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Canadian Paediatric Society

Federal government policies and programs

Child and youth well-being is essential to a strong and prosperous country. Provincial and territorial governments play a critical policy-making role in education, health and transportation, while federal leadership can improve the public health and socio-economic well-being of Canada’s youngest citizens in major ways, for the long term.

The recently elected federal government made serious policy commitments on behalf of children and youth and included several in ministerial mandate letters in the fall of 2015. Besides the landmark issues rated below, the Canadian Paediatric Society (CPS) urges the government to enact evidence-based legislation in other ‘high impact’ areas for children and youth: firearm safety, recreational marijuana use, access to mental health services, injury prevention strategies, and youth criminal justice system reforms.

The government’s mandate is still in its early days. Because thoughtful policy change takes time, the CPS is reserving assessment – temporarily – on a number of issues contained in this report. The report’s new online format will allow us to track progress and update ratings as needed over the coming months.

Immunization

Rating: Pending

Infectious diseases were once the leading cause of death in Canada but now account for less than 5% of deaths, making immunization the most cost-effective public health effort of the last century. While provincial/territorial immunization programs have clearly benefited from federal involvement, the lack of a national immunization registry is a significant gap that should be addressed at the highest levels. A registry would help increase uptake and ensure that vaccines reach all segments of the population. It would facilitate the transfer of patient immunization records across jurisdictions. It would also enhance national surveillance of vaccine-preventable diseases and help track any adverse reactions.

The CPS credits the federal government with:

  • Recognizing the need to increase vaccination rates in the Health Minister’s mandate letter. Federal departments should continue working closely with their provincial/territorial counterparts and allied stakeholders to increase overall national immunization rates.
  • Introducing label changes for certain homeopathic products – specifically nosodes – that fall under the Natural Health Products Regulations.
  • Investing $3.5 million over three years for CANImmunize (phase two), an innovative mobile app that helps Canadians keep their immunization information close at hand.

The CPS urges the federal government to work with provinces and territories to establish a national immunization registry – an important step toward providing full clinician access to all provincial and territorial registries.

Prevent smoking among youth

Rating: Pending

In recent years, youth have been exposed to a broader spectrum of tobacco products, including smokeless tobacco, flavoured tobacco, water pipes and e-cigarettes, over which there is inadequate government control. The current Tobacco Act has not kept pace with the availability of these new products.63 Despite national prevention strategies and legislation, thousands of teenagers become addicted to tobacco products each year and smoking rates seem to be stabilizing in Canada.64 Proper funding and coordinated inter-jurisdictional regulation are needed to forge a comprehensive tobacco control strategy. Studies show that population-based interventions should be culturally appropriate, target particular groups (such as Indigenous or LGBTQ youth, who have higher-than-average smoking rates), and overlap environments (e.g., home and school/school and community).65

Positive developments at the federal level include:

  • Health Canada’s Federal Tobacco Control Strategy (2012-2017), which has helped reduce demand for tobacco products by making smoking less affordable, less accessible and less appealing to young Canadians.
  • The Health Minister’s mandate letter, which introduced plain packaging requirements for tobacco products.

The CPS urges the government to:

  • Initiate work on the next iteration of the Federal Tobacco Control Strategy. It should include strategies and policies to regulate e-cigarettes and all flavoured tobacco products, including menthol.
  • Introduce legislation banning advertising and products aimed at youth.
  • Implement and fund evidence-based smoking prevention and cessation programs.

Early learning and child care/Early childhood development

Rating: Pending

Quality child care is a key determinant of health, development and learning in the early years. Canada has nearly 5 million children aged 0 to 12, but fewer than 990,000 regulated child care spaces.66 Spending on child care and preschool education is low in Canada compared with other OECD nations.67 The vast majority of families find child care expensive and difficult to access. Ensuring accessible, affordable child care for low-income families would ease their economic burden, make it easier for parents to enter the labour market, and help children learn alongside more advantaged peers.

A positive first step was including a National Early Learning and Childcare Framework in mandate letters to the Minister of Indigenous and Northern Affairs and the Minister of Families, Children and Social Development. The outline for a national child care agreement, to be used as the basis for funding agreements between federal and provincial/territorial governments, is projected for the summer of 2016.

The CPS urges the government to work closely with provinces, territories, Indigenous communities and experts in early learning to implement a national early childhood education and child care program. Quality of service should be the same wherever children live and whatever their socio-economic status or cultural origins.

Child and youth poverty

Rating: Pending

Nineteen per cent of children and fully half of status First Nations children now live below the poverty line in Canada.68 Income and socio-economic status are prime determinants of child and youth health.69 Federal investments are critical for reducing child poverty.

Positive developments at the federal level include:

  • Introducing the Canada Child Benefit (CCB).
  • The Minister of Families, Children and Social Development’s mandate letter promised development of a national poverty reduction strategy and an affordable housing strategy. 
  • The reinstatement of the mandatory long-form census – an essential tool for tracking poverty rates in specific or marginal populations.

