Highlights from a rookie researcher’s first conference.

A few weeks ago I attended the conference Progress 2013 (http://progress2013.org.au/). The first of its kind in Australia, it brought together progressive left thinkers with not-for profit organizations, unions, private industry and experts in the health and environment sector. Its aim was to talk about the issues that will define Australia’s not-for profits and social movements for the years to come. As a recent graduate, this was my first ever conference and a chance to understand how people from all over the workforce come together to share skills, nut out ideas and most importantly – network. This blog post will cover some of the major highlights from the conference and touch on some of the lessons I learnt, from the perspective of a budding young researcher.

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Highlight no 1.
To begin, one of the major highlights for me was listening to rock star academic and expert on the social determinants of health, Richard Wilkinson (http://www.ted.com/talks/richard_wilkinson.html), speak about the importance of understanding how income inequality affects health and wellbeing. Wilkinson, author of ‘The Spirit level’ and co-founder of The Equality Trust (http://www.equalitytrust.org.uk), researches the problems of inequality in society and produces evidence-based arguments to support social movements for change. In particular, Wilkinson drew attention to the problem that health and wellbeing in high and middle income countries is worse for all when the gap between the rich and poor is greater. Data was collated to demonstrate that even in high income countries as measured by Gross Domestic Product (GDP), population levels of health and wellbeing are influenced by income inequality. Therefore, the average wellbeing of societies is not dependent on gross national income and the rhetoric of economic growth but rather the relation between each other within society itself. This trend also occurs in child health and wellbeing, mental health, drug abuse and obesity – proving the tangible effect that inequality has in society. Some factors Wilkinson attributed as the drivers of negative health in unequal societies include status anxiety, stress, mistrust and dominance caused by a competitive consumer based economy. Wilkinson therefore advocated for a more inclusive society where value is placed on the way we relate to one another and where possible to harness positive social relations, such as friendship. Although these insights seem somewhat intuitive, I was taken aback by how relevant it is to continue to produce evidence that highlights this problem. When considering health and wellbeing, Wilkinson makes us think about the less visible effects of how we relate to one another and re-establishes the importance of family, friendship and positive social interaction to maintaining a sustainable quality of life.

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Highlight no 2.

Another highlight was the talk given by Anat Shenker-Osorio, a communications expert and researcher who authored the book ‘Don’t Buy It: The Trouble with Talking Nonsense about the Economy’. Her work looks at how people understand issues, such as the economy or climate change, through the words used to narrate them. Without getting too bogged down in detail, the gist of her research suggests that you can reliably persuade or change a person’s thinking about an issue depending on the words used to describe it. For example, immigration. A study was conducted to measure how people responded to immigrants depending on whether they were framed as either a burden or a resource. The findings showed that when immigrants were talked about in a positive framing, by expressing what they bring to society and not what they lack, people’s acceptance of immigrants were overall more favourable. Shenker-Osorio argues that by literally changing the words we use to speak about an issue, we can also influence how people think about it, having repercussions for politics and policy. Something to think about when writing the next report or talking at a conference about a sticky issue. Frame it positively and you will have people receive it much more favorably.

Highlight no 3.

Arguably one of the best parts of Progress 2013 however, was the chance to mingle with those I consider some of my professional role models. As I mentioned above, this was my first ever conference, so the task of introducing yourself to those you admire is quite daunting. However, after a few awkward first conversations I learnt the following things;

  1. Go with a plan. Since time is scarce at these events and the professionals you meet talk to so many different individuals every day, working out a plan of who you want to speak to and what you want to speak to them about prior to the meeting is essential. This way, you won’t get caught in a conversation about the weather and how good the muffins are, but instead get to use your limited time to your best advantage.
  2. Don’t be scared to introduce yourself. As daunted as you might be about shaking hands with someone you find just a huge bit intimidating because of their greatness, it never hurts to just introduce yourself and say you are a huge admirer of their work. A few times I saw rock star academics on their lonesome at the coffee table, probably because everyone was too in awe to say hi.
  3. When in doubt ask questions. When you have reached your small talk capacity and feel like the conversation is drying out, ask questions of them. People love to talk about themselves and asking them questions about themselves shows that a) you have a strong interest and b) that you are engaged in what they do.

