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 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 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.

 

 

 

 

 

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.

.

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 minus 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.

Another Brick In The Wall? Transforming Global Learning

Its progress we rarely acknowledge. Today across the world, in savannah and steppe and in city and village, most children will go to school. A few decades ago, this was a pipe dream. Access to education is a hard-fought human right which makes our world a better place. It is an accelerator for every other form of progress in any society. For example, half of the global reduction in child mortality over the past 20 years is attributable to the first generation of mothers in many poor countries receiving an education. A third of the world’s poorest girls continue to be out of school with huge societal costs. In total, 9% of the world’s children still don’t go to school. By 2030 we must achieve the goal of basic access to universal education.

Now the global discourse is expanding from access to quality and relevance of what children learn. From this lens, global education is in a learning crisis. 53% of children in low and middle income countries cannot read a basic text by the time they are 10. This is a benchmark described by the World Bank as learning poverty. Education spending has increased in many low and middle countries. Yet it is not directed towards the poorest children who need it the most. In low income countries, almost half of education budgets go to the wealthiest 10%. Against a background of fast-paced technological change in the labour market, poorer children will be left behind.


We now know that brain development is most prolific before the age of 5. Primary and secondary school are hugely important, but not the most impactful institutions for social, emotional and cognitive development of the child. The family in infancy and then pre-school from 3-6 years of age yield the most influence on learning and life outcomes. Yet, the poorest families have little guidance on early stimulation and brain development. Research has shown that 3 year olds from families on welfare hear around 600 words an hour. Those from professional families hear over 2000. This gap in language acquisition is an indicator of huge inequality even before the child enters pre-school.

Such early disparity could most obviously be addressed by a pre-school education starting at 3, as the child’s brain continues to develop rapidly. But in many countries most poor children just do not go to pre-school. The gap in pre-school access between the wealthiest 20% and poorest 20% is vast. The OECD Pisa survey shows that much later at 15 you can see the outcome of this early inequality. 15 year olds who attended pre-school are on average between one and two years ahead in maths science and language. Together, these early disparities drive an intergenerational cycle of poverty. This harms the individual child, exacerbates inequity and undermines economic and social development.

Even many well-resourced primary and secondary education systems in wealthy countries struggle to keep pace in a changing world. Education reform is never a progression from one static position to another. It is an evolution constantly informed by two streams of change. The first is the changing labour markets and civic culture Education should prepare citizens contribute and gain from progress and prosperity. The second is our growing knowledge of brain development and how children learn. Systems creak and move slowly, and despite the amazing dedication of most teachers, schools are behind the curve on both counts.

All research shows the one thing that drives good education outcomes is the performance of teachers. Yet stakeholders including unions, parents and parliamentarians often focus on structural issues like class size or teaching hours rather than teaching itself. Children learn from teachers they love and who inspire a passion for their curiosity. The 20% of children affected by multiple traumas at home cannot learn at all unless the teacher provides a sense of safety, calm and belonging.

Most countries do not have a system to recruit high calibre teachers, keep them motivated and developing in step with a changing world. Many spend less than 1 % of their education budgets on in-service development. They are teaching for a moving target. A glance at todays vacancy pages shows jobs that did not exist when I started school millions of years ago. Teachers should be preparing children for jobs that don’t exist yet, and for working lives with much greater change than we have known before. Teachers need to shift from teaching kids stuff to teaching them how to think and create stuff. Children also need to learn how to learn and to be inspired to keep learning throughout the life course. For good citizenship they need media literacy too. Many countries are not adequately making these obvious changes happen. Pink Floyd railed against authoritarian teachers in the 70s. Today the threat is “authority-less” teachers with kids checking their smart phones in class to see if what the teacher is saying is up to date.

No public service institution can keep up with the pace of start-ups and tech. No country can address the learning crisis without engagement of the private sector. No private sector can flourish without a properly equipped workforce. Each needs each other, yet there is so little collaboration between them.

Both our evolving knowledge of adolescent brain development and of the labour market lead us to the same conclusion. The most relevant and rewarding way for a teenager to learn is through collaboration with peers in developing a creative solution to a problem. Yet most classrooms do not and cannot practice this.

Rutger Bremen questioned the mantra about educating children to find their place in the labour market of tomorrow. Instead he argued we should educate children to create the kind of labour market and society we would like them to live in. School informs character development, whether we intend it to or not. Inclusive moral and civic learning is a prerequisite for individual and societal flourishing. The UK-based Jubilee Centre has developed a framework for teaching integrity, respect, neighbourliness alongside core performance and intellectual competencies. The framework is being adopted in UK schools, and adapted oversees.

To address the global learning crisis we need to make sure that children are ready for three big transitions. The first is school readiness at 5 or 6. This requires narrowing the gap in early learning. All parents should receive knowledge of early stimulation through pre-existing primary health networks, at the same time they learn about vaccines and nutrition. We should pursue universal access to pre-school for 3-6 year olds as we have pursued access to primary and secondary education. Governments should invest at least 10% of their education budgets in early learning. They should also end the huge wealth disparity in pre-school attendance.

