A Right to Love?

“He feels a dark star of pain in his throat and the last warmth of her touch on his fingers” 
― Kit de Waal, My Name is Leon

At 92 years of age, Stuart, was reluctantly bought by his son to see psychologist Daniel Siegel. Despite initial protests, he warmed to the therapy sessions. The more he talked, he more he saw his lifelong feelings of emptiness and emotional detachment. That realization motivated him to continue with the therapy and to become a better companion for his wife in their retirement . The therapy began to chip away at rigid walls that prevented intimacy and affection and made him numb.

Stuart’s wife saw how tuned-in to her feelings he became through the therapy. They were now happier than at any previous point in their 62 years of marriage. She told Professor Siegel that Stuart’s parents were the coldest and emotionally distant people she had ever met.

Stuart’s painful journey had indeed began at the start of life, not towards the end . Babies are programmed for connection, warmth and love. When absent or disrupted because of emotional neglect or loss, it is scary. The rapidly evolving young brain and body adapts to survive this trauma. But that adaption can become a lifelong maladaption. We cannot remember or recall our relationships as infants. But the earliest years define how we navigate the world and relate to others.

Neglect is often inter-generational and unintentional. We rarely think about what it meant for our parents to have been children themselves. If their parents were emotionally unavailable or unreliable in their affection, then it leaves an imprint. Children don’t come with a handbook and parenting is largely automatic and instinctive. What if our instincts are distorted by an early deficit of love?

9 year old Leon has a “dark star of pain” at losing his beloved brother and mother for the uncertainty of foster care. Between Leon’s 9 and Stuart’s 92, dark stars that are not soothed can be the source of much silent pain. Such stars are everywhere. Up to 40 % of adults struggle to connect or to thrive within relationships due to scars of childhood

I recently heard love defined as the promotion and protection of another’s internal emotional world. Love empowers with the soothing sense of being a “we”.  To truly love, we need to be emotionally present and in-tune with another. This can be intolerably painful and uncomfortable for someone who has not previously felt part of a “we”.

On one level we know all this. We identify it immediately in the detached James Bond or insecure Bridgette Jones. In the songs of Amy Winehouse. It has driven plot lines from Tolstoy, Dickens and Hugo to many 2020 Oscar nominee films. But it rarely drives us to demand a public conversation about how we may address it.

The right to Love  is not set out as a specific right in the 1989 UN Convention on the Rights of the Child although the preamble states: Recognizing that the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding,”  The latest science on human development shows child protection and development depends on the presence of love. Is it time to have an internationally recognized right to love?

We await any sequel from Kit De Waal to see how Leon’s life pans out. Healthy relationships with Maureen, Tufty and Mr Devlin are healing for Leon . An authentic connection with a teacher or another caring adult can help a traumatised child recover.   Leon’s foster carer Maureen soothed him and helped him to believe that in the end “things would be alright”. Crucially, she helped him to understand he mattered as an individual. We live in a world where mental health services are scarce and stigmatized and only accessed by a faction of those who need them. Soothing relationships are the best hope for recovery for most.

Stuart’s healing began when he became self-aware that mental maps from his childhood were not serving him well.  We can imagine how much richer his life may have been if this had occurred earlier. Or if the emotional neglect was prevented from the start. Research shows that mothers who become similarly self-aware are less likely to neglect their own children. This knowledge has informed parenting programmes designed to give attached and nurturing caregiving.

A right to love would call on governments to ensure every child has a loving family in which they are protected. It would call for parenting programs to be universally available and stressors removed from parents. It would demand that schools and communities prevent loneliness and isolation of children. That no adolescent reaches adulthood without being part of a “we”.   That everyone knows how to talk about about attachment, neglect, belonging and connection. That we talk about it without stigma or judgement.

Over recent decades we have seen unprecedented, game-changing results in public health. The world has harnessed the latest science to reduce child and maternal mortality and expand life expectancy. The next frontier of human rights in many countries has shifted from survival and basic protections, to helping us thrive and flourish. We need the public demand and political will to ensure, within this, everyone has the right to love .


Time For Us All To Grow Up and Take Childhood Seriously

For anyone concerned with childhood policy in the UK, this month has been a shocker. Children have been headlines news. Return to School and Exam algorithms have been debated and pontificated over by high-brow media, political grandees and lofty intellectuals.

Childhood is usually a second tier political issue. If debated, it appears as the parlimentary equal of Scunthorpe United versus Stevenage Town. While debates on tier one issues such as Brexit, the budget or any given war are Barcelona versus Bayern.

This was best illustrated by an article on a 2016 Conservative leadership contest in The New Statesmen. 9 Reasons You Should Be Truly Terrified of Andrea Leadsom Becoming Prime Minister. ‘Leadsom has long campaigned around parental attachment, and reportedly spent several minutes talking about babies’ brains at the first Tory leadership hustings, to the bemusement of fellow MPs’ the article tittered. The candidate had a crackpot idea that investing early could prevent costly negative life outcomes . Luckily the razor-sharp intellectuals of the New Statesmen and the bemused (probably male) MPs were not fooled.

How can a candidate for the Prime Minister talk piffle about brain development. Surely there are serious tier one issues to discuss? Terrorism, Crime, Drugs, Poor Productivity, non-communicable disease, obesity or poor education outcomes anyone?