Written by Hannah Morrice
Research Assistant, Jack Brockhoff Child Health & Wellbeing Program
The University of Melbourne
e: hannah.morrice@unimelb.edu.au

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Health in Orphanages Project (HOPe)

A few years ago while studying the oral health of school children in Kerala, India, one of the schools I visited was a boarding school for orphaned children. It was obvious from just observing these children and through dental examinations that the health of these orphaned children was a lot worse than children from the non-orphanage schools in my study. While at the time I was doing my masters degree and did not have the liberty to pursue this issue further, I made a mental note that when I had settled down in my career I would re-visit this issue. Fast forward to 2013 (five years since I visited the orphanage in Kerala) and we (my wife and I) have set up the Health in Orphanages Project (HOPe), with support from University researchers and community partners, to explore the health of children residing in orphanages in India.

So what is an orphan – United Nations Children’s Fund (UNICEF) defines an orphan as not only a child who has lost one or both parents but also those who have lost a father but have a surviving mother or have lost their mother but have a surviving father (1, 2). It is estimated that, as of 2010, there were 132 million orphaned children across the globe (about 2% of the world’s population), a shocking number. Of these children, 69 million were located in Asia, 53 million in Sub-Saharan Africa, and 10 million in Latin America and the Caribbean. India alone is home to 32 million orphaned children (~ 2.6% of India’s population or 7.5% of India’s child population). Yet it is quite rare for the local populace in India to encounter these children in their normal lives. The social structure in India has ensured that these children are a hidden and socially stigmatised community.

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Photo of an orphanage from my last trip to India

In spite of such large numbers the available information on the health of children residing in orphanages, particularly in India, is very limited. The available information gave us some insight into the health of these children but again highlighted the need to work with this hidden section of the community that we call the ‘disadvantaged among the disadvantaged’. A parent-child relationship is important for the mental and physical development of the child and the absence of this relationship can be detrimental to their health. Such a separation can negatively impact on various aspects of their development, particularly in relation to their psychosocial, emotional and cognitive skills. The social disadvantage is due to the lack of social and cultural identity that growing up in a family would provide. A joint report by UNICEF, UNAIDS & USAID on orphaned children state that institutional care such as orphanages can be detrimental to the child’s development as they socially isolate the children, discourage autonomy, put the children at risk of losing their family and community identities, and fail to provide any mechanism to support a child’s emotional or mental needs (1). As a result of these issues, orphaned children generally have poor oral health; poor mental health; are malnourished; have low immunity; are prone to medical conditions such as HIV, cardiomyopathy, fetal alcohol syndrome, hepatitis C, otitis media & congenital adrenal hyperplasia; and recurrent episodes of diarrhoea, fever & cough (3, 5-10). These children, particularly girls, are at a high sexual risk which includes having sex at an earlier age, pregnancy and the risk of contracting HIV/AIDS (11-15). Also common among orphaned children are behavioural and cognitive issues such as thought problems, rebellious nature, aggression and being withdrawn (6, 7, 17). A study of children in Romanian orphanages found that due to ‘global neglect’ (when deprivation occurs in more than one domain of child development, such as language, touch and family support) the brain size of orphaned 3-year-olds was significantly smaller when compared to that of a normal child of the same age (16).

So it is quite evident that these children face additional challenges that impact on their health and wellbeing. However, without sufficient country/location specific evidence local program planners and policy makers will not be able to make a case for targeted interventions. We aim to provide this evidence and use the information from this research to determine the future direction of the project. Our first stage will be to explore the health issues affecting children residing in orphanages in the State of Kerala, which is located on the south-west coast of India. At present there are approximately 400 registered orphanages in the State of Kerala alone, with on average 100 children per orphanage (18). We envisage that through HOPe we will be able to provide the evidence needed to progress towards healthier and more socially inclusive environments for these children.

About the author: Bradley Christian is a Research Fellow at the Jack Brockhoff Child Health and Wellbeing Program, working on Teeth Tales – a community based oral health promotion intervention for pre-school children from a refugee and migrant background. Brad is a dentist with specialist training in Dental Public Health whose research interests are around social disadvantage, children and oral health.

