Intervention or Prevention? National Child Well-Being Strategies in

Germany and Great Britain Instancing Health Behaviour in Early Childhood

Carolyn Stolberg & Carina MartenGeorg-August-University Goettingen

3rd conference of the International Society for Child Indicators (ISCI): „Children‘s Well-Being: The Research & Policy Challenges“

York, July 28th, 2011

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Research BackgroundThe POLCHI-Project

Embedded in PolChi -Project “Governing ‘new social risks’: The case of recent child policies in European welfare states”•funded within: ORA •start: May 2011•national team: France, Germany, Great Britain, the Netherlands

Aim of the project: Analysing the logics of prevention and intervention programmes for parents in four countries

Our focus: child health in the early years

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Our research within the projectRelevance

THE CONVENTION ON THE RIGHTS OF THE CHILD (UN 1989)

Guiding principles: general requirements for all rights

Right to life, survival and development (Article 6):

Children have the right to live. Governments should ensure that

children survive and develop healthily.

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Our research within the projectRelevance

Fig. 1: overall child well-being index (Data from 2006)

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Source: Bradshaw/Richardson 2009: 324, own excerpt.

Rank Country Child WB in EU 29

Health Subj. WB

Relation-ships

Material Risk Edu-cation

Housing

1 NL 117.3 2 1 1 7 4 4 9

2 SWE 114.8 1 7 3 10 1 9 3

8 GER 106.1 17 12 8 12 5 6 16

15 FR 100.9 20 14 28 11 10 13 10

24 GB 92.9 24 21 15 24 18 22 17

28 LT 82,3 22 27 25 25 28 24 24

Our research within the projectRelevance

Fig. 1: overall child well-being index (Data from 2006)

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Rank Country Child WB in EU 29

Health Subj. WB

Relation-ships

Material Risk Edu-cation

Housing

1 NL 117.3 2 1 1 7 4 4 9

2 SWE 114.8 1 7 3 10 1 9 3

8 GER 106.1 17 12 8 12 5 6 16

15 FR 100.9 20 14 28 11 10 13 10

24 GB 92.9 24 21 15 24 18 22 17

28 LT 82,3 22 27 25 25 28 24 24

Source: Bradshaw/Richardson 2009: 324, own excerpt.

Our research within the projectRelevance

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Rank Country Child WB in EU 29

Health Subj. WB

Relation-ships

Material Risk Edu-cation

Housing

1 NL 117.3 2 1 1 7 4 4 9

2 SWE 114.8 1 7 3 10 1 9 3

8 GER 106.1 17 12 8 12 5 6 16

15 FR 100.9 20 14 28 11 10 13 10

24 GB 92.9 24 21 15 24 18 22 17

28 LT 82,3 22 27 25 25 28 24 24

Source: Bradshaw/Richardson 2009: 324, own excerpt.

Fig. 1: overall child well-being index (Data from 2006)

Our research within the projectAim and research question

Central research question: How do British respectively German policies approach the issue of health behaviour in early childhood?•How are parents’ abilities and potentials in good health behaviour adressed?

•Are these institutions based on logics of prevention or rather intervention?

•To what extent do programmes balance aspects of social control and supporting parents by empowerment?

•Which agencies of policy services are involved?

•Do the logics and practices of child-centred policies converge or diverge in the two countries?

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Structure

1) TerminologyEarly childhood & Health; Intervention & Prevention

2) Welfare regime and child-centred policyThe case of Germany & Great Britain; Typology

3) Policy strategies in Germany Health Check-ups before and after birth; Family-midwives within the pilot project “Pro Kind”; Opstapje – Step by Step

4) Policy strategies in Great BritainThe Healthy Child Programme (HCP); Family-Nurse Partnership programme (FNP); Children‘s Centres

5) ResultsThe case of Germany & Great Britain within the Typology

6) Summary and Conclusion

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Early childhood: before birth – 3 years •“What happens during the very earliest years of a child’s life … influences how the rest of childhood and adolescence unfolds” (UNICEF 2001: 2)

