Intended for healthcare professionals

Views And Reviews Provocations

A radical proposal: to promote children’s wellbeing give them the vote

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1862 (Published 02 May 2018) Cite this as: BMJ 2018;361:k1862
  1. Neena Modi, professor of neonatal medicine
  1. Imperial College London, London, UK
  1. n.modi{at}imperial.ac.uk
    Follow Neena on Twitter @NeenaModi1

This straightforward change might ensure that child friendly policies get political attention

The health of the adult population is an appropriate and important concern for governments, given its bearing on productivity and economic prosperity. Adult health is in large part determined by child health, yet around the world policies directed at improving children’s health remain inadequate.

In the UK, for example, the government’s response to the shocking prevalence of childhood overweight and obesity (a fifth of 5 year olds and one in three 10 year olds) has been heavily criticised for being ineffective and too accommodating of commercial interests, though the vast majority of these children will go on to become obese adults.

All too often, governments listen only to a vocal electorate. This poses a problem for infants, children, and teenagers, almost a quarter of the UK population. Most have no vote and so are, in effect, denied their democratic right to shape national destiny, despite the fact that their right to have their views and interests represented is enshrined in law.

Evolution of children’s rights

The idea that children have personal rights was first mooted less than a century ago. For most of history children were considered the property of their parents, who were free to do to them as they saw fit. It wasn’t till 1989 that the United Nations adopted the Convention on the Rights of the Child, since ratified by 194 countries. The legally binding agreement sets out the civil, political, economic, social, and cultural rights of children.

The consequence of children having no vote, and hence no voice, was brought into sharp focus in the UK by the realisation that the result of the Brexit referendum might very likely have been different if the voting age had been lower. And of course it is the young who will be most affected by the consequences of that supposedly democratic decision.

Although lowering the voting age is a reform that is creeping slowly to adoption, it still leaves the question of the rights of infants and children. The suggestion that parents could be provided with a proxy vote for each underage child is often met with bemusement, outright ridicule, or the charge that this would just give parents extra votes for themselves. Yet in all other domains the default expectation of societies is that parents will act in the best interests of their children. This assumption is revoked, by legal intervention, only if a child’s physical or mental health is endangered. It seems reasonable therefore to assume that parents would indeed put their children’s wellbeing first if they could cast votes on their behalf.

Expectations are similar in medical care. When children are very young, parents give consent on their behalf, and it is assumed that decisions are made in their best interests. As they grow older, the expectation is for parental consent to be accompanied by child assent, until finally the child assumes responsibility for personal consent.

Imagine family discussions, as children start to question their parent’s proxy voting intentions. Might this grow a sense of civic responsibility? Might parents be more inclined to consider the long term implications of voting decisions that will determine national policy? Of course, parents will interpret the representations of political parties and the likely effect on their children in different ways. However, isn’t that precisely the nature of democracy?

The idea of parental proxy votes for their children is not new and has been discussed in many countries, including Canada, Germany, the US, and France. Japan has proposed it to counter the over-representation of the interests of elderly people as its population ages.

When Eglantyne Jebb, founder of Save the Children, proposed in 1923 that children had rights, this was considered radical. So too when women argued for the right to vote. Think again then whether proxy votes for parents might provide the much needed 21st century stimulus to bring child friendly policies to political attention at long last.

Acknowledgments

I thank colleagues at Wayne State University and other institutions around the world for stimulating discussions that led to this piece.

Footnotes

  • Competing interests: NM is immediate past president of the UK Royal College of Paediatrics and Child Health.

  • Provenance and peer review: Commissioned, not peer reviewed.