Life’s Lottery Season 2 Episode 3: Building blocks for life – public health for kids

Jeni Whalan: Hello and welcome back to Life’s Lottery, a podcast produced on Gadigal Country. I’m Jeni Whalan.

Glyn Davis: And I’m Glyn Davis. This episode, how do we create the building blocks of a good life? We know that the first few years are crucial.

Jeni Whalan: Two years of Covid disruption have taken a real toll on the health, development and wellbeing of Australian children. Now more than ever, we need to address the distinct and diverse needs of our children. The pandemic has widened the gaps between kids, and increased inequalities.

Glyn Davis: Covid demanded a strong and bold public health response, and it has saved lives. What would it look like if we applied the tools of public health to improve the well being of all children?

Jeni Whalan: That’s the question that drives Professor Sharon Goldfeld. She’s a paediatrician, public health physician, research leader at the Murdoch Children’s Research Institute and Director of the Centre for Community Child Health at The Royal Children’s Hospital Melbourne.

Her research focuses on investigating, testing and translating sustainable policy relevant solutions that eliminate inequities for Australia’s children.

START INTERVIEW

Glyn Davis: So, Sharon, to get started. Can you tell us about the problem that motivates you and what it is that draws you in?

Sharon Goldfeld: I’ve got an interesting history, so I’m first generation Australian and my parents are both Holocaust survivors, so both of them were children during the actual years of the war and escaped to Russia, and they were living under what was then communist Russia. So they sort of escaped genocide, then kind of lived in pretty much abject poverty for about sort of five to seven years and then came back to came back to Poland and lived in what was in Stalin’s Poland, in an area called Galicia, which is near Germany, and about 350 000 Jews or so came back to Poland. And so they kind of grew up there and then met each other. And then in the 50s, a new president came into Poland and it was pretty anti-Semitic time again, and most of the Jews then just left and they emigrated. My mother emigrated here to Australia, my father to South America until he could get here. And then so I was born here, my brother born here. And we got educated, particularly me, very educated.  Underneath all of that, and I think what really drove me personally was how societies can be so uncivil to their populations and how that incivility sort of stems from social injustice and the tolerance of social injustice. I think since then, I’ve always been angry, I think, at injustice and sort of thinking about how do we create a more just society? And so that’s why I’ve always been interested in public health and populations of children. And how do we particularly address inequity in this country in this very rich country, actually? And how do we kind of tolerate that? That’s what sort of gets my juices going, which is how is it that we tolerate this level of inequity in Australia?

Jeni Whalan: That’s fascinating, I certainly didn’t know that Sharon.

Glyn Davis: You did say once, though, that as a paediatrician, you’re both part of outreach to children. But part of the problem, because of the way the profession is structured. Do you want to say a little about what does it mean to be a paediatrician and what are we missing?

Sharon Goldfeld: Only certain people, I think, become paediatricians and you do have to have a sense of caring for kids. And if you care for kids, then you care about social justice because they really bear the brunt of social injustice. But it’s really interesting in our –  the way that we structure our healthcare system so that there is very little public paediatrics. So we have – particular community paediatrics, which is where I’m particularly interested in seeing children with developmental / behavioural problems, which are really the kind of major issues that we see in kids, that sort of paediatrics, actually, there’s not much of it that’s in the public, so there’s a little bit in hospitals and outpatients. New South Wales does a relatively good job of providing what we call salaried or public paediatricians. But actually around Australia, most paediatrics is private paediatrics other than what’s happening in tertiary hospitals. And so I think there’s a really interesting reflection point for us as paediatricians. How do we get more public paediatrics? So paediatricians that are based out in the community that for which you know there isn’t an out of pocket cost?

Jeni Whalan: So, Sharon, you’ve spent your career really at the forefront of looking after kids and kids’ health and wellbeing, and often that’s been pushing for change against some pretty intransigent governments or policy settings that don’t make it easy to put kids’ wellbeing at the centre. I’m wondering what it was like for you over the last two years and perhaps in the earlier days of the COVID response, what it was like for you, just watching governments do things overnight that had been unimaginable just a few months earlier.

