On 20th November, we celebrated ‘Healthy Child Healthy World’ Day, a new initiative designed to raise awareness of every child’s right to a healthy and nurturing life. Dr. Rob Ross Russell, member of the European Academy of Paediatrics (EAP) Executive Committee, organised a full day of celebrations to mark the United Nations Universal Children’s Day (held annually on the anniversary of the 1959 Declaration of the Rights of the Child’s signing).
There were a variety of stalls and events including cancer support group Maggies, Knit-a-Neurone (who focus on brain injury), a ‘Flashmob’ of children singing The Circle of Life; and a delicate heart transplant operation in our Teddy Bear’s Hospital. We were also honoured to welcome a special guest, Dr Waheed Arian, who is the founder of Arian Teleheal and the winner of this year’s Rotary Peace prize.
Next year will mark the 60th anniversary of the Declaration, and we encourage other hospitals to join us in commemorating this important commitment to protecting child rights.
In 1959, the United Nations adopted the Geneva Declaration of the Rights of the Child. Thirty years later, in 1989, the same declaration was used by United Nations General Assembly as the basis for the Convention of the Rights of the Child – a human rights treaty laying out civil, political, economic, social, health, and cultural rights of children. The Convention defines the child as a human being with his or her own distinct set of rights, and binds its 140 signatory nations by international law to protect children’s rights and wellbeing.
The United Nations Convention on the Rights of the Child (UNCRC) has had a proven impact on multiple countries, with developments in laws and practices that ultimately aid and improve the lives of millions of children around the world, including increasing school enrolment and decreasing infant mortality rates. Despite significant improvements, inequalities and discrimination persist in our society, and many children still do not enjoy their full rights.
From the moment they are born, every child has the right to a name, a nationality, and to know and be cared for by their parents. A particular challenge to this today is displacement due to war and persecution, which is a reality for an increasing number of children. According to the latest UN International Migration Report, the number of international migrants worldwide has continued to grow rapidly in recent years, reaching 258 million in 2017 (a sharp increase from the 220 million in 2010 and 173 million in 2000). Despite the benefits of migration, some migrants (including children) remain among the most vulnerable members of society. Women and children in particular are prone to falling victim to human trafficking, exploitation, and abuse. Unfortunately, many migrant children become separated from their families, something that has grave psychological consequences and contributes to a life of turmoil and uncertainty.
Though every child has a right to health and health services, plenty of communities around the world still face a lack of basic sanitation, including readily available potable water. Inadequate sanitation is a major cause of disease worldwide; diarrhoea, for example, is one of the leading killers in children under 5 years old. Improving sanitation is known to have a significant beneficial impact on health in both households and across communities.
Access to safe and high-quality health services is a crucial right for all children, regardless of their families’ socio-economic status. Unfortunately, there’s still a long way ahead to reach universal health and health access, due to vast socio-economic inequalities. Children from the poorest 20% of society are nearly twice as likely to die before their fifth birthday than children from the richest 20%. Likewise, children in Sub-Saharan Africa are 14 times more likely to die before their fifth birthday than the rest of the world (WHO, 2017).
Evidence shows that social factors, including education, employment, socio-economic status, gender, and ethnicity, have a marked influence on how healthy a person is. In all countries, there are wide disparities in health from one social group to another. Studies have shown that the lower a family’s socio-economic position, the higher its risk of poor health. Once again, vaccinations play an important role in maintaining health and protecting children from preventable communicable diseases. Despite the undeniable advantages of vaccination, not all children across the world have access to immunisation. This is a feature of health inequality with significant social and economic costs to individuals and societies. (WHO April 2017).
Universal primary education is also among the most pressing issues in terms of children’s rights , and remains a concern in multiple parts of the world. Developing countries often lack the necessary resources to build schools, train teachers, and provide school materials for children. This leads to densely populated classrooms with a mix of educational levels, inhibiting the pupils’ ability to benefit from an education adapted to their needs and capacities, which ultimately may result in education failure and drop-outs. As a result of poverty and marginalisation, more than 72 million children around the world remain unschooled. Girls are at a particular disadvantage, accounting for over 54% of the unschooled population worldwide. This is common in many Asian and Arab regions, where culture and tradition favour investing in boys’ education, while girls are expected to work in the family home.
