Prevention travels South to learn not to teach

Some of the most innovative, evidence influenced, best evaluated prevention programs are taking place in the Global South. The CHASE project in Tanzania, for example, reviewed here yesterday, is a case in point [see: Making it work is doing it together [1]].

So, at a more general level, what might those working to improve children’s well-being in the South have to teach those doing the same in the North?

For a start, we can learn a lot from the relationship between environments and well-being. This, too, is difficult to tease apart in the North. As Tom Achenbach reminds us, [see North or South it's the same – only different [2]] economic disadvantage consistently correlates with poor mental health, but there is not very much difference between the incidence of psychological disorders in either hemisphere.

There is concomitant interest in the impact of economic change. Jane Costello and Adrian Angold’s experiment on sudden improvement in income levels in highly deprived communities in the Great Smoky Mountains of the eastern United States has much to say about the potential benefits.

So how about the impact of rapid economic development in China and India? The effects can be hypothesized positively and negatively. Less poverty should be a good thing, but widening inequalities in wealth almost certainly spells trouble for children’s health. The reduction in inequities in the United Arab Emirates and its benefits for child health are a good example [see When will we learn that it's fairer to be middling? [3]].

Resilience has become a buzz word in the South, mainly as a result of the evangelism of Northern experts. From one perspective it is not surprising: children in the South cope with chronic adversity as well as with natural and man-made disasters.

In other respects the conversations about resilience are disappointing. There’s a big difference between observing that some children have the capacity to withstand anything life can throw at them, and making a scientific study of how families, schools, neighborhoods and societies mediate and moderate the ordinary risks of life. The interest in children who cross continents unaccompanied by parents, sometimes working, sometimes caught up in conflict, should permit much greater understanding of these issues.

The severity of the need and the scarcity of resources to support children are very depressing, but there is the small consolation that they make experimentation a more straightforward proposition. Services taken for granted in the North and entangled in the fabric of everyday life can be tested at a more basic level.

The story of Cuba Libre illustrates the point. Only Cuba has managed to introduce truly universal early years interventions. In making distinctions between children from poor and less poor communities, the North can generally manage only progressive universal solutions. Lessons from Cuba and other central American countries could prove highly influential in the North [see: Canadian researchers say, Take us to Cuba [4]].

Finally, we can learn much from the changing power relationships between Northern funders and Southern beneficiaries. Emma Crewe has described how innovation is stifled by restrictions placed on investments by the North [see: Where the children of the South are empowered - there's hope [5]]. Felton Earls has been tireless in his confidence in the power local community support adds to any intervention. Indeed in some contexts the local support is the intervention.

The governments of the North rarely get it right when they start instructing local government about how to prioritize evidence, which programs to implement and how to evaluate them. The failure to trust local communities to arrive at their own solutions to problems of child development is perplexing, especially in the light of Earls’s findings that the process can improve the way adults view adolescents.

• Prevention Action welcomes submissions in this area and will be running "specials" on these and related themes. Our first concern is to learn from the South. This special edition has drawn heavily on articles in the Annual Research Review of the Journal of Child Psychology and Psychiatry.

References

Costello E, Angold A, Burns B, Erkanli A, Stangl D, Tweed D. The Great Smoky Mountains Study of Youth: functional impairment and serious emotional disturbance. Archives of General Psychiatry. 1996b; 53: pp1137-1143.

Costello E, Angold A, Burns B, Stangl D, Tweed D, Erkanli A, Worthman C. The Great Smoky Mountains Study of Youth: goals, designs, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry. 1996a; 53: pp1129-1136.

Costello E, Compton S, Keeler G, Angold A. Relationships Between Poverty and Psychopathology A Natural Experiment. JAMA . 2003; 290: pp2023-2029.