Sharon Goldfeld: I just love this story of what Covid’s done in terms of disrupting the kind of the things that we thought were kind of undisruptable. When the pandemic first started, and for many of us, that was an incredibly stressful time. And children, by the way, have not been part of the pandemic narrative really up until recently. That’s maybe for another question. In the time of the beginnings of the pandemic, we saw a number of things that we really never thought we would see. So things like telehealth, telehealth was kind of something you did every now and then. So it was a 10 year rollout agenda for government. We did it in two weeks. So every clinic in the entire country went to telehealth. I mean, just mind blowing. You can’t imagine having this conversation five or 10 years ago, we’d said, Hey, we’re going to double, you know, what’s now JobSeeker, but we’re going to double that and we’re going to create something that’s really not tailored to anyone who’s going to give people more money so they don’t lose their job. And we’re going to do all that while we have a relatively conservative government. Not in a million years would you think that was going to happen. You would just – it’s always been in that too hard basket, it’s just not possible.

Sharon Goldfeld: And yet we did that and it had an extraordinary outcome for families, at least in that short term. And then we’ve never been able to house the homeless. Well, we did. We housed the homeless. We’ve never been able to have free childcare. We had free childcare. So now when people say, I think you can and can’t do that, I don’t think that’s true because you simply can do things that’s really obvious. And the other thing, of course, we did, I just want to add to that is within a year, we’ve got a vaccine. So, you know, just extraordinary medical advance. It’s not a can and can’t narrative. It’s actually a will and won’t narrative. Will you or won’t you do that is different to can you or can’t you do that? What we thought was impossible is now possible. And I think the limitations to what we do next. Yes. It will be partly political and policy because that’s always been there, but it’s probably as limited by our sense of imagination and what we could do than anything else.

Glyn Davis: So let’s go to what we might do next. And in a paper you published recently in the Medical Journal of Australia with a number of colleagues, you outline the five interventions you thought were essential to providing a much more child focussed policy setting. Can I ask you just to walk us through those and to say why they are, in your view, the core questions before us?

Sharon Goldfeld: Thank you for bringing up that paper because that was a kind of work of love from our centre trying to think about how do you apply this community child health lens to thinking about all the things that were happening? I don’t think we would say these are the five things you should do, and we’re the holder of all knowledge, and that’s it. But there are five things for people to consider, and there are five things that you might not think we would necessarily put up. So the first of those is this idea of could we think about a parent supplement? So let’s go back to the evidence. The evidence says very clearly the first thousand days are really important. If you invest then – I can show you lots of papers, children who live in disadvantage then have poorer cognitive outcomes when they’re older. Heaps, heaps of data to support that. And so the question is, should we just stare the social determinants in the face? We kind of always do things to sort of say, yeah, yeah, the social determinants, and then we’ll do this because we can’t really do much about the social determinants, but actually, we probably can now.

Sharon Goldfeld: As I said to you, it’s not a can and can’t argument anymore. It’s a will and won’t. And so in that case, could we invest in parents of young children so that in fact, we give them that extra money and we’re doing a little bit of work on how you might model that, how much should it be? But could you give them more money and could we follow up to see whether or not that makes a difference? Because we do want to know the answer. And then could we use a platform like Generation V, Gen V, which we’re doing in Victoria, so recruiting an entire state of children born to test that? So, you know, we could actually do it as a trial and test that. So we’re pushing at fences. You know, we’re not economists. I do talk to economists about this and they sort of like the idea as well. But you know, it’s really starting to push the boundaries of saying, Hey, let’s not avoid those social determinants. So that’s one idea.

Glyn Davis: That’s the financial. And you quote the US example of providing $300 per family with very little means testing just to encourage that. The next you go to is the use of schools. And I might ask Jeni to take this one up.

