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Paediatr Child Health. 2009 December; 14(10): 692–693.
PMCID: PMC2807818

Improve health by reshaping public policy

Reprinted from Are We Doing Enough?
Canadian Paediatric Society

Français en page 694

As an advocate for child and youth health, the Canadian Paediatric Society (CPS) devotes considerable attention to identifying evidence-based approaches to critical health issues. This focus has served us well in improving clinical practice. However, the long-term well-being of children and youth requires a broader view of the health of populations. In the 2009 edition of Are We Doing Enough? A status report on Canadian public policy and child and youth health (1), the CPS looks at issues of health promotion and primary prevention through the lens of the social determinants of health. Income and social status, education, housing, early child development and cultural status all play a far greater role in the health of children and youth than any of the health services we can provide them. Government leadership has had an impressive impact on issues such as immunization, tobacco control and seat belt safety. The CPS calls on all governments to take action on evidence-based policies and interventions to address the basic issues that determine good health. Prime among these is income disparity.

Child poverty – Poor children and youth are not as healthy, and have higher infant mortality rates and shorter life expectancies than others. While this may seem like an obvious statement, it has been the focus of considerable research of late, and the conclusion is irrefutable. Health disparities among Canadian children and youth are primarily linked to differences in family socioeconomic status. Children of new immigrants and Aboriginal children are particularly vulnerable, and are far more likely to grow up in poor families (2). According to the Health Officers Council of British Columbia, “Among all the policy areas for…reducing health inequity, none is more significant than that of income security and measures for reducing poverty in the province” (3).

Aside from the moral imperative, addressing child poverty makes economic sense. The poorest one-quarter of residents uses twice the health care services as those in the wealthiest quarter (3). Referring to early child development programs, Canada’s Chief Public Health Officer’s report notes that “…$1 invested in the early years saves between $3 and $9 in future spending on the health and criminal justice systems, as well as on social assistance” (4).

Although some efforts have been made in Canada through the introduction of the national child tax benefit system and other tax benefits, these have not been adequate. There has been only a slight reduction in the number of children living in poverty during the past 20 years (5). More comprehensive strategies that take advantage of the full range of policy and program levers are necessary to both significantly reduce child poverty in Canada and to reduce the impacts of poverty on the life chances of children and youth. These measures include, but are not limited to income security programs, labour market training, tailored employment supports for vulnerable groups, minimum wage policies, employment standards, settlement programs, access to quality child care and early child education, affordable housing, and drug, dental and vision care insurance for lowincome families.

Legislation and public policy have the power to save young lives and provide the support necessary to allow children and youth to develop to their full potential. Sweden’s wealth distribution and child care policies ensure low child poverty rates. Recent efforts in the United Kingdom have resulted in significant progress to reduce poverty (6). The CPS believes that all children and youth deserve equal opportunities for success in life.

Progress on the issues raised in our two previous reports has been mixed. While important gains have been made on some issues, movement has been much slower or nonexistent on others.

Smoking – Canada’s efforts regarding smoking cessation continue to reap benefits. Smoking rates among teens continue to drop, reaching an all-time low of 15% in 2008 among youth 15 to 19 years of age (7). At the same time, Aboriginal youth continue to smoke at three or four times the rate of other Canadian youth (8). Children and youth from low income families also smoke at higher rates than the national average (9). Four Canadian provinces have recently introduced legislation against smoking in cars where children are present, and other provinces are considering doing the same (10). Meanwhile, brand new federal legislation amended the Tobacco Act to finally ban all tobacco advertising in magazines and newspapers. It also prohibits the sale of flavoured and small packages of ‘cigarillos’.

Mental health – A comprehensive approach to addressing mental health among children and youth in this country is still lacking. While work is underway to develop a national mental health strategy, including a focus on children and youth, many provinces and territories do not have a mental health plan. Even where plans exist, access to mental health services is lacking and, in some cases, declining. Both screening for and treatment of mental health disorders continue to be severe problems, with three-quarters of children and youth who need specialized treatment not receiving it (11). Approximately 70% of mental illnesses have their onset in childhood or adolescence, reinforcing the importance of early monitoring, prevention and treatment to reduce their potential lifelong impact (11).

Injuries – Unintentional injuries remain the leading cause of death for children and youth in Canada, yet no cohesive national injury prevention strategy is on the horizon. This is a clear case of inaction in the face of compelling evidence. Strong legislation prevents injuries and saves lives. A 10-year review of data shows that hospitalization and death rates have declined by almost one-third, partly due to changes in helmet use and the introduction of helmet laws in six provinces during this period (12). In provinces where bicycle helmet legislation has been enacted, injuries have been reduced by 25% (13). Yet there continues to be a hodgepodge of uneven and, in some cases, contradictory legislation that threatens the safety of children and youth.

Some children are at greater risk of injury. Research shows that children who live in poverty have higher rates of death due to unintentional injuries than those who do not (14). Among First Nations populations, injury is a leading cause of death and by far the greatest source of potential years of life lost, at almost 3.5 times the national average (15).

