Feature article

I'M told that for the mums and midwives who are busy in the labour suites on New Years Eve, it becomes quite a competition to deliver the first baby of the year, be it just seconds or minutes past midnight.

As I think of our first new citizen of 2008, I wonder what it really means to be an Australian child of this generation and how the decisions that we all make will affect that tiny one as he or she travels through life.

Life is very unequal even before conception. The egg from which our 2008 baby grew was developed in the baby's mother's ovary when that mother was in utero in our baby's grandmother.

So her health influences our baby's health perhaps as much as her mother's does. No new eggs are produced after birth and hence even just the age of our baby's mother will influence not only the capacity of that mother to conceive (fertility falls off drastically after the mid-30s and part of that story is that the eggs are getting older along with the mother), but her risk of having a multiple birth or a Down syndrome baby as well.

And just in case she feels that it will all be OK because IVF is here to help, success rates for that fall markedly with age, the risks of birth defects are double and of course you are more likely to have a multiple birth from the intervention.

So in 2008 it is important to tell our young women not to leave it too late in the fertility and motherhood stakes.

Once ensconced in the womb, surely my little 2008 fetus is protected from all the external harms? Sorry. Mum's womb is a wonderful thing but the chemicals from smoking, from alcohol and most drugs (illicit and legal) and from environmental exposures that get into the mother from food, air and water, can cause a multitude of problems for our baby. If the mother is excessively stressed, exposed to domestic violence or has severe health problems such as diabetes or obesity, our baby may suffer irreversible problems that could compromise his or her development for their whole lives.

For these things there is no cure: the pathways are to poor outcomes such as difficult behaviours, poor school performance, mental health problems, inability to concentrate, ADHD, risk-taking behaviours and aggressive crimes. Alcohol exposure in pregnancy is now the most common cause of preventable intellectual disability in the world. How many schoolies and binge-drinking young women know this? What is the best way to inform them so that their behaviour changes? How much do these early exposures explain the epidemics of youth disengagement we are observing and the high rates of such problems in some areas and groups, including our Aboriginal youth? Probably quite a lot; I can't do the sums accurately because the data on these things are incomplete.

The message however is clear: failing to urgently mount the best preventive strategies we can will mean not only this generation having these problems but their children as well; we could be on an exponential increase here.

Day after day The Australian reports on a variety of examples of what we in public health would call failed prevention: children being found in suitcases and starved to death, of yet more children being sexually and physically abused.

The universal cry is for more services to identify these children, take them away, find the perpetrators and lock them up. Important actions, but not the whole solution. Does no one ask and question, as I do, why is this happening? How could we have avoided these horrible situations in the first place?

Is it not more cost-effective, more humane and more morally acceptable to avoid the situations that lead to these outcomes? The research is clear; most of our responses to these types of issues come too late to prevent the crisis and are largely ineffective.

There are many examples. The most significant outcome from locking up young people is that their crime rates rise. Mandatory reporting of child abuse doesn't stop children from dying but sees swamped social workers with scant resources diverted to low-risk children and neglecting the high-risk.

Schools cannot turn around Aboriginal children who arrive already well behind, and treatment for obesity, developmental problems and fetal alcohol syndrome either does not exist or fails to help. Has anyone asked why there are so many problems in Aboriginal communities and do they care enough to want to make a difference by reducing the causes?

In 1900, in contrast, the community seemed to understand what children needed better than we do today with all our prosperity and knowledge.

Our founding fathers knew that the health of the nation depended upon the health and education of mothers, adequate resources for living (good housing, hygienic conditions and nutritious food) and childhoods that allowed for learning and playing in safety.

Without any knowledge of the major causes of diseases of the time and with few known treatments, they implemented the most effective preventive strategies with resulting spine-tingling falls in infant deaths and illnesses that meant so many more or these babies survived to have good lives. Our founding fathers got it right big time.

In 2008 we know what our baby needs for the most healthy life with chances to participate fully in our society. It's up to us as a society whether we make them a priority. The exciting thing is that everyone benefits from programs, environments, activities, communities and places that value children, focus on prevention, enhance antenatal health, improve birth outcomes, reduce or avoid alcohol exposure, and improve living conditions and educational opportunities for the disadvantaged. If we invest early and get it right in 2008 for this child, then over the years we will reap the benefits with less of our budget spent on end-stage problems such as preventable illness, mental health, crime, educational failure, and unemployment.

Better still, this child will be able to participate more fully in the social, civic and economic future of Australia. For the child's sake, for all the babies of 2008 and for Australia's future, surely putting the needs of our children first should be our most urgent priority.

Fiona Stanley, AC, is the executive director of Australian Research Alliance for Children and Youth and director of Telethon Institute for Child Health Research.