In Australia, the first 2000 days of life—from conception to five years—are increasingly recognized as crucial for long-term health, development, and societal participation. This growing political interest is reflected in recent national initiatives such as the Early Years Strategy and the Measuring What Matters framework, alongside state-level efforts like New South Wales’ First 2000 Days Framework and the Putting Queensland Kids First Plan. These initiatives aim to create a coordinated health and education system that prioritizes prevention and early intervention, ensuring all children and families have access to the holistic supports necessary for optimal health and development.
The best way to support children and families is by promoting positive experiences and preventing negative ones. Across Australian jurisdictions, Child and Family Health (CFH) services provide free, high-quality, non-stigmatizing healthcare from birth to school entry. As a form of universal primary healthcare, CFH services play a critical role in health promotion, prevention, and early identification, and should be accessible regardless of geographic location or socio-economic status.
Challenges in the Current System
Despite the political recognition of early childhood’s importance, Australia’s focus has primarily been on early childhood education and care (ECEC), specifically universal preschool for three and four-year-olds. CFH services, crucial for engaging and supporting families from birth, have received less attention. Although a national framework was developed in 2011, it was not endorsed, leaving the sector without consistent guidelines or standards.
This perspective highlights CFH services as the health backbone of a universal early childhood development system, emphasizing the importance of monitoring and equity. The Centre for Community Child Health (CCCH), with 30 years of experience, underscores the need for strengthening CFH capacity and impact, working with families, communities, and policymakers to improve children’s health and development.
The Importance of Monitoring and Equity
Despite state and territory governments collecting data on CFH service delivery, public monitoring and data sharing remain limited. A 2024 study in New South Wales revealed significant variation in service uptake, with 17% of children having no contact with CFH services, while others had more than 20 visits. In Victoria, over 99% of families received a home visit within two weeks of birth, demonstrating near-universal reach facilitated by legislative changes.
In Victoria, attendance at scheduled CFH appointments in the first six months exceeded 95%, showing the potential for high engagement.
However, CFH services are not consistently or equitably implemented. Research indicates that those who would benefit most from high-quality services often have the least access, reflecting the inverse care law. Aboriginal and Torres Strait Islander families, for instance, report lower engagement than non-Indigenous families.
A Conceptual Model for Equitable Services
Australia’s CFH services should serve as the health backbone of universal primary healthcare in the early years, delivered through proportionate universalism. This approach, adapted by Sir Michael Marmot, emphasizes universal support with tailored assistance for those who need it most.
The model consists of three tiers:
Tier 1: Universal Support
This tier provides a platform for monitoring child development and identifying social factors influencing health, with relationship-building central to early detection of concerns. Ideally, care begins before birth, integrating pre- and peri-conceptional services with CFH for smoother transitions.
Tier 2: Tailored Support
This tier offers additional, flexible support for families needing more in-depth exploration or brief interventions. Strengthening this tier’s evidence base is crucial for refining its role and impact, ensuring comprehensive care through integration with general practice and allied services.
Tier 3: Sustained Support
For families experiencing multiple adversities, this tier provides intensive prevention through sustained home visiting, a model with strong evidence for reducing inequities. International modeling shows that initial investments are recouped through improved outcomes over a child’s lifetime.
Strengthening CFH Services for Equity and Impact
For the conceptual model to function effectively, greater flexibility between tiers is essential. This requires workforce planning, adequate funding, structured appointment guidelines, and ongoing data collection for quality improvement. By embedding proportionate universalism within CFH services, Australia can enhance service impact and improve health outcomes for all children and families.
CFH services are essential for promoting equitable health and developmental outcomes during the first 2000 days of life. They provide the health backbone of a universal early childhood development system, alongside education. Despite their universal intent, inequities in access and inconsistent implementation across Australia limit their impact. A tiered, proportionate universalism model offers a pathway to better support diverse family capacities and strengths, from routine clinic-based health promotion to sustained home visits. By optimizing existing investments and leveraging Australia’s strong universal foundation, we can enhance CFH services and improve outcomes for all children and their families.