Jeni Whalan: Well yeah, it’s interesting to me because I think one of the big shifts that we’ve seen   in the covered years the last two years of the pandemic is a bit of a repositioning of education… to schools being at the centre of child wellbeing, schools being crucial for thriving kids and in ways that perhaps many of us had taken for granted until lockdowns and home schooling occurred. And we saw the effects on mental health and socialisation on our kids. How have you seen that shift play out? What do you think it’s done from a health and wellbeing perspective to understand the critical role of schools and education?

Sharon Goldfeld: I’m so excited by what’s happening in schools now, and it’s another one of those disruptive moments in time. Where parents are gone as well, ‘wow. Schools are really important for these kids’ social and emotional well-being. It’s not just their learning, it’s their social and emotional wellbeing. And what a scary time it was for many people when no one had eyes on kids. So when kids weren’t going to school, no one had eyes on kids.  In 2030/ 2040,  what could schools look like, where we might move from schools in their current form to kind of these holistic platforms that give as much sway to children’s health and well-being as they do to children’s learning? And what would that look like? And and you know, Jeni, I’m not 100 per cent sure what they would look like, and I’m not an educationalist either, but I think there’s this extraordinary opportunity to explore that in a really meaningful way with different sectors sitting around the table, with the aim being exactly as you say, what is the role of this platform called schools in enabling all children – and I do say all children because of course, we have terrible social gradients in our education outcomes- but allowing all children to thrive? What do we need to bring to bear in order for that to happen?

Jeni Whalan: How confident are you that we might, you know, you’re doing lots of advocacy around the place at the moment for this agenda. You’re talking to lots of folks across different sectors. How confident are you that we’re going to seize these opportunities rather than just try to default back to some sort of pre-pandemic normal where health is in one corner and education’s in another corner and the economists are in the next room?

Sharon Goldfeld: So I suffer from a little bit of optimism bias. So I do think with sufficient efficacy and sufficient incentives and I guess sufficient innovation – So I think if we all just say, well, this is only going to change, if governments decide to do things differently, then that will be really hard because governments are really, you know, they’re made of people who have got pretty limited bandwidth at the moment. It’s been a really tough time, particularly in some states. But I think if we say, well, let’s not wait for some massive, scaled, fantastic thing to happen, let’s just try innovating in a few places and sort of have a kind of design approach where we might let’s just do something in a couple of schools, then do it in a few more schools. And really, I think you have to bring a lot of sectors along. But we’ve done that before, and I and I do think this is a moment in time when we can do it again. But the best time to do things is when you’ve created a level of chaos and disruption, that’s your biggest opportunity to make change. And so this is it. And so I think we’re all struggling with this. Oh my God, I just need to take a breath versus, Oh my God, I need to make the most of this moment. Because if we don’t, I’m scared the window will close.

Glyn Davis: So alongside schools, your paper advocates changes to the health care system and delivery. Can you say a little about the changes that you’re looking for?

Sharon Goldfeld: Yeah, there’s a couple of changes we’re thinking about. One is this idea of trying to have a more integrated approach to both bringing health and social care and education together in the way that we deliver health services. So there’s two aspects of this. One is a kind of what we’ve called integrated hubs for children where we try and bring together these services and a kind of one stop shop, but not just health, but health and social care and potentially education as well. Because there’s a couple of things. First of all, families who live in adversity don’t have I live in adversity printed on their forehead. So the opportunities for their health care system, which is a really considered often quite a non stigmatising front door for families to come through. If we could get that system asking families, How are you doing? And then knowing that I can actually help you or I’ve, there’s someone else just down the corridor. But just to start thinking about rather than families having to navigate the system, it’s the system navigating itself for families. And that’s I think that’s quite a different narrative.

Jeni Whalan: Yeah, well, you can’t look away from the mental health crisis, really that had been there before COVID hit, but surely has been hugely exacerbated by the effects of the last two years. What does it really look like and what are you advocating for? What needs to change in this space that we’ve talked about changing for such a long time, but feels really difficult to make big, substantial transformation?

