No child deserves a bad start in life. That principle is edging into policy.
A child of one is the child of all. That principle probably held good on the savannah at the dawn of humanity when, in the daily challenge to survive, losing a child was a high cost.
Investing in children pays a dividend in good and productive citizens. That principle has been slow to work into policy. It needs a different economics from the small-state orthodoxy of the past three decades.
A unanimous report yesterday by Parliament’s health select committee chaired by Paul Hutchison encapsulates all three principles. It lays down a big challenge, and bigger potential, to this and future governments.
Hutchison is of a rare species in politics: unassuming, polite and gentlemanly. He was passed over for a cabinet post, which requires pushiness and self-belief. But this report may leave a greater legacy than that of all but a few ministers. Hutchison, a gynaecologist, is leaving Parliament next year.
Yesterday’s report has been long in gestation. Public submissions closed in May 2012. It is far-reaching, wide-ranging and in places verges on radical. Importantly, it has the support of all MPs on the committee — five National, three Labour, one Green and one New Zealand First — though there is some disagreement on some detail. (Contrast that with one-vote parliamentary majorities for asset sales, spy-on-everyone law, major changes to resource management and local government law, the Sky City slinter and more.)
The report makes a multitude of recommendations focused on “best-practice, evidence-based policies and services” before conception (in reproductive health, education and nutrition), in maternity and post-natal (0-3 years) care and in early childhood education, health, housing and social services.
Included in that are health promotion and primary and non-communicable disease prevention, starting before birth by enrolling at least 90 per cent of pregnant women in antenatal programmes by 10 weeks gestation, coupled with an action programme to cut alcohol, drug and tobacco use during pregnancy and even research into taxing sugary drinks.
And it wants action on socioeconomic factors, including “poverty, discrimination, healthy housing, optimal nutrition, access to health and education services and safe home environments”.
There is much more. Hutchison is ambitious for children.
To do it all, the report wants the Prime Minister to take “formal” “leadership from the top” to set quickly a timeline for whole-of-government, interagency action and to define the economic and other evidence base for action, with “every attempt to secure cross-party agreement”.
So what? Another earnest report en route to the archives?
First, it is science-backed, not do-good, feel-good ideology. New Zealand’s internationally acclaimed longitudinal studies show that the links between early childhood nutritional, emotional and cognitive experience (or lack of it) and later problems and failure are so strong that they can almost be called causal.
Second, it is backed by science linking mothers’ obesity, drug and alcohol use and substandard or violent domestic conditions to damage to the foetus and baby. Sir Peter Gluckman, an internationally notable researcher in this area and now John Key’s science adviser, has been arguing generally for better use of science in policy.
Third, the report draws on economic analysis that shows not fixing damage before and directly after birth piles up costs later in inability to work, mental ill-health, crime and, at the worst, prison (which is what we now call what used to be mental hospitals) and expensive remedial action. The report draws on Nobel Prize-winner James Heckman’s work showing “compelling economic evidence that investment in the very early years, probably from pre-conception, will yield a significantly higher return for every dollar than delayed investment”.
This “investment” approach was first advocated a decade ago by Steve Maharey but blocked by his Prime Minister. This decade Bill English has applied it, in a narrow form, to reforming “welfare” — arguably National’s most important policy initiative so far.
English backs the Hutchison report in principle, in effect thereby endorsing much wider use of the investment approach. His issue is not “whether” but “what-to-do-exactly”.
Key continues to say, as since before taking office, that he wants his legacy to be what he does for disadvantaged children.
Annette King produced a child-first policy along these lines (minus the investment angle) in 2010. Labour made little of it in the 2011 election but Jacinda Ardern has been developing detail for release from early 2014.
So, even though implementing the Hutchison report would be a major policy shift that could take years, there is now (potentially) a real chance of real change for the many children who, without our whole tribe’s support, will not get the good start in life every child deserves.