Every day, too many children and youth in Canada experience preventable injuries and infections, chronic disease, poverty, or unequal access to quality health care and education. Many of their difficulties are rooted in public policies that do not put the needs of children and youth first. According to the 2016 UNICEF-Innocenti Report Card, Canada ranked 26th among 35 rich countries on the overall well-being of its children.2 When responses from children and youth to a life satisfaction survey were factored in, Canada only gained one level, meaning our young people are among the least happy in the developed world.
Are We Doing Enough? can help change this picture. The Canadian Paediatric Society has a long and successful history of working with government representatives, agencies and allied organizations to improve the health and well-being of children and youth. Government-led programs and health promotion strategies have proven and substantial powers to save lives, prevent injuries and protect against disease. But we can always do more. While legislation has progressed in some areas since the 2012 status report, some governments still need to coordinate and implement better public policies on the issues evaluated here. Further steps are needed because, as we’ve already seen, sustained advocacy and sound policies produce amazing results.
Policy matters... In recent years, significant progress has been made in protecting children and youth from vaccine-preventable diseases. With only a few exceptions, children and youth across Canada have publicly funded access to all routine vaccines. Vaccination programs have significantly reduced many vaccine-preventable diseases such as meningococcal and pneumococcal infections, Haemophilus influenzae, and rotavirus disease, among others. Three provinces have yet to implement a rotavirus program, though the evidence shows that rotavirus vaccination protects young children and alleviates demands on emergency departments.3
Policy matters... When governments implement strong policies to prevent and reduce smoking rates among children and adolescents, smoking prevalence decreases. Fewer children are exposed to second-hand smoke, leading to healthier families and fewer trips to the hospital for pneumonia and asthma-related complications. However, while Canada’s efforts on smoking cessation have reaped significant benefits, new challenges lie ahead. Youth are being exposed to a broader spectrum of tobacco products, including smokeless tobacco, flavoured tobacco, water pipes and e-cigarettes, for which traditional government controls are wholly inadequate. Governments must develop policies that regulate e-cigarettes and novel tobaccos as strictly as cigarettes and traditional tobacco products.
Policy matters... Where injury prevention legislation is strong, paediatricians see fewer ER visits, hospitalizations, brain injuries and preventable deaths. However, unintentional injuries are still the leading cause of death, morbidity and disability in Canadian children and youth, and legislation is a sorry patchwork on some key safety issues. For example, there is no consistent approach to bicycle helmet, booster seat or off-road vehicle legislation in this country. Five provinces or territories still have no legislation on bicycle helmets despite evidence that helmet wearing reduces risk of brain injury by up to 80%.4 Effective safety policies and programs reduce the human and economic costs we all bear.5 Canada needs a national injury prevention strategy which includes outreach, education and safety legislation that is enforced at all government levels. Injury prevention is undoubtedly the best approach to reducing the present burden of harm and, like immunization, could be one of the great public health achievements of the 21st century.6
Policy matters… Where child death review processes are standardized – including data collection – positive outcomes follow, such as effective injury prevention campaigns and laws that truly safeguard young lives. Also, stakeholders from multiple disciplines and agencies tend to share information and learn from one another. When we understand how and why children die, we can take better measures to protect them.7
Policy matters… Where universal newborn hearing screening programs are in place, early diagnosis leads to earlier interventions and better outcomes for children with a hearing impairment. Permanent hearing loss is one of the most common congenital disorders of childhood, occurring in about two per 1,000 live births. Children with hearing loss who do not receive timely intervention often have problems with communication and psychosocial skills, cognition or literacy later on.
Far too often, physicians see children and youth with preventable medical issues. While every government has the onus to protect through policy and legislation, health experts play an essential role in shaping such laws and programs. Are We Doing Enough? is for advocates working with governments to keep kids healthier and safer. As a tool, the status report is most effective in the hands of experts who care about these issues. The changes to public policy recommended here are based on best evidence and decades of experience persuading governments to take paediatric issues seriously.
