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Public health measures that successfully eliminated the spread of Covid-19 in Aotearoa New Zealand during 2020 also profoundly reduced the normally high seasonal burden of non-Covid infectious diseases. One outcome of this extraordinary year was that life expectancy in New Zealand actually increased during 2020, the first year of this global pandemic. We should not accept or allow a return to previous levels of illness and death during the winter months. Transformative change will require an integrated approach to infectious disease policy that builds on the knowledge and infrastructure developed during the first two years of the pandemic response. An effective strategy will include generic elements – notably, science-informed strategic leadership, a Tiriti and equity focus, and an upgraded alert level system. We will also need a specific plan for infectious respiratory diseases, including measures to improve indoor air quality, a national mask strategy, and an enhanced system to deliver vaccinations against seasonal respiratory infections. Such an approach can have immediate and long-term benefits, protecting New Zealanders from endemic, epidemic and pandemic infections. We face a potentially difficult winter in 2022, with multiple infectious disease threats. There is an urgent need for integrated policy and action to prevent and control both Covid-19 and more familiar winter season respiratory infections. In the future, 2020 should be seen as the watershed year that triggered a transformative improvement in New Zealand’s poor track record of infectious disease incidence and inequities.

Objectives To identify COVID‐19 quarantine system failures in Australia and New Zealand. Design, setting, participants Observational epidemiological study of travellers in managed quarantine in Australia and New Zealand, to 15 June 2021. Main outcome measures Number of quarantine system failures, and failure with respect to numbers of travellers and SARS‐CoV‐2‐positive travellers. Results We identified 22 quarantine system failures in Australia and ten in New Zealand to 15 June 2021. One failure initiated a COVID‐19 outbreak that caused more than 800 deaths (the Victorian “second wave”); nine lockdowns were linked with quarantine system failures. The failure risk was estimated to be 5.0 failures per 100 000 travellers passing through quarantine and 6.1 (95% CI, 4.0–8.3) failures per 1000 SARS‐CoV‐2‐positive travellers. The risk per 1000 SARS‐CoV‐2‐positive travellers was higher in New Zealand than Australia (relative risk, 2.0; 95% CI, 1.0–4.2). Conclusions Quarantine system failures can be costly in terms of lives and economic impact, including lockdowns. Our findings indicate that infection control in quarantine systems in Australia and New Zealand should be improved, including vaccination of quarantine workers and incoming travellers, or that alternatives to hotel‐based quarantine should be developed.

Public health lessons from one pandemic become the planning assumptions for the next one. Aotearoa New Zealand’s 2017 pandemic plan was derived from past experience of influenza. When Covid-19 emer...

ABSTRACT INTRODUCTIONMass masking is emerging as a key non-pharmaceutical intervention for reducing community spread of COVID-19. However, although hand washing, social distancing and bubble living have been widely adopted by the ‘team of 5 million’, mass masking has not been socialised to the general population. AIMTo identify factors associated with face masking in New Zealand during COVID-19 Alert Level 4 lockdown to inform strategies to socialise and support mass masking. METHODSA quantitative online survey conducted in New Zealand during April 2020 invited residents aged ≥18 years to complete a questionnaire. Questions about face masking were included in the survey. The sample was drawn from a commissioned research panel survey, with boosted sampling for Māori and Pacific participants. Responses were weighted to reflect the New Zealand population for all analyses. RESULTSA total of 1015 individuals participated. Self-reported beliefs were strongly related to behaviours, with respondents viewing face masking measures as ‘somewhat’ or ‘very’ effective in preventing them from contracting COVID-19 more likely to report having worn a face mask than respondents who viewed them as ‘not at all’ effective. The strongest barriers to face mask use included beliefs that there was a mask shortage and that the needs of others were greater than their own. DISCUSSIONHighlighting the efficacy of and dispelling myths about the relative efficacy of mask types and socialising people to the purpose of mass masking will contribute to community protective actions of mask wearing in the New Zealand response to COVID-19.