Apart from the fact that any credible scientist from Harvard to Oxford with now tell you this: To prevent terrorism, crime, drugs, poor productivity, non-communicable disease, obesity or poor education outcomes we should invest early. The Nobel prize winning economist, James Heckman has shown that every 1 public dollar invested in early childhood yields up to $13. This makes early childhood the best investment any government can make. The World Health Organisation, Centre for Disease Control and UK National Health Service all see correlations between early trauma and costly life outcomes. The groomed, addicted, radicalised and obese are likely to have come from backgrounds of early trauma. And we now know how to prevent it. This is what Andrea Leadsom was talking about.

Most democratic political philosophies have a longstanding position on childhood. Moderate conservatives venerate Edmund Burke, who advocated for a form of intergenerational justice. Social democrat discourse on childhood was shaped by a quest for fairness and equality, as championed by Dickens and Hugo. The left has a strong focus on addressing child poverty and exclusion . These ideas remain relevant, but incomplete. All political parties are slow to champion our new understanding of how children’s brains develop and how transformative this can be for our society.

New York Times columnist, David Brookes advocates for investment in early childhood development. Like Andrea Leadsom, he was belittled by another writer for turning away from tier one politics. This time by Anne Applebaum in her recent book on geopolitics and populism Twighlight of Democracy. In many countries we can see polarised election campaigns with rhetoric that harms children. While any debate on their welfare will be out on the margins.

The same misguided hierarchy of political priorities is often seen elsewhere too. A recent conference on violent extremism was only attended by geopolitics and security experts. It is increasingly obvious that a driver of radicalisation is child trauma. We need to factor-in early preventative policies if we are to address it.

Over the course of your life, investment in childhood policy could do more for your security and wealth than any defence or economic policy. There is huge evidence that investment in parenting, pre-school and child poverty should be a tier one political priority. Depending on your politics, you may or may not be “terrified” of Andrea Leadsom. But we definitely should fear political systems that fail our children. It is time for us all to grow up and take childhood seriously!

Life Without School

21st March 2002, Afghan New Year, was the most humbling and memorable day of my working life. I was coordinating a “Back To School” campaign in the Northern Afghanistan, and the 21st was the target date for opening of schools. This was the first major national reform after after a post-Taliban peace agreement signed a few months earlier. Rebuilding education was seen as a peace dividend for the Afghan people and a symbol of hope for their children on the first day of the first peaceful Spring after 23 years of war.

In this case, Back To School was a slightly misleading campaign title. There had never been more than 10% of children in school in Afghan history. If large numbers of children did go, they wouldn’t be going “back” to school. Most would be going for the very first time and would be the first in their families ever to attend school.

We worked for the preceding 60 days in one of the biggest logistical operations in UN history with the aim of creating an improvised national school system. Millions of classroom tents, text books and school backpacks were delivered via air. We distributed them to makeshift schools across the country, often via donkey or camel train. Many villages were not accessible by road or the routes had been badly war-damaged. A teaching workforce was built mainly from scratch by training anyone with a high school diploma on the basics of teaching. Schools were established in tents, fields, houses and former factories. In some cases. deadly land mines had to be cleared first. The campaign was intense, rapid and exhausting, but at 4 am on the the 21st March we put the final pin in a map. It showed every community in our zone had a designated school space, a teacher and supplies.

Just a few hours later we woke up to see the streets full of children hurrying in different directions to their first ever class. A total of 3 million children went to school that day. Seeing this was indescribable. It wasn’t just about learning. We knew that hungry children would receive lunch, traumatised and neglected children would receive attention, acknowledgement and maybe a sense of belonging. We knew that if children learned to read and write in school today, they would be less likely to die while giving birth or through preventable disease tomorrow. School connected those children to an enchanted world of learning. More than that, it is an accelerator for every other aspect of healthy child development and wellbeing.

The absence of education was a severe deprivation that the Afghan people yearned to overcome, for their children and their future. Similar struggles in different parts of the world have dramatically increased school access. Prior to the pandemic, 91% of the world’s schools age children were enrolled. This was unimaginable a few decades ago.

Todays school closures, affecting some 1.3 billion children globally, have momentarily reversed these gains. They affect all children, but have harmed the most vulnerable in three devastating and potentially life-lasting ways that :

  1. School closures exacerbate existing inequalities of access, quality and attainment for the poorest and most vulnerable children everywhere. Hard fought gains in attendance and access for female, Roma, indigenous or other excluded groups are under threat. Attention and resources risk being diverted away from a pre-covid learning crisis where half of the world’s children are in school but not really learning. Remote learning remains deeply unequal. Here in New York the 300,000 children who don’t have digital access are the poorest and already blighted by the lowest attainment and opportunities in the education system.
  2. 370 million of the worlds poorest children are missing out on vital school meals. These are children at risk of malnutrition and depend on school feeding programmes for basic health. Further to this, school is often a key community centre for monitoring overall child health. Health or nutrition deficits in childhood are not momentary, they impact development with life-lasting costs. School closures are a threat to the health and nutritional status of children
  3. At least 20% of children in any given society are affected by multiple forms of neglect, abuse and dysfunctional parenting at home. Only a fraction of them become child protection cases with dedicated and active social work support. For the rest, a soothing relationship with a teacher and school friends that can help them find a pathway to a better future and rebuild self belief. These relationships have been cut off with school closures. We know that unaddressed trauma in childhood is a major driver of poor mental and physical health throughout life and worse outcomes on almost every wellbeing measure.

