ACSPRI Conferences, ACSPRI Social Science Methodology Conference 2018

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How Universal are Universal Pre-School Health Checks? Evidence from New Zealand’s B4 School Check

Nichola Louise Shackleton, Sheree Gibb, Barry Milne, Rick Audas

Building: Holme Building
Room: Cullen Room
Date: 2018-12-14 11:00 AM – 12:30 PM
Last modified: 2018-09-21


We aimed to estimate how many children were not attending a universal pre-school health screen (the B4 School Check) in New Zealand and to identify characteristics associated with non-participation. In order to do this we first had to determine the estimated resident population of 4-year-olds using linked administrative data records. Children were included in the population for a given year if they lived in New Zealand for at least 6 months during the reference year, were alive at the end of the reference year, were included in the IDI spine (which aims to cover an “ever-resident” population including all those who either were born in New Zealand, migrated to New Zealand, or paid tax in New Zealand), and: Appeared in any hospital (including emergency) admissions, community pharmaceutical dispensing, or GP enrolment datasets during the reference year; OR had a NZ birth record.
We found that participation rates varied markedly for each component of the B4 School Check (in 2014/15 91.8% for Vision and Hearing tests (VHT), 87.2% for nurse checks (including height, weight, oral health, SDQ, PEDS) and 62.1% for Teacher SDQ (SDQT)), but participation rates for all components increased over time. Māori and Pacific children were more likely to miss out on VHT (Māori OR=1.67(1.63,1.72) Pacific OR=1.73(1.67,1.78)), nurse checks (Māori OR=1.60(1.56,1.63) Pacific OR=1.49(1.45,1.53)) and SDQT (Māori OR=1.32(1.29,1.34) Pacific OR=2.70(2.63,2.76)) than non-Māori and non-pacific children. Children from lower socioeconomic households, born to young mothers, with worse health status, from rented homes, residing in larger households, with higher rates of residential mobility were less likely to participate in the B4 School Check than other children. We conclude that the patterns of non-participation suggest a reinforcing of existing disparities, whereby the children most in need are not getting the services they require. There needs to be an increased effort by public health organizations, community and whānau to ensure that all children are tested and screened.