Identifying Strategies to Advance Health Equity through Action on Social Determinants of Health and Human Rights for Street-Connected Children and Youth in Kenya

Despite the fact that street-connected children and youth (SCY) in low- and middle-income countries experience numerous social and health inequities, few evidence-based policies and interventions have been implemented to improve their circumstances. Our study analyzed strategies to advance health equity through action on the social determinants of health (SDH) for SCY in Kenya based on General Comment 21 of the United Nations Committee on the Rights of the Child. To identify policies and interventions, we analyzed archival newspaper articles and policy documents and elicited ideas from a diversity of social actors across Kenya. Our results identified three types of policies and interventions: repressive, welfare oriented, and child rights based. We then situated these strategies within the World Health Organization’s conceptual framework on SDH inequities to understand their mechanism of impact on health equity. Our results demonstrate that a child rights approach provides a strong avenue for advancing health equity through action on the SDH for SCY in Kenya. As a result of these findings, we developed a checklist for policy makers and other stakeholders to assess how their policies and interventions are upholding human rights, addressing needs, and working to advance health equity for SCY.     

‘When we think about risk,we think about rights’: community-based organisations’ staff members' perspectives on risk,resiliency and rights in Juiz de Fora,Brazil

In this article, we draw on a qualitative case study undertaken in 2008 and 2009 of staff working at community-based organisations for at-risk youth in Juiz de Fora, Brazil, to examine staff members' perspectives of adolescent health-risk behaviours and resiliency. We use these data to explore how recent policy changes in Brazil have led to a shift in the ways in which adolescent risk taking is perceived by those working in youth services, and to suggest the influence that this has had on the way in which these entities promote resiliency among the population they serve. Specifically, we argue that Brazil's Child and Adolescent Act of 1990, a policy derived from the United Nations Convention on the Rights of the Child, has been instrumental in reframing for the community-based organisations the question of adolescent health-risk behaviours into a rights-based framework and has shifted the perceptions of those working at such organisations as to who a youth ‘at-risk’ is, why young people engage in risk taking and how best to promote resiliency. This work has implications for understanding both how risk and resiliency are constructed in different social and cultural contexts and how such concepts may change over time due to shifting socio-political climates.     

Alternative Education,Equity and Compromise: Dilemmas for Practice Development

The focus of this article is to provide a child rights analysis of the equity of educational experience afforded to young people outside mainstream schools by alternative providers. The dilemma for policy and existing practice is that alternative education supports children's right to an education as stated in Article 28 of the United Nations Convention on the Rights of the Child “when schools find they cannot”. However, in accepting alternatives are we compromising those same children's rights to achieve access to education on the basis of equality of opportunity? This is a right enshrined in the same article. In order to explore this dilemma, the present paper will firstly consider policy and practice concerns with regard to alternative education, drawing on periodic reports from the Committee on the Rights of the Child for the United Kingdom and how these findings relate specifically to the situation in Northern Ireland. The paper will then look at the articles relevant to the issue of exclusion from education within the United Nations Convention on the Rights of the Child. From this consideration of legal standards applicable to the issue of exclusion, the paper will focus on the complexities of the issue within the context of current debates on marginalized young people and education.     

Children: Rights, education and equal opportunity

The point of departure in this paper is the concept of RIGHTS. Whereas most countries accept that children have rights as is evidenced in the UNO Declaration of Rights of the Child (1959), such rights are statements, not laws. Statements advocating benefits, care, love, education etc. are goals or beliefs. Few countries have legalised rights; consequently, children may be at risk. In countries where there is discrimination of some degree in respect of race, colour, sex, religion, national or social origin, financial standing in society, level of education and so on, the right to “rights” as stated in the UNO Declaration is further jeopardised. The implications for educational provision from early childhood and onwards in countries where “rights” are not entrenched in statutes or where child advocacy is not forceful enough for all people are examined in this paper. Consequently, the chances for equal opportunity in life are reduced in situations where the child did not receive the benefit of education. Such a child may not perish as he might as a result of being deprived of food, but “the deprivation and injustice, the degradation of an individual and the setting of his vital interests at naught would at least approach in gravity the act of allowing him to die for the want of food” (1981, Wringe). In this paper, the author argues for the Rights of the Child, particularly where discrimination and inequalities exist and where provision for early education has to contend with excessive population growth.     