The safe reopening of schools needs to be an urgent priority for governments everywhere. Remote learning is only a good alternative when schools are closed as a last resort. But as the UK Commissioner for Children Anne Longfield recently pointed out schools must be the last public space to close and the first to open. When there is a possibility to ease social distancing measures, it should be schools first not pubs!

It is a realistic proposition in the 21st century to set a target of connecting every child, every where to digital learning. This makes school systems more resilient to shocks and it can also network kids into public health and social work systems when direct access is not possible. Furthermore, the current digital gap is one of the major determinants of learning inequality. This needs huge innovation and investment, but it is achievable.

As much as disruption to schooling threatens our economic recovery, it also harms social fabric. Prior to the pandemic we were more atomised, polarised and lonely than ever, amidst an onslaught of identity conflict and receding communal values. School is the one place where children are socialised together and with common purpose and expectations. It is our great hope for healing, for binding and for belonging. Along with public health and social insurance, our educations systems are an endeavour that has propelled our societies forward and helped us to flourish. The longer they remain closed, the more difficult it is to narrow the gaps on quality, access and attainment and the wounds inflicted on children affected by poverty, exclusion or trauma. Thats why we need to prioritise the reopening of schools above all else.

All Of Our Dignity

It would be impossible to forget Antonio. His abandonment and isolation had been so complete, nobody even knew how old he was. We guessed about 8 or 9. He lay in a cot, lifeless and listless in a dark corner. The lack of animation was the not the outcome of his severe disability and blindness but rather caused by extreme neglect.  The institution “housed” around 150 adults and children.  It wreaked of human waste and human disregard.

My index finger gently brushed against his palm and he gripped it tightly as his face broke into semi-toothless smile.  He had lived a life cut adrift from love, attention or even basic human acknowledgment .

Antonio’s story inspired a shared effort by the government of North Macedonia and the UN to end placement of children in large scale institutions. Children like him would be provided with family-based care, connection and stimulation in community settings.

The plan was knocked off script when locals in the town of Timjanik angrily refused  a mayor’s request to accommodate some of the children . We went there with the minister to find out why. On arrival, we sustained a three hour volley of abuse and hostility from several hundred protesters.  People watching this back in the capital on livestream  were horrified. Pundits, influencers and activists began lambasting the protesters as primitive, callous and hillbilly.

We listened carefully. Their’s was a small town in decline. It could have been in Oklahoma or South Yorkshire.The townsfolk had previously been dependent on industry and agriculture. For generations their income and opportunities had been on a modest, upward trajectory. But they now feared their children would have a much more  precarious future. They had lived with years of unfulfilled promises to fix their roads, improve their schools and provide a pre-school. They longed for someone to give a voice to them, alongside the regular campaigns they heard from human rights activists for migrants, sexual minorities and people with disability.  Like Antonio, in their own way they felt abandoned.

But why did these two different forms of deprivation and abandonment compete with each other? Broadly speaking there are three catastrophic burdens in childhood  that drive lifelong inequality:

  1. Discrimination or Exclusion based on race, gender or disability  for example. It creates barriers that exclude one from opportunities, justice and often the basic safety that others take for granted.
  2. Income Poverty through  a lack of the basic means to survive, thrive and access opportunities to reach one’s potential.
  3. Emotional Poverty through the absence of the basic nurturing and protective parental relationships due to violence, neglect or other forms of dysfunctional parenting (also known as childhood adversity). This is often transmitted inter-generationally and unintentionally.

If you look at  Black Lives Matter, Hillbilly Ellergy and Good Will Hunting through the lens of identity, they seem so different to each other. When we look at them through the lens of fairness and dignity for all, they seem the same. It sometimes feels like we have forgotten a sense of ourselves as a whole, we are looking for the differences and barriers. This fragmentation polarises us into differing sides in a counter-productive culture war.

People in places like Timjanik perceive human rights champions  to be selective in the injustices they seek to address. Those living with rural and town poverty  feel both politically and economically abandoned. They are at the fag end of a painful transition from an industrial to a knowledge economy. This transition has concentrated opportunity in large cities at the expense of almost everywhere else. Those same champions scratched their heads as populists have hoovered up support in poor and abandoned communities. Despite their best intentions, they must bear part of the responsibility for the growth in populism and polarisation.

I felt this recently back home when I  took a group of young adult care leavers for lunch in London. They had each lived with all of the three catastrophic burdens described above. It is hard to think of a more deprived group in the UK.  We walked past a protest march urging us to support the rights of an oppressed minority in a far flung country. The comparatively wealthy looking protesters obviously felt that from our position of privilege we should all support this vulnerable minority oversees and that this was the most important human rights issue of the moment. But whose privilege is it? One of the young people in our group said he could not imagine the same protesters marching for kids in care. To highlight injustice, without acknowledging it is not the only injustice is itself an injustice.

Coming back to the story of Timjanik. The following day at an unrelated press conference  in the capital, we were asked by journalists about the events in the town. We were expected to join the public condemnation of the protesters behaviour. Instead we articulated the townsfolk’s grievances and their struggles and explained that we could understand them, though did not agree with them.

Within two hours our inboxes were flowing with warm messages from people in Timjanik. They had not expected that we would actually listen to them and tell their story. They had needed to be acknowledged and heard. To understand that we think they matter too. From a collective refusal to host the small group home just 24 hours prior, it was now back on.