Sharon Goldfeld: So, first of all, you’re so right that these issues were there pre-pandemic, in fact, pretty much everything we’re talking about was there pre-pandemic. I think sometimes we think there was some sort of utopian existence and then the pandemic came along and everything fell apart. Someone described it as kind of the ooze that has gotten into all of the cracks that were there already and just exposed them all. In the whole mental health sphere, there’s a couple of challenges. One is the language of mental health. And I guess the language of mental health for most people, if I talked about mental health, the mental model that goes into your mind is actually mental illness. So there’s this kind of default mental model, from mental health to mental illness. So I guess there’s a piece of work to think about, what do we actually think about mental health? So mental wellness and mental illness? So how do you have mental health difficulties but still have mental wellness because they’re not one end or other of a spectrum? You can actually have mental wellness and schizophrenia, for example. What do we do around the language of that? But more importantly, there’s a huge amount going into mental illness services. Most of us are of the view that that is never going to be enough. It’s sort of a vortex. And so if we’re not thinking about prevention now, we’ll just have this constant and inevitably inequitable system going forward that’s trying to meet demand. So whilst we’re seeing high levels of mental health distress at the moment in both parents and children, we don’t know how much of that will continue.

We’re certainly having a short term spike, and that is incredibly distressing for families. But over time, things may change, and I think we have to kind of plan now for later around what are we going to do around mental health prevention and mental health prevention is not really about mental health services at all. It’s about all the other things that actually some of the things we’ve been talking about. So you know, our hypothesis is that if you give parents more money, you’re probably create less mental health distress. If we could do things like sustain nurse home visiting with families, we’ve shown actually that you get improved mental health, so you get both improved wellbeing and less mental health problems. So it’s really how do we capitalise the non mental health system, our primary health care systems, our universal health systems, our early childhood education and care systems to be part of the mental health prevention where we’re thinking about the mental health and well-being of parents and children. And again, reorienting systems to thinking about well-being. And I think that is an enormous system that could be repurposed to thinking about number one, are we asking people? And number two, what are the tools we could give that system to actually respond if we create a seek and refer system? I’m going to ask you and refer you out, we won’t be able to meet demand. But if we can create a seek and seek and response system, then we’re in a whole different place in terms of being able to actually make a difference to families.

MUSIC

Jeni Whalan: In Western Sydney, Think and Do Tank is a neighbourhood hub that’s putting some of these ideas into practice. Since 2017, they’ve been engaging with local families across language barriers. With psychologists, creatives, and multilingual community connectors on staff, they’re crafting innovative solutions to the everyday challenges of belonging, mental health, wellbeing, and literacy faced by migrant communities.

Jeni: Marion Abboud and Afaf Al-Shammari took us inside the space…

Marion Abboud: Think and Do Tank is a hub of creativity, a hub of multilingualism, a hub that offers services. We’re situated in Fairfield.

Shahad: It’s really interesting to see different people, different languages, identities and cultures. It makes me feel special because just say I was in my country, I wouldn’t be hearing that. I’d only be hearing Arabic.

Marion Abboud: My name is Marian Abboud. I’m the curator of multilingual creativity. At the moment, we have a very large group of recently arrived people from Afghanistan and Iraq and Syria. But we also have quite a large group of people that have settled in Fairfield for a very long time. Spanish speaking, Vietnamese speaking, Mandarin speaking. Every kind of new wave of catastrophe in the world, people kind of get sent to Fairfield. So it becomes a very challenging place. That holds a lot of weight, actually, like a lot of stories, a lot of trauma. But also it holds an amazing opportunity for new beginnings.

 Afaf Al-Shammari: My name is Afaf Al-Shammari. I’m the lead community connector at Think and Do Tank. All the effort, all the work is around to answer a question, which is what makes people’s lives better, easier and more affordable. And to do that, we try to listen carefully to the community. To listen to the community, to have people who understand the language, understand the culture, connect with the- And that’s why we try to employ many community connectors that speak the community language so we can create programmes, reflect the need, the challenge, the hope, the desire of the community, the reality. We try to do it in an innovative way, trying to use art, music, creative way to find a solution to those challenges and needs. So many programmes for young children under five. For primary kids. For mums.

