News

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‘Opportune moment’ to improve children’s health inequities

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While the direct health impacts of COVID-19 have so far been relatively minimal for children, a new research review published in the MJA emphasises that the ongoing indirect impacts are significant.
 
The effect on children and young people’s mental health has already been well established. In 2020, one in three Australian parents reported that COVID-19 had negatively affected the mental health of their child, while the number of children and adolescents using hospital mental health services increased by 30–55% from June 2020 to February 2021.
 
Meanwhile, indirect impacts have also seen some children engaging in less physical activity, eating more unhealthy food, and having increased screen time.
 
However, the new review, conducted by the Murdoch Children’s Research Institute (MCRI), has further highlighted the toll the pandemic has had, not only on children’s mental health, but also academic results and physical health.
 
As a result, the authors have warned of a widening of disparities in child health and developmental outcomes due to ‘generation-defining disruption’ and called for a ‘community child health lens’ across pandemic recovery plans.
 
‘The public health measures have resulted in positive benefits for some, while others have been adversely and inequitably impacted,’ MCRI paediatrician and review lead Professor Sharon Goldfeld said.
 
‘As with previous global crises and pandemics, this can provide an opportune moment for creative change to reduce social disadvantage.’
 
If children’s needs are targeted in policy responses as Australia charts a course out of the pandemic, the researchers believe that long-term negative impacts can be avoided.
 
The review recommends five key strategy areas:

• Addressing financial instability through family supplements
• Expanding the role of schools to address learning gaps and wellbeing
• Rethinking healthcare delivery to address reduced access
• Focusing on prevention and early intervention for mental health
• Implementing digital solutions to address inequitable service delivery

In late 2021, the Federal Government launched the first National Children’s Mental Health and Wellbeing Strategy, which provides a framework to ensure early interventions and prevention during childhood.
 
RACGP Specific Interests Child and Young Person’s Health Chair Dr James Best previously told newsGP that early intervention is ‘possibly the most important aspect of COVID-19 concerning children’.
 
The strategy focuses on community‐based approaches, empowering families and the role of education settings, as well as ongoing evaluation of mental health services.
 
The MCRI’s recommendation to ‘rethink’ healthcare delivery to address reduced access and minimise inequities aligns with the strategy.
 
According to the review authors, facilitating collaboration of healthcare practitioners will ensure that services are co‐designed and respond to the needs of children and their families, use evidence‐based care, and aid evaluation of the care’s efficacy.
 
Dr Best agrees the collaborative care model is essential, and strengthens GPs’ central role in children’s mental health prevention and management.
 
‘The [strategy] report has got it right and taken note of the critical role of primary care, particularly general practice, in this area,’ he previously told newsGP.

‘The emphasis on looking at the child in a family or a community context is very sound, and it’s also consumed with the principles of general practice.’
 
With school set to return across most of Australia over the coming week, the MCRI supports the position that the mental health benefits of children outweigh the risk of infection.
 
Professor Goldfeld said COVID-19 restrictions have highlighted the importance of schools beyond learning, by cultivating social and emotional development and providing a safe place for some children.
 
Moreover, she says some families may also lack the resources and time needed to support their children’s learning.
 
‘It has been estimated that the achievement gap between advantaged and disadvantaged students grows at triple the rate during remote learning,’ Professor Goldfeld said.
 
‘Children with existing disabilities also report increased trouble with virtual learning.
 
‘It will be difficult to predict how long it will take those with lost learning to catch up, but strategies to identify those left behind and targeted long-term interventions for those especially in low socioeconomic school settings will be critical.’
 
Examining findings from previous pandemics, epidemics and natural disasters, the MCRI review also shows the current pandemic’s adverse impacts on children are either repeated or extended from previous large-scale outbreaks of infectious disease.
 
The review calls for longitudinal follow-up data to identify children needing intervention and ongoing care, and align policy efforts in this area with clinical need. It also says there is a need for ongoing intervention studies to address the gap in disparities caused by the pandemic.
 
‘The indirect impacts of COVID‐19 and related policy responses will likely have broad, long‐lasting implications for children,’ the authors write.
 
‘Now is the time to not only repair the past, but to start to re‐imagine the future for a more equitable Australia for children.’
 
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children's health COVID-19 mental health paediatrics pandemic

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