From that moment on, we numerically balanced our public facing advocacy. We gave equal attention to the situation of the overall population and to those living with one or more of the three catastrophic burdens . If we did a public event on exclusion of Roma minority or children with disability one month, we made sure we also had an event on poverty or a  population-wide issue like education or health the next. This struck us as fair, just and effective.

A few weeks after the protest, the government agreed a strategy to transfer all children out of large scale institutions through family re-unification, foster care and small group homes. The government named the strategy “Timjanik” in testimony to what we had all learnt from these events.

On October 15th last year, the last remaining children were removed from large scale institutions. The situation may have improved for children in state care in North Macedonia, but there is still so much to do to prevent exclusion, poverty and adversity in the lives of children the world over. We can only do this when everyone finds their place in a shared story of justice and fairness. We need to “re-universalize” our human rights story.

And the children in the story? Antonio is out of the cot, living in a small group home with adequate care and stimulation and for the first time in his life, he is enrolled in school. Today in Timjanik, the locals visit with cakes and play with the children at the small group home.  Just ordinary people in an ordinary place with the extraordinary courage to reimagine a better tomorrow in a world that protects all of our dignity.

 

 

 

 

 

That British Class Thing

On top of the things James Brown said were great about “Living in America”, an additional one for me is the outsider’s perspective it gives on my own country.  Interest in the UK is now fuelled by lockdown binges of Peaky Blinders on the one hand and Downton Abbey on the other.  A confused American friend recently asked “So where do you come from on this British class thing?”

In his 1960s infamous and groundbreaking  comedy sketch  John Cleese ridiculed our class system. It feels like an awkward subject today as it did then.  Many of us just wish class had retreated along with black and white TV, outside loos and coal sheds. So I reformulated the question in my head to the less awkward “which type of community did you grow up in?”  After that pontification, my answer was : “poor, urban and multicultural”

I wrote about the poverty bit before, We were so far at the bottom of the ladder, we didn’t even make it onto the Cleese class sketch. I spent my formative years in inner city  South Birmingham and North London. Without any fuss, we grew up with a diversity which was as influential as class in shaping our identity . Many of our school mates were only second or third generation British. Their grandparents had arrived in the migration waves that followed the second world war, forged ties across communities and faced down the duel struggle of poverty and racism.

There were rites of passage for all teenagers . First kiss, first football game…and in those days first smoke. But poor, urban kids like us had specific obsessions: Music, fashion and navigating trouble.

You could hear all types of music in our neighborhood, but Reggae was the main soundtrack and everyone wanted to be a DJ. In those days this was usually through a “sound system” with wobbly speakers piled on top of each other, booming out fresh imports from Kingston at neighbourhood parties. The average age of first buying a vinyl record would have been around 11 or 12.

Reggae and punk had been the most subversive music of the previous teenage generation . Back then, punk bands had no DJs to spin tunes between performances, so they hired reggae sound systems.  The Punk and Rasta collaboration that followed was celebrated in Punky Reggae Party by Bob Marley and inspired a uniquely British, urban sound. It can be traced from the The Specials and the Beat and through to UK streetsoul collectives like Soul II Soul and Massive Attack and on to Amy Winehouse and even Stormzy. We loved Jamaican Reggae and US R& B, but we also had a sound that came from our own communities and reflected our experiences. It was political, but not ideological. It reflected our anxiety about violence and unemployment. The teenage toaster of the Beat, Ranking Roger sang of “Love and Unity”. Community and shared struggles above hatred and racism.

Despite our poverty, we were also irrationally obsessed with style. The precise geometry of where a trouser hem ended and a shoe began  and the colour of the socks in between.  The nurturing care of a pair of Brogues, High Tops or Nikes. The shame of being turned out in something below par. We were not peacockish. You just had to hit a certain standard and then you could go about your regular business.

The diversity affected the way we held ourselves and spoke. It was completely normal for someone of say Irish or Indian heritage to curse with a Yiddish word in a Jamaican patois accent….or the other way around.  . We were poor, but our style and music was our source of dignity.

There was also a whole heap of trouble. It was not like The Wire. There were less crack dens and guns. Communities like ours could be vibrant and aspirational-with the music, Asian food, Irish pubs. But just beneath the surface, it seemed like an assault course of gangs, violence and drugs too. Joining a gang and dealing drugs were easy-access compared to healthier options. Poor kids like us did not go to university.   Those with strong, united families tended to navigate better than those from broken or dysfunctional homes. For many , our futures hung by a thread. I was a proper tearaway, kicked out of multiple schools and in trouble with the law. I was eventually rescued by the influence and care of a wonderful teacher

It was a blessing to grow up with so much diversity. As Ezra Klein wrote in “Why We Are Polarised”: research shows how super-diversity with multiple identities and influences sets you up well for co-existence. Difference only becomes divisive and polarising when there are just two sides facing off across a single fault line. This is worse when bad politicians amplify identity above ideas and hate above hope. That type of politician is not faring so well in this pandemic. When difference is cut across multiple lines, it is a strength.

Covid 19 exposes the inequities of class and race, but it also shows how much we yearn for community, not tribe. As New York Times columnist David Brooks wrote”Community is based on mutual affection and tribalism on mutual hatred”. In this pandemic we are now united by our shared vulnerability and dependence on the same public systems and low pay delivery workers. Even our conservative Prime Minister acknowledged that our National Health Service is powered by love. Its workforce is radically diverse and disproportionately hails from similar streets to the ones I described above.  Thats where I come from in the “British Class thing” . Here’s to Love and Unity.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COVID-19, Violence & The Need To Act with Urgency

Amidst the fear and uncertainty of the Covid19 lockdown in China, 26 year old Lele experienced something more terrifying than the virus itself. Her husband fashioned a weapon from a kitchen stool and beat her semi-conscious as she held her 11 month old baby in her arms. There was nowhere to go, no services to support, no possibility to flee. She had to spend several more weeks with her abuser before she could reach safety.

