The moral foundations of child health and social policies: A critical interpretive synthesis

Abstract

Background: Allusions to the uniqueness and value of childhood abound in academic, lay, and policy discourse. However, little clarity exists on the values that should guide child health and social policymaking. We review extant academic literature on the normative dimensions of child health and social policy to provide foundations for the development of child-focused public policies. Methods: We conducted a critical interpretive synthesis of academic literature on the normative dimensions of child health and social policy-making. We employed a social constructivist lens to interpret emergent themes. Political theory on the social construction of target populations served as a bridge between sociologies of childhood and public policy analysis. Results: Our database searches returned 14,658 unique articles; full text review yielded 72 relevant articles. Purposive sampling of relevant literature complemented our electronic searches, adding 51 original articles, for a total of 123 articles. Our analysis of the literature reveals three central themes: potential, rights, and risk. These themes retain relevance in diverse policy domains. A core set of foundational concepts also cuts across disciplines: well-being, participation, and best interests of the child inform debate on the moral and legal dimensions of a gamut of child social policies. Finally, a meta-theme of embedding encompasses the pervasive issue of a child’s place, in the family and in society, at the heart of much social theory and applied analysis on children and childhood. Conclusions: Foundational understanding of the moral language and dominant policy frames applied to children can enrich analyses of social policies for children in a range of sociopolitical contexts. Our proposed schema of values, and allied exploration of their points of consonance and tension, is an important step in efforts to gauge social policy prescriptions not only by measures of outcome but also by evidence of their alignment with social values.

A case study investigation into a children’s rights approach to health services

“…This decision was in part influenced by the best interests of the child, first and foremost being interpreted as a 'welfarist principle' in the Welsh context 723 and the wider UK context. 724 725 Williams reporting on a study on the UNCRC and the professions in Wales, comments that, professionals often 'reflected a traditional, paternalistic, welfare-orientated conceptualisation of the relationship between the professional and the child.' 726 This interpretative lens perceives children as vulnerable and in need of protection which often results in denying their voice and agency, and also results in adults (practitioners, managers, parents) determining best interests without always giving consideration to the child's view point or considering the child as capable of making decisions in their own right.…”