Aims: We aimed to compare COVID-19 control measures, epidemiological characteristics and economic performance measures in two high-income island nations with small populations, favorable border control options, and relatively good outcomes: Iceland and New Zealand (NZ). Methods: We examined peer-reviewed journal articles, official websites, reports, media releases and press articles for data on pandemic preparedness and COVID-19 public health responses from 1 January 2020 to 1 June 2022 in Iceland and NZ. We calculated epidemiological characteristics of the COVID-19 pandemic, as well as measures of economic performance. Results: Both nations had the lowest excess mortality in the OECD from the start of the pandemic up to June 2022. Iceland pursued a mitigation strategy, never used lockdowns or officially closed its border to foreign nationals, and instead relied on extensive testing and contact tracing early in the pandemic. Meanwhile, NZ pursued an elimination strategy, used a strict national lockdown to stop transmission, and closed its international border to everyone except citizens and permanent residents going through quarantine and testing. Iceland experienced a larger decrease in gross domestic product in 2020 (relative to 2019) than NZ (–8·27% vs. –1·22%, respectively). In late 2021, NZ announced a shift to a suppression strategy and in 2022 began to reopen its border in stages, while Iceland ended all public restrictions on 25 February 2022. Conclusions: Many of Iceland’s and NZ’s pandemic control measures appeared successful and features of the responses in both countries could potentially be adopted by other jurisdictions to address future disease outbreaks and pandemic threats.

Key messagesRisk assessment for children has been a polarising issue during the Covid-19 pandemic. Governments around the world are preparing to ‘open up’ before risks to children are fully quantified, with unknown implications for their long-term health.Applying the Precautionary Principle to child health requires decision makers to 1) take preventive action until risks are better understood; 2) ensure that the burden of proof rests with proponents of risk; 3) explore alternatives to the risk; and 4) use participatory approaches to decision-making.Policies relating to children must be centred on the rights and wellbeing of children. We provide a framework for comprehensive Health Impact Assessments to ensure that direct and indirect impacts upon children are taken into account in major policy decisions.Elimination strategies offer an integrated approach to the protection of children’s wellbeing, the wellbeing of the population as a whole, and health equity. Where countries are transitioning away from elimination, a tight suppression approach is preferable to loose suppression or mitigation.

Elimination and eradication of disease are among the ultimate goals of public health1 (for definitions see box 1). Vaccination has globally eradicated smallpox, rinderpest (a cattle disease that caused famines2) and two of the three serotypes of poliovirus.3 Three other vaccine-preventable diseases are eradicable globally with current technology,4 with measles the leading contender and with MMR vaccination potentially eradicating mumps and rubella at the same time. Some other diseases are close to being eradicated but without use of vaccines such as with the Guinea Worm Eradication Programme.5 Similarly, China has recently eliminated malaria with a range of non-vaccination tools, to become the 40th country to be certified malaria-free.6 Box 1 Definitions of key disease control terms from the Dahlem Workshop19 Control: The reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. Example: diarrhoeal diseases. Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts; continued intervention measures are required. Example: neonatal tetanus. Elimination of infections: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent re-establishment of transmission are required. Example: measles, poliomyelitis. Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. Example: smallpox. Extinction: The specific infectious agent no longer exists in nature or in the laboratory. Example: none. Is COVID-19 also potentially eradicable? Or is it inevitably endemic having established itself across the world? Commentators have focused on the challenges of reaching population (herd) immunity,7 yet population immunity is not essential and was not achieved for smallpox, which was eradicated through ring vaccination. As proof of concept for COVID-19 eradication, several countries and jurisdictions have achieved elimination without vaccination, using new and established public health and social measures (PHSMs) (eg, border control, physical distancing, mask wearing, testing and contact tracing supported by genome sequencing).8 Successful jurisdictions have included those with vast land borders such as China, high population densities such as Hong Kong,9 but also island nations such as Iceland and New Zealand, although with occasional outbreaks from border control failures that have been brought under control.10

This research explores the experience of low-income New Zealanders during the COVID-19 pandemic lockdown and their advice to the Government about addressing future pandemics. New Zealand had a rapid and effective lockdown that meant the virtual elimination of community transmission.Twenty-seven semi-structured interviews were undertaken with low-income people in June-July 2020 immediately after lockdown was lifted.Life during lockdown was challenging for study participants. They were fearful of the virus and experienced mental distress and isolation. Most participants felt safe at home and reported coping financially while still experiencing financial stress. Participants were resourceful and resilient. They coped with lockdown by using technology, self-help techniques and support from others. New Zealand's welfare state ensured participants had access to health services and welfare payments, but there were challenges. Welfare payments did not fully meet participants' needs, and support from charitable organisations was critical. Participants were overwhelmingly positive about the Government's response and advised the Government to take the same approach in the future. This is a particularly reassuring finding from some of the most vulnerable New Zealanders.An early and hard lockdown, the welfare state, compassion and clearly communicated leadership were keys to a successful lockdown for the low-income people in this study. Research of the experience of low-income people during pandemics is critical to ensuring inequities in pandemic impact are mitigated.

