13.6. Prioritising children’s health

13.6.1 Measurement of burden and effects of ill-health in children

Disability Adjusted Life years (DALYs) or Quality Adjusted Life Years (QALYs) are measures which are widely and effectively used, but have an adult-focused view of life, burden of illness and disability. Their focus is primarily economic and on the effect on the individual. However, as pointed out in the report of the CHILD project (Rigby and Köhler, 2002; Rigby et al, 2003), in children the effects of illness are very different. As reported in the project, if a child is unable to play normally, he or she loses developmental stimulus from the natural interaction with other children and with their family. Once the child reaches school years, the loss of education also has a detrimental effect. These losses of social and educational development are hard to catch up with. Thus, they have an adverse effect on the child throughout his/her life – for instance, these children may obtain lower level employment and also have greater and enduring difficulties with self-confidence and with social relationships.

The child, however, is not the only one disadvantaged by childhood illness. Parents have to dedicate time and efforts (including emotional efforts) to the care of their child. This may result in a reduction in employment availability, and thus in turn have an adverse economic impact on the whole family. Siblings are also disadvantaged by the presence of an ill, or disabled, child – not just by the loss of parental time, but possibly by a reduced range of family activities and outings, by the need to reside in a particular area or type of dwelling, and by a reluctance of other family and friends to interact.

The CHILD project report summed up the burdens of child ill-health as those of:

·          Discomfort and pain on the child;

·          Anxiety, stress, and possibly loss of earning of the parent(s);

·          Cost to society of health care and on occasions of special education and social care;

·          In extreme cases, lifelong societal costs for supporting a person with a disability or handicap;

·          Effects on the child of loss of play, education, and socialisation, in terms of both personal development and of earning potentials in his/her adult life; and

·          Effect on future generations, if a disabled child becomes an adult who needs assistance with parenting, and becomes a dependent adult earlier than their peers.

This overall burden is much more than that calculated by the DALY approach – though the DALY results are important as a subset. There is much work to be done in assessing systematically this overall picture.