Summary Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective ...medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions ( r =0·83), and human resources for health per 1000 ( r =0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation.
In this paper, we want to present research on children's perspectives in the context of participation. We emphasize that the survey of children's perspectives is a form of participation. We ...understand participation based on children's rights. We refer to the Lundy model (2007. "'Voice' Is Not Enough: Conceptualising Article 12 of the United Nations Convention on the Rights of the Child." British Educational Research Journal 33 (6): 927-942.
https://doi.org/10.1080/01411920701657033
), which emphasizes that it is not enough to simply ask children to speak their minds. Rather, they also need the experience that their views have an influence. In the discourse on quality in ECEC, children's perspectives became only recently the focus of extended research. In evaluation instruments, at least in Germany, the inclusion of children's perspectives is rare. In the study presented here, these two aspects are brought together using the example of the evaluation instrument QuaSi. We describe how children's perspectives are taken into account in the evaluation and feedback process in contrast to everyday life in ECEC centres. It becomes clear that the collection of children's perspectives and their feedback to the pedagogues in the centre does not automatically lead to their views influencing the quality of the centre.
This paper examines the way in which translation and re-editioning intervene in the representation of the mutable concept of gender in a classic of children's literature. It explores Carlo Collodi's ...Le Avventure di Pinocchio literally: The Adventures of Pinocchio (
1883
) and the first English translation of the novella (
1892
), as well as selected re-editions and reprints of this translation (1911-2011), focusing on the anthropomorphic characters of il Gatto The Cat and la Volpe The Fox. Through a comparative analysis of the ways in which gender is constructed through these two characters in the source text, the first English translation, and the re-editions and reprints, this paper foregrounds how the translation process can influence the portrayal of the social construct of gender that is presented to the child reader. The analysis reveals that the first English translation reverts to conventional gendered ideologies that reinforce the model of the androcentric society, an aspect that is absent from the Italian tale. This idea is carried through time in the re-editions and reprints, some of which were published in the twenty-first century after the social construct of gender had arguably become framed differently to how it was regarded in the nineteenth and twentieth centuries.
•Adverse childhood experiences (ACEs) are positively associated with health conditions.•Associations are similar across child race/ethnicity and gender.•ACEs may exacerbate existing social ...disparities in health.
Adverse childhood experiences (ACE), potentially stressful or traumatic experiences that are concentrated among already vulnerable populations such as children of color and economically disadvantaged children, can accumulate throughout childhood. The stress process perspective suggests that ACEs, such as parental incarceration or violence exposure, can have deleterious implications for childhood health. This analysis used data from the 2016 and 2017 National Survey of Children’s Health (NSCH), a nationally representative sample of non-institutionalized children ages 0 to 17 in the United States (N = 71,811), to estimate the association between number of ACEs and children’s health (including three general and 12 specific health indicators). ACEs are common, with nearly half (45.3%) of children exposed to at least one ACE. Exposure to three or more ACEs, compared to no ACE exposure, is positively associated with fair or poor overall health, activity limitations, and recurring school absence, adjusting for an array of child and parent characteristics. Exposure to three or more ACEs is also positively associated with specific indicators of children’s mental (such as depression, anxiety, behavioral or conduct problems) and physical (such as asthma, allergies, headaches) health conditions. These associations exist when restricting the sample to children with similar risks of ACE exposure based on their age. These associations are also similar across child race/ethnicity and gender. Given that ACE exposure is concentrated among already vulnerable children, ACEs may exacerbate existing social disparities in children’s health.
Having a voice in family matters is considered a protective factor from harm, and key to promoting children’s wellbeing. However, since the adoption of the United Nations Convention on the Rights of ...the Child (1989) and specifically Article 12 pertaining to children’s participation, research reveals that children’s voices often remain invisible in child protection and family welfare services.
While there is renewed interest in hearing children’s voices about their experiences in out-of-home care, there remains little awareness and knowledge of children’s voices in family support services. This article addresses this gap by presenting children’s own meanings and experiences of having a voice, derived from a research collaboration between UnitingCare and Queensland University of Technology .
17 children aged 6–16 years (8 sibling groups) whose families received family support services (voluntary or ordered) from UnitingCare in Queensland, Australia.
An interpretative phenomenological approach with activity-based interviews involving art, play and Reflexions cards were used to support children to share their lived experiences.
Children’s sense-making related to having a voice revealed four connected meanings that poignantly illustrated that not only should children have a say about the supports they receive because they are part of a family, but because they are knowledgeable agents with insights that can improve their and their family’s experiences.
Family support services need a sustained paradigm shift towards protection with participation to incorporate the voices of children as an everyday practice to ensure their wellbeing and safety.
Young children's questions may offer powerful leverage for knowledge acquisition and deep level learning, yet often go unrecognised and undervalued in early childhood education (ECE) settings. When ...young children's questions are not heard or respected, they are denied their UNCRC Article 12 right to express their views freely and have 'due weight' accorded to them. A pilot case study framed by critical pedagogy and young children's rights perspectives was conducted in the Midlands region of England to investigate the nature and extent of young children's questioning in ECE settings and its relationship with knowledge acquisition and learning. Early childhood students recorded questions young children (n = 9) (2.2-4.5 years) asked in ECE settings. Four categories of young children's questions emerged, two oriented to knowledge acquisition and learning. Evidence also revealed effects of performativity impeding knowledge acquisition and learning by both adults and young children in ECE settings. Further study is indicated.
To foster children and young people's skills, dispositions and understanding that underpin a voice agenda, practices need to be developed that support this from the earliest age. This article ...explores issues relating to this complex, challenging and under-researched area from the perspective of practitioners working with children aged from birth to seven. Using vignettes of practice, we explore practical and pedagogical examples and take the opportunity to deepen our understanding of the elicitation of voice through the lens of the eight factors previously identified in the Look Who's Talking Project. Through this approach we highlight practices that elicit voice as a key element of children's rights in a localised way, and exemplify productive connections between theory and practice.
Before the implementation of the Affordable Care Act (ACA), most children in low-income families were already eligible for public insurance through Medicaid or the Children's Health Insurance ...Program. Increased coverage observed for these children since the ACA's implementation suggest that the legislation potentially had important spillover or "welcome mat" effects on the number of eligible children enrolled. This study used data from the 2013-15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post ACA. We estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA. Welcome-mat effects were largest among children whose parents gained Medicaid eligibility under the ACA expansion to adults. Public coverage for these children increased by 5.7 percentage points-more than double the 2.7-percentage-point increase observed among children whose parents were ineligible for Medicaid both pre and post ACA. Finally, we estimated that if all states had adopted the Medicaid expansion, an additional 200,000 low-income children would have gained coverage.
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