1000 days to close the gap
What we can learn from the early baby health centres in Victoria to close the gap in Indigenous infant health.
International research has shown that the first 1000 days, from conception to age two, offers a crucial window of opportunity to positively impact later life health. This inspired the 1000 Days global movement, established in 2013 to address child development specifically for countries experiencing high infant mortality rates and poor growth.\
Professor Kerry Arabena
Focussing on child and family health underpins Professor Kerry Arabena’s work to improve life expectancy and health quality for Aboriginal and Torres Strait Islander children and communities. “As our understanding of developmental science improves, it becomes clearer that adverse events in a child’s life leads to structural changes in brain development that have life-long and societal ramifications,” says Professor Arabena, in recent a statement to the Australian Human Rights Commission.
“We now also know these effects are intergenerational. Not intervening will not only affect this generation of children, but also the next.” The opportunity to transform the international 1000 Days idea to address the inequity between the health of Indigenous and non-Indigenous children appealed to Professor Arabena as the next major project she could lead at the University of Melbourne’s Indigenous Health Equity Unit.
The model aims to bring together antenatal and neonatal support designed by and for Indigenous health providers and leaders to address the needs of families and babies, and tackle the social determinants that impact on the quality of life for the whole community. Ample evidence for the positive impact early intervention has on the futures of young babies and children can be found in the legacy of Dr Vera Scantlebury Brown.
Ninety years ago Dr Scantlebury-Brown was appointed the first Director of Infant Welfare in Victoria. Her legacy includes the network of baby-health centres spread across the state which, since that time, have provided essential antenatal and neonatal care and educational services for mothers and their babies.
More than this, she inspired a generation of her colleagues to join her in working for the health of mothers and their babies, effecting a cultural change that placed great importance on universal maternal and child health care as the foundation for a healthy and thriving community.
Connecting then and now
Professor Kerry Arabena’s work holds the same promise for Indigenous communities. “A radical change is required in how we think about and enhance the early outcomes for Aboriginal and Torres Strait Islander children in Australia,” says Professor Arabena. “It is crucial that our interventions achieve sustained change by investing in the early years, rather than the default position of intervention at the point of crisis.”
Just like we still see today across the world and in Australia, the more disadvantaged a community, the more they are affected by high infant mortality rates.
In the 1920s, 3000 Victorian babies died before their first birthday. With so many lives lost from the war and the Spanish influenza, the health community turned their attention on reducing infant mortality. Dr Scantlebury-Brown expanded baby health centres across the state to remote communities which were essential in promoting good practices for new mums across the state.
Getting the right start
Reducing the infant mortality rate (IMR) is a key priority of the Closing the Gap campaign, but little progress has been made. The 2016 Parliamentary report card on Closing the Gap in Indigenous disadvantage stated significant improvement in infant mortality rates, but many Indigenous children are developmentally vulnerable, living in violent circumstances or in poverty.
Despite community efforts working with families, many Indigenous children are still not getting the start they need. Tackling all of these issues – drug use, nutrition, teenage health – and maintaining strong cultural links is essential for strengthening our community and improving the health of our children. A major aspect of improving the health and wellbeing of Indigenous children is finding ways to strengthen the role of men as fathers and parental supports.
“Involving men in children’s lives is crucial for the child’s health and well-being and has a strong intergenerational effect. Positive parents and supportive fathers are critical role models for our children,” says Professor Arabena.
Like Dr Scantlebury-Brown whose work reached remote communities across Victoria, Professor Arabena is engaging Indigenous communities across Australia to rise to the challenge and address what they believe are the key obstacles in closing this gap.
“Aboriginal and Torres Strait Islander people, have never benefited from being described as a deficit, that our problems are too big, that our problems actually need outside, external interventions. We are strong. We are capable.” The First 1000 Days Australian model is taking part of what made Vera Scantlebury-Brown a pioneer for infant health and translating it to meet the needs of the community. “We must target all life stages, and engage all family members and communities for better health,” says Professor Arabena.