Health: “Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” (WHO 1948)•main health issues: obesity or other nutrition deficits, inequality in infant mortality, psychological health, accidents, chronical illnesses, child neglect and abuse

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1) TerminologyEarly childhood & Health

Intervention & Prevention: Most authors differentiate between primary, secondary and tertiary prevention or (if they use the term intervention) do not distinguish between intervention and prevention (see e.g. Blair et al. 2010; Jahn 2008)

We will focus on the definitions of Parton (2006)

•Prevention is before disease occurs

– syn. with primary prevention

– allways positive (support)

•Intervention is after disease occured syn. with secondary prevention positive and/or negative (service)

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1) TerminologyIntervention & Prevention

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2) Welfare Regime and child-centred policyThe case of Germany & Great Britain

The case of Germany

•Conservative

•State driven

•Transfers rather than services

•Early warning system to safe-guarding child health

•Health within the 13th Children and Youth Report

More preventionionist?

The case of Great Britain

•Liberal

•Market driven

•Services rather than transfers

•Health contribution by early years services

•Health within National Action Plan

More interventionist?

Prevention

Intervention

Self-support Professionals

Universal Targeted

Voluntary Compulsory

Fees Free of charge

Advice Service

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2) Welfare Regime and child-centred policyTypology

Dim

ensi

ons

Three programmes per country:

(1) complete health orientated, (2) importation, (3) country-specific

The Goal• healthy development of the (unborn) child

The Concept • medical monitoring during the pregnancy

• medical monitoring and imunisation after birth

long tradition in germany

3) Policy strategies in GermanyHealth Check-ups before and after birth

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Source: BMFSFJ 2009; Khaschei 2006: 52; BzgA 2010.

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3) Policy strategies in GermanyHealth Check-ups before and after birth

Source: BMFSFJ 2009; Khaschei 2006: 52; BzgA 2010.

Dim

ensi

ons

Prevention

Intervention

Professionals (doctors)

Universal (specified amount) Targeted (more check-ups)

Voluntary (most of the federal states) Compulsory (e.g. in Hesse)

Free of charge (e.g. health insurance)

Service

Dim

ensi

ons

The Goals• improvement of health behaviour within the pregnancy

• health promotion in the first two years of the child

The Concept: • Family-midwives are going into the families (idea of the Nurse-

Family Partnership, USA)

pilot project in germany since 2006

3) Policy strategies in GermanyFamily-midwives within the pilot project “Pro Kind”

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Source: Ziert et al. 2010; NZFH 2010.

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3) Policy strategies in GermanyFamily-midwives within the pilot project “Pro Kind”

Dim

ensi

ons

Source: Ziert et al. 2010; NZFH 2010.

Prevention

Intervention

Professionals (midwives)

Targeted (first pregnancy; difficult circumstances)

Voluntary

Free of charge (funded by BMFSFJ)

Advice

Dim

ensi

ons

The Goals concerning• the parents: support in childraise

• the children: guarantee age-related development

• the family: strengthening parent-child-relation

The Concept: • early support; health as an sub-aspect (grow up healthily)

• house visiting over two years

exists in germany since 2001

3) Policy strategies in GermanyOpstapje – Step by Step

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Source: Sann/Thrum 2005.

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3) Policy strategies in GermanyOpstapje – Step by Step

Dim

ensi

ons

Source: Sann/Thrum 2005.

Prevention

Intervention

Professionals (skilled)

Targeted (disadvantaged families)

Voluntary

Fees (paid by parents)

Advice

Dim

ensi

ons

The Goals• improvement of child health and well-being

• “parenting support” (DH 2009: 10)

The Concept: • “begins in early pregnancy and ends at adulthood…” (DH 2009: 7)

• “…screening tests, immunisations, developmental reviews, and information and guidance to support parenting…” (DH 2009: 8)

4) Policy strategies in Great BritainThe Healthy Child Programme (HCP)

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4) Policy strategies in Great BritainThe Healthy Child Programme (HCP)

Dim

ensi

ons

Source: DH 2009.