 

References

  1. UNAIDS, UNICEF, USAID. Children on the Brink 2004: A joint report of new orphan estimates and a framework for action2004.
  2. UNICEF. Orphans. UNICEF Press Centre; 2012 [cited 2012]; Available from: http://www.unicef.org/media/media_45279.html.
  3. Thielman N, Ostermann J, Whetten K, Whetten R, O’Donnell K, the Positive Outcomes for Orphans (POFO) Research Team. Correlates of Poor Health among Orphans and Abandoned Children in Less Wealthy Countries: The Importance of Caregiver Health. PLoS ONE 7(6) 2012;7(6):e38109.
  4. International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005-2006 India. Mumbai IIPS2007.
  5. Watts H, Gregson S, Saito S, Lopman B, Beasley M, Monasch R. Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe. Tropical Medicine and International Health. 2007;12(5):584-93.
  6. Erol N, Simsek Z, Munir K. Mental health of adolescents reared in institutional care in Turkey: challenges and hope in the twenty-first century. Eur Child Adolesc Psychiatry. [Research Support, N.I.H., Extramural]. 2010 Feb;19(2):113-24.
  7. Hermenau K, Hecker T, Ruf M, Schauer E, Elbert T, Schauer aM, et al. Childhood adversity, mental ill-health and aggressive behavior in an African orphanage: Changes in response to trauma-focused therapy and the implementation of a new instructional system. Child and Adolescent Psychiatry and Mental Health 2011, 5:29. 2011;5(29).
  8. Khare V, Koshy A, Rani P, Srilata S, Kapse SC, Agarwal A. Prevelance of Dental caries and Treatment needs among the orphan children and adolescents of Udaipur district, Rajasthan, India. The Journal of Contemporary Dental Practice. 2012;13(2):182-7.
  9. Lassi ZS, Mahmud S, Syed EU, Janjua NZ. Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: comparison of children in an SOS Village with those in conventional orphanages. Soc Psychiatry Psychiatr Epidemiol 2011;46:787-96.
  10. Johnson DE, Traister M, Iverson S, Dole K, Hostetter MK, Miller LC. HEALTH STATUS OF US ADOPTED CHINESE ORPHANS. .  1996 Abstracts The American Pediatric Society and The Society for Pediatric Research (1996) 39, 135–135; doi:101203/00006450-199604001-008151996.
  11. Birdthistle I, Floyd S, Machingura A, Mudziwapasi N, Gregson S. From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe. AIDS 2008;2008:759-66.
  12. Dunbar M, Maternowska M, Kang K, Laver S, Mudekunye-Mahaka I. Findings from SHAZ!: a feasibility study of a microcredit and life-skills HIV prevention intervention to reduce risk among adolescent female orphans in Zimbabwe. J Prev Interv Community 2010;38:147-61.
  13. Gregson S, Nyamukapa C, GP GG, M MW, JJ JL, et al. HIV infection and reproductive health in teenage women orphaned and made vulnerable by AIDS in Zimbabwe. AIDS Care. 2005;17.
  14. S SK, Dunbar M, Minnis A, Medlin C, Gerdts C, NS Padian NS (2008) Poverty gi, and women’s risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci 1136: 101–110. Poverty, gender inequities, and women’s risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci. 2008;1136:101-10.
  15. Mmari K. Exploring the relationship between caregiving and health: Perceptions among orphaned and non-orphaned adolescents in Tanzania. Journal of Adolescence. 2011;34:301-9.
  16. Perry BD. Childhood experience and the expression of genetic potential: What childhood neglect tells us about nature and nurture. Brain and Mind. 2002;3(1):79-100.
  17. Baguma P.  Assessment of psychosocial support programmes for orphans/vulnerable children in Uganda. International Journal of Psychology. 2012;47(1):467-77.
  18. List of charitable institutions.  Thiruvananthapuram: Department of Social Welfare;  [cited 2011]; Available from: http://www.old.kerala.gov.in/dept_socialwelfare/Grant-in-aid.htm.

