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