their child. I don’t think I need to list all the reasons why the most vulnerable families would have the most difficulty in following this through – so those children are being systematically denied access. 
  • fail to record any routine child health service data by disability status (and often not even by ethnicity or Looked After status), so as to identify/quantify access issues and appropriateness/performance of services

At the recent BACAPH fringe session, we argued that children’s rights and improving child health and wellbeing are fundamentally entwined.  We discussed the specific example of Scots law continuing to allow the 'justifiable assault' of children within the context of discipline/physical punishment – and the associated infringement of children’s rights and negative impact on child wellbeing that this entails.  We encouraged participants to identify concrete actions, relevant to their own practice, that they could take that would achieve the twin goals of protecting children’s rights and promoting their wellbeing. Plain postcards were distributed, on which participants were encouraged to write their pledges. I’ll finish with some examples of these, in the hope that they might inspire others!

  • I will remember that the adult populations/patients involved in my work may have childcare responsibilities, and consider the implications of this
  • I will Google “Unicef UNCRC” and read more
  • I will explore the website of Scotland’s (insert nation of your choice!) Commissioner for Children and Young People, including UNCRC summaries
  • I will explore ways of presenting data on Children and Young People TO Children and Young People locally, and ask for their reflections
  • I will ask local high school pupils how THEY would run a healthy weight intervention
  • I will work on improving local data with respect to children and young people with disability (article 23), and discuss with the office of the commissioner for CYP how we can improve on the data on disability that feeds into the progress reports to Geneva on upholding the CRC. 
  • I will find out how risk factors for unintentional injury differ in children with disability cf non-disabled children, and ensure our local injury prevention programmes are not ignoring this subgroup
  • When developing local immunization, screening, health surveillance and health service programmes, I will hold as a core principle the child’s own right to have the opportunity to benefit from the programme/service, and strive to overcome any barriers their parents/carers may face in accessing them on the child’s behalf. A parent/carer failing to opt in or present a child for an appointment should never be an automatic end to the pathway
  • I will sign up to the Children are Unbeatable alliance http://www.childrenareunbeatable.org.uk to show my support for ending child physical punishment

Lucy Reynolds

Consultant Paediatrician in Community Child Health, NHS Greater Glasgow & Clyde

BACAPH executive committee member

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