9.2.5. Control
tools and policies
Control tools and policies are provided for specific
diseases in Chapter 5 and for specific health determinants in Chapter 10.
Obviously, neither infants, nor young children can be
appropriately accommodated in general adult hospital beds. Similarly, a
hospital setting requires other support for children including play areas, and
education for those of school age admitted for more than a few days. Nurses
need specialist training, while there are other characters such as play
therapists that play an important role in the child health service. There are
several initiatives for Baby Friendly Hospitals (UNICEF, 1991), and for the
rights of children to appropriate hospitals in Europe (EACH, 1988). Yet the
implementation of these structures is not formally monitored, and is far from universal.
Special provisions need to be made in primary and
community care. Across the different countries of Europe, with the subsidiary
principal of health services, there are many different means of providing
primary and community care for children. In some countries there are specialist
primary care doctors specifically for children, whereas in other countries the
primacy of seeing the child in the context of the family treated by a physician
who knows them all, is paramount. However, whilst the preferred pattern of
service delivery is a national prerogative, the lack of a common definition of
paediatrics or of the educational curriculum required for paediatric nursing is
more difficult to accept. In a context in which the European Commission is able
to provide scientific support to Member States in many aspects of health and
healthcare, there seems to be scope for considering impartially and
scientifically the packages of skills necessary for the healthcare of children,
and the minimum standards required at least for invasive facilities and trauma
departments.
More than 50% of the medicines prescribed for children
have not yet been tested and authorised for use by children. The European
Commission acknowledges this and notes that more research and authorisation
needs to be done for what concerns meningitis, tuberculosis,AIDS, arthritis,
diabetes, asthma, psychiatry, anaesthetics and malaria. The European Commission
has recently adopted the Regulation of the European Parliament and the Council
on medicinal products for paediatric use, with the objective of increasing
research, development and authorisation of medicines for use in children.
EU policy for children and young people’s health has been
limited due to the fact that Member States are largely responsible for the
implementation of healthcare in their respective countries. EU focus has been
on data collection, health promotion and education.
In order to strengthen its actions in favour of children
and young people, the European Commission issued a Communication “
Towards an EU strategy on children’s rights” (European Commission,
2006a). The Communication reflects the first comprehensive strategy to
strengthen the protection of children, both within and outside the Union,
against neglect, paedophilia, trafficking, sex tourism and forced
labour. It proposes a wide action plan, with four major objectives:
- To identify priorities for future EU action
- To improve EU policies’ effectiveness vis-à-vis the
Rights of the Child
- To increase cooperation with stakeholders
- To help children to enforce their rights
The European Union has already taken many actions to
protect the rights of the child. For example, in the last few years, around
thirty directives, framework decisions or green papers have been adopted under
several EC policy areas and with children as principal target, notably related
to family reunification, parental responsibilities, trafficking in human
beings, sexual exploitation, children in armed conflict, safety of toys and the
paediatric use of medicinal products.
In addition, the Commission provides funding through a
dozen community programmes for actions in favour of children and young people,
notably concerning violence, a safer use of the Internet, trafficking in human
beings, sexual tourism, participation of young people in the functioning of
democracy and access of Roma children to education.
In 2000, the Commission reported on the health status of
young people (European Commission, 2000), but only those over the age of 15.
The Commission’s 2005 Public Health Work Plan, defined within the framework of
the Community Action Programme in Public Health 2003-2008 (European Parliament
and Council, 2002), refers to issues that influence children and young people.
These include childhood immunisation programmes; prevention of cigarette sales
to children and adolescents; information activities related to under-age
drinking; work on obesity and prevention; development of strategies to address
risky sexual behaviours among young people; and prevention of mother-to-child
transmission of HIV/AIDS.
The European Commission's Communication on the
Rights of the Child (European Commission, 2006a) represents a formalised
framework of the Commission's future work to protect the interests of children
and young people and promote their role in society. This supports the UN General
Assembly’s adoption in 2002 of a resolution entitled “A World Fit for
Children”. The resolution encompassed seven main objectives, among which the
provision of care for every child and the combating of HIV/AIDS.
In response to the growing problem of obesity, the
European Commission launched the EU Platform for Action on Diet, Physical
activity and Health in 2005, bringing key stakeholders together at EU
level to initiate Europe-wide action (European Commission, 2006b). A White
Paper on Nutrition was published in May 2007 focusing on obesity and physical
activity and on proposals on how the EU will address these issues
(European Commission, 2007) An assessment of the available data measuring
nutritional and physical activity behaviour of children,
commissioned by the EU, is currently being published (Alexander et al, 2008)
WHO Member States adopted The Global Strategy on Infant
and Young Child Feeding in May 2002. This strategy recommends
exclusive breastfeeding for six months and continued breastfeeding, with
appropriate complementary feeding, up to two years and beyond. Unfortunately,
data on its impact is limited and patchy, suggesting that despite high profile
support this has not had any effective local impact.
Health21, the health for all
policy framework for the WHO European Region, addresses the social and economic
factors that influence health and lead to disparities among different
population groups. It calls for action: ‘the health gap between socioeconomic
groups within countries should be reduced by at least one fourth in all Member
States by substantially improving the level of health of disadvantaged groups’
(WHO, 1999).
WHO/Europe’s programme on child and
adolescent health and development: this programme works to promote
the health of children, adolescents and young people in the WHO European
Region. Its main aim is to assist Member States in the European Region to
design and carry out health programmes that are in line with the health-related
articles of the United Nations Convention on the Rights of the Child, and help
to achieve the United Nations Millennium Development Goals. A major current
initiative is the European Strategy for Child and Adolescent Health and
Development (WHO 2005a), which provides a strategic approach and related
toolkit, to enable each Member State to produce a national strategy based on
sound evidence-based policy, and framed according to a life-course approach,
using cross-sectoral planning. Each Member State committed itself to report
back on their progress to the WHO Regional Committee in autumn 2008.
Children's Environment and Health
Action Plan for Europe (CEHAPE): This plan addresses the
environmental risk factors that most affect the health of European children
(WHO, 2004). It was developed at the request of WHO Member States and adopted
by European Ministers at the Fourth Ministerial Conference on Environment and
Health (2004) on "The future for our children". This action plan
highlights the main commitments on children's health and environment and
focuses on four regional priority goals (RPGs) for Europe:
·
RPG
I: ensure safe water and adequate sanitation
·
RPG
II: ensure protection from injuries and adequate physical
activity
·
RPG
III: ensure clean outdoor and indoor air
·
RPG
IV: aim at chemical-free environments
Also largely devoted to protect and
promote children’s health is the EU “Environment and Health Action plan
2007-2010” (European Commission, 2004)
