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Child well-being: The long-term benefits of a ‘child rights’ approach to pediatric practice

Sue Bennett, MBChB, FRCP Director Child & Youth Protection Program, Children’s Hospital p of Eastern Ontario, Professor uOttawa Pediatrics & Shafik Dharamsi, PhD Lead Faculty Faculty, Health Advocacy Assistant Professor, UBC Department of Family Practice

Canadian Paediatric Society Friday, June 8, 2012 11:00am - 12:00pm

Objectives 

Do pediatricians have a role in advocating for human rights g for children?

Should pediatricians recognize the UN Convention on the Rights of the Child?

Should Sh ld pediatricians di t i i apply l th the UN Convention in health services and policy?

WHO definition of health

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. WHO 1948

The Physician as Advocate

The Need to Advocate for Children for their Best Possible Health   

They cannot vote They rarely have access to the courts They are not members of trade unions or professional associations They do not have powerful lobbies acting on their behalf Public policy impacts children

Health Advocacy Action by a physician that responds to the social, economic, educational, and political factors that contribute t suffering to ff i and d threats th t to t human h health h lth and d well-being. ll b i Advocacy is more than helping individual patients get the services they requires working at various levels to address the root causes of illnesses, and inequities in h lth health.

C Case S Scenarios: i 

A 13 year old child wanting contraception but unwilling for her parents to be informed

A child reveals that she is being abused by a family member

A disabled child refuses a painful corrective treatment that the parents want undertaken

A teenage girl who has been brought by her mother to see yyou,, turns out to be p pregnant g

A mother with HIV/AIDS wants to breast feed her baby

A six year old who refuses a necessary injection

UN Convention on the th Rights Ri ht off the th Child 

  

Adopted by UN General Assembly on November 20 20, 1989 Canada signed the Convention on May 28th, 1990 and it was ratified on December 13th, 1991 193 ratifications Defines the full range of children’s needs and provides a practical framework for addressing these needs Contains 54 Articles and provides a universal set of standards with which to measure and improve the care and treatment of children For everyone y under the age g 18

Th UN C The Convention ti ď Ź

First international instrument covering economic, social,, cultural,, civil and p political rights, g , including g special protection measures

ď Ź

It is legally binding on all countries that have ratified it. Governments are required under international law to o take a e a all necessary ecessa y measures easu es to o implement p e e itss provisions.

The UN Convention

ď Ź

Poses a challenge to traditional approaches to children hild th thatt views i th them as iincompetent, t t passive i objects of adult protective care.

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IInstead, d iti acknowledges k l d them h as both b h capable bl off and entitled to active participation, as subjects, in decisions that affect their lives

F From Pawn P to t Person P

4 Guiding Principles Inherent t Human to H Di Dignity it 1. 2. 3.


Non-discrimination (Art 2) Best interests of the child (Art 3) The right to life, survival & development (Art 6) Respect for the views of the child – Right to be heard (Art 12)

A Child Rights Goal or “Prize” 

The protection and promotion of the child’s survival, i l physical, h i l psychological, h l i l social, i l moral, spiritual health, well-being and development and personal security as well as all of the child’s rights.

Relationship Between Child Children’s ’ Rights Ri ht and d Needs N d 

All children have needs needs, the fulfillment of which will facilitate their health and development. development Needs extend beyond the physical to encompass (bio)psycho/social/cultural/ economic needs. Children cannot fulfill these needs without adult support.

Examples of Physical Needs      

Adequate food Adequate clean water and sanitation Adequate clothing Shelter Health care Protection from violence,, exploitation p and abuse Protection from environmental pollution

Examples of Psychological and d Emotional E ti l Needs N d     

A stable and loving family environment Opportunities for play Access to education Age appropriate information and stimulation Opportunities pp to be listened to and taken seriously

Examples of Social and C lt Cultural l Needs N d 

  

  

Knowledge of and respect for own language language, religion and culture Freedom from discrimination and prejudice Stable social and economic environment Family environment, environment whether the biological or a substitute family Access to appropriate guidance and support Access to play and friendships Respect for privacy

Needs Are Translated into Rights in the Convention     

1. Social Rights 1 2. Economic Rights 3. Cultural Rights 4. Protective otect e Rights g ts 5. Civil and Political Rights These rights are indivisible and universal. There is no hierarchy of rights.

What the Convention requires of Governments

• To implement the Convention’s rights, without di i i ti discrimination, for f allll children hild

To make the Convention widely known to both children and adults To report regularly to the UN Committee on the Rights of the Child

Alternative Report to the CRC ď Ź

Canadian Coalition for the Rights of Children

UN Committee on the Ri ht off the Rights th Child 

Strongly recommends to governments that professionals should have training on child rights

To date, T d t little littl progress – few f paediatricians, di t i i nurses, teachers, social workers, lawyers, judges police are even aware of the judges, Convention and its implications in their practice

Commonly Asked Questions about b t the th Convention C ti Q1: Can children have rights without responsibilities? 