Research with culturally and linguistically diverse communities

Encouraging people to participate in research can be a tough gig. We are usually asking people to volunteer their time just for a small piece of information, which is sometimes only relevant and generalisable if large numbers provide this same, small piece of information. As researchers we know the enormous value that gathering this information can have to inform change at the policy, practice and the community level. But the general population sometimes does not place the same value on research or understand how important the research and outcomes can be. So, how do we encourage people to participate in research? And in particular, how do we encourage those from culturally and linguistically diverse backgrounds, where research may not be a common concept or practice.

I am currently working on a large scale child oral health research project entitled ‘Teeth Tales’, being conducted in partnership with government and community agencies  and Australian families from refugee and migrant backgrounds. Oral health is included in the Victorian Health and Wellbeing Plan 2011 – 2015 as a priority area for preventative health, as it is one of the most preventable diseases, particularly for children. Tooth decay is Victoria’s most prevalent health problem, with more than half of all children and almost all adults affected (1). Initial qualitative research was conducted with mothers from Lebanese, Iraqi and Pakistani backgrounds exploring oral health practices, beliefs and service needs. We learnt about many cultural differences and the real interest these communities have to learn more about keeping their children’s teeth healthy. From this earlier research, a community-based trial was developed to include an oral health education program for parents delivered by a trained educator from the same cultural background. This peer educator is able to talk about traditional beliefs and practices and introduce parents to the key Dental Health Services Victoria oral health messages of ‘Eat Well, Drink Well, Clean Well and Stay Well’. The program also included a site visit to local dental and family services. In addition to this education program, local services underwent a review of their practices to improve their competence in dealing with culturally diverse communities.

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Photo from:  http://www.dshs.state.tx.us/dental/promo_oh.shtm

For this trial we recruited Lebanese, Iraqi and Pakistani families in metropolitan Melbourne with children aged 1 – 4 years. We wanted to make sure that the research was as useful and relevant to families as possible so we sought the advice and expertise of relevant cultural organisations. They provided guidance on the cultural practices and beliefs of the target cultural groups, and the cultural appropriateness of our research methodology. They also helped us to recruit families, conduct the trial, interpret the findings and they provided language assistance. If it wasn’t for these partnerships we may have been lucky to recruit 10 families rather than the over 500 families who ended up participating! The advice and support of these cultural partners is invaluable when trying to recruit families with a refugee or migrant background, some of whom may be unfamiliar with research conduct, health promotion and the Australian health system.

In order to evaluate the success of the program we needed to check children’s teeth before and after the trial, as well as ask parents to complete a questionnaire. The free dental screenings for the children proved to be a key incentive for parents to register for the study. Oral health is one of the most contentious current health issues in Australia as access to fast, affordable dental care is often not available. The private dental system is run as a business and many walk out of the service with an expensive bill. The public dental system has huge waiting lists and strict eligibility for access. We found that many parents were not aware that children and refugee and asylum seekers in Victoria are considered a priority group for public dental services access. So when our study offered a free dental screening for children many families jumped at the opportunity!

The strategies outlined above helped us to successfully recruit over 500 families into our study. Engaging culturally and linguistically diverse groups in research can be difficult, but is very important, particularly for health services that need to respond to the evolving health needs of refugee and migrant and groups.

To read more about the ‘Teeth Tales’ study please visit:  http://mccaugheycentre.unimelb.edu.au/research/current/intergenerational_health/teeth_tales

Blog by Dana Young

Research Fellow, Child Public Health

The University of Melbourne

e: dana.young@unimelb.edu.au

References

  1. NACOH. 2004, Healthy mouths healthy lives: Australia’s National Oral Health Plan 2004-2013. Adelaide, National Advisory Committee on Oral Health, Australian Health Ministers’ Advisory Council.

It’s time we all listen to Indi

With the seat of Indi still too close to call it may well be that the role of children in same-sex relationships may have had some small bearing on the outcome. Sophie Mirabella, a Liberal Party frontbencher who headed into the election with a comfortable 9 point lead, has found herself in the fight of her life. Her competition, Cathy McGowan, is a popular local independent enjoying significant support in an election that generally saw a considerable swing to the Liberal Party. Now I am not a political pundit, and I am sure there are many factors at play that have led to this surprising result, but I can not look past the role that same-sex families may have played in the final days of the campaign.

