Keep children's health in mind

Apr 18 2008

If there is any real purpose to the 2020 summit, it could be to establish a national program of research, clinical and community activity that would deliver a 21st century response to the real child and youth mental health problems that our society creates.

Although most of us now live long lives, we are well aware that we face new health challenges in the 21st century. In-depth community studies report that we all realise that the big gaps are in child health, mental health and Indigenous health. Thankfully, we now have a Prime Minister who has set real goals for closing the gap in Indigenous health. He has followed this up with his most recent announcement supporting high quality child care and early health and education initiatives.

Twenty-five per cent of all health-related disability under the age of 14 is due to mental health problems. This rises to 60 per cent for 15 to 34 year olds. Overall 75 per cent of all adult mental disorders commence before age 25. Eight out of ten of the major causes of premature death or disability in teenage boys are mental health or substance abuse conditions. That is, if you really want to know what health problems will result in your child dropping out of school, failing to go on to adult employment or living a socially chaotic life in the 21st century the answer is simply mental health or substance abuse. Most of this has its roots in childhood and early adolescence.

Unfortunately, the big inter-generational issue that dominates the health debate is not related to our children. We baby boomers are ageing and talking up our demands for better health care. In reality, we are healthier than any previous generation. We should not retire at 65 but rather go on and lead long and productive lives. Collectively, we are the beneficiaries of past social and economic stability, remarkable advances in child health (such as mass vaccination) and critical public health initiatives (such as the rapid reduction in smoking rates and improved diet).

Our current health system now reflects its 19th and 20th century roots. It has big hospitals, technological breakthroughs and effective medicines. By contrast, we have no health system to deal effectively with the real mental health issues of those in early childhood or in the teenage years - 'generation Z '. Of course, we will need to rely on these same people from 2020 onwards to build and sustain our communities, support our economy and generate prosperity for future generations.

If we really cared about the future, first, we would concentrate on consolidating into practice what we already know. Second, we would invest in research designed to reverse these undesirable patterns of child mental health. It is clear that changing social trends over the last 50 years have led to more isolated children and young adults. The decline in participation in all forms of extended family and community life has been bad for the mental health of young people. Our adult world needs to re-engage with its young people. We need to use all the new technologies and combine these with the wisdom that experience brings.

Our declining engagement with our kids has been compounded by our very liberal attitudes to alcohol and substance abuse. Recent studies indicate that the critical frontal area of the brain, which really oversees the transformation of children into adults, is not complete until the early 20s. Serious consideration should be given to lifting the legal drinking age back to 21 years.

At this stage we do not know how to prevent the onset of many of the mental disorders that we now recognise. So, we must invest a large portion of our intellectual and health research strength in this area. A range of conditions such as childhood autism, attention deficit hyperactivity disorder, teenage-onset psychosis and bipolar and other severe mood disorders are now more openly recognised and discussed.

New genetic, biomedical, psychological and social tools are available to investigate the origins of these baffling conditions. Many will prove to be the result of complex interactions between inherited characteristics and other environmental or social agents. New opportunities for genuine prevention or effective treatments are likely to result from unravelling these complex processes.

If the debate is left simply to our health professionals then by 2020 we can expect that more money will simply be spent on our ageing population. Related health system problems, such as our lack of capacity to manage chronic diseases, the lack of an effective primary care system, the increasing out of pocket expenses associated with accessing treatments and the failure to provide adequate services in rural and remote regions do demand immediate political solutions.

The swag of new taskforces commissioned by the new government should get on and deal with these realities of the day. If, however, there is any real purpose to the 2020 summit, then perhaps it could be to establish a national program of research, clinical and community activity that would deliver a 21st century response to the real child and youth mental health problems that our society creates. Its great to see the Prime Minister has now put this real issue into play!

Ian Hickie is Professor of Psychiatry at the University of Sydney and Executive Director of the University'sBrain & Mind Research Institute. He is a delegate to the 2020 Summit in the long-term national health strategy group.

By Professor Ian Hickie