Using a public health approach to prevent child abuse

Professor Dorothy Scott explains how primary, secondary and tertiary approaches can help address the underlying causes of abuse and neglect

Teenagers talking Public health approaches have been stunningly effective in lowering the prevalence of health problems such as the spread of infectious diseases, heart disease or cancer.

This success has been achieved through primary prevention (such as providing clean water), secondary prevention (for example targeting smokers as a high risk group for cancer or heart disease) or tertiary prevention (giving people access to early diagnosis and treatment).

Similar thinking has been applied to road safety with great results.

I’m going to discuss how a public health approach can be used to prevent child abuse and neglect from taking place.

A new approach to tackling child abuse and neglect

A public health approach to preventing child abuse and neglect is important for 3 reasons:

  • abuse and neglect causes children suffering and long-term harm. So it’s vital to do whatever we can to stop it happening.
  • child protection services in many nations are becoming overwhelmed and cannot cope with the demands being placed upon them. Without the capacity to increase staff and budgets, we need an approach that can reduce the number of families being referred to child protection services.
  • being in the child protection system can have negative effects on a child’s wellbeing, particularly if they need to be removed from their parents and if they have multiple foster placements. A public health approach could help minimise the number of children who need to go through this process.

Current approaches to child protection focus on people reporting their concerns to child protection agencies and practitioners assessing the level of risk to a child on a case-by-case basis.

A public health approach addresses the underlying factors that contribute to child abuse and neglect, in order to achieve a population-level reduction in the prevalence of child maltreatment.

This doesn’t replace individual services, but aims to reduce the need for such intervention.

Evidence that this approach works

We’ve already seen a reduction in certain types of injuries to very small children – those typically associated with lack of supervision, such as ingestion of medication or poisons; burns; falls and drownings. This was achieved by a combination of “engineering out” the risk wherever possible (using childproof medication containers, for example) and public education campaigns.

We need to build the evidence base for strategies that can help prevent other forms of child maltreatment, learning more about the pathways that can lead to abuse and how to intervene effectively at a whole community level.

And we need to understand more about how positive social changes have come about organically, such as how and why the use of physical punishment has declined in many societies in the past generation or two, with or without legislation.

Population-based measures and tackling key risk and protective factors

Strategies aimed at reducing the prevalence of child maltreatment must tackle factors that increase the level of risk to a child as well as factors that help protect them from abuse.

We know things can be particularly challenging for parents who are affected by domestic abuse, alcohol and drug misuse and mental health problems, as well as those who have financial problems. If we can help these families get back on track, we can help to protect children.

For example, there is evidence to show that measures such as a ban on alcohol advertising, minimum pricing on alcoholic drinks, taxing all alcohol products the same according to their actual volume of alcohol and reducing the number of retail outlets for alcohol can all help to minimise alcohol misuse.

Using health promotion messages such as “alcohol and children don’t mix” may also prove to be valuable in changing social norms, in the same way that social marketing helped change public opinion about drink-driving. Child advocacy organisations need to lend their voices to those lobbying for such reform.

At a secondary prevention level, making evidence-based treatment programmes readily available for parents can prevent harm to young children. For example, the NSPCC’s Parents Under Pressure™ aims to support parents who are on a drug or alcohol treatment programme, helping them to learn parenting tips and life skills, and improve their relationship with their baby.

A key factor in protecting children from abuse is parent-child attachment; this is fundamental to a parent’s motivation to protect and nurture their child.

There is some evidence that conducting ultrasound consultations during pregnancy in ways that help prospective parents see their unborn child as an individual with an identity can improve a parent’s attachment to their baby.

Similarly, there is evidence that mothers who breastfeed are less likely to physically abuse their children. Other protective factors include social support for families facing high levels of stress.

A public health approach to child protection for the future

There are many models of support which have been shown to reduce the risk of child abuse and neglect at a family level, but we are yet to see a systematic national policy for tackling the broad range of factors associated with child abuse.

A strong government commitment to a public health approach is essential – it’s not something that can be delivered by an individual child protection service. There is a compelling case for the cost-effectiveness of prevention strategies: although a public health campaign would cost money, it would create savings in the long term by reducing the prevalence of child abuse.

The founders of the UK’s child protection movement and the NSPCC shared a vision of preventing child abuse and neglect. By using a public health approach, we have the capacity to turn that vision into reality.

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