Previous research suggests that gains in positive mental health (often termed flourishing, wellbeing, or competence) is associated with stronger academic achievement. This study examines the relationship between positive mental health at school entry and academic achievement at Grade 3, drawing on a representative sample of Australian children with linkage to results of standardized academic testing. Propensity score analysis was used and small positive associations were found between positive mental health and most academic outcomes. Associations were modest in size but sustained over the 3-year period and were similar across a range of academic skills. Future intervention research should assess the potentially wider ranging impact of targeting positive mental health outcomes in the early years of schooling.

Objectives: To identify COVID-19 outbreaks and border control failures associated with quarantine systems in Australia and New Zealand and to estimate the failure risks. Design, setting, participants: Observational epidemiological study of travellers transiting quarantine in Australia and New Zealand up to 15 June 2021. Main outcome measures: The incidence of COVID-19 related failures arising from quarantine, and the failure risk for those transiting quarantine, estimated both per 100,000 travellers and per 1000 SARS-CoV-2 positive cases. Results: Australia and New Zealand had 32 COVID-19 related failures arising from quarantine systems up to 15 June 2021 (22 and 10, respectively). One resultant outbreak involved an estimated 800 deaths and quarantine failures instigated nine lockdowns. The failure risk for those transiting quarantine was estimated at 5.0 failures per 100,000 travellers and 6.1 failures (95%CI: 4.0 to 8.3) per 1000 SARS-CoV-2 positive cases. The latter risk was two-fold higher in New Zealand compared with Australia. The full vaccination of frontline border workers could likely have prevented a number of quarantine system failures. Conclusions: Quarantine system failures can be costly in terms of lives and economic impacts such as lockdowns. Ongoing improvements or alternatives to hotel-based quarantine are required.

Physical distancing (also commonly known as social distancing) is an important non-pharmaceutical strategy to minimise the risk of transmission of SARS-CoV-2 virus. A range of restrictions to promote physical distancing form a key part of the Aotearoa New Zealand (NZ) all-of-government response to the global COVID-19 pandemic. The effectiveness of physical distancing strategies is highly dependent on buy-in and the actions of individuals, households and communities. This NZ population survey was conducted to identify people’s views on the effectiveness of various strategies, and factors impacting on their capacity to follow physical distancing requirements during Alert Levels 4, 3, and 2 (April 24th–June 8th 2020). The majority of the 2407 participants were supportive of the public health measures implemented to promote physical distancing across Alert Levels. Few substantial differences were observed in relation to demographic characteristics, suggesting high overall levels of understanding and willingness to adhere to distancing requirements. Around half of the participants reported difficulties practicing physical distancing when in public. Reasons included being an essential worker and challenges related to the behaviour of others. These survey findings highlight the willingness of NZ’s population to play their part in eliminating COVID-19 transmission, and the way in which behavioural change was rapidly adopted in line with government requirements.

