Federal government policies and programs
Child and youth well-being is essential for a strong and prosperous country. Federal policies and programs that strengthen paediatric health have a direct impact on lifelong health and wellness and are foundational to the pursuit of health equity for every child in Canada.
The current federal government has made meaningful policy commitments on behalf of children and youth and included several in ministerial mandate letters. In addition to the landmark issues below, the Canadian Paediatric Society (CPS) urges the Government of Canada to enact evidence-based legislation in other priority issue areas for children and youth including: firearm safety, recreational marijuana use, access to mental health services, and injury prevention strategies.
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
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
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
Today, nearly 1 in 5 children in Canada (17.4%) live in poverty.68 For First Nations children, that number more than doubles to at least 37.9%. 69 Despite Canada’s place as one of the wealthiest nations in the world, and our 1992 ratification of the Convention of the Rights of the Child, children represent 25% (1.2 million) of Canada’s 4.8 million people in poverty. 70
Income and socio-economic status are prime determinants of child and youth health, impacting food and nutrition, housing, clean water, early childhood development, educational outcomes and access to prescription drugs and medical services.
Recent positive developments in reducing child and youth poverty at the federal level include:
- Expanding the Canada Child Benefit (CCB) and indexing it to inflation
- Reinstating the mandatory long-form census – an essential tool for tracking poverty rates in specific or marginal populations
- Introducing Canada’s first National Housing Strategy, which includes:
- A commitment to invest $40 billion over 10 years in housing to provide Canadians with accessible, affordable housing that meets their needs
- A commitment that at least 33% of funds will go to projects for women, girls and their families, recognizing the unique vulnerability women and children face in housing
- A commitment to support the successful implementation of housing strategies for First Nations, Inuit and Métis
- Introducing Canada’s first Poverty Reduction Strategy, which includes:
- An official poverty line for Canada, based on the cost of a basket of goods and services that individuals and families require to meet their basic needs and achieve a modest standard of living across the country
- Targets to reduce poverty by 20% by 2020 and 50% by 2030 (in line with Canada’s 2015 commitment to the UN Sustainable Development Goals)
- The establishment of a National Advisory Council on Poverty to advise the Minister of Families, Children and Social Development on poverty reduction and to publicly report on the progress that has been made toward poverty reduction every year
- A proposal to introduce a Poverty Reduction Act in Parliament to entrench the targets, official poverty line and the Advisory council into legislation
The CPS urges the government to fully implement the commitments made in the National Housing Strategy and Poverty Reduction Strategy, and – in consultation with provincial and territorial governments, Indigenous leadership and NGOs – a national child care program. A national child care strategy that recognizes the impact of the early years on a child’s chances for success later in life and for reducing rates of family poverty (particularly for single-parent, female-headed households) is essential for putting an end to intergenerational poverty and ensuring every child has the opportunity to grow into their full potential.
Jordan’s Principle (click here for context)
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
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
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
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.
- Justice Canada. Tobacco Act (S.C. 1997, c. 13): http://laws-lois.justice.gc.ca/eng/acts/T-11.5/ (accessed April 20, 2016).
- 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).
- 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.
- 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).
- 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).
- Statistics Canada. (2017). Table 111-0015 – Family characteristics, Low Income Measures (LIM), by family type and family type composition, annual, CANSIM 2015.
- Statistics Canada – 2016 Census. Catalogue Number 98-400-X2016173. This figure likely underestimates poverty among First Nations people in Canada due to incomplete enumeration of certain Indian reserves and settlements in the 2016 Census.
- Campaign 2000. Report Card on Child & Family Poverty, 2017: https://campaign2000.ca/wp-content/uploads/2017/11/EnglishNationalC2000ReportNov212017.pdf.
- 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).
- Department of Justice Canada. Government response: http://s3.documentcloud.org/documents/2829073/Fed-Govt-Response-to-CHRT.pdf (accessed April 20, 2016).
- 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).
- 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).