On the other side of the world in Greenland, the capital city banned alcohol sales to prevent growing child abuse during lockdown. In India the were 92,000 calls to a child abuse helpline in the first 11 days of lockdown. France experienced a 34% increase in abuse helpline calls by children and an even bigger increase in the number of peers and school mates calling on behalf of friends. . As closed schools and stay at home orders spread, so did the risk of abuse.This pattern played out across the world, in three ways:

The first is the way that lockdown piles pressure on households . Even the calmest, securely attached and ‘child development-aware’ parents are being tested by ‘pandemic-parenting’. Often they are working in uncertain jobs while teaching ‘cabin fever kids’ while adapting to loss of space and privacy. But most will not suddenly become abusive or neglectful. In more volatile families however, this stress can spill over into violence or exacerbate existing abuse patterns. The biggest beneficiaries of #StayAtHome are the serial abusers who practice coercive control and other forms of psychological aggression. the lockdown increase the likelihood of adverse childhood experiences.

Secondly, the means of reporting severe child abuse or neglect have been dramatically reduced. According to the US Department of Health & Human Services child protection interventions are initiated by reports from teachers, social workers or nurses. Social distancing measures have reduced reporting. From the 1980s onwards increased reporting of family violence was a major mark of success and progress in protecting the rights of women and children. Momentarily, reporting is in decline.

The third issue, is complex but equally serious. In normal circumstances less than 1 or 2 % of children are subject to interventions by social workers. Yet Adverse Childhood Experience (ACE) research across populations suggests between 15 and 20% of children are affected by chronic, multiple forms of abuse, neglect or dysfunctional parenting at home. This 15 to 20% of children are now in a state of isolation. Children have a biological imperative to have protective, soothing relationships with an adult and are simply not built to be isolated. When a positive relationship at home is absent, the child interprets it at risk. It over-activates their stress response system which wreaks havoc on all aspects of healthy development. Unaddressed it can lead to catastrophic health and wellbeing outcomes throughout life. But when the stress is buffered and soothed by a healthy relationship with a teacher, grandparent or friend and the child is made to feel they matter on an individual level-then the recovery can begin. Right now around the world, hundreds of millions of children have been cut off from those relationships.

This is deeply distressing. Accounts of childhood maltreatment often recall a despairing loneliness and unbearable slowness. Loneliness when the parent who should soothe the pain, is actually the source of that pain. Slowness during long pauses of waiting for a violent outburst or scarce moments of maybe feeling loved. The isolation of the pandemic amplifies this pain exponentially. It is malleable with no end in sight. Relationships with teachers, grandparents and friends were cut off suddenly with no date for restoration.

We need to act with urgency on all three issues. Governments and communities could appoint ministers or local leaders to coordinate child wellbeing during lockdown. A priority must be engagement with parents on managing stress, home schooling and positive discipline, tailored to lockdown conditions. Online and media platforms could be adapted to facilitate a conversation with families and disseminate pandemic-specific parenting tips, similar to the global UNICEF parenting hub. Social protection and housing support must be adapted to reduce the stress on vulnerable families. Behavioural insights and technology innovations should be used to understand how we can best support parents and protect children.

Expanded helplines and channels that enable neighbours and friends to report maltreatment anonymously need to be provided . Equally we need to encourage extended family and friends to maintain regular communication with children in lockdown with abusive or neglectful parents. One of the most moving stories of the pandemic so far is the upsurge in calls by friends of victims reporting maltreatment in France.

Innovation and adaptation could help teachers and social workers restore normal levels of communication with children, despite lockdown. If they are not giving lessons, can they call each child for five minutes? These measures need to be population-wide and not just targeted to 1-2% of children who are child protection cases.

Decades ago, it became normal to ensure every child was immunised against deadly disease with a vaccine. In the future we could hope for a world were every child is buffeted from trauma by a calm and predictable adult connection. A world in which we improve prospects for parenting in every family at the earliest possible stage and maltreatment is managed and prevented as a part of routine public health . All we can do now is demand protection for Lele, her baby and millions of abused children and women locked down, unreported and isolated around the world as part of our immediate and shared struggle to defeat Covid19

 

 

 

 

 

A Children’s Pandemic

A month of Pandemic measures and I already wince at a handshake or touched face on Netflix. Just yesterday, New York was bustling, packed and confident. Now it is cautious, dispersed and masked. If our relationship with the world around us has been instantly transformed, what about the impact upon children in their formative years?

It may be the single blessing of this ruthless pandemic that children are least vulnerable to the virus. But sadly not the potentially deadly ricochets and aftershocks it leaves in its wake. This week the UN Secretary General reported that health and food system impacts will increase other childhood diseases and malnutrition. The number of children living in extreme poverty is projected to increase from 386 to as much as 450 million as a direct result of a new Covid19-induced economic crisis. Extreme poverty is always a killer and likely to take more children than the virus itself. Perhaps reversing 2-3 years of global progress on preventable childhood deaths.