A few examples... Past CPS President Dr. Richard Stanwick worked for years to raise public understanding about the serious health consequences of second-hand smoke, which has resulted in stronger anti-smoking legislation. In 2013, paediatric residents in Manitoba were instrumental in persuading their provincial government to introduce bicycle helmet legislation. Dr. Susanna Martin’s concern over car-related injury and death rates led her to champion booster seat legislation in Saskatchewan, with results clearly reflected in this report. Paediatricians are uniquely qualified to engage government on policies to improve child and youth health and well-being.
Child and youth mental health strategies have not been re-evaluated in this edition, but the CPS recognizes the serious challenges to mental health in Canada. The need to reduce First Nations and Inuit youth suicide rates may be the loudest call to action, but there are many. Children and youth deserve equitable access to mental health services, treatments and culturally competent support programs. And while some provinces and territories have developed mental health strategies since 2012, CPS members tell us this step has not improved access to services and programs significantly. Wait times and other barriers to mental health services have serious and lasting consequences for individuals, families and communities. Because about 70% of mental illnesses first appear in childhood or adolescence, early prevention, screening, and treatment are key to reducing lifelong impacts.8 Along with mental health experts and partnering organizations, the CPS urges all levels of government to develop and fund programs providing timely mental health services to young people.
Child poverty is not easy to measure, but a national poverty reduction strategy remains an issue of foremost importance. The federal government has recently committed in mandate letters to help Canadian families living in substandard conditions. In fact, 19% of children and fully half of status First Nations children now live below the poverty line in Canada.9 Among the many effects of low socioeconomic status is a strong association with poor health later in life. All Canadian children and youth deserve the same opportunities no matter where they live. The CPS urges governments at every level to work together and with allied stakeholders to eradicate family poverty. Supplementary health benefits, accessible and affordable child care, and targeted nutrition and housing programs would all help children and youth to thrive and reach their full potential. Governments must partner with First Nations, Métis and Inuit communities to eliminate the causes of systemic poverty.
The CPS commitment
The status report is only a snapshot, but the picture it provides is clear enough to raise concerns. Despite past efforts, a persistent patchwork of health and safety policies in Canada means that children and youth are not being cared for equitably. Far too often, the quality of care they receive depends on where they live. Are We Doing Enough? is a practical starting point for advocates, policy-makers and care providers who want to help all children and youth reach their full potential. They deserve no less.
- UNICEF Office of Research-Innocenti, 2016. Fairness for children: A league table of inequality in child well-being in rich countries (Report card 13): www.unicef-irc.org/publications/pdf/RC13_eng.pdf (page 12, accessed May 20, 2016).
- Coyle D, Coyle K, Bettinger JA, et al. Cost effectiveness of infant vaccination for rotavirus in Canada. Can J Infect Dis Med Microbiol 2012;23(2):71-7.
- Parachute Canada. Safe Cycling. http://www.parachutecanada.org/injury-topics/item/safe-cycling1 (accessed April 20, 2016).
- Parachute. The cost of injury in Canada report, 2015: www.parachutecanada.org/downloads/research/Cost_of_Injury-2015.pdf (accessed April 20, 2016).
- Yanchar NL, Warda LJ, Fuselli P; Canadian Paediatric Society, Injury Prevention Committee. Child and youth injury prevention: A public health approach. Paediatr Child Health 17(9):511.
- Ornstein A, Bowes M, Shouldice M, Yanchar NL; Canadian Paediatric Society, Injury Prevention Committee. The importance of child and youth death review. Paediatr Child Health 2013;18(8):425-8.
- Mental Health Commission of Canada, 2009. Toward recovery and well-being. A framework for a mental health strategy for Canada: www.mentalhealthcommission.ca/English/system/files/private/FNIM_Toward_Recovery_and_Well_Being_ENG_0.pdf (accessed April 20, 2016).
- 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).