Paediatric human resources – The health needs of children and youth are unique and complex. No single health care professional can meet all of them. A commitment to a coordinated team approach – with family physicians, paediatricians, child and adolescent psychiatrists, nurses and other specialists working together – is vital to providing quality health care for young people (16). The CPS continues to raise the alarm regarding the pending shortage of paediatricians. As with other health care professionals, paediatricians are retiring in ever-increasing numbers, without a sufficient group of incoming physicians to replace them. Currently, no jurisdiction has a plan to address this concern, putting the future health of children and youth in jeopardy.

Rights of the child – Spring 2010 marks the 20th anniversary of Canada signing the United Nations Convention on the Rights of the Child. In May 1990, Canada recognized the special needs of children and youth, and agreed to protect their rights. Unfortunately, there is no Canadian Commissioner for Children and Youth or other independent mechanism in place to enforce this commitment. Most provinces (but none of the territories) now have child and youth advocates; however, many of these advocates address only children and youth in the care of the province. Their limited mandates and lack of independence impede their power to protect the unique rights of all children and youth.

CPS COMMITMENT

The 2009 edition of Are We Doing Enough? raises a number of areas of concern. The CPS hopes it serves to spur governments on to meet their responsibilities to children and youth, and that it is useful to other advocates. We aspire to a day when all policies and programs that affect children and youth are automatically reviewed by an independent body designed to stand for the rights of young people. In the meantime, we hope that the issues highlighted by Canada’s paediatricians are taken seriously by our legislators. The CPS is committed to working with all Canadians to improve the health and welfare of children and youth. This is our promise.

REFERENCES

1. Canadian Paediatric Society Are We Doing Enough? A status report on Canadian public policy and child and youth health Ottawa: Canadian Paediatric Society; 2009. <www.cps.ca> (Version current at December 1, 2009).
2. Campaign 2000 2008. Report Card on Child and Family Poverty in Canada <www.campaign2000.ca/reportCards/national/2008EngNationalReportCard.pdf> (Version current at November 13, 2009).
3. Health Officers Council of BC, Health Inequities in British Columbia: Discussion Paper, November 2008. <www.bchealthyliving.ca/files/HOC_Inequities_Report.pdf> (Version current at November 19, 2009).
4. Grunewald R, Rolnick A.Public Health Agency of Canada, The Chief Public Health Officer’s Report on the State of Public Health in Canada 2008. <www.phac-aspc.gc.ca/publicat/2008/cpho-aspc/index-eng.php> (Version current at November 19, 2009).
5. Campaign 2000 2009. Report Card on Child and Family Poverty in Canada. <www.campaign2000.ca/reportcards.html> (Version current at November 10, 2009).
6. Lemstra M, Neudorf C. Health Disparity in Saskatoon: Analysis to Intervention. Saskatoon: Saskatoon Health Region; 2008.
7. Canadian Tobacco Use Monitoring Survey 2006. <www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_2006/ann-table1-eng.ph> (Version current at November 19, 2009).
8. Canadian Paediatric Society, First Nations and Inuit Health Committee Use and misuse of tobacco among Aboriginal peoples – update 2006. Paediatr Child Health. 2006;11:681–5.
9. Pomerleau J, Pederson LL, Østbye T, Speechley M, Speechley KN. Health behaviours and socio-economic status in Ontario, Canada. Eur J Epidemiol. 1997;13:613–22. [PubMed]
10. Canadian Press, June 2008.
11. Mental Health Commission of Canada Towards Recovery and Well-being. A Framework for a Mental Health Strategy for Canada, January 2009. <www.mentalhealthcommission.ca/SiteCollectionDocuments/Key_Documents/en/2009/Mental_Health_ENG.pdf> (Version current at November 19, 2009).
12. Safe Kids Canada Child and Youth Unintentional Injury: 1994–2003, 10 Years in Review, July 2007. <www.mhp.gov.on.ca/English/injury_prevention/skc_injuries.pdf> (Version current at November 19, 2009).
13. Macpherson A, Spinks A. Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries. Cochrane Database Syst Rev. 2007:CD005401. [PubMed]
14. Birken CS, Parkin PC, Macarther C. Trends in rates of death from unintentional injury among Canadian children in urban areas: Influence of socioeconomic status. CMAJ. 2006;175:867. [PMC free article] [PubMed]
15. Health Canada A Statistical Profile on the Health of First Nations in Canada: Health Services Utilization in Western Canada, 2000, June 2009. <www.hc-sc.gc.ca/fniah-spnia/pubs/aborig-autoch/2009-stats-profil-vol2/index-eng.php> (Version current at November 13, 2009).
16. Canadian Paediatric Society A model of paediatrics: Rethinking health care for children and youth, Paediatr Child Health. 2009;14:319–25. [PMC free article] [PubMed]

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