Children's health is mediated by a complex and dynamic social, economic and physical environment that affects every aspect of a child's well‐being. Ironically, the more we learn about the molecular and genetic basis of health, the more we have come to understand the influence of this environment on the expression of genes and the biochemistry of life. This is as true for children in the North (resource‐rich countries) as it is for children in the South (resource‐poor countries), and its relevance to paediatricians transcends the geography of their practice In a globalised world, paediatricians will increasingly be confronted with child health issues rooted in a global society.
These and other societal transitions demand a new framework for conceptualising children's health and well‐being, and a new set of principles to guide child health practice to ensure its relevance to children. The CRC provides this framework, these principles, and an architecture to support the application of children's rights to child health. In one holistic document, the CRC defines the prerequisites for the health and well‐being of all children and the obligations of all elements of society to fulfil their rights. It is only through the fulfilment of children's rights that equity in child health can be achieved.
The CRC also redefines the role of children in society as participants (article 12) and, through their participation, as critical contributors to their own health and that of the community in which they live. As a result, the relationship between paediatricians and children will necessarily assume a new balance in which the predominant, non‐biomedical determinants of health, particularly those that relate to behaviour, risk reduction, health promotion, mental health and chronic illness, could be more effectively dealt with.
The principles of the CRC can be applied at all levels of child health practice. The social and environmental roots of most current acute and chronic child health issues require the engagement of practitioners at all these levels to deal with the causes and symptoms of ill health which afflict most of the world's children. At the clinical level, the clinician can implement the core principles of the CRC by ensuring that children are not discriminated against in the healthcare system (article 2), considering the best interests of children whenever decisions are made that could have an effect on them (article 3), giving a voice and listening to children (articles 12–15) and by providing developmentally appropriate information to enable them to participate in decisions that will affect their lives (article 17). In addition, respecting the privacy and confidentiality of children will do much to facilitate their involvement in the healthcare system (article 16).
The CRC is also an effective tool to guide and support the expanded involvement of paediatricians and other healthcare providers in child advocacy and public policy development. There is an important part for professional organisations and individuals to play in advocating for the rights of children in their communities and globally. Globalisation and the intricate intersection of the lives of children throughout the world with societies in the North and South dictate the need for paediatrics and paediatricians to establish an international context for advocacy and public policy. The CRC provides a universally accepted framework to support these efforts. Examples of issues that paediatricians in the North and South will increasingly face in the context of their clinical work and advocacy include the following:
- The movement of children across borders through immigration, trafficking, adoption, etc, is a global child health issue. Articles 7, 8, 9, 10, 11, 20, 21, 22, 30 and 35 deal specifically with these concerns.
- In a global economy, the exploitation of children for and by adults within and outside a child's community is an international matter. Articles 32, 34 and 36 relate specifically to the protection of children from child labour and sexual and other forms of exploitation.
- International standards of conduct required to develop civil societies and peace benefit all countries. Societies cannot reach these standards unless children are extended the rights required to ensure that they are protected from abuse and marginalisation. Articles 19, 37, 38 and 40 extend the rights of children to be protected from abuse and neglect, torture and deprivation of liberty, armed conflicts and aberrant juvenile justice systems.
- Finally, investment in the health and development of children (articles 23, 24 and 31), standards of living (articles 26 and 27) and education (articles 28 and 29) will pay significant dividends for all of us in the present and future.