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Canada lags behind other countries when it comes to investing in families with children. Canada, therefore, fails to promote health by not optimizing early development. The authors diagnose the Canadian failure. The problem is not research or fiscal capacity, but rather a sickness in Canadian culture. Four ailments are identified: Canadians are convinced they cannot afford new social investments, tend to treat illness rather than promote health, ignore that good family policy requires gender equality, and discount intergenerational justice. In response, the authors propose four policy solutions. Their pan-Canadian framework would cost $22 billion annually, not even one-half of current elderly and pension benefits. The new investment would reduce child vulnerability from approximately 30% to just 10% of children within 10 years. This reduction in early vulnerability would increase gross domestic product 20% more over 60 years than if Canadians tolerate the status quo.
Le Canada accuse du retard par rapport aux autres pays en matière d’investissement pour les familles. Ainsi, le Canada néglige de promouvoir la santé en n’optimisant pas le développement de la petite enfance. Les auteurs diagnostiquent l’échec canadien. Le problème ne provient pas de la recherche ou de la capacité fiscale, mais plutôt d’une maladie de la culture canadienne. Quatre symptômes sont repérés : les Canadiens sont convaincus qu’ils ne peuvent pas se permettre de nouveaux investissements sociaux, ont tendance à traiter les maladies plutôt qu’à promouvoir la santé, ne tiennent pas compte du fait que de bonnes politiques familiales exigent l’égalité des sexes et accordent peu d’importance à la justice intergénérationnelle. En réponse, les auteurs proposent quatre solutions en matière de réglementation. Leur cadre pancanadien coûterait 22 milliards de dollars annuellement, soit moins de la moitié des prestations aux aînés jumelées aux prestations de retraite. Le nouvel investissement ferait reculer la vulnérabilité des enfants d’environ 30 % à seulement 10 % d’ici dix ans. Cette réduction de la vulnérabilité de la petite enfance accroîtrait le produit intérieur brut de 20 % de plus d’ici 60 ans que si les Canadiens tolèrent la situation actuelle.
Teacher evaluations of students in almost all kindergarten classes in British Columbia (BC) and Manitoba reveal that nearly 30% of children who start school are vulnerable on at least one domain of development, as measured by the early development instrument (EDI). These BC- and Manitoba-wide findings are consistent with vulnerability levels reported for selected neighbourhoods and school districts in Ontario and other Canadian jurisdictions. Such high rates of early vulnerability caution against relying on Canadian results in the Organisation for Economic Co-operation and Development Programme for International Student Assessment (PISA) to evaluate child development trajectories in Canada. While PISA reports that Canadian high-school students are historically strong achievers by international standards, we know that children who are vulnerable on the EDI are significantly less likely to even write standardized examinations later in school. This trajectory information warns that standardized tests, such as PISA, reflect a substantial sample bias because children who were vulnerable during their early years are disproportionately excluded. Population-level linkages between medical service records and standardized test achievement in Manitoba schools reinforce this sample bias concern (1).
As scholars reconsider what PISA reveals about child development in Canada, it is imperative to recognize that the high rates of early vulnerability measured by the EDI are not surprising, because our country lags behind other nations in promoting development through effective parental leave, early learning and care services, and antipoverty measures (2). Why does Canada fall short in supporting the early stages of human development with these tools? And what can be done to remedy the problem?
Answering these questions requires that we first understand what the problem is not. As the articles in the present special issue confirm, policy deficiencies in Canada do not reflect a dearth of research. Building on evidence which shows that optimizing the early stages of human development promotes health over the life course, the United Nations Children’s Fund (UNICEF) (2) synthesized the best international literature to establish 10 benchmarks for addressing child poverty, parental leave, and quality early education and care programs.
Although Canada achieved only one benchmark out of 10, technical hurdles do not prevent the implementation of strong policy. On the contrary, Sweden received full marks for achieving all 10 policy benchmarks, while Finland, Norway, Denmark and France satisfied eight of the criteria. If some countries can meet nearly all of the benchmarks, so too can senior levels of government in Canada, while still respecting the jurisdictional boundaries of our federal system.
