Future Healthy Countdown 2030: from passive trickle-down to active participation for improved health and wellbeing of children, young people and future generations

What is it like to be growing up in Australia? Although Australia is one of the wealthiest countries in the world, health and wellbeing measures are not only stalling for many children and young people, but they are actually moving backwards in some domains.¹

This is because the safety, health and wellbeing of children are not a national priority and there is a lack of government accountability for evidence-based reform. This was demonstrated in an analysis of 12 years of Royal Commissions and inquiries, which found thousands of recommendations repeated over this time.²

Regarded as the responsibility of states and territories, unlike other important issues, children appear nowhere on the list of priorities for the National Cabinet. It is a choice to not address the social determinants of health and wellbeing. We wait until a crisis or a crime compels a reaction. Politics is getting in the way of prevention, leaving our most vulnerable children behind as victims of “federation failure”.²

At its core, this tragedy is due to a lack of respect for the human rights of children and young people. Despite ratifying the United Nations Convention on the Rights of the Child in 1990 (https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child), we have failed to incorporate their rights into Australia's laws.

Rather than centring and respecting the human rights of children and young people, Australia relies on the deeply flawed trickle-down approach, allowing policy to be dominated by the limited concerns of adults. This compromises the future wellbeing of children and of our communities, as well as limiting the health, development, learning and wellbeing of too many children right now. To turn this around, we need to look closely at the evidence and work together across the federation, making child safety, health and wellbeing a priority for the National Cabinet.

Health is inextricably linked to environment. Since the framing of social determinants of health was first introduced,³ the concept has expanded to include political,⁴ commercial,⁵ digital⁶ and environmental determinants of health,⁷ among other framings. The human world is complex, incorporating multiple spheres, all of which influence health and wellbeing. The greatest burden from unhealthy environments rests on the young.

The Future Healthy Countdown 2030 documents what is going wrong for children, young people and future generations and, also, what needs urgent action to turn things around. The Countdown was introduced in a 2023 supplement published in the Medical Journal of Australia.¹ Seven domains capture the complex forces that influence physical health, mental health and wellbeing for children, young people and future generations, reflecting the co-designed framework developed by the Australian Research Alliance for Children and Youth (ARACY).⁸ We intend to publish an annual supplement of the MJA to unpack one of the domains and also report on progress (or lack thereof) on the Countdown itself, up to the target year of 2030.

There is also a commitment to embed the active involvement of young people in the overall governance of the Future Healthy Countdown 2030, in the design and article selection of each supplement, in authorship, and in policy advocacy opportunities. The Future Healthy Countdown 2030 is also considering how to incorporate the active participation and voices of children. This initiative advocates for centring the voices of the younger generations for policy that supports improved health and wellbeing; it is also making space in the academic processes and outputs and is exploring how to push the boundaries of what is possible. This is an ongoing process and will be documented and shared as the initiative progresses.

The capstone article for this 2024 supplement is the presentation of the Countdown by Lycett and colleagues.⁹ A rigorous consensus-building process included input from academics, policy experts and young people. The extensive process has produced seven achievable policy actions (one per domain), which, if actioned before 2030, will make a significant, lasting and positive contribution to improving health and wellbeing for children, young people and future generations of Australians (Box). Accompanying each policy action are indicators to track progress, on which we aim to report annually.

This list of actionable policies will inform advocacy for a growing number of agencies and peak bodies. Let it not be said that we did not know what to do; these policy actions represent the bare minimum required to ensure young and future generations can thrive. Moreover, inaction will further entrench the barriers to health and wellbeing that our children and young people are facing.

We intend each annual supplement of the MJA to focus on one of the seven domains of interest. This year the topic is participating, and the articles unpack how participating — at various ages and stages across the developmental years (0–24 years) and in differing contexts — can improve health and wellbeing for children and young people.

In a youth-led article, Kapeke and colleagues¹⁰ discuss how lowering the voting age to 16 years could mitigate harms arising from young people's lack of power to shape the policy decisions that affect their health and wellbeing, which came starkly to light during the lockdowns associated with the coronavirus disease 2019 (COVID-19) pandemic.

For younger children, participation looks different but is nevertheless critically important. Bessell and colleagues¹¹ argue cogently that children in middle childhood (aged six to 12 years) are constricted in their direct interactions within community settings outside of schools or their homes.¹¹ Communities that reflect child inclusivity and foster stronger social connections and participation also support healthy, connected and active children, young people and adults.

Aboriginal and Torres Strait Islander children and young people carry far more than their share of poor physical and mental health, and much of this burden can be directly attributable to colonisation and the deliberate withholding of active voice and participation in matters that directly affect their lives. Cory and colleagues¹² discuss how the Koorie Youth Council provides the representation and supports for meaningful and culturally responsive dialogue, engagement and expressions of agency. Koorie Youth Council is run by and for Aboriginal young people; it provides channels for direct engagement with government and other relevant agencies, and it has also developed resources to support culturally safe engagement in other settings.

Safeguarding young people who are engaged in consultation is addressed by an important article by Guo and colleagues¹³ that reports on a resource co-designed by young people. This article presents evidence-based recommendations for designing and implementing youth participation initiatives that prioritise protecting mental health and wellbeing for young participants.

How children and young people interact and actively participate with service providers is seldom considered. Montgomery and colleagues¹⁴ provide an evidence review of how Australia's growing number of child and family hubs, which co-locate and integrate services, allow children to participate in early intervention care services in a safe, tailored and non-stigmatised way.

The Future Healthy Countdown 2030 creates a platform of evidence, data, policy action and accountability that supports allies to advocate for policy change that will improve the health and wellbeing of Australian children and young people and sets a strong foundation for those not yet born. Working together across diverse roles, domains and generations, the vision is to prioritise the health and wellbeing of Australia's children and young people through identifying specific, practical and achievable action that is grounded in evidence and human rights. The initiative will continue to centre the perspectives and voices of children and young people and will call on policy makers to consider the long term impacts of policy across portfolios on the health and wellbeing of the next generations.

Kevin Kapeke and Susan Maury are employed by the Victorian Health Promotion Foundation. Anne Hollonds is the National Children's Commissioner, Australian Human Rights Commission.

Not commissioned; not externally peer reviewed.