There is barely a child on the planet whose life has not been affected by the Pandemic in some way. 1.5 billion are at home and not school. At least tens of millions of children will be born into this crisis, mostly in conditions that would have been different if it weren’t for the pandemic. Children cannot see their friends and suffer major disruptions to learning, life and play. Sports tournaments, excursions and hackathons all shelved, teenage romance on hold. A recent study suggested that prolonged quarantine in general can make a person 4 times more likely to have poor mental health. The pandemic shocks touch all children .

Fortunately many children have the shock absorbers of a safe home, loving family and freedom from poverty, social exclusion or war. If just one from the set is missing, the impact of the pandemic is likely to be deeper and life-changing. There is now a new single thread of additional vulnerability tying together children in tightly packed slums in African cities with those in camps in Syria and Yemen. It extends to the low income children in rich countries like the UK and US and those at risk of severe acute malnutrition in the poorest countries. It also hits the approximately 5% of the world’s children with disability and the 15-20% in seriously dysfunctional, neglectful and violent homes. This pandemic has been merciless in piling more pressure on to those least able to absorb it.

The bottom billion have no means for social distancing or hand washing. Their health systems often have just a few ventilators and Intensive care beds. They are not thinking of flattening the curve, but rather a couple of dozen cases flattening their entire health system. Prevention of other childhood diseases is already disrupted, including vaccination programmes on hold in 23 countries. 30 million conflict affected children are dependent on humanitarian assistance which is likely to be battered as supply chains buckle and aid financing and fiscal space contract. 40% of the world’s children don’t even have hand washing facilities.

Remote learning is a great solution for most children, but even here in New York city it is estimated that 300,000 low income children don’t have the digital means to participate. School closures will widen the two main learning gaps. The first between countries with high performing education systems who have the agility and means to switch and those countries which cannot run their education system effectively at the best of times. The second gap is between the learning outcomes of wealthy and poor children within countries. 368.5 million of those poor children have also been cut off from essential school feeding programmes which are often the only source of nutrition. Children in need of special learning support at school or dependent on relationships with teachers and friends to mitigate the pain of violent and neglectful homes are suddenly adrift. All against a rising backdrop of increased reporting of intimate partner violence and child abuse from India to Greenland to Australia and all points in between.

If the Coronavirus was a pantomime villain waiting behind a curtain for an opportune moment to pounce, it did so with precision. Thus far, dwindling internationalism has made us too weak to address the Pandemic in the whole. But you cannot partially address a pandemic. Even during the Cold War, the USSR and the West realized this and joined forces to end smallpox. And thats what our polarised world needs to do now. If everyone is not safe, no-one is safe. The virus shows our interdependence and in the end, maybe thats its virtue.

This is not insurmountable. WHO, UNICEF, the Red Cross, scientists and artists have joined forces in the Solidarity Fund to mobilise resources for a vaccine and for prevention and response work in low and middle income countries. Scientists shared the genetic sequencing on the virus very early on and are collaborating across borders despite nationally-minded governments. There is also a global initiative to galvanise leaders into more collaborative and internationally-minded policy-making in response to the pandemic.

We have also seen national governments and societies prioritise children. 83 countries have adapted their social protection systems to help shield poor families and children from the crisis. Health, education and social work systems have often adapted to maintain basic services. Armies of school and health volunteers are helping minimise the impact of the pandemic upon children.

We should now see maintaining supply chains, aid flows and health systems in poor and humanitarian contexts as a first line response for us all, even though it seems far away. Look how far the virus has already travelled. We may also need to invest in social protection to help the bottom billion socially distance, particularly those in densely packed and poorly resourced urban slum and refugee/migrant camps.

In wealthy and poorer countries alike we should support adaptions for teachers and social workers to have exactly the same amount of contact with children as they had before the crisis and for school feeding programmes to be delivered to homes. When adapting education we need to prevent remote learning widening the gap between wealthy and poor.

Albert Camus may have appreciated the importance of teacher contact and continued learning. In 1957 he dedicated his Nobel Prize for literature to the teacher who was there for him in the midst of poverty and adversity. His masterpiece The Plague is once again a bestseller and remains a testimony to our interdependence and collective strength in the face of this crisis. In it, he wrote: “No longer were there individual destinies, only a collective destiny, made of the disease and emotions shared by all.” .

Reasons to be Humble

It is humbling to work on global health and humanitarian communications in this moment. The vastness and vulnerability of the human race are breathtaking in equal measure. Talking with people in Nairobi, Geneva or Bangkok on how Covid19 could quickly collapse a fragile health system in a conflict zone or disrupt a medical supply chain on one continent causing a deadly drug shortage on another. Consulting on strategies for incentivising rebellious European teens to stay at home or to help impoverished children in low income countries stay safe without soap and water. Even the uncertainty of where we are heading. We are all vulnerable, in different, but equal ways. There is no ‘us and them’ this time.

People in Liverpool, Lagos and Laos are all social distancing and uber- handwashing as the virus wafts right across isolationist and nativist barriers. The nationalist orientations of just yesterday seem small and redundant today. We are on a war footing with a deadly enemy, but Covid19 is not an ethnic or ideological foe. Like all living things it simply wants to reproduce. We cannot counter it with an alternative ideology. We need the two things that populism seeks to diminish: science and international collaboration. A solution found in one country or more, will become a solution for all countries everywhere.

