The Common Good

Global progress requires three things. A laser-focus on results, measurable targets and ability to find common ground. In the period between the end of the cold war and the global economic crisis, child mortality was halved, primary school attendance doubled and Polio cases reduced by 99%. This accompanied a near-global endorsement of the Convention on the Rights of the Child and UN Development Goals. Such a consensus is always contingent on a shared view of human rights and global development as a Common Good. The aspiration is that this progress must be universal, not selective.

After the global economic crisis, populism soared and health and education results stagnated. A sense of common good gave way to growing inequality and polarisation. Populists tried to shift from a universal view of human rights to a selective one that tied rights to identity. Culture warriors present a unique threat to universal progress. They suck the oxygen from public discourse without providing any improvement in the lives of the people they claim to serve.

Our vulnerability to the pandemic was turbo-boosted by surging inequality. When schools closed in New York city, the poorest 300,000 children did not have access to online learning. Globally 40% of families had no consistent means of hand hygiene. The virus mutated while those in poorer countries who wished to be vaccinated could not be. In rich countries the misinformed fought for air in hospital beds having refused the jab. Vaccine inequality and vaccine refusal are mutually reinforcing pandemic prolongers driven by bad politics.

Despite all of this, it is a moment to be optimistic. There is the knowledge and technology now to end preventable childhood death and disease and dramatically reduce abuse, neglect and harmful practices. It is possible to deliver fairer and more relevant education in countries currently suffering what the World bank has termed a Learning Crisis. With better global collaboration and leadership we could uphold the protection of the one in four children currently living in conflict zones. Equally, it is not a moment to be complacent. Climate change and population growth bring new challenges which require hard work to maintain prior progress and build out from it.

When we think about the leaders we love, they carried themselves with an abiding sense of the common good. They served all constituencies and took responsibility for what they said and the secondary impacts of how it may be interpreted by others. They delivered results by producing policies that may not have been loved by anyone, but which were acceptable to all.

Reimagining a post-pandemic world needs to bring focus back to a universal common good that appeals across constituencies. We need to talk about how nationalism, isolationism and inequality made us vulnerable to the pandemic. To reward politicians for humility, service and delivering progress for the people they serve. Building a better world, based on values of human rights and a common good is more possible now than it has ever been.

The Ghislaine Maxwell Story Must Be About The Victims.

The media noise of the Ghislaine Maxwell trial drowned out victim’s voices. The ‘socialite’s’ fall eclipsed the pain of lives devastated by organised criminal exploitation. Ghislaine Maxwell was found, through due process, to be a groomer and trafficker of vulnerable children.

What does it do to the life of a young teenager to be groomed for exploitation? Groomers have a laser-focused recruitment strategy. They identify, target and exploit the most vulnerable children and young people. Children who are already in pain. Those who feel unloved or unworthy. Those already affected by violence. Girls without a reliable adult to call for advice on an offer of a trip or friendship from an older stranger. Groomers take broken lives and break them further. They are ruthless and heartless.

Our society lacks both understanding of the grooming process and compassion for the victims. The victims evoke misogyny and class prejudice. That prejudice prevents or delays prosecution. Trauma, the lapsed time and absence of witnesses to sex crimes means testimonies can be inconsistent. Former Public Prosecutor for North- West England Nazir Afzal said that inconsistency itself is a sign of the authenticity of the testimony.

From a base of vulnerability, the victims show heroic tenacity in fighting their case. Defence lawyers try to denigrate their character. The strategy is to brazenly play into public prejudice and re-traumatize the victims. The use of a ‘false testimony’ expert was rightfully dismissed by the judge and jury at the Maxwell trial. Do we as a society believe allowing defence lawyers to roast traumatised victims of historic child sex abuse is a pathway to a fair hearing? Is it in the public interest? Does it serve justice?

Maxwell’s defence team requested a retrial on finding a juror mentioned lived experience of child abuse during jury deliberations-as if this was an outlier. According to CDC population surveillance data, between 11 and 20% of adults experienced sexual abuse as children. Data from the Council of Europe shows 1 in 5 European adults experienced sexual abuse as children. Tragically, child sex abuse is not marginal it is mainstream. A jury that did not include survivors of abuse would in itself be an anomaly-and arguably itself an injustice for a trial on organised sexual abuse.

