Children's health and development outcomes follow a social gradient: the further up the socioeconomic spectrum, the better the outcomes. Based upon a review of multiple forms of evidence, and with a specific focus upon Australia, this article investigates the causes of these socially produced inequities, their impact upon health and development during the early years and what works to reduce these inequities. Using VicHealth's Fair Foundations framework, we report upon child health inequity at three different levels: the socioeconomic, political and cultural level; daily living conditions; the individual health-related behaviours. Although intensive interventions may improve the absolute conditions of significantly disadvantaged children and families, interventions that have been shown to effectively reduce the gap between the best and worst off families are rare. Numerous interventions have been shown to improve some aspect of prenatal, postnatal, family, physical and social environments for young children; however, sustainable or direct effects are difficult to achieve. Inequitable access to services has the potential to maintain or increase inequities during the early years, because those families most in need of services are typically least able to access them. Reducing inequities during early childhood requires a multi-level, multi-faceted response that incorporates: approaches to governance and decision-making; policies that improve access to quality services and facilitate secure, stable, flexible workplaces for parents; service systems that reflect the characteristics of proportionate universalism, function collaboratively, and deliver evidence-based programs in inclusive environments; strong, supportive communities; and information and timely assistance for parents so they feel supported and confident.

In childhood, mental health problems primarily consist of behaviour and emotional problems. These affect one in every seven children (i.e. 200 000 in Australia). Left untreated, up to 50% of preschool problems continue through the childhood years. Because of their high prevalence, population-based approaches will be needed to reduce their associated burden. The aim of the present study was therefore to identify evidence-based preventive interventions for behavioural and emotional problems of children aged 0-8 years. Randomized controlled trials of preventive interventions for behavioural and emotional problems were located by searching standard clinical databases and systematic reviews. The authors determined which programmes were effective and ineffective, dividing the effective programmes into those with high or low risk of trial bias. Among effective programmes, the most promising for delivery in Australian contexts were identified, selected for their strength of evidence, sample comparability to Australia's population, and programme compatibility with Australia's service system. Around 50 preventive interventions have been evaluated in randomized controlled trials. Most targeted children's behavioural problems, and a few targeted emotional problems. Three US programmes have the best balance of evidence: in infancy, the individual Nurse Home Visitation Programme; at preschool age, the individual Family Check Up; at school age, the Good Behaviour Game class programme. Three parenting programmes in England and Australia are also worthy of highlight: the Incredible Years group format, Triple P individual format, and Parent Education Programme group format. Effective preventive interventions exist primarily for behaviour and, to a lesser extent, emotional problems, and could be disseminated from research to mainstream in Australia, ensuring fidelity to original programmes. Future research should develop programmes targeting emotional problems, and replicate effective programmes for behaviour problems in quality population translation trials. Randomized trial methods in staged roll-outs can determine population cost-benefits for children's mental health without delaying dissemination.

No abstract