Marion Abboud: I think one of the biggest things is having a place to actually express concerns, a place that doesn’t hold shame. A lot of migrant families will come here with quite a come from quite a challenging environment and to be able to even ask for help could be quite shameful as well.

Shahad: My name is Shahad. I’m 17. I’m a very passionate artist. Like, my whole personality is based on art, and all I talk about is art. When I told my parents, I’d be like, Okay, yeah, but you’re going to be a doctor. Okay, yeah, you’re going to be this. Then one of the ladies, he suggested to my mum that I come here, she’s Muslim and everything. And when people from your own communities connect and tell you something, you take it in. Like, let’s just say if someone who wasn’t Muslim or was that of a different culture or background told my mum, she’d be like, ‘they wouldn’t understand’. My mum took it in and actually let me join. And after joining, he they allowed us to meet more artists who are not necessarily like known by everyone like Picasso or Van Gogh or everything. But, you know, they’re successful, they’re living their life and it’s okay. They do art, do what you want to do. And it’s not always about money. That’s what this place has taught me.

Mayson: ARABIC

Afaf: She said, like I learnt in this sessions, how to communicate with my children the best way to communicate with my children, although I’m always compassionate and I give a lot of love, but there is a specific way to effectively deal with the children. And I learnt this through those sessions.

Mayson: ARABIC.

ATMOS: ‘We are astronauts…’

Marion Abboud: So one of the most important things that we do here is the cross-generational work. It’s really important to work with the mums and the parents and the dads and create support because that information does trickle down into the children and the youth and they really benefit from having happy, healthy parents. They really kind of thrive.

Glyn Davis: Sounds from Think and Do Tank in Fairfield, Western Sydney.

Jeni Whalan: Prevention is hard to often galvanise public resources around because until you can know that you see a problem, there’s always that danger of a wastage of resources that didn’t need to be expended. The dog that doesn’t bark idea, but they’re good examples from a public health perspective on where we’ve done prevention well, that might be something that we could draw from when we think about the mental health space.

Sharon Goldfeld: So surely the number one example is the pandemic. We asked an entire city to stay at home to prevent transmission of a virus, and they did. You know, that is public health prevention. We asked everybody to get vaccinated to prevent a virus, actually overwhelming our health care system and making everyone ill. And they did. We asked people to wear masks to prevent transmission, and they do so that to me, the pandemic is a par excellence example of the importance of public health interventions. I could roll out others like I mean, the other one that people really like is the smoking and the packaging and the fact that smoking kills people. And we had a very strong public health campaign. I think we can apply that to mental health, certainly by saying, how do we enable services to give people the power they need to maintain their own mental health?

Glyn Davis: You’ve mentioned a couple of times the importance of service delivery and also the inequity in service delivery to the final part of the picture that you presented in this MJA paper was around the use of digital delivery to try and provide more equality of services, but also to provide integration of services. Can you tell us how that would work?

Sharon Goldfeld: There is absolutely no doubt that through the pandemic, our ability to think about and utilise digital platforms has really accelerated. The question for us going forward is how do we harness that and how do we harness it in a way that we don’t accidentally create more inequities? Because the digital divide, of course, is very real. And if I circle back to the school issue, we know that some kids got access to data and devices and some kids didn’t. So I think we have to be careful with these things is that we just don’t replicate the same inequities, just using a different platform. However, if I could step you through some thinking about how we could do that quite differently tomorrow. If I take the telehealth example, telehealth works really well. If you have a computer and a good internet connection, it doesn’t work for all kids. But if you have all of that in place and in particular for a young person, then you can really sit there and have a kind of decent telehealth. And if you’re living in the middle of a rural area, you can actually sit, talk to a specialist anywhere in Australia using that platform. However, if you don’t have access to data and you don’t have access to a device, then what do you do? So I think it’s really important with our digital solutions that we do end to end solutions that we don’t go, Hey, wow, we’ve got a new app.

