Parenting is probably the most important public health issue facing our society. It is the single largest variable implicated in child...
Parenting
is probably the most important public health issue facing our society. It is
the single largest variable implicated in childhood illnesses and accidents;
teenage pregnancy and substance misuse; truancy, school disruption, and
underachievement; child abuse; unemployability; juvenile crime; and mental
illness. These are serious in themselves but are even more important as
precursors of problems in adulthood and the next generation.1 This is why British and other governments are giving
parenting high priority (such as, in Britain, the cross departmental committee
chaired by the Minister for Public Health and the prime minister’s social
exclusion unit).
The importance of
parenting arises from its role as a buffer against adversity (such as poverty
or delinquent influences) or mediator of damage (as in child abuse). Parenting
usually involves biological parents but is not confined to them.2 Carers, teachers, nurses, and others fulfil parenting
tasks with children. Parenting has three essential components. Firstly, care
protects children from harm. Care also encompasses promoting emotional as well
as physical health. Secondly, control involves setting and enforcing boundaries
to ensure children’s and others’ safety, in ever widening areas of activity.
Thirdly, development involves optimising children’s potential and maximising
the opportunities for using it. Although a reasonable consensus exists about
“bad parenting,” there is no agreement about its opposite, particularly in a
diverse and rapidly changing society.3
Even more variable
are levels of motivation for sustaining this complex and demanding job. Most
parents care for their children, sometimes against great odds.4 Yet motivation to nurture and protect children is not
inborn in humans but acquired and shaped through past experience and current
circumstances. We know that factors such as severe poverty and maternal
depression seriously distort or damage the parenting process. Yet under such
circumstances parental qualities and skills become ever more important because
even in adversity parents may protect children against abuse or exposure to
intrafamilial and external stresses.5
An extensive and
complex social organisation exists for dealing with children and family
difficulties.6 Yet these problems seem to be getting worse, because
little is done to alter fundamentally the lot of the most disadvantaged. Help
is fragmented between health, education, and social services.Parents are often
marginalised to the position of onlookers of their children’s management,
particularly in health services.
Crucially, most professional
responses are reactive rather than preventive. When intervention fails the
cumulative nature of children’s problems means that further interventions
become more costly and less effective. This is seen most starkly in conduct
disordered and delinquent children.7
General
practitioners, community paediatricians, and primary health teams are in a key
position to promote services for the whole child, delivered through supporting
better parenting. They are best placed to identify children at risk—literally
before birth—through their knowledge of the parents and to monitor their
development and their parents’ ability to meet their needs through surgery
visits and health visitors. They should insist that the currently fragmented
and inefficient services by multiple agencies should be integrated to make the
optimum impact on frequently puzzled and fraught parents. Together with social
services and education, they can institute programmes that teach and enhance
parenting skills so that parents can take a more effective role with their
children.
All this is based on
the premise that health professionals are respected experts in children’s
health and social development and should use this to promote the wider welfare
of children, without which their health will suffer. Above all, this demands an
urgent shift of emphasis from reactive intervention to prevention and health
promotion—which is well justified by the evidence. We know, for example, that
low birth weight and mental handicap can be reduced ninefold and disruptive
behaviour improved by early intervention.8
The
result will be emergence of a “parenting society,” in which all citizens
recognise their shared rights and responsibilities for giving and receiving
care, control, and development, particularly to the needy, among which children
are the most prominent.