I have been lucky to work alongside epidemiologists in large scale humanitarian responses, but never on this scale. Public health, along with universal education and social protection, are amongst the UN’s basic international human rights tenets. In disaster and war, maintaining public health is a recognised humanitarian principle. Good public health is when societies improve health outcomes for all: reduced child mortality, non-communicable disease and longer life expectancy. It is also our first line of defence against a deadly enemy like Covid19.

The global child survival revolution of previous WHO/UNICEF and public health generations dramatically reduced child mortality by attacking disease transmission. For the first time in history, major childhood diseases were stopped in their tracks. This occurred through herd immunity via mass immunisation and access to clean water and sanitation. Vaccines, clean water and Sanitation transformed our world beyond recognition and still stop more deaths than any invention since. This is the reality that many of our societies have come to take for granted for the past few decades. Until now.

Pandemics recede when the basic reproduction rate drops way below one. This is the average number of people someone with the disease will infect. The current basic reproduction rate for Covid19 is estimated at between 2 and 2.5. It is much more infectious than regular flu which has a reproduction rate of 1.3, but much less infectious than measles with a rate of up to 18.

Without vaccines or herd immunity for Covid 19, we need other means of reducing transmission. Mass testing and then isolating and caring for cases is our primary form of attack. Social distancing and rigorous hand washing are the best defensive assets we have. Often these public measures are challenging as recent politics has shrunk space and trust for public intervention. We need to rebuild it to defeat Covid19. In doing so we can build a more cohesive society, as many places did after the second world war. This is up to us.

I have seen children die in countries where herd immunity and vaccine confidence has dipped following a concerted anti-vaccination campaign . The Covid19 crisis is only a very moderate version of where they would take us. The anti-vaxxers and their friends would unravel decades of progress on the major childhood diseases and leave our children exposed to something much worse than Covid19. Deadly diseases, including measles, with a basic reproduction rate of between 5 and 18.

One example is Polio. Only two generations ago Polio was every parents worst fear. The paralysing, life changing and often deadly disease has a reproduction rate of between 5 and 7. In 1955 Jonas Salk, a virologist from a working class, Jewish migrant family in the Bronx became a global hero when he found a Polio vaccine.

Just 60 days into Covid19, we already have a vaccine being trialled. This is unprecedented and would never have happened if countries had not put the genetic sequences out in public. It will probably be a multi-national team of Jonas Salks who will deliver the final vaccine to defeat Covid19.

Mostly now we are seeing the best of ourselves. We can see that the values that have recently stripped employment rights, public services, science and international collaboration to the bare bones are flimsy and reckless. We can see that wealth makes you no less dependent on the at-risk front-line health worker or low-paid food delivery person. It is a humbling time indeed. Maybe that humility will help us regroup, rethink and defeat Covid 19. And then build a better tomorrow.

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A Tale Of Two Pandemics

Will Covid19 Widen Inequality?

With Rugby & Football postponed and social gatherings replaced by social distancing-the only hope for an exhilarating weekend was a long bicycle ride. As Hudson suburbs gave way to inner city Bronx & Harlem before the more prosperous heartland of Manhattan- a simple bike ride shows how different income groups cope with Corona Virus. In prosperous neighbourhoods, cafe bars and barbers shop were half or three quarters empty. There was not a hipster to be seen. By contrast, poor migrant areas were bustling. It’s a bike ride-not a piece of scientific research. But do high rents, poor pay, insecure employment, no sick leave & “for profit” health systems prevent the poor from social distancing? Do they need to carry on as normal? Even when they are frightened of the virus?

We may all be frightened of getting sick. But the poor often fear the sickness itself less than the life consequences. One pay check away from homelessness, the potentially ruinous out of pocket hospitalisation costs or the direct relationship between todays work-shift & tonight’s family meal. Over time the secondary costs will hit the poor the most. If children are out of school, who will look after them? Online learning is a brilliant solution for social distancing, but those who already have the worse learning outcomes also have the worse connectivity: the poor. In the end, there will be job layoffs. Corona virus will break some businesses and the working poor will be the first to go.

27 million Americans don’t have health insurance. The world’s wealthiest country equals many middle and low income countries in having dramatically worse health outcomes for it’s poor. Brits shouldn’t be smug. Low income males in the UK die almost ten years earlier than the wealthy. Many of the non-communicable diseases and conditions that render Covid 19 lethal are much more prevalent for those in poverty. In the poorest countries on the planet, weak health systems may be overwhelmed by Corona Virus. This will divert resources from other child killers such as ebola, measles, cholera and pneumonia.

Child poverty is not the only driver of lifelong inequality. Adverse childhood experiences such as family violence and neglect also lead to serious inequality throughout adulthood . How do you think #StayAtHome sounds to a child who only feels safe when they are not at home? Whose only soothing & supportive relationship is with a teacher or a school deskmate. The pandemic will turn their already fragile world upside down and minimise their chances for recovery. When schools were closed during the Ebola crisis in West Africa increased rates of sexual abuse and exploitation of children were recorded.

Privileged cultures, wealth and education rightly equip children with skillsets to better navigate complex challenges in a way that often eludes the less well off. This is highly relevant in a pandemic. The ability to distill a stream of useful facts about the virus amidst an explosion of noisy fake news. The agility to regularly absorb and update ones knowledge and act up upon it. Adaptation to change and uncertainty and knowing where to seek help. When something goes wrong for a poor or high-adversity kid and they are knocked off course, it takes them much longer to get back on their feet.