Children's rights: television programmes aired in Singapore

This article focuses on aspects of children's rights as portrayed in television. The results of a six-month research study show analyses of television content of Channel 5, which is the only free-to-air, 24-hour, English-language entertainment channel in Singapore. The results identify the role of television in assisting Singapore to meet its obligations in regard to the Convention on the Rights of the Child. News and advertisements aired on Channel 5 during primetime (between 7 pm and 10 pm) were recorded over a six-month period, and those featuring or related to children were analysed for the study. The samples were categorised and subcategorised based on the principles of the Convention (UNICEF, (2011a, June 2). Convention on the rights of the child. Rights Under the Convention on the Rights of the Child): Participation, Protection, Development, and Survival. A fifth category, not under United Nations Convention on the Rights of the Child-Object, was devised by the researchers. The results of this study have shown that the representation of children on television in Singapore is, in part, a reflection of how Singaporean society views children. Analyses of the media content indicated that protection and development of children was Singapore's top priority. Despite the fact that children were considered to need adult protection there was no reference to the Convention.     

Act-Up, other AIDS groups targeted for FBI surveillance. Federal Bureau of Investigations

Documents obtained by a civil rights group, the Center for Constitutional Rights, showed that the Federal Bureau of Investigations (FBI) monitored the activities of Act-Up, Gay Men's Health Crisis (GMHC), the Coalition for Lesbian and Gay Rights, and Senior Action in a Gay Environment. Act-Up was the main target from 1988 through 1992, the years it staged its most conspicuous demonstrations against the Federal government's policy on AIDS. According to one of the documents, George Bush, then president, complained about Act-Up holding protests and tossing condoms outside his summer home in Maine in 1992. The documents showed that the organization posed little threat of harm.     

Why the Convention on the Rights of the Child must become a guiding framework for the realization of the rights of children affected by tuberculosis

Background

Until recently, paediatric tuberculosis (TB) has been relatively neglected by the broader TB and the maternal and child health communities. Human rights-based approaches to children affected by TB could be powerful; however, awareness and application of such strategies is not widespread.

Discussion

We summarize the current challenges faced by children affected by TB, including: consideration of their family context; the limitations of preventive, diagnostic and treatment options; paucity of paediatric-specific research; failure in implementation of interventions; and stigma. We examine the articles of the Convention on the Rights of the Child (CRC) and relate them to childhood TB. Specifically, we focus on the five core principles of the CRC: children’s inherent right to life and States’ duties towards their survival and development; children’s right to enjoyment of the highest attainable standard of health; non-discrimination; best interests of the child; and respect for the views of the child. We highlight where children’s rights are violated and how a human rights-based approach should be used as a tool to help children affected by TB, particularly in light of the Sustainable Development Goals and their focus on universality and leaving no one behind.

Summary

The article aims to bridge the gap between those providing paediatric TB clinical care and conducting research, and those working in the fields of human rights policy and advocacy to promote a human rights-based approach for children affected by TB based upon the Convention on the Rights of the Child.

     

Does industry regulation of food advertising protect child rights?

This paper explores whether industry self-regulation of food advertising to children protects child rights. The New Zealand Advertising Standards Authority (ASA) system is analysed with respect to the United Nations Convention on the Rights of the Child (UNCROC). Content analysis of data sources such as the ASA website and key documents is used. Eight decisions on public complaints about advertising are analysed. This research finds that implementation of the codes includes partial, unjustified and inconsistent decision making by the complaints board; failure to implement changes to codes; and failure to prevent unhealthy food advertisements being developed and aired. The ASA system is found to be reactive, to have limited sanctions, to provide little incentive for restraint by advertisers, and to lack independent monitoring. This analysis suggests the New Zealand advertising standards system does not protect the rights of children by failing to enact the spirit of UNCROC and specifically by not adequately addressing Articles 3, 6 and 13. Given the extent of the harm to children worldwide of unhealthy eating patterns, the evidence of the contribution of marketing to poor nutrition and the findings of this research, it is concluded that government regulation of marketing of food to children should be implemented globally. This would assist governments to reduce the effects of one of the key environmental contributors to unhealthy eating patterns and enable them to meet their obligations in international law to protect the rights of children.     

