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Boyer Lecture touts early-childhood investment as poverty antidote

Professor Michael Marmot began his second of the 2016 Boyer Lectures with a heartrending anecdote about the suicide of an 11-year-old Indigenous boy, Peter, found “hanging from a tree” near his grandparents’ house in Geraldton, WA.

Yet this dramatic introduction was not the most surprising aspect of his talk, broadcast on the ABC’s Radio National program on Saturday, September 10.

Marmot, who is president of the World Medical Association and director of the Institute of Health Equity, could have explored any aspect of the ‘gap’ between Indigenous and non-Indigenous Australians, or any other disadvantaged group, for that matter, for his lectures on the theme, Fair Australia: Social Justice and the Health Gap.

Instead, in a speech titled “Give every child the best start”, he chose to focus on the importance of healthy development, including early education, for Indigenous children.

He explained his rationale upfront: “The good and bad things that can happen in early childhood set the stage for health and wellbeing through the life course. The mind is the gateway by which the social environment affects mental and physical health. Development of the mind is, therefore, crucial.”

Inequality kills

Marmot teased out the correlation between childhood poverty and, ultimately, instances of youth suicide. Six cascading factors: difficult early-childhood circumstances; inadequate education; joblessness; lower incomes; worse environments; and higher rates of poor diets, illegal substance usage, including alcohol, cigarettes and drugs can all contribute to a sense of despair, which can result in children taking their own lives.

But is poor parenting or poverty to blame? Marmot imputes both. “These findings serve as a political litmus test,” he said. “People on the right, politically, blame poor parenting; those on the left say it is poverty and deprivation. I say they’re both correct. The social conditions in which parents are trying to raise their children affect their ability to be ‘good’ parents,” he reasoned.

So nip it in the (human) bud

Yet, Marmot believes the bleakness can stop in early-childhood by reducing “deprivation and, more generally, inequality”.

Although Australia already invests in Indigenous communities, Marmot suggested there’s room for further outlay, as the country ranks just 18th in a UNICEF table of relative child poverty, behind countries such as Slovenia and Hungary.

“Poverty is not destiny,” he pronounced. “Having quality preschool services and educationalists who are committed to bringing the performance level of deprived children up to that of the average makes a major difference.”

What doesn’t kill you makes you weaker

Marmot then turned to other, poverty-related detrimental facets of early childhood that require redress. By reference to results from hundreds of studies, including the seminal Adverse Child Experiences Study from San Diego, California, he revealed that harmful experiences in the early years, such as sexual abuse or neglect, which are more common in deprived, Indigenous communities, lead to greater rates of depression, attempted suicide, alcoholism, sexual promiscuity and injectable drug usage.

“People love to quote Nietzsche: that which does not kill us makes us stronger. Well, it doesn’t actually. It makes us more likely to get sick,” he averred.

Politicians: listen up

“It is not ignorance of the health consequences that lead to unhealthy behaviours,” Marmot argued. “Making ends meet, avoiding violence and other crime all take priority. People are not responsible for the social forces on their life. Get the social conditions right, ensure optimal early-child development, and then, of course, people can be expected to take responsibility for their own health.”

By instructing our government to “get the social conditions right”, he shifted blame for these circumstances from individuals. Marmot’s thesis is illustrated nowhere more starkly than on a cover of the WHO Commission on Social Determinants of Health – final report, from a body he chairs. The cover reads, “Social Injustice is killing on a grand scale.

If Canberra lawmakers heed his advice, perhaps a tragic story such as Peter’s could, some day, have a different, positive ending.

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