In many countries including the US and UK, inequality seems to be expanding and social mobility declining. If you grow up without university educated parents, your future prospects seem to be in decline. It is rarely articulated, but deep in the sub-conscious of working class and poor people this trend has transformed voting trends. Growing inequality has created space for populist braggarts who shun science and international cooperation. The very people who now appear shrivelled and sheepish next to scientists with international networks of practice.

Covid 19 is not just a public health crisis. It will be an economic and social crisis, a jobs crisis, a housing crisis and it will certainly be a child crisis. It needs a social strategy as well as a public health strategy. Are we the Italian balcony Sopranos who celebrate our shared humanity by singing our hearts out together? Or the hysterical supermarket goers who elbow each other out the way to buy endless supplies of loo roll? I think time will show us to be more like the sopranos, but that social strategy needs to bring us together rather than build wedges to drive us even further apart.

Do the Academy Awards Point to an Awakening on Adversity?

I am unbearable company during the Oscars. Like most US-based Brits I can’t help but do football stadium style cheering every time someone from the UK wins anything. Worse still I can’t watch films like Judy or Rocketman without analysing the”underlying messages” on insecure attachment. Nor can I enjoy The Joker, Harriet or Honeyland without giving a droning commentary on how toxic stress ruins lives. The invitations are drying up.

In case you are not clued up on the lingo: Insecure attachment is the term used to describe how poor early parental attachment undermines our ability to form healthy and nourishing relationships . Toxic stress is when prolonged childhood trauma chronically activates our stress response systems. Robust recent research now shows how people with either do worse in education, employment, physical and mental health and inter-personal relations throughout life.

From a rough estimate, about a quarter of 2020 Oscar nominee productions feature a story line with the following formula: Child trauma – healing/soothing relationships = train wreck adulthoods. Does the proliferation of these story lines in films mean our recognition of the link between early trauma and poor life outcomes ? It is not just happening in Hollywood. In the sober UK BBC Question Time a couple of weeks ago. Decorated former Police Chief Mike Barton told a studio audience that we can only reverse the London drug and crime problem if we address adverse childhood experiences (ACEs). Research in the USA shows how media coverage on the theme has dramatically increased in recent years.

Our shared narratives should never be deterministic about the pathway from childhood trauma to adult dysfunction. Sometimes those with high childhood adversity flourish. But the most recent evidence suggests those with higher levels of trauma are much more likely to have poorer life outcomes. As Mike Barton may concur, they are the ones most likely to be targeted by criminals, groomers and radicalisers alike. As the US Centre for Disease Control has shown, they are also do much worse on almost every health and wellbeing indicator. The costs are huge and quantifiable. The UK Based Overseas Development Institute modestly estimated that violence against children alone (excluding the devastating global costs of child neglect) cost 8% of GDP. Conversely Nobel Prize winning economist James Heckman argues that if we invest in prevention in the very beginning of childhood-the return on investment through life is up to 13-fold.

Film scripts don’t always end with trauma. They can also inspire us with recovery and resilience. Gus van Sant’s Good Will Hunting had nine Oscar nominations and won two and is one of America’s most popular films. It is perhaps the most compelling cinematic representation of how a young adult overcomes debilitating childhood trauma through connection with an empathetic witness . When the film was made, recovery through connection was only a common sense proposition. Now that proposition is firmly backed up by science base. Human connection and a sense of belonging in family, school or community provides a buffer against toxic stress. It calms the stress response system and helps rebuild the attachment model. It enables the child to build the resilience to navigate future shocks and see a lifeline to a better future. We call this science of resilience.

The opposite of Good Will Hunting’s story of recovery is the inter-generational emotional neglect suffered and transmitted by Elton John’s father in RocketMan. Deep in middle age he sings: “I can’t love, shot full of holes, I don’t feel nothing, I just feel cold“. At the extreme end of this spectrum is the character played by Joachim Pheonix in The Joker. Severe childhood trauma with no empathetic witness on the path to adulthood is costly for the individual, their family and society as a whole.

Film and literature critics often tell us that fine writing gives a tangible narrative to feelings the viewer or reader has, but could never put into words. The research shows that between 50 and 80% of any given population have experienced one ACE and between 10 and 20% have experienced 4 or more. Everyone, everywhere is affected by childhood adversity. We don’t talk about it easily. We could assume it has been taboo for most of human history. But if we are not affected by it directly, our spouse, neighbour or colleague is. It is often manifested in their decisions and behaviour. It’s why we identify so much with these stories. It’s one of the reasons Good Will Hunting is held in such affection and why so much of our popular culture alludes to this theme. This is our story. Our broken childhoods and our struggle to overcome them are a central theme of human existence and spirit. But a marginal theme within our national and international conversations. Could that be changing?

From an advocacy perspective I hope so. More public openness to the theme could drive the political will and public demand needed. A good public policy start would be investment in 3 things. Trauma prevention though early parent outreach and support. Recovery and resilience through trauma-informed communities and schools. Open and taboo-busting public discussion on adverse childhood experiences. These interventions could close the costly gap between what we know and the policies we do. Imagine how much trouble could have been prevented if Gotham City had had better childhood policies. In Pinner and Philadelphia too.

And that brings us back to Elton and his Oscar nominated recovery anthem: “Find the wind to fill my sails, Rise above the broken rails, Unbound by any ties that break or bend, I’m gonna love me again” How rich our world would be with an opportunity for everyone to rise above those broken rails.