Child rights and health are closely related. To promote children’s health in Europe, the World Health Organisation (WHO) Regional Office for Europe developed a strategy for child and adolescent health for the period 2015-2020. This framework is built on the principles of a life-course approach, equity, intersectoral action, and participation of children and adolescents. It emphasises childhood and adolescent health and experiences have a significant impact on adult health and illness. This rights-based strategy has been adopted by all 53 of the WHO’s European member states, endorsing that all children and adolescents in Europe should have the tools and opportunities to realise their full potential for health, development, and wellbeing. A recent publication shows that progress has been made towards the adoption of this framework, but many important areas for further action still exist, including the direct involvement of children and adolescents in matters which affect them.
We are compelled to stop and reflect on how our own roles as physicians in society can affect and improve the wellbeing of children, and always support and respect their rights. As Paediatricians, we may feel we are limited to only looking at the healthcare needs of children. However, there is much more we can do to advocate for children’s rights.
We can start by ensuring that all children seen in our services are treated fairly, regardless of their background or circumstances. We should strive to ensure that all children enjoy equal accessibility to our services and commit to breaking down any barriers to access (finances, education, travel). As health professionals, we must remember to routinely promote public health initiatives, such as vaccination, healthy eating, and stop smoking campaigns, not only to children and young people, but to caregivers and adults, as all children have the right to be protected from illness and exposure to harmful environments.
It is our responsibility to educate ourselves on these topics ensure that all healthcare professionals have robust knowledge to pass on to patients and their caregivers. Beyond this, however, we believe that a level of standardisation in healthcare education is necessary to ensure that this robust knowledge is both reliable and present across Europe. Similarly, we must advocate for all children to have access to quality education, and engage in cross-sectoral cooperation to enable this to happen.
Finally, we should not underestimate the power of pressing for improved legislation. Lobbying policy makers not only serves as a reminder to keep child rights at the heart of work on migration, education, public health, and healthcare initiatives, but is a way of representing children’s voices where they otherwise lack influence
We have a responsibility to advocate for the rights of children and young people, and Young EAP and EAP urge paediatricians to keep the rights of the child at the forefront of their work by making the voice of those more vulnerable heard. In striving for progress, it is important to remember that there is strength in numbers and in cooperation; we therefore encourage solidarity and collaboration across sectors in the fight to protect children’s rights.
References
About the authors:
List of Authors
Lenneke Schrier is the European Junior Doctor Representative to the European Academy of Paediatrics, and the Chair of Young EAP. She is a 4th year paediatric trainee at the Leiden University Medical Center in the Netherlands.
Sian Copley is a 4th year resident from the UK working in the North East of England. Sian represents UK paediatric trainees within Young EAP, and paediatric trainees/Young EAP within the EAP Advocacy Group.
Paul Torpiano is a paediatric resident in Malta, and the Young EAP Representative for Migrant Health.
Veronica Said Pullicino is a 4th year paediatric trainee in Malta, and she represents the Maltese paediatric trainees within the Young EAP.
Robert Ross Russell is the chair of the European Board of Paediatrics and a member of the Executive Committee of the European Academy of Paediatrics. He is a Consultant Paediatrician at Cambridge University Hospitals Foundation Trust in the UK.
New ways to test high-risk medical devices.
Manufacturers of medical devices need to test their products before being allowed to market them. Specifically, they require clinical data showing their medical device is safe and efficient. In this context, the EU-funded CORE-MD project will translate expert scientific and clinical evidence on study designs for evaluating high-risk medical devices into advice for EU regulators. The project will propose how new trial designs can contribute and suggest ways to aggregate real-world data from medical device registries.
It will also conduct multidisciplinary workshops to propose a hierarchy of levels of evidence from clinical investigations, as well as educational and training objectives for all stakeholders, to build expertise in regulatory science in Europe. CORE–MD will translate expert scientific and clinical evidence on study designs for evaluating high-risk medical devices into advice for EU regulators, to achieve an appropriate balance between innovation, safety, and effectiveness. A unique collaboration between medical associations, regulatory agencies, notified bodies, academic institutions, patients’ groups, and health technology assessment agencies, will systematically review methodologies for the clinical investigation of high-risk medical devices, recommend how new trial designs can contribute, and advise on methods for aggregating real-world data from medical device registries with experience from clinical practice The consortium is led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, and involves all 33 specialist medical associations that are members of the Biomedical Alliance in Europe.