The 2021 prosecution of Ghislaine Maxwell is rare and hopeful. Before Nazir Afzal re-opened a case against grooming gangs in Rochdale in England they had abused an estimated 1400 children with impunity between 1997 and 2013. Hundreds of complaints of systematic abuse were met with fear, incompetence and misguided politics. The eventual successful prosecution was a game-changing breakthrough.

Where do we go from here? Investigate those implicated in this case without fear or favour, regardless of how powerful they are. Turbo-charge the capacity of justice and police systems to detect, disrupt and destroy grooming gangs whether managed by Rochdale roughnecks or Manhattan socialites. Beyond that we need to address vulnerability. The first line of defence is family, friends and community. Investment in services that support families and communities to protect children and help them flourish. This enriches our society and yields an unrivaled return on public investment.

The case in Rochdale was a pre-cursor for the #MeToo movement in the UK. #MeToo later exposed widespread sexual violence against women and girls everywhere. It networked victims and activists to dismantle the structural inequalities and barriers that protect perpetrators and bring them to justice. We can build on that by scaling up action to prosecute the organised gangs that so ruthlessly exploit our most vulnerable children and young people.

A Safe Place to Return

There were many jobs that helped me pay my way through university. Selling leather jackets on Camden market, a very bad wedding DJ and a bartender in more places than I can remember. One of my favorites was driving a private-hire cab in North London. It had downsides: Nauseous drunks, exhibitionist backseat love-makers and menacing football hooligans who wanted to know which team I supported. But in general, it was a decent gig.

It was rare then for someone from state care to go to university. A fragile milestone on a long journey from one world to another. At times it felt like a no mans land. In my rear view mirror there was a world that seemed dysfunctional and full of violence, poverty and pain. Just across the horizon I imagined somewhere bathed in prosperity, purpose and safety. A university degree would be my rite of passage.

Driving a cab at Christmas, there was one thing worse than the small number of horrible customers. It was the much larger number of nice ones. They would jump into the back of the cab, armed with gifts, en-route to relatives or for Christmas drinks. After a few sherries they would sing Christmas songs and exchange shared memories of Christmas past.

Their joy illuminated what I lacked. I was so focussed on getting through that stage of life, I had not yet developed an adequate vocabulary to describe my life to myself. I now realize that no mans land was an unfathomably lonely place. I was 22, but had already had 25 addresses. It felt like there was no single thread tying it all together. The early roots of friendships and relationships that would endure for a lifetime were beginning to take shape. I was lucky enough to be one of the few care leavers who now always had a Christmas dinner invitation. The awkwardness of being an outsider at Christmas and a festive novice was brilliantly captured in the recent film ‘Alex Wheedle/ Small Axe’ by Steve McQueen. I am still a bit of a Christmas novice, but maybe a slightly improved one!

I guess my heart told me the world was divided into two. Those who someone cared about and those who nobody cared about at all. Deep inside I felt I was one of the second group and there because I was unworthy. What I didn’t know was that this a completely normal feeling for someone from my background.

The whole field of attachment psychology started in the 1940s when John Bowlby interviewed young offenders in London. He noted that many self- blamed for being abandoned by their parents and felt similarly unworthy. This research led to decades of work which helped the world to understand the way that childhood experience shapes adult outcomes. Inconsistent or absent affection in childhood may affect up to 40% of any given population. The situation of young people from care is just the most severe and manifest part of a much more widespread social problem that otherwise had remained taboo.

Our modern, idyllic image of Christmas comprises jolly people singing and feasting around a warm family hearth while snow falls outside. We owe this partially to Charles Dickens whose Christmas Carol did much to shape the identity and aesthetic of Christmas. His formative childhood years coincided with a rare decade of snowy London winters and a spell of abandonment and child labour at the age of 12 , as his parents languished in a debtors prison. Christmas Carol is ultimately a joyous tale when Scrooge overcomes emotional poverty and trauma and finds his place at a Christmas hearth. Many popular Christmas songs represent an aesthetic of the return to this hearth.

In the UK there is now a movement to de-Grinch Christmas for Care Leavers. An army of volunteers make sure that careleavers across the country have a Christmas dinner. Sophia Alexander Hall sensitively created a list of care-leaver Christmas films that don’t go overboard on the whole family thing. Less sensitive was Paperchase’s ‘comedy’ greeting card featuring a Mommy rabbit demanding a refund from the orphanage for a young foster rabbit who spilt milk. Sophia and Lemn Sissay led an online protest and the card was withdrawn.

