Abstracts Child Health and Justice

Rosario Carmona: The right of the child to enjoy the highest standard attainable of health in situations of poverty  or economic crisis: Analysis under the Convention on the Rights of the Child

The binding legal nature of the Convention on the Rights of the Child, its almost universal ratification and the general acceptance of its guiding principles explain and justify the importance of this treaty on all actions concerning the child.

In this case, our work will focus on a specific issue addressed by the Convention - the children's health - and the impact on it of some factors like poverty, the global economic situation or others financial structural determinants.

We will outline some general concepts to determine the extent of such rights; we will emphasize the importance of approaching children's health from the perspective of children's rights; and will specify the scope of the obligations of States to enforce that right.
So, we will find a close link between the concept of health established by the WHO (“state of complete physical, mental and social well-being”) and the right of children to enjoy the "highest attainable standard of health" (Article 24 of the Convention); the indivisibility and interdependence of children´s rights may us explain the indispensability of the right to health for the enjoyment of all other rights enshrined in the Convention; and the obligation of  States parties to the Convention to enforce this right allow us to interpret its commitment to "undertake ... measures to the maximum extent of available resources" (Article 4).
The doctrine of the Committee on the Rights of the Child - control mechanism and legitimate interpretation of the Convention - will be critical to the analysis of these issues, especially its General Comments and Concluding Observations on the reports of States Parties to the Convention, primarily in the years since the start of the global economic crisis.

Sridhar Venkatapuram: Health equity among children, and the case of vaccinations

There is a recognizable effort toward making an argument for the right of every infant/child for health and wellbeing. This language of rights, however, has been downplayed over the last decade in global health, and in child health programmes. This, I would argue, is largely due to the larges funders of global health being dismissive of the language and concepts of rights, and human rights more broadly.  Instead, like in public health generally, global health funders are largely maximizers; they seek to maximize the outcomes such as health outcomes given certain amount of resources such as time, personnel, and finances.

For maximizers working to improve child health, there is thought to be a clear trade-off between maximizing versus recognizing equal rights, or prioritizing those that are worst off. In this paper, I will aim to work through why a maximizing approach to child health, or not being concerned about equity at all, is unjust. And, I will try to work through different argumentative strategies for ensuring that there is priority given to the worst off, or perhaps, universal access. The case of vaccinations, particularly in India, will be used as the case study. It is a situation where the growing middle classes and the elite are vaccinating their children, while there is not a strong public commitment to ensure access to the worst off, or a demand for vaccinations from the poorest parts of society.  The paper aims to show why equity or priority of the worst off, has to be a central part of justice for children.

 Bill Gardner: Children’s Differential Susceptibility to Treatments: Implications for Justice

The child developmentalist Jay Belsky and his colleagues have argued for the “differential susceptibility hypothesis” (DSH). The DSH generalizes from many studies of how children with different genotypes develop differently in response to environmental stresses or psychosocial interventions. The DSH says that there is genetic variation in children’s resilience. That is, genetic factors predispose some children to be highly responsive to interventions and other children to be less responsive.

Belsky argues that if the DSH is confirmed, it supports (what I call) the Differential Susceptibility Policy (DSP). The DSP says that to implement a psychosocial (or, by extension, medical) treatment for which the DSH is true, we should first genotype children. We should then preferentially target interventions to the children who have genes predisposing them to be most sensitive to the interventions. By allocating treatments to the children who are most responsive to treatment, the DSP achieves the most efficient use of scarce treatment resources, and is therefore welfare maximizing.

Let’s stipulate that the DSH is true in the sense that genes predispose some children to have reduced -- but not zero -- responsiveness to treatment interventions. I argue that the truth of the DSH does not require us to follow the DSP. I raise three concerns about the DSP.

First, genetic screening for resilience may itself have adverse effects. It’s possible that children who are less responsive to interventions are nevertheless sensitive to social expectations about their responsiveness to treatment. Perhaps being labeled as genetically unresponsive to treatment would make the treatment even less effective. Because of this and other unanticipated adverse consequences, we cannot know whether the DSP works from the DSH alone: we must test the DSP directly.

Second, the evidence supporting the DSH is not sufficient to show that the DSP is welfare maximizing. Whether the DSP is welfare maximizing depends on how genetic variation conditions the distributions of the lifetime welfare outcomes of an intervention. These lifetime outcomes are usually hard to measure. For example, the benefits of high quality preschool have only become apparent by following participants over decades. The lifetime welfare outcomes of preventing a highly adverse developmental trajectory -- e.g., a conduct disordered child who becomes a career criminal -- might be very large. They might be so high that it would be efficient to expend substantial resources to achieve them, including investing resources in children who are significantly less responsive to interventions than their peers. When the shape of the lifetime welfare outcome distributions is unknown – the standard case -- the efficiency of the DSP will be unknown. This weakens the DSP case for denying a genetically disadvantaged child access to an intervention.

