Kate Lundy (ACT, Australian Labor Party, Shadow Minister for Local Government) Share this | Link to this | Hansard source

One in four Australian children is overweight or obese. Type 2 diabetes has risen dramatically over the last five years. One in eight children has asthma and one in 12 has a chronic allergy. But perhaps some of the most concerning statistics relate to the mental health of our children. In Australia and across the world learning and behavioural disorders such as attention deficit hyperactivity disorder, ADHD, and autism spectrum disorder, ASD, are exploding into epidemic proportions with some huge unexplained increases in the last 10 to 15 years. Of concern is the fact that Australian children today are being medicated for ADHD with stimulants in unprecedented numbers.

Despite the lack of current up-to-date Australian statistics on children’s mental health, we know that around 11 per cent of children aged four to 14 years suffer from ADHD and a further one in 160 children from autism. These numbers are similar in the United States and the United Kingdom. According to the Australian Institute of Health and Welfare report Australia’s health 2006, Australian children should be the healthiest they have ever been. Death rates and communicable disease rates have fallen markedly in the past decades, living conditions are the best ever, passive smoking has been reduced and vaccination rates are at optimum levels. However, there are a number of areas of concern such as obesity and diabetes, while allergies and behavioural and developmental health problems are becoming more common. Why?

What we now know is that these illnesses are lifestyle related. Children are not born obese. They are not born with ADHD or autism. Diet is emerging as a major factor in these illnesses and also as a common link. This rise in childhood illness is part of a worldwide trend and Australia is lagging far behind the rest of the world in adequately and urgently addressing these crucial children’s health issues. Compounding the crisis, further studies show childhood illnesses have far-reaching consequences in adulthood. Research in 2005 showed that 88 per cent of children who were overweight and obese in 1985 stayed overweight and obese as adults. The 26 per cent of boys and 24 per cent of girls that are overweight or obese in Australia today, compared to 11 per cent in 1985, will now face problems like type 2 diabetes, heart disease, kidney damage, liver failure and certain cancers much earlier in life. As I have said before in this place, for the first time our children could have a lower life expectancy than their parents.

Further, the NSW government’s Schools Physical Activity and Nutrition Survey 2004-05 study of New South Wales schoolchildren showed that lack of physical activity is no longer considered the major contributing cause of childhood obesity. The study showed that while children are exercising more they are also consuming more energy. The energy, or kilojoule intake, of children rose around 13 per cent between 1985 and 1995, and the New South Wales data indicates that it continues to rise. The huge increase in the availability of sugar-laden, processed carbohydrates, processed fats and chemically enhanced foods as substitutes for simple fruits, vegetables, seeds, fats and proteins in our children’s diets is implicated not only in an epidemic of illness such as obesity and diabetes but also, alarmingly, in behavioural and learning disorders. Unless we address the diet and nutritional status of our children urgently the consequences may be far-reaching and insidious.

The lack of up-to-date Australian statistics and survey data is a huge impediment to evaluating the true state of our children’s health; in particular their mental health. How can good public policy be made in the absence of accurate and up-to-date data? There has not been a comprehensive national survey on nutritional status since 1995. The statistics collected by the Howard government on the levels of physical activity of children is confusing, inconsistent and erratic, so much so that different agencies have produced different results in participation level surveys. The only detailed study of children’s mental health was the National Survey of Mental Health and Wellbeing, which included a child component, conducted in 1998. Nine years is too long to wait for up-to-date statistical data while childhood illness escalates. In the absence of national data, state surveys such as the New South Wales Labor government’s SPANS report have been valuable in filling in the gaps.

In June 2006 the Australian Institute of Health and Welfare identified several unfavourable trends in children’s health in its report Australia’s Health 2006. Of concern were childhood overweight and obesity, diabetes and Indigenous health. The report mentioned, importantly, the difficulty in assessing trends in children’s mental health without up-to-date survey data. Despite this lack of information, federal Labor’s shadow minister for health, Nicola Roxon, and I, in my role as shadow minister for health promotion, have sought to provide some leadership by identifying four key causes for concern in children’s health. These are behavioural and learning disorders, including ADHD and autism; asthma and allergies; obesity, diabetes and physical inactivity; and diet and nutritional status. We know that Australian children have increasingly high levels of learning and behaviour disorders. ADHD is the most prevalent and often coexists with oppositional defiant disorder, conduct disorder and other anxiety or depressive disorders. Up to three times as many boys as girls have ADHD.