BackgroundExcess winter mortality (EWM) has been attributed to both seasonal cold exposure, and to infectious disease. In 2020, New Zealand’s border management and lockdown measures successfully eliminated community transmission of SARS-CoV-2, and also largely eliminated influenza and many other respiratory viruses. This study investigates the contribution of infections and temperature to EWM and typical extended winter (May to October) deaths in this natural experiment created by New Zealand’s COVID-19 pandemic response.MethodsWe used age-standardised weekly deaths to measure EWM 2011 to 2019, then used historical patterns to estimate high, medium and low scenario 2020 EWMs. We then modelled typical year and 2020 heating degree day: mortality relationships to estimate relative contributions of cold temperature and infection to typical EWEDs.ResultsEWM 2011 to 2019 averaged 14.7% (low 11.4%, high 20.9%). In contrast, 2020 EWM was estimated at 1.6%, 2.7%, or 3.8% under high, medium, and low spring-summer mortality scenarios. Between 2011 and 2019, temperature was estimated to explain 47% of extended winter deaths, and infection 27%, with the remaining 26% attributable to the interaction between infection and temperature.DiscussionThe society-wide response to COVID-19 in 2020 resulted in a major reduction of winter mortality in this high-income nation with a temperate climate. In addition to influenza, other respiratory pathogens likely also make a significant contribution to EWM. Low cost protection measures such as mask wearing (eg, in residential care facilities), discouragement of sick presenteeism, and increased influenza vaccine coverage, all have potential to reduce future winter mortality.Research in contextEvidence before this studyExcess winter mortality (EWM) is a widely observed phenomenon, commonly attributed to physiological responses to short and long-term outdoor and indoor cold exposure (and associated increased air pollution); other seasonal physiology changes; and higher incidence of some infectious diseases. Previous estimates of EWM in New Zealand range from 10.3% to 25.6%, with influenza estimated to make up roughly a third of that excess. Internationally, deaths attributable to cold temperatures are also found outside the traditional winter period, with influenza making a large contribution to cold temperature deaths.Added value of this studyThis study finds that following a successful COVID-19 elimination strategy, which simultaneously prevented the annual winter influenza season, and likely other winter respiratory infections, New Zealand is likely in 2020 to experience less than a third of the usual winter mortality excess. Further, this study for the first time estimates the relative contributions of cold temperature and infection, and the interaction between the two, to New Zealand winter deaths. We estimate that of the 9.5% fewer deaths than in typical years recorded between 1 May and 31 October 2020, 92.5% were prevented by infection control measures; 1.4% by the 1.14°C warmer than average winter; and 6.1% by the interaction between infection and low temperature.Implications of all the available evidenceInfluenza and other infectious respiratory pathogens appear to make a much larger contribution to winter mortality than previously recognised. Low cost protection measures such as mask wearing (eg, in residential care facilities), discouragement of sick presenteeism, and increased influenza vaccine coverage, all have potential to reduce future winter deaths, and lower overall annual mortality rates.

Between August and November 2020, Aotearoa New Zealand experienced eight known failures of the COVID-19 border control system. Multiple introductions of this highly transmissible virus into New Zealand's almost completely susceptible population present a high risk of uncontrollable spread, threatening New Zealand's elimination strategy. In this editorial, we propose that, although steps are being taken reactively in response to these known breaches, systematic underestimation of risk across the pandemic response makes future failures inevitable. We present an epidemiological framework for identifying and addressing risk, giving examples of actions that can be taken to reduce the probability of further outbreaks and enable New Zealand to benefit from sustained elimination of COVID-19.

Hotel-based Managed Isolation and Quarantine (MIQ) is a key public health intervention in Aotearoa New Zealand's (NZ) COVID-19 border control strategy for returning citizens and permanent residents. We aimed to investigate the experience of transiting through MIQ in NZ, to inform future refinements of this type of system. A qualitative thematic analysis method was utilised to explore experiences in depth with seventy-five individuals who had undergone MIQ in NZ between April 2020 and July 2021. Participants were interviewed by telephone or Zoom or completed an online qualitative questionnaire. Interviews were audio recorded, transcribed and coded; questionnaire responses were sorted and coded. All data were subjected to thematic analysis. Three main themes described the key elements of the participants' experience of MIQ that influenced their overall experiences: 1) The MIQ process, 2) MIQ Hotels, and 3) Individual experience. The variation in participants' overall experience of MIQ was strongly influenced by their perceptions of how well the MIQ process was managed (including communication, flexibility, and compliance with disease prevention and control measures); and the quality of the hotels they were allocated to (in particular hotel staff, meals and information). This valuable insight into the experience of individuals in NZ MIQ hotels can inform better planning, management and implementation of the MIQ process for NZ and adds to the literature of countries utilising such strategies to minimise the transmission of COVID-19, whilst protecting the wellbeing of those using the system.

