Child Well-being at the Crossroads: The Impact of Parental Work and Lifestyle Choices from a Socio-ecological Perspective

The greatest challenges and solutions to improve children's health and well-being worldwide in the next decade and beyond: Using complex systems and implementation science approaches

“…System-wide or multi-level theories, models or frameworks should be considered as part of complex systems and implementation research in child health evaluations and study designs (9). Examples of these include the socioecological model of factors influencing child and family health and well-being (6), and an ecological model of child development adapted from Bronfenbrenner (1979) (40). The latter places the individual in the centre, surrounded by four nested levels of influences including family and classroom, parents' workplaces and individual's ethnicity, culture or beliefs.…”

“…In the past decade advances have been made in advocacy for child, person-centred and family-centred models of health care involving children and families, that has included recognition of the need to personalise care and evaluation (17)(18)(19). Greater attention has been paid to mental ill-health in children and their parents and the social determinants of health (6) and advances have been made in understanding child development, prenatal care, nutrition, hygiene and family strengths (6,14). We are on the cusp of a new wave of models of care and evaluation of initiatives based on input from children and families themselves, where recognition is given to the important role of coordinating and involving multiple disciplines and sectors (4).…”

“…Research gaps that require greater attention are the current disjointed consideration of physical, psychological, and social factors related to children's health and well-being which are often examined separately; a lack of holistic care for children and families with complex conditions; and a lack of consideration of other contextual factors beyond the child that have a bearing on their health trajectory (for example, health of family members, intergenerational trauma, caregiver work-life balance, and the physical environment) (4,6). The way health systems have evolved and operate means they are often inadequately equipped to provide holistic care that considers the child, family, treating health providers and community as a part of the whole system that works together to improve the outcomes of children (4,17).…”

“…Awareness of the dynamic interaction of social-ecological, structural, cultural and environmental drivers of child, family and community health beyond the health system must continue to be considered and better understood to progress changes within relevant systems (for example, health, education) in this decade. Residential green space, air quality, screentime, sedentary living, consumerism, sleep habits, and neighbourhood noise have all been identified as impacting on children and families (6,26). Socio-ecological factors of physical caregiving (providing supervision, meeting needs for food, parent work and lifestyle choices) and peer support (the presence of peers during challenges and feeling supported by peers) have been identified as helping to mitigate the negative effects of disaster thus bolstering resilience in children and youth (27).…”

“…These challenges may include disasters, wars, food supply issues, epidemics and rapidly changing modes of communication which are likely to disproportionally affect women and children (5). An epidemic of mental ill-health, complex chronic disease, and lack of social connection and have been part of the health challenges for children and their caregivers over the last decade, which seems likely to continue and require urgent action (6)(7)(8). Despite widereaching impacts from children's health on society, a lack of commitment to children's health has been reported in some countries (9) and regression globally has occurred to an extent not seen in more than a generation (10).…”