Sharon Goldfeld: And by the way, you won’t be able to use it if you don’t have any data. Could we think about having freely available data internet at a citywide level? We could actually do that tomorrow.

Jeni Whalan: What’s the role of research in all of this, Sharon? In addition to being a public advocate and a practising paediatrician, you’re also a researcher at the Murdoch Children’s Research Institute. What can ambitious research initiatives do, and here I’m thinking in particular of Generation Victoria – Gen V – to change the futures of our youngest generations.

Sharon Goldfeld:  I think the rhetoric is always really important, but I’m always aware that underneath the rhetoric and passion, there needs to be substance. I feel, and I’m sure a number of us feel that the integrity and authenticity that we bring to advocacy is underpinned by research evidence. In other words, we’re trying to make a difference in a way that research would suggest is the way we ought to go. Because you’ve kind of, you’ve got resources you’ve got to think about –  if I’m utilising resources to do X, I’m not utilising resources to do Y, I really want to know that X is delivering in the way that we think it ought to. And research and evaluation underpin all of that. We can’t be naive to the fact that we have limited resources. And that’s why something like Gen V is so extraordinary because it does what a lot of research doesn’t do, which is take something to scale, and that’s something we all need to think about quite seriously, which is this idea of when we do research, sometimes we get kind of stuck at the prototype phase. We’ve done a research project. We’ve done it sort of to some people or to some areas, but then scale kills everything.

And so it’s really important that we think about in our research thinking this is the knowledge translation thinking, which is how do we take things to scale and keep testing them? And that’s what Gen V is. It’s creating a scaled platform of data that will allow us to number one observe. So we’ll be able to articulate the problems both in children and in their parents. So we’ve got that dual parallel cohort of babies and their parents. So really interesting from that point of view, but it’s also an intervention platform. And this is not a small intervention platform. This is the whole of the state. This is our dreams in terms of, hey, we could do things in one city and not in another city and not in another city and another city and actually look at at a statewide level, does that make a difference? And we’ve been grappling with these complex issues about how do we do great place based work and know whether or not it works. And I think that’s why research is so important because it moves us beyond the rhetoric into a place where number one,  I think we can go in or authentically to funders like government and say this really works. And number two, and everyone’s different about this. But for me personally, it means I can authentically advocate for something that I know will make a difference.

Jeni Whalan: So, Sharon, if we imagine a future in which children genuinely are at the centre of our public policy, our budgets, our public services, what would be different in the lives of people?

Sharon Goldfeld: This country doesn’t, I don’t think, talk about children at the centre of its thinking very well. If you spoke to Anne Hollonds about this, she would definitely tell you how difficult it is. So I think I could see a future where people really, really value children as our future, not just as a line in a song, but really, really value children as our future. And once you do that, once you realise the importance of investing in children, then everything else around it kind of makes sense. You just wouldn’t. You would do things so differently if that fundamental starting point was there and you would set up the structures both in government and outside government. That would enable that. Everything from the way that we run our green spaces right through to the way we run our services and our welfare systems would all look different if right at the heart of that, we had the optimal outcomes for children at the centre.

THEME MUSIC

Glyn Davis: That was Professor Sharon Goldfeld from Murdoch Children’s Research Institute and the Royal Children’s Hospital Melbourne.

Jeni Whalan: You’ve been listening to Life’s Lottery – produced by the Paul Ramsay Foundation in partnership with UTS Impact studios.  Please keep the conversation going – Head to lifeslottery.com.au

Glyn Davis: Next week, we’re asking a question that’s close to our hearts – how do we best invest in early childhood, and what’s the role of philanthropy? Jay Weatherill from Minderoo’s Thrive by Five joins us for the conversation, along with some special guests from the west coast.