Objective Children from socioeconomically disadvantaged backgrounds have poorer learning outcomes. These inequities are a significant public health issue, tracking forward to adverse health outcomes in adulthood. We examined the potential to reduce socioeconomic gaps in children's reading skills through increasing home reading and preschool attendance among disadvantaged children. Methods We drew on data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107) to examine the impact of socioeconomic disadvantage (0–1 year) on children's reading skills (8–9 years). An interventional effects approach was applied to estimate the extent to which improving the levels of home reading (2–5 years) and preschool attendance (4–5 years) of socioeconomically disadvantaged children to be commensurate with their advantaged peers, could potentially reduce socioeconomic gaps in children's reading skills. Results Socioeconomically disadvantaged children had a higher risk of poor reading outcomes compared to more advantaged peers: absolute risk difference = 20.1% (95% confidence interval [CI]: 16.0%–24.2%). Results suggest that improving disadvantaged children's home reading and preschool attendance to the level of their advantaged peers could eliminate 6.5% and 2.1% of socioeconomic gaps in reading skills, respectively. However, large socioeconomic gaps would remain, with disadvantaged children maintaining an 18.3% (95% CI: 14.0%–22.7%) higher risk of poor reading outcomes in absolute terms. Conclusion There are clear socioeconomic disparities in children's reading skills by late childhood. Findings suggest that interventions that improve home reading and preschool attendance may contribute to reducing these inequities, but alone are unlikely to be sufficient to close the equity gap.

Summary: Approaches to preventing or mitigating the impact of the COVID-19 pandemic have varied markedly between nations. We examined the approach up to August 2020 taken by two jurisdictions which had successfully eliminated COVID-19 by this time: Taiwan and New Zealand. Taiwan reported a lower COVID-19 incidence rate (20.7 cases per million) compared with NZ (278.0 per million). Extensive public health infrastructure established in Taiwan pre-COVID-19 enabled a fast coordinated response, particularly in the domains of early screening, effective methods for isolation/quarantine, digital technologies for identifying potential cases and mass mask use. This timely and vigorous response allowed Taiwan to avoid the national lockdown used by New Zealand. Many of Taiwan's pandemic control components could potentially be adopted by other jurisdictions.

This article takes a public health perspective on New Zealand’s pandemic preparations, its pandemic response, and the successful outcome (as of June 2020) of its Covid-19 elimination strategy. The health outcome appears to be the best in the OECD, but some other countries made better use of certain control strategies. In the postpandemic era there are many emerging opportunities for society to be gained by embedding better plans for controlling future emerging diseases, strengthening public health infrastructure and consolidating the evident benefits of reduced pollution during the lockdown.

There is large uncertainty around the case fatality risk (CFR) for COVID-19 in China. Therefore, we considered symptomatic cases outside of China (countries/settings with 20+ cases) and the proportion who are in intensive care units (4.0%, 14/349 on 13 February 2020). Given what is known about CFRs for ICU patients with severe respiratory conditions from a meta-analysis, we estimated a CFR of 1.37% (95%CI: 0.57% to 3.22%) for COVID- 19 cases outside of China.

Approaches to preventing or mitigating the impact of the COVID-19 pandemic have varied markedly between nations. We examined the approach up to July 2020 taken by two countries which had successfully eliminated COVID-19: Taiwan and New Zealand (NZ). Both jurisdictions experienced the COVID-19 pandemic in the first half of 2020. Taiwan reported a lower COVID-19 incidence rate (19.0 cases per million) compared with NZ (235.5 per million). Extensive public health infrastructure established in Taiwan pre-COVID-19 enabled a fast coordinated response, particularly in the domains of early screening, effective methods for isolation/quarantine, and digital technologies for identifying potential cases. This timely and vigorous response allowed Taiwan to avoid the national lockdown used by NZ and the majority of high-income countries. Many of Taiwan’s pandemic control components could potentially be adopted by other high-income jurisdictions.

BackgroundChild health and developmental inequities exist in all countries. Comprehensive and robust concepts of disadvantage are fundamental to growing an evidence base that can reveal the extent of inequities in childhood, and identify modifiable leverage points for change. We conceptualise and test a multidimensional framework of child disadvantage aligned to a social determinants and bioecological perspective.MethodsThe Longitudinal Study of Australian Children is a nationally representative sample of two cohorts of Australian children, including the birth cohort of 5107 infants, which commenced in May 2004. The analysis focused on disadvantage indicators collected at age 4–5 years. Confirmatory factor analysis was used to test a theoretically informed model of disadvantage. Concurrent validity was examined through associations with academic performance at 8–9 years.ResultsThe model comprising four latent factors of sociodemographic (10 indicators), geographical environments (three indicators), health conditions (three indicators) and risk factors (14 indicators) was found to provide a better fit for the data than alternative models. Each factor was associated with academic performance, providing evidence of concurrent validity.ConclusionThe study provides a theoretically informed and empirically tested framework for operationalising relative child disadvantage. Understanding and addressing inequities will be facilitated by capturing the complexity of children’s experiences of disadvantage across the multiple environments in which their development unfolds.