We also cannot blame our fiscal capacity for Canada’s last place ranking on the UNICEF report card. Canada enjoys the lowest debt-to-gross domestic product (GDP) ratio among G7 countries (3), while we pay less in taxes than the G7 and Organisation for Economic Co-operation and Development averages (4). Canadian governments are therefore well positioned fiscally to invest in a health promotion strategy that targets the early years. This is true even in the current recession, because research shows that child care services are among the most effective local economic development tools for creating or sustaining jobs, and boosting economic growth (5).
If the problem is not research, technical ability or fiscal capacity, then what is it? Canadian readers should look in the mirror, and look around, because our culture is the problem. Canadian culture impedes the implementation of policy that will promote healthy early development.
Since the publication of Esping-Andersen’s (6) seminal book The Three Worlds of Welfare Capitalism, it is widely recognized that Canada clusters with other English-speaking western countries because cultural predilections discourage public provisioning out of concern that citizens may select government support over relying on the market or family. This cultural tendency found expression in the British Poor Laws of 1834, which influenced social policy design in other English-speaking countries thereafter. The legacy of the Poor Laws tradition means that Canada, the United States, Australia, New Zealand and the United Kingdom prioritize means-tested assistance or very modest universal transfers and social insurance plans more than other countries.
The relatively meager means-tested approach to social policy in Anglo-Saxon cultural contexts is well documented. However, four additional cultural dimensions merit scrutiny in Canada, especially as family policy innovations in the United Kingdom, Australia and New Zealand begin to leave Canada behind. First, despite our strong fiscal footing, we have convinced ourselves that we cannot afford to invest in many social determinants of health until citizens reach the apparently ‘magic’ age of six years, when we sanction and fund children attending school full time. The language of affordability is distracting, however, because there are very few public policies that nation-states cannot afford. Indeed, in response to the recession, Canadians have learned that we are able to afford a range of government decisions – which would have been surprising many years previously – including partial ownership of the (until recently) largest auto corporation in the world. Recession-induced policy decisions thus helpfully remind us that affordability debates are typically debates about priorities. Canadians have not invested much in the early childhood years, because we have prioritized other policy decisions, especially tax cuts over the past decade, and, to a lesser extent, medical care (re-)investments.
Although public opinion polls consistently rank health care among the top Canadian priorities, a second problem with our national culture is that we continue to think about this issue primarily as the medical care needed to treat illness rather than the promotion of well-being and preventive care. But as provinces (such as BC) trade reductions in child care spending in favour of medical care investments for an aging population (7), we must become sophisticated critics of medical care. Key questions include (5): What do we owe one another in a just society as our capacity to save lives increases dramatically with the use of costly technologies and drugs? And what does it mean for a society when it can and does spend hundreds of thousands, if not millions, of dollars to save a preterm baby – one life – but is hesitant to promote population health through programs such as early learning and care, housing, food, etc?
The worrisome vulnerability levels at kindergarten further reflect that Canadian culture increasingly ignores the relationship between gender equality and strong family policy. Norway, Finland and Sweden, countries that rank at the top of UNICEF’s family policy report card, all enjoy top international rankings for gender equality as measured by the World Economic Forum (8). In contrast, Canada ranked 31st.
Canada’s gender ranking falls short of these leaders because we are slower to discard post-World War II attitudes about family policy. Feminism in combination with declining real male wages propelled the majority of Canadian women with preschool-age children into the labour market to sustain household income. Yet policy makers have compensated with too few measures that culturally support fathers taking more time to fulfill personal care aspirations; oblige men to assume responsibility for caregiving whenever they shirk this social reproduction; and provide new community caregiving services that free mothers as much as fathers to produce in the marketplace (9). Instead, we cling to the vestiges of our family allowance tradition, one of Canada’s first universal programs. This allowance was implemented as World War II child care services were eliminated to support the patriarchal, middle-class goal of a ‘family wage’ sufficient to sustain male breadwinners, their wives at home, and dependent children. The nostalgia we have for this policy approach is problematic because contemporary measures, such as the Canada Child Tax Benefit and the Universal Child Care Benefit, are insufficient to stave off poverty for more than 10% of families with children; and they are anachronistic because they fail to recognize that the best insurance against financial poverty in the global economy is for families to support two adults in the labour force. In the absence of maternal earnings, the National Council of Welfare (10) reports that the percentage of poor Canadian husband-wife households with children younger than six years of age would triple.
