• By Kevin Mount
  • Posted on Tuesday 30th October, 2007

The Treasure who's pushing Australia toward its children's rights exam

The turning point in Fiona Stanley’s early career happened in the early 1970s when she was working in the Children's Hospital in Perth, Western Australia, among sick children who were being flown backwards and forwards from remote Aboriginal settlements for life saving treatment. For someone whose childhood fantasies had been inspired by Albert Schweitzer it was a distressing revelation. "In my eight-year-old dreams I would sail out to all the undiscovered islands of the world and inoculate the inhabitants in a whirlwind race to conquer disease and pestilence." But in Perth as a real doctor, "we would perform expensive miracles and then dump children back into the environments that had caused their problems". The low point was watching the preventable death of a boy who had been treated and returned home to no avail on several occasions.The road Fiona Stanley took has enabled her to transform her country's attitudes to child health and development to such effect that she was named Australian of the Year in 2003. A year later she was honored as a “National Living Treasure” by the Australian National Trust. The catalyst was an advertisement in The Lancet that had been placed by a pioneer in the field of public health and social medicine Jerry Morris, inviting people to train in social medicine at the London School of Hygiene and Tropical Medicine. "It changed my life," she says. She spent six years in the UK at the Social Medicine Unit and moved from there to research in the US before returning to Perth to establish research programs at the University and within the health department. She became part of the vanguard of what Australia recognizes as the next trend in medicine – the move from a preoccupation with curing disease to a focus on prevention and social causal pathways.Every conversation with her is a reminder of the need for evidence. "Knowledge and data are powerful" she says. But what marks her apart is a balancing attention to social justice and human rights. "Most poor child outcomes can be traced back to disadvantage." This twin commitment is reflected in the work of the Telethon Institute for Child Health Research, which she founded and directs in Subiaco, Western Australia. Since 1990 it has published over 1,600 scientific papers but it is also recognized as one of the major advocates for Australian children and families. Stanley is proud of the fact that over 30 Aboriginal staff and students work at the Institute and are helping to establish a culturally-sensitive research agenda. It is a far cry from the almost apartheid conditions she witnessed at the beginning of her career.Much of the success of the Institute's activity rests on the availability of high quality population data. She told Prevention Action, "since most of it already exists and is being used for secondary purposes we can use it without getting consent. Our skill is bringing different sources of information together and, most importantly, using it to inform improvements in policy and practice".The investment has radiated from health into all aspects of child well-being, including child maltreatment, disability and mental health. The Institute was one of the early advocates for the Australian Early Development Index. [See Is Canadian Index the key to standard child development measures?. ]The results are sobering and relevant far beyond the Australian context. "The Index shows quite extraordinary variations in children's health and development," Stanley explains. "But when you map services against needs, the pattern is the reverse of what’s required. Libraries, green space, early years support and much more into adolescence are most available in the communities that require them least". Getting politicians to recognize that “health is not just about hospitals” and “development is not just about child welfare” is a struggle that crosses national borders.She has succeeded in lobbying Australian politicians often in inauspicious circumstances. In 2002 for example, having set up the Australian Research Alliance for Children and Youth, she persuaded Prime Minister Howard to launch it.If the Alliance is being taken seriously, then Australia is beginning to wake up to the paradox of life in the developed world, where greater wealth occurs simultaneously with greater risks to children's well-being, leading to increases in asthma, obesity, diabetes, child abuse, binge-drinking, drug abuse and mental health problems. Among possible reasons for the decline Stanley points to greater inequalities in opportunity, housing, employment and access to services. "Science is one way to understand and respond to the problem, but building civil society also has its place." she says.Asked what she considers to be her greatest achievement she answers unhesitatingly. "Setting up the Institute and the people who work in it gives me a great sense of pride". But there have also been frustrations. As long ago as 1991, as part of international research, her team helped to discover the potential to prevent birth defects, including spina bifida, by ensuring the diet of pregnant mothers is sufficiently rich in folic acid. The Australian Government has only just decided to mandate the fortification of bread with folate.A greater disappointment harks back to her original work on the health of Aboriginal children. Of her continuing struggle to improve the well being of all Australian children, she says: "If Australia were to be examined on the way it respects children's rights, it would fail the test. And that’s why it will not take the exam".

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