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Logo of pchealthPaediatrics and Child Health HomepageCurrent IssueSubscription PageSubmissions Pagewww.pulsus.comPaediatrics and Child Health
Paediatr Child Health. 2009 December; 14(10): 649–650.
PMCID: PMC2807800

Promises, promises...

Robin Williams, MD BSc DPh FRCPC1 and Clyde Hertzman, MD MSc FRCPC FRSC2

The articles in the present issue are from a five-day session, aptly named “Putting Science into Action”, that occurred in May 2009 in Sackville, New Brunswick. Experts from across the country and around the world, many of whom are internationally reknowned, met to review the science and discuss the Canadian challenges in translating both the science and the experiences from other countries to better serve our young children and families. As contributors to the meeting and as editors of the present issue, we have had plenty of time and opportunity to reflect on the learning and next steps for us all. We have, therefore, decided to share our “ah-ha’s”.

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We as Canadians have got to do something to improve outcomes for our youngest

We now know that early child development influences health, well-being, learning and behaviour across the balance of a child’s life course. Children who reach school age while vulnerable – ie, behind where we would like them to be in their physical, social-emotional and/or language-cognitive development – are those who are at greatest risk in terms of their future development. Right now, more than one-quarter of Canadian children reach school age while vulnerable in their development. This is an unacceptably high proportion. Even more children are ‘good enough’, but they are not doing as well as they could be. Trying to fix one child at a time will never make a real difference. A great deal is known about how societies can invest in the early childhood years to reduce vulnerability and encourage optimal development. It is time that we learn these lessons and implement them for all Canadian children, because it is important not only for school entry, but also for health outcomes in middle to late adulthood.

In spite of what we say about ‘children are our future’, how we really treat kids and families is grounded in our history and culture

The English Poor Laws of 1601 defined a basic relationship between the family and the state. The family was to take care of itself but, if it could not do so adequately, the state would step in and impose solutions, which were also punishments, on both parents and children. The era of colonization, which began soon after these laws were passed, spread this approach to all the English-speaking countries where Britons dominated: Canada, the United States, Australia, New Zealand and Ireland. In contrast, in many non-English-speaking societies, traditions, laws and practices evolved along more communitarian lines, as reflected in the saying, “It takes a village to raise a child”. These 400-year-old differences are still influencing children’s policies today. Among the 26 most developed economies in the world, the six English-speaking countries (the United Kingdom and the five mentioned above) are those that invest the least public money in the early childhood years. Most continental and northern European countries (as well as Quebec) have responded to new understandings of the importance of the early childhood years, the changing social roles of women, and the demands of the economy with universal, high-quality programs that support early child care and development, provide economic protection for families with young children, and provide solutions for families to balance work and home life responsibilities. On the other hand, the responses of the English-speaking countries to these challenges originate from the English Poor Laws of 1601 – let each family work out its own solution. This has not worked. In Canada, the result is a steadily declining fertility rate and that more than one-quarter of children reach school age vulnerable in their development.

Changing how we value kids and families has to begin now

How we value our youngest children and their families is embedded deep in the consciousness of members of society. One example demonstrates this the best. Every time there are calls for universal, high-quality child care or early education programs in Canada, a loud voice emerges to claim that the state is trying to take control of the family and that ‘the government wants to raise your children’. This is, of course, patently absurd. In countries with universal access systems, there is no evidence of reduced family autonomy. Instead, universal systems have created conditions in which child birth rates have stabilized and even begun to rise. In addition, programs and services that are funded by senior government can be managed locally, with strong parental involvement. Why, then, does this reactionary voice persist? Why is it credited publicly? There seem to be three reasons for this. First, our notions of the appropriate relationship between the family and the state go back hundreds of years, as we have seen, and are now operating at a level below that of conscious thought and reflection. Second, the dreadful, made-in-Canada experience of Aboriginal residential schools is a vivid, and still unresolved, example of why the state should not involve itself in family affairs. Finally, influential Canadians who do not want to invest public money in the early childhood years use the media to amplify and exploit the ‘state taking control of the family’ canard, and to slow down every initiative that would take us off the 1601 English Poor Law trajectory and move us toward a policy response that would expand public provision of any sort.

Bottom feeding on international lists of how we treat and invest in our youngest sucks!

At the time of this writing, Canada has ranked last among the economically developed nations on the two most recent rankings of commitment to the early childhood years: the Organisation for Economic Co-operation and Development’s Starting Strong II report, and United Nations Children’s Fund league tables on early learning and care in economically advanced countries. From levels of coverage of regulated early child care, to opportunities for parental leave and even to levels of immunization coverage, Canada comes up short in comparison with continental and northern Europe. On the international scene, these results are greeted with astonishment. Canada is known as a world leader in creating frameworks of understanding regarding the importance of the early childhood years. “How”, people ask, “can you know so much about the importance of the early years and yet do so little?” How, indeed! It is time for Canada to close the gap between what we know and what we do in the early childhood years.

The true investment required in our early years system and supports for families seems large ($18 to $22 billion), but pales in comparison with what we are spending on health care and education

The correct way to assess a public investment is not to simply look at the dollar value; it is to compare the investment with the size of the economy as a whole (the gross domestic product [GDP]). Presently, Canada spends approximately 10% of its GDP on health care and 7% on education. Both of these figures are comparable with other economically developed countries. However, our expenditures on the early childhood years are less than 0.25% of GDP, while the countries with the most comprehensive programs are spending more than 1.5% of GDP on the early childhood years – the United Nations Children’s Fund benchmark is 1.0% or more of GDP. Canadian costing studies show that investing $18 to $22 billion per year of public money is required to create universal access to quality child care, and parenting and development programs; expand coverage, duration and generosity of parental leave; identify and intervene effectively in developmental delays that require a patient-based response; and support family-friendly community early childhood programs. Such an investment would bring Canada into the 1.5% of GDP range – still a tiny fraction of expenditure on health care and education. However, the evidence that such an investment would produce lifelong human developmental benefits and significant economic returns to society is stronger than the evidence for any other conceivable new social investment. In a generation, the benefits to a sound foundation in early childhood and reduced costs to later educational remediation and health care would offset the public investment. Doing nothing will increase health care and education costs, to say nothing of lost prosperity, increased social service costs and incarceration costs.

“O Canada, we stand on guard for thee”

Every day in our offices, we see individual children and families in an endless line with behavioural problems, emotional problems, and sickness from an illness or trauma. But it is only when we stand back and reflect, and add up the stories and the experiences, that the big picture emerges – the population health picture. As we do, as we have these “ah-ha” moments, we realize we have a part to play in shaping a different future and a different investment in our kids – one for all our kids. It is time, indeed, for the paediatric community to add its voice to the choir of support for a better Canadian system of early learning and care, and truly “stand on guard for thee”.

Articles from Paediatrics & Child Health are provided here courtesy of Pulsus Group