A three-year longitudinal school-based family social work service in two project schools was compared with the 'standard' service of two comparative schools, in respect to truancy, delinquency, school-exclusions, family functioning and school morale. A multi-method evaluation demonstrated significantly better outcomes in the project schools, halving truancy; reducing delinquency, improving teachers'morale and pupils'educational achievements. A cautious cost-benefit analysis identified a 250 per cent 'saving' above the cost of the project.
The major concern for social work, namely child abuse‐related deaths (CARD), involves parental neglect. Societal neglect, when measured by child mortality rates (CMR), is considered by bodies such as UNICEF to be indicative of how a nation meets the needs of its children. This population‐based study analyses CARD and CMR for children aged from newborn to four years old between 1989–91 and 2013–15 to identify any relative child neglect in the USA and 20 other developed nations (ODN).
World Health Organization data were used for CARD, CMR and undetermined deaths (UnD), a possible source of unreported CARD, juxtaposed against World Bank income inequality data.
The USA had the highest number of CARD, the highest CMR and the worst income inequality. Five countries reduced their CARD significantly more than the USA, and 14 countries reduced their CMR more than the USA. Income inequality and CMR were correlated.
Had the USA matched the CMR of Japan, where income inequality was narrowest, there would have been on average 16 745 fewer child deaths annually.
CARD and UnD correlated, suggesting that UnD may contain unreported CARD. US CMR data indicate that services in the USA are less effective than those in ODN, possibly due to income inequality. These results will be unwelcome but child protection services must dare to speak truth to power.
‘This population‐based study analyses CARD and CMR for children aged from newborn to four years old between 1989–91 and 2013–15 to identify any relative child neglect in the USA and 20 other developed nations’
Key Practitioner Messages
The richest country in the world, the USA, has the highest rates of child abuse and total child mortality in the Western world.
The USA has the highest income inequality in the West, highlighting the statistical link between child mortality and poverty.
Children's services should lead the call for the necessary changes and ‘speak truth to power’.
Introduction: Parental child `neglect’ is usually linked to parents but can apply to nations using the criteria explicit in UNICEF statement “in the last analysis Child-Mortality-Rates (CMR) indicates how well a nation meets the needs of its children”. Hence under-five (0-4) CMR rates of Japan and twenty Other Developed Countries (ODC) are compared within the context of relative poverty. Method: WHO data yields CMR rates per million (pm), analysed between 1989-91 and 2012-14 to compare Japan against ODC. World Bank Income Inequality data used as a measure of relative poverty. Excess deaths calculated by matching the most unequal Income Inequality country’s CMR with the most equal nation. Results: All countries reduced CMR substantially. The highest CMR was in USA 1383pm, followed by three English-speaking countries. Japan at 597pm was 19th of 21. USA and New Zealand were double Japan’s CMR, whilst twelve ODC had rates 25% higher than Japan. Most unequal Income Inequality USA at 15.9 times, Japan the most equal at 4.5 times. Income Inequality and CMR were strongly correlated (+0.6188 p<0.005). The countries with the lowest Income Inequality, had lowest CMR namely Finland Japan, Norway and Sweden. America not matching Japan’s CMR, meant an average excess of 16,838 US children’s deaths annually. Discussion: The strong statistical association between higher CMR and Income Inequality, suggests that one factor in Japan’s results is the lower social inequality, unlike Canada, New Zealand, the UK and USA. Does Japan’s results indicate cultural factors suggesting Japan is more child orientated than English-speaking countries?
It is well-established that for a considerable period the United Kingdom has spent proportionally less of its gross domestic product (GDP) on health-related services than almost any other comparable country. Average European spending on health (as a % of GDP) in the period 1980 to 2013 has been 19% higher than the United Kingdom, indicating that comparable countries give far greater fiscal priority to its health services, irrespective of its actual fiscal value or configuration. While the UK National Health Service (NHS) is a comparatively lean healthcare system, it is often regarded to be at a 'crisis' point on account of low levels of funding. Indeed, many state that currently the NHS has a sizeable funding gap, in part due to its recently reduced GDP devoted to health but mainly the challenges around increases in longevity, expectation and new medical costs. The right level of health funding is a political value judgement. As the data in this paper outline, if the UK 'afforded' the same proportional level of funding as the mean average European country, total expenditure would currently increase by one-fifth.
Causes of suicide are complex indicating a nation's psycho-socio-economic well-being hence this population-based study explores whether USA suicides worsened compared to nineteen Other Western Countries (OWC) being possibly related to gun ownership in the 21st Century.Total suicide data are drawn from the latest WHO Age-Standardised-Death-Rates per million (pm) controlled for age, sex, and population, along with suicides in the five age- bands 15-34 years to 75 + years. National gun ownership data from the international Small Arms Survey. Chi-square tests any significant difference between American and OWC suicides during the century. Spearman Rank Order correlations are used to determine comparability of suicides and gun ownership per thousand person rates over the period 2000-15.USA had the highest gun ownership, treble the rate of the next highest country. American Total suicides rose 27%, significantly more than eight other countries (p < 0.05). The USA had significantly worse suicide outcomes for Older (75+) people than three OWC; eleven for Mature Adults 55-74; eight for Adults 34-54 and for ten countries for Young Adults 15-34. Young Adult suicides numbered 12,438, 6,702 gun-related in 2015, exceeding recent USA military losses. Only Young Adult suicides positively correlated with gun ownership (<0.025).The key finding is whilst most countries reduced suicides American rates rose substantially this century, raising questions about US society. Importantly the easy access to firearms in the USA makes Young Adult suicide more likely when facing psycho-social stress. This study exposes the vulnerability of distressed young American adults in a permissive gun culture, with its sequel, life-long grieving parents.HighlightsDuring 21st Century USA suicides rose substantially more than other Western nations.Only USA suicides rose >20% amongst Total suicides and in those aged 15-to-74years.USA Young Adult suicides 150,099 in 21st century, 12,438 in 2015, 6,702 were gun-related.
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