The symptoms of ADHD range from being inattentive, unable to concentrate or focus, unable to complete tasks and lack of self-control through to hyperactivity, impulsiveness, inappropriate social behaviour, fidgeting, talking, interrupting and being unable to stand still. ADHD is estimated to affect around 11 per cent of children or one in nine Australians, although surveys have shown this figure to be as low as seven per cent and as high as 14 per cent. Again, statistical data is extremely limited, with the last major national mental health survey back in 1998, and only limited data was collected from parents in the ABS national health survey in 2004-05. In 2005 a Western Australian study by Zubrick et al indicated that Aboriginal children had significantly higher rates of ADHD, at 24 per cent compared with 15 per cent of all children in WA aged four to 17 years. A study this month published in the American Journal of Psychiatry found the worldwide incidence of ADHD at 5.2 per cent, or one in 20 children. The highest rates were from Africa and South America, while Japanese and Finnish children scored the lowest. Australia does not even have current national guidelines on ADHD, unlike the majority of industrialised countries, including New Zealand. The Howard government rescinded the NHMRC guidelines on ADHD in December 1995 because they were ‘out of date’. The release date for the revised guidelines is now January 2008.

ADHD medication is controversial at best, because the medicines usually prescribed are amphetamine based. Between 1991 and 1998 prescriptions for dexamphetamine sulphate increased by a whopping 2,400 per cent, while Ritalin prescriptions increased by 620 per cent. In the US, Ritalin prescriptions increased by 700 per cent between 1990 and 2000. In Australia, prior to 1995, dexamphetamine sulphate was on the PBS and therefore attracted more prescriptions than the better known Ritalin. After 1995, prescriptions of Ritalin skyrocketed in a matter of months after being put on the PBS.

There has been a lot of confusion about the statistical level of the use of Ritalin in the media recently, and I note that Media Watch intervened helpfully on 4 June to clarify the data with their article tiled ‘Bitter Pill’. A 2002 Australian study, published in the Medical Journal of Australia, concluded that approximately 13 per cent of children with ADHD are taking stimulant medication. That means that, out of our four million children, about 1.45 per cent are being treated with amphetamines. This has raised many issues in Australian law, medicine and family welfare and requires urgent systematic investigation, particularly in light of the fact that there is now clinical and anecdotal evidence that, for some people, amphetamine based treatment for ADHD can be effectively replaced with diet modification and nutritional supplementation.

In 2002, US researchers found that a combination of vitamin, mineral, amino acid, probiotic, essential fatty acid and phospholipid treatments improved attention and self-control in children with ADHD equally as well as Ritalin treatment as administered to two identical groups of children. Further studies have focused on various essential fatty acids, the good omega fats found in fish, seed and nut oils, which must be obtained through diet and which are essential for brain function. In April 2007, an Australian study reported that children who were given combined fish oil and evening primrose oil supplements improved markedly on parental ratings of core ADHD symptoms such as inattention, hyperactivity and impulsivity. In the UK earlier this year, the Associate Parliamentary Food and Health Forum commenced an inquiry to examine the links between food and behaviour with a special focus on the role of essential fatty acids in the diet.

Autism spectrum disorder includes autism and Asperger’s syndrome, a high functioning form of autism where the child is often very gifted and very intelligent. There are two types of autism. Classic autism occurs from birth and is still very rare—occurring in only one to two of every 10,000 children—and regressive autism, which generally appears between the ages of 12 and 24 months after a period of normal behaviour. The diagnostic criteria for autism include the following characteristics: restrictive, repetitive behaviours; inability to interact socially; avoidance of eye contact; and abnormal language and communication skills.

A three-year study commissioned by the Australian Advisory Board on Autism Spectrum Disorders has just concluded, with the results showing that around 10,000 children aged six to 12 have ASD. Unfortunately, it is difficult to locate any historical statistics on autism in Australia, making a trend analysis next to impossible. But in the US children diagnosed with autism rose from one in 10,000 in 1970 to one in 500 in 1996 to one in 150 today. Dr Kenneth Bock, on his recent Australian visit to speak at the Mindd Foundation’s—Metabolic Immuno Neurologic Digestive Disorders—children’s forum, asserted that, in some cases, ADHD and autism could be reversed through his step-by-step program to heal children via diet, nutritional supplementation and detoxification. His program, based on treating ADHD and autism as medical illnesses arising from physical dysfunction rather than psychiatric disorders, offers hope to parents who have little left, as do his descriptions of how intensive dietary intervention and nutritional therapy have improved the lives of many children in the US.

A survey conducted by the US Autism Research Institute found that the symptoms of 65 per cent of children with autism and Asperger’s syndrome improved significantly on one particular diet—a combined gluten, or wheat, free; and casein, or dairy, free, diet. Controversially, however, Dr Bock links learning and behavioural disorders, including regressive autism, with the build-up of mercury, which is toxic. Bock claims factors like environmental pollution and genetic susceptibility make some children even more vulnerable to the toxic effects of mercury. Bock also points out that the symptoms of mercury poisoning and autism are nearly identical. Where his views get really controversial is that he draws the link to those childhood vaccinations which in the past have contained mercury as a preservative. His reported success with detoxification and nutritional therapy seem to strengthen his claims of a link between autism and mercury. By way of background, thimerosal or thiomersol—there are two spellings of this particular substance—is a preservative which contains 49.6 per cent ethyl mercury. This preservative was removed from childhood DTP—diphtheria tetanus pertussis—vaccinations in Australia in 2000 and in the US in 2001.

