The short walk from Grand Central to the United Nations this Tuesday completes a journey that has taken a lifetime. It started at 13 when I fled a violent children’s home and shivered through the night on a park bench. I like to think running away was a defiant refusal to accept my lot . An effort to re-sanctify my humanity and sense of selfhood. Probably I was just very scared.
I always thought child maltreatment was an anomaly, blighting a small number of us. At leastone in three children grow up in chaos or emotional poverty. We all know the stories of Elton John, Oprah, and Billy Conolly. 30% of Oscar-nominated films in 2020 had a storyline of child trauma. Why would we be surprised?
For children, danger is not just the presence of violence but also the absence of love. A child’s adaptation to danger creates lasting trauma that can drive a lifetime of pain, poverty, and ill health. Childhood adversity is catastrophic for the child and the costliest and deadliest of social problems. for society.
Yet none of it is inevitable
On Tuesday I will present a joint UN policy call  to member states aimed at preventing abuse, neglect and abandonment before it happens. The call draws on the recent body of global science on why child maltreatment occurs and what works in preventing it.
In the decades that have passed since that lonely park bench, our global understanding of child maltreatment has transformed in three ways.
We know child abuse and neglect are not marginal. These adversities do not only affect the 1-3 per cent of children who become child protection cases. Globally, at least a third of us experience significant maltreatment during childhood. Abuse, neglect and dysfunctional parenting are transmitted across generations, often automatically and unintentionally. It doesn’t always occur in chaotic, rage filled homes. It can be mild or moderate, quiet and unseen. In all cases it causes lasting harm.
Child maltreatment costs a packet. It is the main preventable cause of life-course mental illness , addiction, obesity and vulnerability to exploitation and violence. It also increases the likelihood of non-communicable disease poor learning outcomes and fewer job prospects. It is the most common factor amongst those recruited by organized crime, extremist and terrorist groups. Abuse and neglect are one of our greatest social problems and estimated to cost between 2 and 5 per cent of global GDP. In one way or another, we are all affected by childhood adversity.
It is not inevitable. The best protective factor is a dedicated, loving parent or caregiver. Babies are biologically programmed to attach with a parent for care and protection. The absence of love and attachment is seen by children as a threat. This activates the stress response system and derails healthy development. Parents who were neglected or abused as children themselves are at higher risk of poor attachment with their own kids. This inter-generational transmission of trauma can be disrupted by providing an opportunity to develop parenting skills and self-awareness . Evidence-based, low cost parenting programmes have shown improved outcomes in attachment, nurturing care and violence prevention. Nobel prize winning economist James Heckman argues that parenting programmes deliver up to US$13 return on every dollar invested through better life outcomes
Global progress occurs when humanity unites behind a single accelerator that attacks multiple problems . A laser focus on vaccines against childhood diseases in the 1980s increased global coverage from 20 to 80% of under-fives and halved child mortality. The world became a place where child death was no longer seen as inevitable or unpreventable.
As an absolute minimum standard, the World health Organization and UNICEF are calling on governments to ensure 5-7 home visits in early childhood with ‘booster’ sessions at critical development stages such as adolescence. Like vaccines, parenting programmes are an accelerator rather than a panacea. They are the most effective and proven way we currently know to prevent abuse and neglect. This very minimum package could tip the balance and disrupt transmission of intergenerational trauma. They should be made available globally and universally in the same way that vaccines are intentioned. We call this the parenting vaccine
The minimum standard is for deployment in all contexts including humanitarian and low-income countries. The more a country can do, the more it should do. The parenting vaccine is a galvanising accelerator that would turbo-boost support for other critical interventions including family friendly policies, caring for the caregivers, universal pre-school and better funded mental health and social work services.
The launch of the parenting vaccine carries the same urgency for me as the work I have done on humanitarian crisis and natural disaster. At thirteen I refused to accept my maltreatment as inevitable. With a small and cherished group of colleagues from the UN and academia we are refusing to accept it as inevitable for any child.
For most of adulthood I suppressed an inner pain, buttoned up under the cover of sporting, academic or professional accomplishment. Therapy delivered an Ebeneezer Scrooge-style epiphany. I was never financially stingy like scrooge for the record. My austerity was with emotions. The world seemed so much more joyful, enchanting and loving after recovery . I have a deep appreciation for the feelings and sensibilities that cascaded from a place that had felt barren and broken. All around me I see people who live with unresolved trauma. They don’t even have the vocabulary to describe it, let alone acknowledge and change it. We could build a world in which everyone could understand, describe and seek to overcome trauma.
Until a few years ago I had no photo from my childhood. My mother had died when I was a young adult without me really knowing her or holding her image in my head. A long-lost family friend recently shared some much-treasured childhood photos and a single video. In the grainy film I can see my mother and the friend chatting. The friend bounces her infant on her knee effortlessly while chatting. I am off to the side, out of my mother’s gaze or affection. In my mother I see the face of someone deeply unsure of herself. We rarely think of our own parents as once having been children. I imagine my mother had been neglected herself as a child and simply lacked the relational tools to protect or love a child. Someone who never recovered. I imagine her as a beneficiary of the parenting vaccine programme . I imagine her bouncing that child on her knee and of them growing in mutual love. This is what we should all want for every child and parent.
Previous generations dramatically reduced hunger, disease and war as the science and resources became available. In doing so they uplifted humanity. We are the generation that can end abuse and neglect as an accelerator for health, wellbeing, prosperity and peace . We can imagine a world where Ebeneezer Scrooge doesn’t need an epiphany and I didn’t need a bench.
NB: This Article if the third in a triology. The first can be found here and the second here. I dedicate this article to my amazing colleagues Etienne Krug, Sabine van Tuyll and Alex Bouchart of WHO, Professor Lucie Cluver and Professor Frances Gardiner at Oxford University and Stephen Blight, Oluwatosin Akingbulu, Emma Ferguson, Cornelius Williams and Zeinab Hijazi of UNICEF> All of whom work tirelessly for the cause set out in this blog. The photo is taken from with the last cohort of abandoned babies who were de-instutionalised as part of a programme with the Government of North Macedonia
 Created by UNICEF, WHO and the UN Special Representative on Violence Against Children