Prevention

Intervention

Professionals (health visitors)

Universal (every family) Targeted (families in need)

Voluntary

Free of charge (DH)?

Service

Dim

ensi

ons

The Goals are to improve (DH 2011: 13):

• “maternal and child pregnancy outcomes”

• “child health and developmental outcomes”

• “parent’s economic self-sufficiency”

The Concept: • Nurses are going into the families (idea of the Nurse-Family

Partnership from the USA)

pilot project in Great Britain since 2006

4) Policy strategies in Great BritainFamily-Nurse Partnership programme (FNP)

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Source: DH 2011.

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4) Policy strategies in Great BritainFamily-Nurse Partnership programme (FNP)

Dim

ensi

ons

Source: DCSF/DH 2009.

Warum hier beides?

Prevention

Intervention

Professionals (nurseries)

Targeted (low income mothers within their first pregnancy)

Voluntary

Free of charge (funded by DCSF, DH)

Service (subaspect of children‘s centres)

Dim

ensi

ons

The Goals• “…helping every child get the best start in life and helping them to be

healthy, stay safe, enjoy and achieve, make a positive contribution, and achieve economic well-being – the five vital Every Child Matters outcomes” (DCSF/DH 2010: 2f.)

The Concept: • “…place …through which early childhood services are made

available…” (DfE 2010: 6)

exists in Great Britain since 2004

4) Policy strategies in Great BritainChildren‘s Centres

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4) Policy strategies in Great BritainChildren‘s Centres

Dim

ensi

ons

Source: Lewis et al. 2011; DCSF/DH 2010; DfE 2010.

Prevention

Intervention

Professionals (e.g health care professionals)

Universal (all children/families)

Voluntary

Fee Free of charge

Service

Dim

ensi

ons

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5) ResultsThe case of Germany & Great Britain within the Typology

Is Germany more preventionist andGreat Britain more interventionist?

Prevention (self-control ↑)

Intervention (self-control ↓)

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5) ResultsThe case of Germany & Great Britain within the Typology

Is Germany more preventionist andGreat Britain more interventionist?

Prevention (self-control ↑)

Intervention (self-control ↓)

Health Check-ups before and after birth (GER)

Family-midwives within the pilot project “Pro Kind” (GER)

Opstapje – Step by Step (GER)

The Healthy Child Programme (HCP) (GB)

Family-Nurse Partnership programme (GB)

Children‘s Centres (GB)

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5) ResultsThe case of Germany & Great Britain within the Typology

Is Germany more preventionist andGreat Britain more interventionist?

Prevention (self-control ↑)

Intervention (self-control ↓)

Health Check-ups before and after birth (GER)

Family-midwives within the pilot project “Pro Kind” (GER)

Opstapje – Step by Step (GER)

The Healthy Child Programme (HCP) (GB)

Children‘s Centres (GB)

Family-Nurse Partnership programme (GB)

6) Summary and Conclusion

• Historical development to judge about divergence or convergence– Germany: pilot projects

– Great Britain: long tradition of early years services

• Outcomes differ also within countries– after analysing the logic of health programmes in more detail,

– their effect on different groups of children has to be evaluated

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Thank you!

Carolyn Stolberg

Institute of Sociology

Dept. Political Sociology and Social Policy

Georg-August-University Goettingen

Platz der Goettinger Sieben 3, 37073 Goettingen

Dr. Carina Marten

Institute of Sociology

Dept. Political Sociology and Social Policy

Georg-August-University Goettingen

Platz der Goettinger Sieben 3, 37073 Goettingen

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http://www.parenting.eu

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Tab. 1: Summary of indicators components and domains

Source: Bradshaw/Richardson 2009: 322.

Appendix