Working With Street Children: A Child-centred Approach

This paper reviews the theoretical approaches that espouse a child-centred approach in intervening with street children. It focuses on two major themes, namely the rights of the child and client self-determination as proposed by Adler (Corey, 2001). The discussion acknowledges that providing street children with opportunities to participate in decision-making regarding their own lives is imperative. Notwithstanding their alleged marginalization, substantial motivation is provided for the adoption of a client-centred approach that upholds the rights of the child. The paper draws attention to the fact that despite the ratification of the United Nations Convention on the Rights of the Child (1989), many street children experience deprivation with regard to their basic human needs. It is envisaged that whatever the circumstances for children being on the street, their involvement and participation in alleviating their plight will not be compromised.     

Children's Services Planning in Northern Ireland: Developing a Planning Model to Address Rights and Needs

This article reflects on a number of key concepts and planning tools that have been developed or adapted through the inter-agency planning of services for children and young people in Northern Ireland (Children's Services Planning). These conceptual models have been developed between 1999 and 2005 and illustrate the key contribution of Children's Services Planning to two significant shifts in how the planning task has been understood. These refer to, firstly, the movement from service orientation to needs orientation, and secondly, the progression from needs to rights within service planning.

Children's Services Planning in Northern Ireland is now based on the United Nations Convention on the Rights of the Child and the Whole Child Model, which demonstrates the understanding that there is no such thing as a uni-dimensional child who only requires services from one agency. The Family Support model has been in use for some years within the process, and the joint outcomes framework, to be designed to enable agencies to address rights and needs has also been adopted across all four Children and Young People's Committees. In terms of outcomes, an overarching Strategy for Children and Young People will develop an outcomes framework within Northern Ireland, which is likely to build upon that of Every Child Matters, as well as children's rights. Children's Services Planning has also demonstrated that the approach to planning of universal services must be consistent with the planning of services for children with additional needs. There needs to be a strong linkage between the planning and delivery of universal and targeted services.

It is a contention of the article that concepts such as those described are required for multi-sectoral planning, and that a whole system planning approach is required to address the rights and needs of children and young people.     

Do health reception policies in the Nordic region recognize the rights of asylum-seeking and resettled refugee children?

According to the United Nations Committee on the Rights of the Child, it is critical that refugee children’s rights are upheld in all national policies covering vulnerable children. This article examines how health policies in the Nordic region recognize the health needs of newly arrived refugee children, and whether these policies respect their individual rights. The article maps out, compares and contrasts health reception policies in Denmark, Finland, Norway and Sweden, paying particular attention to how each addresses the rights and needs of refugee children. The policy documents were obtained through desk-research conducted from January 2017–January 2018. We analysed 34 national laws and guidelines that support the health reception of refugee children. We find that only a few health reception policies across the Nordic region have been written specifically for refugee children. The policies identified predominantly recognize refugee children’s right of access to somatic healthcare services, and to emergency services. Their rights to mental health services or broader health-enabling contexts were addressed to a lesser extent. We conclude that there is a need for further recognition of refugee children as rights-holders, and for the intentions of health reception policies to be expanded to include mental health services and health-promoting initiatives. Further research is needed on whether and how the current policies play out in actual health reception practices.     