A final feature of Canadian culture that merits critique is the latitude we give baby-boomers to neglect the generations that walk in their footsteps. Baby-boomers are presently the dominant generation, especially politically. It is thus the baby-boomer generation that tolerates nearly 30% of children becoming vulnerable before they reach school. It is baby-boomers who collectively inherited relatively little environmental degradation, but now tolerate Canada remaining a fossil fuel dinosaur at the expense of environmental sustainability. And it is baby-boomers who inherited little debt in the decade after World War II, but now leave other generations with a federal debt that surpasses 30% of GDP. Ironically, baby-boomers are the generation who benefited from the Depression and World War sacrifices of their parents and grandparents who sought to leave a better world for future children. Although baby-boomers echo their parents’ rhetoric about leaving a better place, their collective political, economic and environmental decisions belie a different reality, one that ignores intergenerational justice.
What is to be done? The UNICEF report card identifies policy levers that support access to the time, money and community services that all families need to rear children who benefit from optimal early development. Kershaw (9) and Kershaw et al (11) adapted the international evidence to the Canadian context, recommending that senior levels of government:
Table 1 estimates the costs of the four recommendations for each of the 10 provinces (territorial estimates are ongoing). The pan-Canadian price tag is just under $22 billion annually. Although substantial, the investment would be very modest compared with total federal/provincial spending on health care, estimated to be $170 billion annually (12). It is also less than one-half the combined annual federal investment in elderly benefits ($32 billion in 2007/2008) (13) and registered pension plan/registered retirement savings plans ($28 billion in 2009) (14).
The $22 billion price tag is the additional investment required per year to reduce vulnerability rates at school entry from 30% to 10% over 10 years, and to sustain vulnerability at this low level (11). A meta-analysis of the hundreds of studies that examine how ECEC influences child development by Barnett (15) affirms that our ECEC service recommendation alone would reduce the majority of this early vulnerability gap.
The research regarding biological embedding of early social stimuli is now so compelling that economists increasingly argue that the most cost-effective human capital interventions will occur among young children (16). Thus, there is growing economic support for investing substantially now to forestall the future human capital problem that is foreshadowed by current levels of child vulnerability. In keeping with this research, Kershaw et al (11) used unique population-level data to quantify what biologically unnecessary vulnerability above 10% costs society. They showed that this vulnerability will cause the BC economy to forgo 20% in GDP growth over the next 60 years because of lost human capital. The economic value of this loss in BC amounts to a $401.5 billion investment today, along with the interest it would earn over the next 60 years. Projecting the BC analysis to the entire country, we estimate that unnecessary early vulnerability costs Canada the equivalent of investing $3.1 trillion, nearly seven times the Government of Canada’s current debt (accumulated deficit). By reversing the early brain drain represented by biologically unnecessary vulnerability, the $22 billion annual investment in the four policy recommendations would yield returns that outweigh costs by a ratio of 6:1.
Patience is a necessary virtue, however, because the children who benefit from less vulnerability must work their way through school to become the majority of the labour force before their increased human capital will enhance GDP growth substantially. In the meantime, the proposed policy changes will generate partial cost recovery by enhancing labour supply, reducing health expenditures related to work-life conflict and reducing the social costs of crime. Conservative projections indicate that even in the first years of policy change, governments will recoup at least 25 cents of every dollar, and the cost-recovery will accelerate thereafter.
In short, reducing early vulnerability is smart economics. It is also a just cause, minimizing inequality in the determinants of health and minimizing gender inequality. All that remains is for Canadian culture to evolve so that we rank this reduction as a top policy priority. As long as we delay, being Canadian will compromise our health because we fail to invest in its social determinants (7).