Monitoring oral language skills at the population level would provide valuable data to inform policy decisions to better support children's oral language skills in schools. The Australian Early Development Census (AEDC) is a teacher-rated population measure of early child development that includes a rating of children's oral communication in the classroom (OCC).This study evaluates the validity of the OCC indicator for population monitoring of children's oral language skills, capitalising on data from two datasets: the 2012 AEDC cohort (n = 289 973) and a subsample of children from the Longitudinal Study of Australian Children for whom AEDC data were also collected (n = 720).Construct validity was demonstrated by showing significant differences in OCC ratings between subpopulations of children who would be expected to differ in terms of oral language skills at school entry (e.g. children with a diagnosed speech-language impairment compared to those with no impairment). OCC ratings were associated with externally validated measures of language, suggesting convergent validity. No relationship was found between OCC ratings and physical health scores, indicating divergent validity.The findings support the use and interpretation of the OCC indicator as a tool for population-level monitoring of oral language in Australian school entrants.

Background Very little high quality evidence exists on the causal relationship between income poverty and childhood health. We provide a comprehensive overview of the association between household income poverty and hospitalisations for children. Methods We used New Zealand’s Integrated Data Infrastructure (IDI) to link income poverty data from the Survey of Family, Income and Employment (SoFIE; n = 21,759 households) and the 2013 New Zealand Census (n = 523,302 households) to publicly funded hospital records of children aged 0–17 (SoFIE: n = 39,459; Census, n = 986,901). Poverty was defined as equivalised household income below 60% of the median income, calculated both before and after housing costs, and using both self-reported and tax-recorded income. Results Correlations for the association between income poverty and hospitalisation were small (ranging from 0.02 to 0.05) and risk ratios were less than 1.35 for all but the rarest outcome—oral health hospitalisation. Weak or absent associations were apparent across age groups, waves of data collection, cumulative effects, and for estimates generated from fixed effects models and random effect models adjusted for age and ethnicity. Alternative measures of deprivation (area-level deprivation and material deprivation) showed stronger associations with hospitalisations (risk ratios ranged from 1.27–2.55) than income-based poverty measures. Conclusion Income poverty is at best weakly associated with hospitalisation in childhood. Measures of deprivation may have a stronger association. Income measures alone may not be sufficient to capture the diversity of household economic circumstances when assessing the poverty-health relationship.

Aim A fifth of children enter school with special health care needs (SHCN) impacting on their physical, psychosocial or educational development, including many with emerging SHCN who often do not qualify for additional supports. This study aimed to compare the perceptions of parents and teachers on children's emerging SHCN, and explore correlates of conflicting reports. Methods The Longitudinal Study of Australian Children (LSAC) is a nationally representative study of Australian children, which includes the abbreviated Children with Special Health Care Needs Screener. Data were analysed from a subsample of n = 720 children from the LSAC Kindergarten cohort (n = 4983) for whom teachers also completed the Australian Early Development Index checklist, a measure of early childhood development that includes teacher reported SHCN. Results Teachers (n = 120, 17.34%) identified more emerging SHCN than parents (n = 74, 10.74%), and reports were often discrepant. Children were more likely to have consistent reports of emerging SHCN when their parents had high levels of involvement at school (OR 4.86; 95% CI 1.08–21.80; P

Participation in a preschool program in the year before starting school can promote children’s healthy development, and has the potential to reduce inequities in developmental outcomes for at-risk subpopulations. In Australia, boosting preschool attendance has emerged as a national policy priority. In this paper, we draw on data from the Australian Early Development Census (AEDC) to describe preschool attendance in two sequential population cohorts, with preschool experiences in 2008 and 2011 reported retrospectively by teachers of children in their first year of school. Overall, findings show that the proportion of children attending preschool remained relatively stable between the two AEDC cohorts (in 2008, preschool attendance ranged from 57.0% to 85.8% across the states and territories, while in 2011, attendance ranged from 49.2% to 93.7%). At a subpopulation level, children from non-English speaking and Indigenous backgrounds and children living in disadvantaged communities all had substantially higher odds of not attending preschool in both 2008 and 2011. These findings highlight the need to maintain policy attention on efforts to further reduce barriers to preschool access for at-risk subpopulations, and the value of monitoring population trends in preschool attendance to better inform policy and service provision.