Third, the DSP may lead to unjust treatment of less responsive children. The DSP appeals to norms of efficiency and welfare maximization. However, an exclusive focus on efficiency and welfare maximization is inconsistent with other principles embraced by liberal democracies. The norm of fair equality of opportunity means that we should help children achieve developmental trajectories that give children the capabilities to be self-sufficient adults. Achieving these developmental outcomes may require that society spend more to help the less responsive children achieve sufficient capabilities, rather than concentrating resources on the most responsive children. I conclude by considering how child policy makers might seek to balance concerns of efficiency stressed by the DSP with concerns about fairness and democratic equality.  

In summary, I argue that the truth of the DSH is not sufficient to show that the DSP would actually maximize welfare (concerns 1 and 2). Even if those concerns can be met, the norms of efficiency and welfare maximization need to be balanced with the egalitarian commitments of liberal polities (concern 3).

  

Carlos Pitillas: Psychological effects of extreme poverty in immigrant children in the settlement “El Gallinero” (Madrid)

Among realities being faced by immigrant youngsters, extreme poverty is probably the one that most strongly impacts upon their wellbeing and mental health. With the present study, we aim to understand psychological effects of such poverty among children and adolescents who live in “El Gallinero”, a shack settlement located outside the city of Madrid. These youngsters, who belong to Romanian families of gipsy ethnicity, represent a case of poverty within big First World cities.

To our knowledge, this is the first study where children from the aforementioned context directly inform about their experience. Participants’ representations of themselves, their way of life, their future aspirations, their perception of opportunities, etc, were gathered in discussion groups and interviews. Additionally, using a symbolic play assessment procedure, indicators of a posttraumatic process were explored.

The core results of our study suggest that: 1. These youngsters are capable of constructing a complex view of themselves and their life conditions. 2. They aspire to forms of living that coincide with a Western, normalized, lifestyle. 3. There exists an intergenerational tension, regarding such aspirations. 4. A significant number of young children seem to suffer from a posttraumatic process.

These results will be described in detail, and discussed in light of the public policies that have been displayed with respect to this settlement. They will also be discussed within a wider framework of recommendations for intervention.

Sepideh Yousefzadeh: Child Growth Monitoring: What lies Beneath the Weights and Height? 

Growth charts for measuring and monitoring children’s healthy growth were introduced during the 60s, when the total number of hungry people was extremely high[1]. Ever since, growth charts have been an important tool to measure and monitor children’s growth globally. Between 1970 and 2000, in the developing world, the proportion of children affected by malnutrition decreased by 20%[2]. Nevertheless, in the 90s, still 50% of all deaths among children were attributed to malnutrition[3]. Therefore, some scholars initiated two interrelated discourses about the global approach in addressing child growth and malnutrition[4]. Some focused on inequalities and the fact that in examining child malnutrition the focus cannot merely be on a country’s average achievements in reducing malnutrition. As such, disaggregated data needs to be analyzed in order to design local policies to reach to children with higher risk of growth faltering. In the meantime, some other scholars discussed the root causes of growth faltering. They argued that causes of growth faltering often cut across different dimensions of children’s being, whereby, nutritional input is only one of those causes. Therefore a holistic approach to take into account different dimensions and causes of growth faltering is required in order to suggest other inputs – next to nutritional inputs- and address children’s growth more effectively.

Given the above mentioned background, the importance of designing approaches that cut across different dimensions of child growth (i.e. multidimensional), address the root causes of growth faltering that are multi-sectoral, and at the same time focus on inequalities has been acknowledged for more than two decades. Nevertheless, today, despite the increasing trend in the field of ‘multidimensional measurement’ in various studies concerning children (poverty, deprivation and wellbeing), child growth has received the least attention.

This paper aims to propose a framework for multidimensional child growth. It combines Bronfenbrenner’s bioecological model to human development with Amartya Sen’s Capability Approach in order to propose the framework. The Capability Approach is applied in order to: a) reflect on the importance of contexts that shape and contribute to children’s growth, b) define growth as a multidimensional concept, and c) reflect on the agency and freedom of choice in achieving optimum growth. Therefore the Capability Approach provides insights into different capabilities that are required in order for children to have a healthy growth.   

The bioecological model on the other hand provide more nuances of different levels factors that affect children’s growth (household and society).

The paper uses DHS India to apply and implement the proposed multidimensional-multilevel tool. By doing so, various variables are introduced and analyzed as entitlements, conversion factors, and capability sets. Eventually, children’s functioning as ‘healthy growth’ is assessed not only by assessing their weight and height, but also by analyzing sets of capabilities that are required for their healthy growth.

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[1] FAO 2002

[2] Wagstaff, Watanabe 1999

[3] O’Neil, Fitzgerald, et al. 2012

[4] Pinstrup-Adersen 1993; Wagstaff, Watanabe 1999; Larrea, Freire 2002; de Poel, Hosseinpoor et al. 2008