Child poverty as public policy: direct provision and asylum seeker children in the Republic of Ireland

This paper evaluates responses to asylum seeker children in Ireland from a child poverty perspective and from that of the United Nations Convention on the Rights of the Child. It draws upon research undertaken in early 2001 on behalf of the Irish Refugee Council among asylum seeker families with children in Cork, Limerick and Ennis on their experiences of poverty and social exclusion. The research was primarily qualitative. Interviews with adult members of households and some children were triangulated with data on benefit entitlements and take-up, household consumption, accommodation and amenities. The research sought to ascertain levels of income poverty and material deprivation. A range of indictors of child poverty and social exclusion were also employed. The research found that asylum seeker children experienced extreme income poverty, material deprivation, housing deprivation and social exclusion in considerable part due to the imposition of a system of lesser welfare entitlements, known as “direct provision”, introduced in April 2000. The paper argues that state-fostered social exclusion of asylum seeker children resulting from “direct provision” is contrary to Ireland's obligations under the United Nations Convention on the Rights of the Child, the goals of the National Children's Strategy and the goals of the National Anti-Poverty Strategy.     

Amnesty International and human rights education

Human Rights Education is becoming an essential ingredient to all societies in the world in order to encourage respect and tolerance to those around us and build good citizens for the future. In both the North and South of Ireland human rights is seen as a vehicle through which positive change could occur. Under the terms of the Belfast/Good Friday Agreement 1998, a priority was given to the creation of a 'human rights culture'. As a result of the Agreement Human Rights Commissions were established in Northern Ireland and in the Republic of Ireland. In the terms of both Human Rights Commissions, Human Rights Education was given a central role. The Good Friday Agreement also made provision for a number of cross-border bodies, one of which focused on education. Both States had made binding international commitments to develop programmes in Human Rights Education. In particular, Article 29 of the Convention on the Rights of the Child requires both states to ensure that children are enabled to develop a respect for their own cultural identity, language and values and for the culture, language and values of others.     

Child labor. A matter of health and human rights

Despite the existence of laws in India that prohibit the labor of children under age 14, 70 to 115 million children between the ages of 5 and 14 are estimated to be part of India's labor force. Child labor in the agriculture sector accounts for 80% of child laborers in India and 70% of working children globally. From May 2001 to July 2001, Physicians for Human Rights (PHR) investigated the health experiences of 100 children in hybrid cottonseed production in rural Andhra Pradesh. Eighty-eight percent of the survey participants were girls, ages 7 to 14. PHR found that children worked on average 12 hours a day, were frequently exposed to pesticides, and were not provided with safety equipment, not even shoes or water to wash their hands and clothes. Children reported having frequent headaches and dizziness and skin and eye irritations after pesticide spraying. All 100 children reported that they were unable to go to school during the hybrid cottonseed season due to work demands. Ninety-four children reported to PHR that they would rather be in school. In addition, a majority of child workers interviewed by PHR reported physical and/or verbal abuse by their employers. Moreover, PHR interviews with representatives of multinational and national companies revealed knowledge of child labor practices for up to 10 years. Child labor is a significant health and human rights problem for children in India. The progressive elimination of child labor practices will require the support of a wide cross-section of civil society.     

Upholding the Convention on the Rights of the Child: A Quandary in Cyberspace

Put in place to protect the rights of the child, the Convention on the Rights of the Child is a set of non-negotiable standards. A core principle underpinning the Convention is the child's right to participate fully in social arenas and to access sources of social support without excessive interference. Juxtaposing this is the right of the child to be shielded from harm, abuse and exploitation. Over the past several decades the Internet has emerged as a fast and easily accessible medium for people to connect and communicate. While the Internet provides children with a source of support through chat rooms, online communities and social networking sites, just as equally it can expose vulnerable children to predatory and deviant individuals exacerbating the potential for harm. Upholding the Convention in cyberspace is a challenge. The Internet is not owned or regulated by any governing body and accountability is difficult to enforce. This article discusses some of the difficulties of upholding the Convention online and provides recommendations for policy-makers to protect children as they participate in cyberspace.     

