Abstracts Child Health and
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
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
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
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
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.
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.
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?
for measuring and monitoring children’s healthy growth were introduced during
the 60s, when the total number of hungry people was extremely high. 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%. Nevertheless, in the 90s, still 50% of all deaths
among children were attributed to malnutrition. Therefore, some scholars initiated two interrelated
discourses about the global approach in addressing child growth and malnutrition. 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
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
 FAO 2002
 Wagstaff, Watanabe 1999
 O’Neil, Fitzgerald, et al. 2012
 Pinstrup-Adersen 1993; Wagstaff, Watanabe
1999; Larrea, Freire 2002; de Poel, Hosseinpoor et al. 2008
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.
 FAO 2002
 Wagstaff, Watanabe 1999
 O’Neil, Fitzgerald, et al. 2012
 Pinstrup-Adersen 1993; Wagstaff, Watanabe 1999; Larrea, Freire 2002; de Poel, Hosseinpoor et al. 2008