"At the time of James' death, the then Healthcare Hawkes Bay had begun a review of the way it identified and dealt with child abuse ... but James was the event that really made us look at what we were doing."
Community paediatrician Dr Russell Wills says violence is an almost accepted part of family life.
"James Whakaruru is important to us, but he's just one of many."
At a conservative estimate, 11 women die from domestic violence and 400 are put in hospital each year. Half all homicides against New Zealand women are committed by their present or former partners, and 15 to 35 per cent of women are hit or forced to have sex by their partners at some time, compared with 7 per cent of men.
Domestic violence is an enormous burden on an already strained health system, Dr Wills says.
Statistics such as these mean it is not enough to ask only women admitted to the emergency department if they have been subjected to domestic violence.
"If Dad hits Mum, the chances the children will be next are 50 per cent ... so if a woman is being hit, you can't not ask if the child is being hit, too."
The statistics for child abuse are similar to those for women: eight to 10 deaths and 200 known hospital admissions a year, although Dr Wills suspects the real figure is more like 800 to 1000 a year.
Abused children are more likely to grow up to become abusers themselves, or become victims of domestic violence. So the cycle continues.
"There's good evidence there is a level of acceptance of violence in families," Dr Wills says, pointing to a 1996 survey of New Zealand men.
Of 2000 men questioned, 98 per cent said violence against their partners was unacceptable. But when they were given a series of "what ifs" - for example, what if you found her in bed with another man - 53 per cent said violence was justified in at least one situation.
When Children's Commissioner Roger McClay released his report into James' death in 2000, he warned that more children would die if his recommendations were not followed.
The report said the agencies that had been in contact with James did not communicate and assumed other parts of the system would protect him.
James was seen 40 times by health professionals, including seven visits to Hawkes Bay Hospital. Information was not exchanged and hospital staff did not follow their own child-abuse policy or check his file notes.
The report's 59 recommendations included some specific to what was then Healthcare Hawkes Bay, and these have been incorporated into the family violence programme.
After the report, the health board set up Dr Wills' position and employed a child protection officer.
Dr Wills explains that the new programme comes down to three basics: having the right policies and making sure they are followed; training staff to recognise abuse and ask the hard questions; and changing community attitudes to violence.
A regular audit makes sure staff are following guidelines, for example that they refer to past notes when an injured child is admitted.
All staff coming into contact with women and children - especially in the children's ward, emergency department and mental-health services - have been trained how to assess risk and give advice to women and children, and where to refer them for help.
The health board also wants to get city councillors, mayors, prominent sportspeople and other "opinion leaders" on side.
"If we're all saying the same thing - that violence is never acceptable - that will help."
- NZPA
nzherald.co.nz/childabuse
Building Tomorrow special supplement
Building Tomorrow - paths to prevent child abuse
