State of Child Health in Aotearoa New Zealand 2023

When Professor Sir Bob Elliott and Dr Ron Caughey founded Cure Kids in 1971 they had a goal of reducing the disproportionate burden of diseases on children in Aotearoa NZ. Tamariki need paediatric research specific to our own unique population and health challenges and our purpose. Cure Kids supports research into these big health issues in order to raise the standard of health of our tamariki in Aotearoa NZ and the Pacific Islands.

Cure Kids have once again joined forces with the NZ Child and Youth Epidemiology Service at the University of Otago to write the report with input from the Paediatric Society of NZ, the Royal Australasian College of Physicians, and with other expert advisors around the country.

For this 2023 report, our advisors built on the previous three reports prepared since 2020 and selected five major classes of health conditions that have a big impact on the lives of infants, children, and young people in Aotearoa NZ: • Respiratory conditions • Rheumatic fever and rheumatic heart disease • Skin infections • Dental disease • Mental health concerns

These conditions were chosen because of their prevalence, the cost to the health system, the severity of disease for individual children, and the long-term consequences for children’s future health. We believe that these are the most urgent priorities for child health. Not only have rates of hospital admissions remained unacceptably high over two decades, but the burden of disease is inequitable. Tamariki Māori, Pasifika children, and children living in areas with the greatest socioeconomic deprivation are disproportionately affected.

These health issues cause crises for children and their whānau, requiring visits to hospital, time away from school, and significant disruption to families. In the long term, this burden of disease causes chronic conditions that can persist into adulthood, with significant social and economic impacts for Aotearoa NZ.

This year, the Cure Kids State of Child Health Report not only shines a spotlight on the unacceptably high rates of disease that our tamariki are experiencing but also highlights some opportunities to improve outcomes across these five health areas. For example: • Respiratory conditions – Continued subsidisation of the influenza vaccine annually. Data has shown that increasing access to the vaccine by subsidisation is a highly cost-effective measure to reduce the risk of influenza-associated hospitalisation. • Rheumatic fever and rheumatic heart disease – Continued funding of research programmes that are investigating the immune pathogenesis of ARF, developing a diagnostic test for ARF, and developing Group A Streptococcus (GAS) vaccines. • Skin infections – Investigation into free treatment (anti-septics and dressings) for minor skin infections/injuries in the community through public nursing, school-based care, pharmacies, and primary care. • Dental disease – Oral health providers need to work with communities to improve access to care and ensure that care is delivered in a culturally appropriate manner. This will ensure that children with some of the greatest need for treatment are seen prior to needing hospital-level care. • Mental health concerns – Quality research into effective treatment strategies, service delivery, and prevention methods (e.g., digital interventions or community development strategies) that ‘stem the tide’ of increasing population level distress is needed. These interventions must be specific to the populations they are targeting and must address the wider social determinants of mental wellbeing.

National action to reduce child poverty, by delivering equitable access to healthcare, nutrition, and appropriate housing, remains one of the most important ways to positively impact the health of our tamariki and reduce risk factors across the five health areas highlighted in this report. Targeted investment into the health of children will generate long-term population-level benefits that far exceed the initial costs. Cure Kids is committed to investing in the big research questions that prevent our children from living their best lives. Only by intentional action will we achieve our vision of healthier children with brighter futures.