Though my young feelings of being unworthy were normal, they were also false. As the years went by, I also understood that the world is not divided between the cared for and uncared for . The land across the horizon of university degrees, suburbs and families is also broken. There is addiction, violence and emotional poverty there too. Care leavers are worthy. I saw that people will wait for us, come across town to see us on a bus or keep us in their thoughts or prayers. Through the beauty of human acknowledgement and connection we can recover and build our own hearth.

Recently a UNICEF colleague (namecheck Aleksandra) visited a juvenile detention facility, as Bowlby had done over 75 years earlier. She commented that most of the problems the young people found themselves in, happened because they had no-one to turn to. For them, any small challenge could quickly morph into something much greater. The cost of running the juvenile facility and the the crimes committed are way higher than the costs of prevention.

If the idea of a return to a safe and warm hearth is so central to our main annual holiday and therefore to our national culture, should it not also be central to our social policy? Could we guarantee a safe place of return for every child? A place of love, safety and belonging. Of shared memories and a soothing sense that one matters as an individual. If this sounds ambitious, just remember that in Dicken’s time the idea that we could do anything about childhood disease, hunger and illiteracy was considered fanciful.

The solutions are known. The evidence shows we can reduce neglect and abandonment through parenting support and social protection. We can also invest in resilient communities and schools We could realistically arrive at a point where it is simply no longer culturally acceptable or imaginable that a child would live or grow in such isolation. Even for pre-epiphany Scrooge types, the return on investment is compelling and cannot be dismissed as humbug.

It was once said that ‘safety, is not just the absence of violence, it is the presence of relationships’. This Christmas lets reimagine a world beyond the pandemic where every child has a safe place to return.

This Blog is part two in the ‘Because I Grew Up in An Orphanage’ Triology. Part one is here

What We Talk About When We Talk About Emotional Poverty

If you put your mask on and go for a socially distanced trawl through New York City’s bookshops, you will note the most in-demand book of the moment hails from Glasgow. Shuggie Bain by Glaswegian New Yorker Stuart Douglas just won the Booker Prize. Its’about a 1980s childhood derailed by poverty, exclusion and adversity, and recovery through love and resilience.

‘ Glasgow was losing its purpose’ pondered Shuggie’s father while surveying the working class communities fractured by pit and shipyard closures.

Glasgow has certainly found new purpose in its world-inspiring efforts to reduce violence and adverse childhood experiences (ACEs). The eminent public health thinker Sir Michael Marmot lauded Glasgow’s community-based violence reduction work for halving gang violence in the city. Sir Micheal described their approach as an example of ‘building resilient communities’. Martin Luther King used to describe community based work on violence and exclusion as striving for a ‘beloved community’. They are one and the same. Love is resilience.

It was a pleasure to join Sir Michael last week in an online public discussion on poverty and adverse childhood experiences (ACEs), hosted by the incredible Ace-Aware Scotland.

This pandemic has shone the light on poverty everywhere. Austerity and prior stagnation on child health coupled with growing inequality had made us more vulnerable to the shocks of Covid19. Globally the number of children in poverty is estimated to have already risen by 15% as a result of the pandemic. We know child poverty is a disaster for children and their families, but it is also bad for society. Tackling child poverty increases wealth and growth for everyone. When we don’t, the scars last a lifetime and can be passed from one generation to another.

I see three catastrophic burdens in childhood that can drive lifelong inequality: Income Poverty through a lack of the basic means to survive, thrive and reach one’s potential. Discrimination or Exclusion based on race, gender or disability for example. Emotional Poverty ( also known as ACEs ) the absence of the basic nurturing and protective parental relationships due to violence, neglect or dysfunctional parenting .

The three burdens often converge and exacerbate each other. But not always. Most middle class respondents to the first ever ACE survey in 1998 had experienced one ACE and 12. 5 % had four or more. We all know people raised in wealthy and loving families who suffer devastating social exclusion because of disability, race or gender. We also meet people from so-called ‘privileged elites’ whose lives have been ruined by devastating emotional neglect or sexual violence in childhood. All need our compassion and our policy advocacy must focus on protecting all children in all circumstances always.

Shuggie Bain was afflicted by income and emotional poverty as well as exclusion because of homophobia. In those days only income poverty had a widely recognized and understood public and policy narrative . Homophobia was endemic and entrenched, as immortalized in the anthem’s of Glasgow’s own Bronski Beat. In 1988 the Conservatives introduced legislation through section 28 of the Local Government Act against promotion of positive images of Lesbians and Gay Men. 23 years later the Scottish Conservatives had an openly Lesbian leader. Ruth Davidson was so talented she could even promote a positive image of the Conservative party…in Scotland! Along with other forms of exclusion, including on gender, race and disability, those 23 years saw a public narrative emerge with clear policy asks to address homophobia.