The second transition is at age 10. We need to eradicate learning poverty by ensuring that all children can read a basic text at 10. More than anything else, this will depend on the quality of teaching. We need behavioural science innovations to keep teachers motivated and systems where teaching practice can be informed by the evolving science of learning. Schools need to be trauma-informed so children affected by family or humanitarian trauma can be soothed, feel safe and make the important connections required to enable learning. Inclusion and gender-responsive school systems are also essential to end learning poverty.

The third transition is at 16 or 18 to work, training or higher education. This is about the relevance of education to both the labour marker and citizenship. We need a global commitment for teaching competencies, collaboration and character in an age of AI and fast-paced technological change..The public sector cannot achieve this alone and needs innovative financing and constructive technical collaboration with the private sector. As has happened in Finland, the teaching workforce needs to become an agile community of practice. This would enable it to adjust and develop teaching based on what it sees in the classroom and in the outside world. Creativity and collaboration needs to be at the heart of teaching.

Wherever we are, in addressing the learning crisis, our aspirations must be high. On the one hand we should work toward a world in which our children and then their children have a quality of life that is better than the one we had. On the other to ensure that they shape a society that is even fairer, kinder and a better place to live. Only a radical rethink of global education will help us get there. We owe our children nothing less.

The Networking of Trauma

Preventing Organised Crime and Other Exploitation Groups Preying on Vulnerable Children

Violent extremists, gangsters and groomers have a simple recruitment strategy. They network trauma. They can spot a vulnerable teenager from 1000 yards. It can be easy to pull them in by sating a desire for belonging or through initial kindness. But the intention eventually is always exploitation.

An Irish security expert once shared three observations about the Northern Ireland conflict. Firstly that at any given moment during the conflict, there were only ever a few dozen people who could actually kill someone. Secondly that they usually came from traumatic homes with fathers who had also killed. He concluded that it seemed political extremists and organised criminals knew exactly how to identify and recruit such people. I have seen similar recruitment strategies in lawless or conflict-affected countries from Afghanistan to Bosnia. It always has devastating consequences.

It’s not black and white. There are economic and structural determinants of violence too. Most people affected by childhood trauma do not turn to crime or violence. But the world is waking up to the impact of childhood trauma as a driver of recurring violence. It occurs in cycles. Data from Wales show that adults affected by chronic childhood trauma were respectively 14, 15 and 16 times more likely to be a victim or perpetrator of violence or use crack cocaine than others. Data on consequences of chronic childhood trauma is similar across continents

There is an underpinning neurobiology to this cycle. Children are dependent on a strong attachment with a parent. If the attachment is absent due to neglect or violence, a child will see it as a serious threat. That threat chronically activates the stress response system. It distorts the way they perceive danger, they way they see themselves as well as their attachments to others. If families, schools or communities cannot provide soothing connections to heal the trauma, the child enters adolescence and adulthood with unresolved chronic trauma. This leaves them extremely vulnerable to exploitation and with limited prospects for learning or finding a lifeline to a better future.

All of this leads to an obvious question for anyone reading this blog. In my neighbourhood are there more forces trying to exploit or trying to prevent the inter-generational cycle of violence? Prevention services, usually delivered through the health system help new parents develop a secure attachment with their child. That attachment is the best weapon against neglect and violence. it can help heal the parent at the same time as protecting the child. In an ideal world these services would be provided globally. As noted elsewhere this type of prevention provides the greatest return on investment for the public purse. No other intervention does more to prevent poor life outcomes including in mental and physical health, crime and productivity.

Response services provide a second chance to children who have already been traumatised. In Trauma-informed schools for example, the teacher creates a calming environment and a caring connection. This ensures every child in school is safe, seen, secure….and most importantly soothed. The four Ss feature in the excellent “The Whole Brained Child” by Daniel Siegel and Tina Payne Bryson. In a Trauma-informed school, the teacher makes the child feel they matter as an individual. Many who come from traumatic childhoods have been rescued by a teacher who did exactly that. Positive relationships and connections build resilience that help teenagers navigate away from poor decisions that bring bad life outcomes. And if a child is approached by a Fagin type exploitation group, they feel they can tell the teacher

A second important question is what is being done in my neighbourhood to prevent the cynical “networking of trauma” by exploitation groups.

Both in the UK and the US, Trauma-informed practice is also being adapted to policing and justice sectors. One of my favourite champions of this is Detective Superintendent Stan Gilmore of Thames Valley Police in the UK. He observed those arrested for “County-Lines” drug trafficking were almost always in their mid teens. He started to see them as much as exploited and vulnerable youngsters as offenders . Instead of pursuing a custodial sentence, the emphasis was placed upon diversion from a potential life-cycle of crime. This included curfews and supervision orders that stopped the gangsters reaching the child . It cut off their source. It also referred the child to services to help address the underlying trauma. The whole approach switches the question to the child from “What did you do?” to “What happened to you?

To me this is intelligent and effective policing. It recognises that the foundations of organised crime are built on networking trauma and vulnerability and if you prevent that networking, you can break the cycle. Childhood trauma is not an excuse for crime, but to effectively reduce crime we need to be trauma-informed.

Just imagine how societies would flourish if we not only prevented the networking of trauma by exploitation groups, but also prevented or mitigated the trauma itself. We now have enough evidence and knowledge to work towards this goal. We just need the political will and the resources

.