I raise Dr Bock’s views in the context of the growing public interest in the increases in autism, ADHD, allergies and asthma in children. To place his controversial views and new treatments of these illnesses into the context of orthodox medical thinking, I think it is also important to put on the public record the current position of the American Academy of Pediatrics:

There are no valid studies that show a link between thimerosal in vaccines and autistic spectrum disorder. A 2004 report from the Institute of Medicine, Vaccines and Autism, concluded that the available evidence is against the existence of a causal relationship between thimerosal--containing vaccines and autism.

In addition, I would like to refer to the formal advice of the federal Department of Health and Ageing in their publication Australian Immunisation Handbook8th edition, published in 2003. Under part (b), ‘Vaccine content’, there is a section on thiomersol, as it is called in this publication. The section begins by providing an explanation as to why there are additives in some vaccines:

Additives may be necessary either as part of the production process of some vaccines, as preservatives, or to help boost the body’s immune response to the vaccine (an adjuvant). These may include formaldehyde, thiomersal and aluminium.

The section on thiomersal provides a description of its historical use in vaccinations and its ongoing use in some vaccines in trace amounts and responds to theoretical concerns about its safety. It concludes with these paragraphs:

People sometimes ask why thiomersal was removed from vaccines fit did not cause adverse health effects in children. There were two main reasons: first, it was an attempt to reduce to a minimum the amount of mercury given, in any form, to very small premature babies with low birth weight in whom there was a theoretical risk.

Second, the intent was to reduce total exposure to mercury in babies and young children in a world where other environmental sources may be more difficult to eliminate.

This inconsistency between the work and findings of Bock et al and the published official position will ensure the ongoing debate about the causes of autism and the effect of mercury continues to rage. My aim in raising these issues is to ensure that the growing awareness and concern about the trends in children’s health is informed by scientific evidence and is open-minded towards new and innovative approaches to treatment and the potential for healing.

I would now like to turn briefly to asthma and allergies before concluding. Australian rates of asthma and environmental and food allergies remain amongst the highest in the world. In particular, while childhood asthma has stabilised in the past five years, rates of food allergies have continued to grow in Australia during the same period. In the US allergies are an epidemic in their own right—food allergies have increased approximately 700 per cent in just 10 years and fatal allergies are now more common. Cases of hospital admissions for anaphylactic shock, which is an acute allergic response, more than doubled between 1993 and 2005 and nearly tripled in children aged 0 to 4. Most were caused by peanut allergy. The number of children allergic to foods also escalated over this time, with the most common triggers being peanuts, eggs, dairy products and tree nuts. The World Allergy Organisation reports that internationally one in 33 children are affected by food allergy, but this is more common in children with other allergic diseases such as asthma and eczema.

In Australia the Australasian Society of Clinical Immunology and Allergy reports food allergies affect one in 20 children and one in 50 have peanut allergy. What cannot be explained is the recent and sudden rise in anaphylaxis in children, and research is urgently needed to provide answers. One in eight children aged less than 15 years, or 12 per cent, were reported as having asthma as a long-term health condition, which was similar to the rate in 2001. Of these children 13 per cent of boys and 10 per cent of girls suffered from asthma. Higher rates of asthma were reported in children aged five years and over than for children aged less than five years. Asthma is the fifth-most common reason for childhood hospitalisation, with nearly 14 per cent of children over 12 years reporting hay fever and allergic rhinitis as long-term conditions in the 2004-05 National Health Survey.

In conclusion, there ought to be far more attention paid to these chronic illnesses, rising in incidence amongst our children—in particular autism, ADHD, allergies and asthma. It is the gravest indictment that, in researching this speech, there was such a problem finding accurate, up-to-date data. I have had to rely on trend data from overseas and make some broad assumptions that we are experiencing similar trends. We as policy makers and legislators, as well as health professionals, need access to information about the ongoing health status of our population. What and how much children are eating is a critical part of that. Australia is one of the only countries that does not have consistent data about food and nutrient consumption. The US, the UK, New Zealand and many European nations have ongoing programs for monitoring diet and nutritional status.

Labor has been calling for a national nutrition survey for years. The Howard government has belatedly allocated some funding for an ongoing program of food and nutrient intake and other measures of wellbeing. According to the Department of Health and Ageing, in evidence given at Senate estimates, this survey will cover about 14,000 people but will not be in the field until 2009, with the results not released until 2010, a full 15 years after the last national survey was conducted. There is also a survey of 4,000 children in the field at the moment, according to departmental officials at the recent Senate estimates round, with the results not due until next year. The massive gap in data over the 11 long years of the Howard government will stand as a perpetual reminder of their neglect of children’s health.