Healthy child development is determined by a combination of physical, social, family, individual, and environmental factors. Thus far, the majority of child development research has focused on the influence of individual, family, and school environments and has largely ignored the neighborhood context despite the increasing policy interest. Yet given that neighborhoods are the locations where children spend large periods of time outside of home and school, it is plausible the physical design of neighborhoods (built environment), including access to local amenities, can affect child development. The relatively few studies exploring this relationship support associations between child development and neighborhood destinations, green spaces, interaction with nature, traffic exposure, and housing density. These studies emphasize the need to more deeply understand how child development outcomes might be influenced by the neighborhood built environment. Pursuing this research space is well aligned with the current global movements on livable and child-friendly cities. It has direct public policy impact by informing planning policies across a range of sectors (urban design and planning, transport, public health, and pediatrics) to implement place-based interventions and initiatives that target children's health and development at the community level. We argue for the importance of exploring the effect of the neighborhood built environment on child development as a crucial first step toward informing urban design principles to help reduce developmental vulnerability in children and to set optimal child development trajectories early.

Background: Understanding the relationship between different aspects of disadvantage over time and domains of child development will facilitate the formulation of more precise policy responses. We examined the association between exposure to aspects of disadvantage over the childhood period (from 0-9 years) and child development at 10-11 years. Methods: We used data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (n = 4979). Generalized linear models with log-Poisson link were used to estimate the association between previously derived disadvantage trajectories (in each of four lenses of sociodemographic, geographic environments, health conditions and risk factors, and a composite of these) and risk of poor child developmental outcomes. Population-attributable fractions were calculated to quantify the potential benefit of providing all children with optimal conditions for each developmental outcome. Results: Trajectories of disadvantage were associated with developmental outcomes: children in the most disadvantaged composite trajectory had seven times higher risk of poor outcomes on two or more developmental domains, compared with those most advantaged. Trajectories of disadvantage in different lenses were varyingly associated with the child development domains of socio-emotional adjustment, physical functioning and learning competencies. Exposure to the most advantaged trajectory across all lenses could reduce poor developmental outcomes by as much as 70%. Conclusions: Exposure to disadvantage over time is associated with adverse child development outcomes. Developmental outcomes varied with the aspects of disadvantage experienced, highlighting potential targets for more precise policy responses. The findings provide evidence to stimulate advocacy and action to reduce child inequities.

Objective A significant proportion of school-aged children experience special health care needs (SCHN) and seek care from pediatricians with a wide range of condition types and severity levels. This study examines the learning pathways of children with established (already diagnosed at school entry) and emerging (teacher identified) SHCN from school entry through the elementary school years. Methods The Longitudinal Study of Australian Children (LSAC) is a nationally representative clustered cross-sequential sample of 2 cohorts of Australian children which commenced in May 2004. Data were analyzed from the LSAC kindergarten cohort (n = 4,983), as well as a subsample of 720 children for whom teachers also completed the Australian Early Development Index checklist, a measure of early childhood development at school entry that includes SHCN. Results Latent class analysis was utilized to establish 3 academic trajectories from 4–5 to 10–11 years: high (24.3%), average (49.8%), and low (23.6%). Descriptive statistics revealed a trend for both children with established and emerging SHCN to fall into weaker performing learning pathways. Multinomial logistic regression focusing on those children with emerging SHCN confirmed this pattern of results, even after adjustment for covariates (relative risk 3.06, 95% confidence interval 1.03–9.10). Children who additionally had low socioeconomic standing were particularly at risk. Conclusions Even children with less complex SCHN are at risk for academic failure. Early identification, together with integrated health and educational support, may promote stronger pathways of educational attainment for these children. Achieving these better outcomes will require the involvement of both educational and health practitioners.

The Australian educational system is increasingly challenged to meet the needs of multilingual students, who comprise a fifth of the student population. Within the context of a monolingual English curriculum, multilingual children who enter school not yet English proficient may be at risk of experiencing inequitable educational outcomes.We examined the relationship between the timing of multilingual children's acquisition of receptive English vocabulary skills and subsequent reading and numeracy outcomes, as well as factors associated with earlier versus later timing of acquisition. Data were drawn from the Kindergarten-cohort (n = 4983) of the Longitudinal Study of Australian Children - a nationally representative, community sample of Australian children.Linear regression analyses revealed that multilingual children who begin school with proficient receptive English vocabulary skills, or who acquire proficiency early in schooling, are indistinguishable from their monolingual peers in literacy and numeracy outcomes by 10-11 years. However, later acquisition of receptive English vocabulary skills (i.e. after 6-7 years) was associated with poorer literacy outcomes. In turn, socioeconomic disadvantage and broader language or learning problems predicted this later acquisition of receptive English vocabulary skills.All children need to be supported during the early years of school to reach their full educational potential.