The CPS urges the government to develop – in consultation with provincial and territorial governments, Indigenous leadership and nongovernmental organizations – a federal action plan with targets and timelines to reduce child poverty. This plan should include an affordable housing strategy70 and a national child care program.

Jordan’s Principle (click here for context)

Rating: Pending

In a 2016 ruling,71 the Canadian Human Rights Tribunal described how the federal government’s narrow interpretation of Jordan’s Principle—as relevant only to children with complex medical conditions under the care of multiple service providers—along with complicated and time-consuming processes, accounted for the government’s report of no cases meeting the criteria for Jordan’s Principle. The Tribunal ordered the Department of Indigenous and Northern Affairs to “cease applying its narrow definition of Jordan’s Principle and to take measures to immediately implement the full meaning and scope of Jordan’s Principle.” In a response to the Tribunal dated May 10, 2016,72 the federal government said that it had expanded the scope of Jordan’s Principle, and “committed to providing the necessary resources to implement Jordan’s Principle”. The CPS acknowledges the federal government’s commitment in July of $382 million in new funding to implement Jordan’s Principle. Along with other advocates, the CPS will continue to monitor and assess progress toward full implementation.

Commissioner for Children and Youth

Rating: Poor

Canada signed the United Nations Convention on the Rights of the Child 25 years ago, agreeing to protect and ensure children’s rights.73 That commitment also acknowledged Canada’s obligation to make sure all children have opportunities to develop cognitively, physically, socio-emotionally and spiritually.74 As yet, there is no federal child and youth advocate to hold the government accountable for this commitment.

The CPS urges the government to establish this independent office to monitor the well-being of Canada’s children and youth, help guide investments in future generations, and promote equitable public policies, with specific focus on Indigenous, immigrant, refugee and other marginalized groups.

Interim Federal Health Program

Rating: Excellent

The CPS commends the government for fully restoring the Interim Federal Health Program, which provides limited, temporary coverage of health care benefits to all protected persons, including resettled refugees, refugee claimants and certain other groups who are ineligible for provincial/territorial health insurance.

Recommendations of the Truth and Reconciliation Commission

Rating: Pending

The federal government has committed to implement all 94 ‘calls to action’ framed by the Truth and Reconciliation Commission in late 2015. What is urgently needed is an implementation plan, with roll-outs designed in partnership with Indigenous community leaders and provincial/territorial authorities.

Endnotes

  1. Justice Canada. Tobacco Act (S.C. 1997, c. 13): http://laws-lois.justice.gc.ca/eng/acts/T-11.5/ (accessed April 20, 2016).
  2. Statistics Canada. Changes in smoking between 1994/1995 and 2004/2005, 2006/2007, 2008/2009 and 2010/2011, by sex: www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health59-eng.htm (accessed April 20, 2016).
  3. Harvey J, Chadi N; Canadian Paediatric Society, Adolescent Health Committee. Preventing smoking in children and adolescents: Recommendations for practice and policy. Paediatr Child Health 2016;21(4):209-21.
  4. Childcare Resource and Research Unit. Early childhood education and care in Canada 2012: http://childcarecanada.org/sites/default/files/CRRU_ECEC_2012_revised_dec2013.pdf (accessed April 20, 2016).
  5. The Organisation for Economic Co-operation and Development (OECD). PF3.1: Public spending on childcare and early education, 2011: www.oecd.org/els/soc/PF3_1_Public_spending_on_childcare_and_early_education.pdf (accessed April 20, 2016).
  6. Campaign 2000. Report Card on Child and Family Poverty in Canada, 2015: http://campaign2000.ca/wp-content/uploads/2016/03/2015-Campaign2000-Report-Card-Final-English.pdf (accessed April 20, 2016).
  7. Health Council of Canada, 2010. Stepping it up: Moving the focus from health care in Canada to a healthier Canada: www.healthcouncilcanada.ca/tree/2.40-HCCpromoDec2010.pdf (accessed April 20, 2016).
  8. Waterston S, Grueger B, Samson L; Canadian Paediatric Society, Community Paediatrics Committee. Housing need in Canada: Healthy lives start at home. Paediatr Child Health 2015;20(7):403-07.
  9. UNICEF Canada. About the Convention on the Rights of the Child: www.unicef.ca/en/policy-advocacy-for-children/about-the-convention-on-the-rights-of-the-child (accessed April 20, 2016).
  10. Department of Justice Canada. Government response: http://s3.documentcloud.org/documents/2829073/Fed-Govt-Response-to-CHRT.pdf (accessed April 20, 2016).
  11. UNICEF Canada. About the Convention on the Rights of the Child: http://www.unicef.ca/en/policy-advocacy-for-children/about-the-convention-on-the-rights-of-the-child (accessed April 20, 2016).
  12. UCL Institute of Health Equity, 2010. Fair Society Healthy Lives: The Marmot Review; Strategic review of health inequities in England post-2010: www.instituteofhealthequity.org/Content/FileManager/pdf/fairsocietyhealthylives.pdf (accessed April 20, 2016).