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Photo from: http://www.cathymcgowan.com.au/

On the Wednesday before the election The Age reported on the distribution of offensive pamphlets in the seat of Indi. Let me make it clear at the outset, there is no evidence that these pamphlets were either the responsibility of, or supported by, the Liberal Party. The pamphlets portrayed young children with quotes such as, “I need my mum and dad.” They went on to urge voters to distribute their vote such that Cathy McGowan, among others, be preferenced last. The reason given in the pamphlet was that Ms McGowan is in favour of marriage equality. Sophie Mirabella has consistently and repeatedly emphasised her position that marriage should only be between a man and a woman and, as reported in The Age, she believes that marriage was “developed for the creation and raising of children.”

It is reassuring to think that perhaps our research is starting to gain significant traction in the community. Where previously these scare tactics might have boosted the conservative vote it seems that we might be moving into an era where the population as a whole understand that there are many valid and healthy ways to raise children. This evolution in public opinion is so important. As our research evolves we are seeing the negative impact that opinions such as those expressed in the unwelcome pamphlets can have on children with same-sex attracted parents. And while these children are in general developing well, a message that may finally be cutting through, the final remnants of negative outcomes could be taking their last gasps as local Australians embrace same-sex parent families, even if some politicians are slow to reflect this.

The coming days will bring a final result in Indi, but whoever triumphs one thing is certain. At least in this small corner of our country attempts to discriminate against, and vilify, same-sex attracted parents seem to have failed. It gives me hope that with the aid of our ongoing work same-sex parent families have a bright future. Perhaps Mr Abbott will realise this and allow a conscience vote the next time marriage equality comes up in parliament.

Come on Prime Minister, listen to Indi.

By Dr Simon R Crouch
Lead Investigator, The Australian Study of Child Health in Same-Sex Families
http://www.achess.org.au

Is marriage equality really that important this election? Just ask Russia.

Although the majority of Australians are in favour of marriage equality many would agree that it is not a high priority issue and that other aspects of policy should take centre stage. But when I vote tomorrow I will be certain that any candidates I mark with the number 1 are on the record as supporting same-sex marriage. OK, so I am perhaps more personally engaged in the debate than most, but it is important that we all contribute to the continued progress of social issues in our country.

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Just take a look at Russia. Recently this European country took a step backwards in terms of human rights when it passed legislation earlier this year that essentially banned any positive discussion of homosexuality in public. There has been a small but significant reaction to this step with some calling for a boycott of the Winter Olympics next year, and high profile celebrities deciding to ‘come out’ and voice their dissent.

 But today reports are emerging that Russian lawmakers have drafted a bill that would see children being removed from parents based on a “nontraditional sexual orientation.” This outdated view, which suggests children need to be protected from exposure to homosexuality, has been lifted right out of the 1970s. Almost forty years ago some researchers tried to suggest that children with homosexual parents will themselves grow up with the same deviant sexuality and that this would be a very dangerous outcome. In fact, what forty years of research has shown is that kids with same-sex attracted parents are doing just fine, thank you very much. And the only thing that has any significant impact on their health and wellbeing is just the type of discrimination that Russian politicians are subjecting same-sex parent families to.

 Australia is at a crossroads. Our research is strengthening previous findings that kids with same-sex attracted parents are doing really well, but that they are adversely impacted by the perceived discrimination they feel when hearing the negative rhetoric that surrounds issues such as marriage equality. This is what drives my work. The ability to provide the all important, balanced evidence that policy makers can draw upon to inform essential debates in our society. Our work on child health in same-sex parent families is still in its infancy but already it has received attention around the globe as more and more countries seek to move on marriage equality. But equally we, the voters, need to understand the evidence as we go to the polls and decide who will lead our country in the coming years.

 This is why we need to move forward as a nation. This is not an issue that wears particular political colours – there are advocates and opponents on all sides. But for the sake of our children pay attention to where your first preference sits on the issue tomorrow. There are children in Russia with an uncertain future – let’s make sure we secure ours.