ObjectivesThere is considerable need to improve the effectiveness of healthcare to reduce morbidity and mortality. Child hospitalisations are influenced by determinants of health, including the home environment. Our aims were: (1) To investigate whether children hospitalised with potentially avoidable conditions thought to be associated with the home have an increased risk of rehospitalisation and death, (2) To investigate whether children hospitalised with particular subgroups of potentially avoidable conditions have an increased risk of rehospitalisation and death, (3) To assess the usefulness of these subgroups for identifying at-risk children.DesignWe used four existing groups of potentially avoidable conditions developed based on expert opinion: 1. the potentially avoidable hospitalisations (PAH) group, associated with social/environmental conditions, 2. the potentially avoidable hospitalisations attributable (at least in part) to the home environment (PAHHE) group, 3. the crowding group, and 4. the Ministry of Health (MoH) group. We analysed national New Zealand hospital discharge data (2000–2014). Rehospitalisation and death were described using Kaplan-Meier curves. Group effectiveness for identifying at-risk children was assessed using Cox proportional hazard models with children hospitalised for non-PAH conditions as comparison.ResultsIn total, 1425085 hospital admissions occurred, for 683115 unique children. Rehospitalisation was relatively common (71.0%). Death was rare (0.6%). All groups performed moderately well identifying at-risk children. Children with PAH have increased risk of rehospitalisation (adjusted HR (aHR):2.30–3.60) and death (aHR:3.07–10.44). PAH group had highest sensitivity (75.1%). The MoH group has the highest positive predictive value (rehospitalisation: 86.2%, death: 2.5%).ConclusionsChildren in the MoH group are very likely to benefit from housing interventions. Rehospitalisation and early mortality are useful assessment measures. Rehospitalisation exerts a considerable burden, and child deaths are catastrophic.

Children with special health care needs (SHCN) have or are at increased risk for a chronic condition that necessitates more health and related supports than their peers. While it is generally accepted that these children are at risk for school failure, the mechanisms through which SHCN impact on children's experiences (and therefore opportunities to intervene) at school are still relatively poorly understood. Based on the current literature, this paper provides a conceptual framework to guide further discussion of this issue in research, policy and practice. Evidence from the literature was reviewed and existing frameworks examined. We propose that SHCN impact on four interrelated domains of children's functioning: (1) body functions and structures; (2) activities of daily living; (3) social participation; and (4) educational participation. Children's functioning is further influenced by risk and protective factors that can be identified at the level of the child, family and service systems. Together, these processes contribute to shaping either positive or negative trajectories of school functioning. The mechanisms influencing school experiences for children with special health care needs are complex, with opportunities for positive interventions at a range of levels. The proposed conceptual model provides an accessible tool for guiding discussion of the support needs of this vulnerable population.

Objective A fifth of children enter school with special health care needs (SHCN), many of whom have difficulties that are milder or not yet formally diagnosed (emerging SHCN). This study aimed to investigate how differing perceptions of children's emerging SHCN across the family and school contexts relates to service utilization. Methods Sample: The nationally representative birth cohort of the Longitudinal Study of Australian Children, which includes parent reports on the abbreviated Children with Special Health Care Needs Screener. For a subsample of 2459 children teachers also completed the Australian Early Development Census, a measure of early childhood development at school entry that includes SHCN. Analysis: Logistic regression analyses were conducted adjusting for severity of condition, gender, language background, and disadvantage. Results Overall 24.1% of children were identified by their parent and/or teacher as experiencing emerging SHCN. Compared with those with consistent reports, children with parent-only identified needs had lower odds of accessing school services (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.10–0.81). Similarly, children with parent-only (OR, 0.39; 95% CI, 0.20–0.75) and teacher-only (OR, 0.25; 95% CI, 0.14–0.46) identified needs had significantly lower odds of accessing services in the community. Conclusions When parent and teacher perceptions of children's emerging SHCN were inconsistent, service use was lower at school and in the community. Further efforts are needed by health and education providers to ensure that common understandings about a child's needs at school are established early in children's educational careers.