The health impact of adverse environment and migration on children

The German situation.

ECPCP Spring Meeting, Rome 2015Elke Jaeger-Roman, Berlin

Convention on the Rights of the Child

• § 3....the best interests of the child shall be a primary consideration

• § 22 States Parties shall take appropriate measures to ensure that a child who is seeking refugee ... receive appropriate protection and humanitarian assistance...

• § 24 States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health...

• § 28 States Parties recognize the right of the child to education... on the basis of equal opportunity

Child (< 18 Years) Poverty Rate in Germany

19,4 % (1 in 5 ) of all children in Germany live in households with an income below 60% of the national median (2014):

= 2,5 Millionen Children

Child Poverty Rates by Family Type

Single Parent, 1 Child

Single Parent, 2 Children

2 Parents, 1 Child

2 Parents, 2 Children

2 Parents, 3 Children

0

10

20

30

40

50

60

Child health disparities are highly dependant on the socio-economic status of the parents

Social StatusLow Middle High

Adipositas (11 – 13 years) 39 28 21 %

Oral health behaviour (brushing teeth < 2 / die) 12 6 3,6 %

Smoking (14 – 17 years) ♂

♀

36 30 26 % 39 33 22 %

Behaviour problems 12,2 6,4 3,5%

ADHS (suspected) 6,5 5,0 3,2%

Physical activity (3 – 10 years; < 1x/week) ♂

♀

36 21 15 % 40 21 12 %

Use of electronic media (TV/Video >3 hrs per day) 32 23 13 %

Poverty and educational background of parents are more important for child development than a migratory background

19 % of the German population have a migratory backgroundThereof > 30% are of Turkish and Kurdish decent (2./3.generation)

Parents from a religiously rooted conservative migratory milieu* have difficulties to accept integration – their children are at risk of missing out on early childhood - and school education.

*Most often islamic Rural background Patriarchal view of the world Rigid moral concepts Educational goal: hierarchical connectivity (vs. autonomy)

Development of Speech – German as Second Language.

Mastery of language is one of the most important factors for good school achievement

40 % of children of Turkish or Arabic background do not speak German well at school enrolment. They are not able to follow normal lessons.

12,8 % of migrant children (vs. 6,5 % children of German descent) are school drop outs.

The Present Refugee Disaster

65.000 refugee children live in Germany without secured residence status Each year,40.000 refugee children come to Germany, of these 9.000 children and adolescents are unaccompanied (as young as 5 years).

They only have the right for treatment of acute illnesses,Schooling is not compulsary.

What do we as primary care paediatricians do for advocacy?

We paediatricians campaign heavily on all political and parliamentarian levels and in all media (TV, radio, newspapers, face book, twitter etc) for children's rights. These should be written into the German constitution.

In March 2015 we launched a petition and collected over 111.000 signatures to appoint an ombudsman in parliament to monitor the rights of children in Germany.

Some – but by far not enough - laws have been changed for the better of children due to our intervention.