Rights are not contingent on the exercise of responsibilities.

Children learn to respect the rights of others through respect for their own rights rights.

The Convention recognizes children’s children s evolving capacity to exercise rights as they grow older

Commonly Asked Questions about the Convention

Q2: Is the Convention anti-family or anti-parent?  The preamble of the Convention, as well as many of its articles p that g growing g up p within a caring g family y environment emphasize is crucial to children‘s healthy development.  The Convention recognizes parental rights and responsibilities to provide direction and guidance to their children (Art.5)  Parental rights and responsibilities exist in order to protect and promote children’s rights (Art.18)  The Convention promotes a culture of respect for children in families through listening to them and taking them seriously seriously.  The Convention does not diminish or undermine the role of parents, but it does imply a more open democratic approach to child rearing.

Successes of the Convention 

Children’s ombudsmen have been employed to monitor and facilitate consideration of children’s issues through legislation.

Internationally, there is greater awareness of and commitment it t to t end d the th exploitation l it ti and d discrimination of children, in particular girls.

Many countries and communities have implemented strategies to engage children in decision making.

Implications of Children’s Rights to Physicians 

Reorients the individual relationship between the physician and the child

Establishes new approaches to the delivery of health care services and development of policies

Defines the role of physicians as advocates for children

Use of the Convention in H lth Services Health S i and d Policy P li 

Principles and standards of the Convention have significant implications for the way that health services and policy are developed and implemented.

The Convention’s articles can be used as a framework with which to develop and monitor health services and policy at all levels.

Making Services Respectful of Child Children & Youth Y th 

Reception 

  

Child/youth friendly and age appropriate books, magazines and toys? Comfortable seating? Access to food, water, toilets? Safe for children to play? Signage and brochures available in more than one language?

Clinics   

Long wait to see doctor? S Same physician h i i available il bl each h ti time? ? Children/youth have enough time and encouragement to ask questions?

Making Services Respectful of Child Children & Youth Y th 

Hospital Wards  

 

Proper introduction to ward given? Staff member identified whom children and youth can go to for help? Are children/youth encouraged to ask for help/information if they need it? Is décor/design age appropriate? Are parents encouraged to seek help and info if they need it? What preparation and support is provided when children/youth face surgery or painful treatment? Is a charter of rights displayed publicly?

Making Services Respectful of Child Children & Youth Y th 

Hospital Services 

 

Children & youth have access to education during hospital stays? Opportunities for age-appropriate play/ entertainment? Food appropriate for children & youth? Are children & y youth consulted on quality q y of food or any other aspect of hospital services?

Sample Children’s / Young Person’s Charter of Rights If I am seeking, needing or receiving services, I have the right to the following: 

The best possible treatment and care

To be listened to and have my views taken seriously

To be given information that will help me understand my treatment

To ask for advice, information and support

To be asked before anyone y touches me

To respect for my privacy

To treatment and care, regardless of my sex, abilities or disabilities color disabilities, color, race race, religion or sexual orientation

To not be hurt or humiliated

The Impact of Public Policy on Children Children’s s Rights to the Best Possible Health

* The fashion industry * Food advertising * Violence * Discriminatory laws and practices

Barriers to Children’s Right to the Best Possible Health 

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Parents’ and children’s lack of information about how to protect children’s health Child poverty Discrimination against certain groups of children P liti i Politicians’ ’ failure f il tto prioritize i iti children’s hild ’ health h lth Resistance towards changing attitudes and practices toward children’s children s health and child rearing Invisibility of children Lack of democratic traditions

Ways of overcome barriers to Children’s Rights t ensure th to the best b t possible ibl health h lth    

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Monitor implementation of the Convention Scrutinize national budgets Introduce protective legislation Give priorityy to making g environments child friendly Run public information campaigns Develop informed and effective public policy

Child Rights g Education for Professionals (CRED-PRO)

CRED-PRO is an international initiative to improve the well well-being, being development and health of children throughout the world by infusing a child rights approach in all aspects of the professional services and policy applied to children and youth youth.

The First CRED-PRO Curriculum: H lth Health

Developed in partnership with AAP and RCPCH

Piloted in USA and UK in 2005

Now being developed as a core from which to b ild curricula build i l relevant l t and d applicable li bl tto different social, cultural and economic contexts

Current Curriculum Plans in Canada

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Pediatric Health curriculum under d development l tb by under d and d postt graduate d t students from UBC, uOttawa

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Social Work curriculum under development b graduate by d t students t d t from f uOttawa, Ott Carleton C l t University and UBC

L Learn More M

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Join the CRED-PRO social network / web site!

Objectives - Did we meet them? 

Do pediatricians have a role in advocating for human rights g for children?

Should pediatricians recognize the UN Convention on the Rights of the Child?

Should Sh ld pediatricians di t i i apply l th the UN Convention in health services and policy?

Th k you ett Merci! Thank M i!

The long term benefits of a child rights approach in pediatric practice  

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