Safeguarding the Lives of Children Affected by Boko Haram: Application of the SAFE Model of Child Protection to a Rights-Based Situation Analysis

The Boko Haram insurgency in northeast Nigeria is responsible for the highest number of lives lost in Africa in the past decade. The country has witnessed significant violations of the United Nations Convention on the Rights of the Child, which Nigeria has signed and ratified. For instance, Nigeria had the second-highest number of children recruited to armed groups and the third-highest number of abductions in 2018. Current humanitarian efforts primarily target camps for internally displaced persons, while state strategies focus mainly on addressing security through combatant-targeted interventions. However, there is a need for more rights-based, integrated, and multifaceted approaches to tackle the interrelated threats to the security of children and their families affected by the conflict. This paper uses the SAFE model of child protection—which examines the interrelatedness of safety, access, family, and education and economic security—to analyze the challenges of children and youth affected by the conflict. We highlight the need for a gendered approach; strategies that address poverty and cultural and governance barriers; and interdisciplinary, context-specific, and autonomous child protection systems. The paper calls for urgent and increased attention to the core rights and human security needs of these children to avoid a replay of negative outcomes of conflict, where the costs and consequences propagate a cycle of violence and disadvantage.     

MCH Functions Framework: A Guide to the Role of Government in Maternal and Child Health in the 21st Century

Objectives: At the close of the 20th century, the government's role in maternal and child health is in a state of transition. What is needed is a framework defining roles and responsibilities and guidance on how to operationalize these functions. This article presents the Maternal and Child Health (MCH) Functions Framework and discusses its value as an advocacy, planning, evaluation, and educational tool. Methods: The Johns Hopkins Child and Adolescent Health Policy Center developed the Framework in collaboration with leading public health organizations. The process entailed formulating a conceptual approach and facilitating consensus among the relevant organizations. Results: The Framework consists of three main components: (a) a list of ten essential public health services to promote maternal and child health, (b) an outline detailing program functions specific to MCH that apply to all levels of government and to all MCH populations, and (c) selected examples of local, state, and federal activities for implementing MCH program functions. Conclusions: The MCH Functions Framework can be used in advocacy, policy development, program planning, organizational assessment, education, and training. To date, it has been used by several state and local MCH agencies and in MCH education and training programs.     

Reporting the Rhetoric,Implementation of the United Nations Convention on the Rights of the Child as Represented in Ireland's Second Report to the UN Committee on the Rights of the Child: A Critical Discourse Analysis

Ireland's second periodic report to the United Nations Committee on the Rights of the Child (CRC) presents the government's case that it is succeeding in protecting and promoting the rights of all children in Ireland. This article presents a critical discourse analysis of the government's Report to the CRC. Using a refined critical discourse analysis model, based on the framework proposed by Chouliaraki and Fairclough, the linguistic structure of the Report is examined alongside consideration of the wider sociopolitical context in which it exists. The Report is itself a promotional genre. It lists legislative change, strategy plans and other policy activity intended to have an impact on children's rights. This promotional genre is realised in the Report through drawing on the language necessary to sell the government as successful in implementation of the Convention, to the CRC. Through adherence to the structured language of reporting, in tandem with the careful positioning of paragraphs, the report serves to circumvent the absences of legislation and provisions that directly influence and impact on children's rights. Thus, the analysis reported in this article confirms the view that much of the discourse is rhetorical. Nevertheless, the Report generally represents the government as progressing in the field of implementation of the UN Convention on the Rights of the Child. This has led to an assumption that the reporting mechanisms of the CRC may allow for such rhetorical construction of reports, thus a brief linguistic textual analysis of the CRC guidelines for periodic reports is included to reveal whether there is a case for this assumption.     

Adolescents' Experiences of the Right to Play and Leisure in Northern Ireland

Under Article 31 of the United Nations Convention on the Rights of the Child, every child under the age of 18 has the right to engage in age-appropriate play and leisure activities. Drawing on the qualitative findings of a wider review of children's rights in Northern Ireland, this article examines the degree to which adolescents in Northern Ireland are currently able to enjoy this right. The data presented in the article are primarily based on the views of young people, as expressed in focus group discussions with their peers, although this is at times contextualised by the contributions of adult participants and the findings of an in-depth policy and literature review. The article argues that young people's right to play and leisure is not currently adequately recognised within Northern Ireland, noting the impact of the increasing demonisation and marginalisation of youth upon both this and their accompanying right to protection. The article concludes with a consideration of the potential implications of the current failure to afford young people adequate and appropriate play and leisure opportunities, calling on the State party to urgently deliver on the commitments it made in ratifying the Convention.