The narrative on poverty may have begun in the 18th and 19th century and on exclusion and discrimination in the 20th century. Some post-2016 soul searching has blamed the rise in populism on a post-industrial working class perception that the left had abandoned fighting poverty to fight exclusion. Thats another blog! But both struggles continue and perceived competition between them is bad for each other and for progress in general.

Our understanding of emotional poverty as a risk factor for lifelong inequality is a 21st century idea. It accompanies an explosion of new knowledge about how our brains develop, emotions work, decisions are made. It shows how healthy relationships are essential for wellbeing. This is powered through new evidence at the intersection of neuroscience, biology, psychology and sociology. It is a crucial part of the jigsaw puzzle with attachment theory, toxic stress and resilience that powers a much better understanding of child development.

This idea is so new, we don’t even have an agreed title yet. For most of us Adverse Childhood Experiences tell a story at a population level, as data sets on prevalence of ACEs and life outcomes. There have been around 30 ACE surveys in different parts of the world and across most US states. They all demonstrate remarkably similar results, though they are not yet nationally representative in the way data on childhood disease is, for example.

The ACEs methodology is often used by WHO, UNICEF, CDC and other major public health bodies. We use it with caution and humility in the knowledge that it is an emerging field of research. But there is now enough knowledge to act and call on governments to invest in the following strength-based population-wide interventions: 1)universal support for early parenting through home visits 2) reducing stress on the caregiver 3) resilient communities, including policing and schools that promote connection and belonging 4) breaking taboos and building a public narrative. These are all accelerators that can drive forward progress on multiple public health and social fields.

In the future we may have internationally comparable data sets for all countries. We can then measure progress in reducing ACEs and poor life outcomes against investments in strength-based policies on parenting and resilience. I have seen internationally comparable data leveraged for policy advocacy to reduce child mortality, disability exclusion and deinstitutionalization and to improve education outcomes. ACEs data used internationally at the population level could be as transformative as when expansion of immunisation, safe water access and improved nutrition dramatically reduced child mortality during the child survival revolution of the 1970s and 1980s.

While we must work to craft a clear narrative, we can also think about the type of conversation we want to have. Here are some initial thoughts:

  1. Poverty and exclusion are system failures. We have a right to be angry and loud about these injustices. Transmission of emotional poverty or ACEs is different. It is when things go wrong in the home and relationships-often inter-generationally and unintentionally. It becomes a system failure when we don’t address it. We need a calm thoughtful conversation that doesn’t blame or create competing victimhoods.
  2. We need to look out at any population and recognize that anyone can be in pain, often even without being aware of it. That everyone is at risk. This topic can be a trigger or a source of healing, or both at the same time. There is no ‘us and them’ as everyone’s life is touched in some way. If we have not had ACEs ourselves, our partners, neighbors or co-workers have. We need compassion.
  3. You cannot have a conversation about emotional poverty or ACEs that is judgemental. The subject feeds into how people feel about their parents, themselves and their children. These are usually complex and deeply private feelings. The policy makers and parliamentarians who we want to legislate and invest in this sphere, are no different to anyone else in this respect.
  4. Addressing ACEs does not detract from the struggle to end poverty and exclusion. Equally it doesn’t always need to take them into account. It is a different framework of analysis. It can also be used alongside child poverty and social exclusion research to advocate for a holistic advocacy agenda to child and human development. There is no competition between the three. Individuals and groups will be drawn to work on the one that is of most interest to them. We cannot talk about ACEs in an atmosphere of polarization or competition.

I write all of this with the humility of knowing it is a much less evolved sphere than say child survival or nutrition. Our knowledge is evolving. But from what I have seen thus far, we need to have a calm, compassionate, non-judgmental and inclusive policy narrative on emotional poverty and ACEs. Child psychologist Peter Fonagy highlighted that parents who become self-aware of the risks of transmitting inter-generational trauma are less likely to do so. With the right type of public narrative we can harness community wide self-awareness to bring an end to emotional poverty in the lives of children everywhere.

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 fraction 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 .

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 reaked 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.  There was violence in the air. 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.






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.


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.