Creating a Child and Youth Health Monitoring Framework to Inform Health Sector Prioritisation and Planning: Reflections on Ten Years Experience in New Zealand

Abstract

In New Zealand during the early 2000s, an emerging disquiet about social inequalities in health led to calls for better information for public health monitoring. Health needs assessments (HNA) had been built into the planning cycles of the country’s newly formed District Health Boards (DHBs), which were tasked with “improving, promoting and protecting” the health of their populations. In child and youth health, a lack of data was seen as a significant barrier to effective DHB planning, with the needs of this age group often being lost amongst the concerns of an ageing adult community. This led to calls for a single national entity to select, collate and disseminate accurate information on the health of children and young people. This paper describes the origins of the NZ Child and Youth Epidemiology Service (NZCYES) and its 10 year journey to build a monitoring infrastructure to inform health service prioritisation and planning. Central to this work has been a theoretical framework, which arranges indicators into four hierarchical domains, reflecting key steps in the causal pathways linking the political, economic and social environment with child and youth health outcomes. These are cross-cut by a horizontal lifecourse dimension. Ten years on, while the available information has improved considerably, child and youth health inequalities remain high. The early hopes that HNA would show the links between socioeconomic conditions and health inequalities and that prioritisation, planning and policy would respond accordingly, have failed to materialise. Government agencies have not fully utilised the scientific evidence; and even when they have wanted to, a range of other factors (political, institutional, budgetary, inertia) have aligned to crowd out the changes that could make a real difference. Overcoming these barriers remains the challenge for the health sector over the next 10 years.