Are We Doing Enough? A Status Report on Canadian Public Policy and Child and Youth Health

The Canadian Paediatric Society (CPS) in its 2016 edition of its Are We Doing Enough? Report, commends the actions taken by federal and provincial governments over the past ten years.  “Canada has certainly come a long way since 2005”, when the first report was released.  “Governments are doing better in many critical areas….However, on every measure contained in this report, there is still work to do.”

The authors of the report state, “How Canada cares for and nurtures its younger generations is our clearest possible expression of collective values and national well-being….Through their daily work with children, CPS members recognize how investing in child and youth health and family health promotion can net huge gains – both human and financial. The purpose of this report is to share these insights and accompanying evidence-based recommendations with policy makers.”

The report assesses public policy in five major areas:

  • Disease prevention
  • Health prevention
  • Injury prevention
  • Best interests of children and youth
  • Federal Government Policies and Programs

New key issues evaluated in the 2016 report include breastfeeding promotion, child death review processes and the management of type 1 diabetes in schools.

The report notes “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….According to the 2016 UNICER-Innocenti Report Card, Canada ranked 26th among 35 rich countries on the overall well-being of its children.”  They stress that, while “government-led programs and health promotion strategies have proven and substantial powers to save live, prevent injuries and protect against disease…further steps are needed because, as we’ve already seen, sustained advocacy and sound policies produce amazing results.”

 Photo Credit: Jorge Barahona, Unsplash Free Stock

Photo Credit: Jorge Barahona, Unsplash Free Stock

Areas of particular relevance in the report to families with young children in BC include:

Disease Prevention

  • Immunization
    • The report notes, “Infectious diseases were once the leading cause of death in Canada.  They now account for less than 4% of deaths, making immunization the most cost-effective public health measure of the last century.”
    • “About half of provinces and territories have an electronic immunization registry…The CPS urges provinces and territories to work toward establishing electronic immunization registries and a universal schedule for administering vaccines.”
    • 2012 status – Excellent; 2016 status – Good (provides all of the recommended vaccines but does not have a central immunization e-registry)
    • Recommended actions:  Implement a central immunization e-registry

Health Promotion

  • Breastfeeding promotion
    • The report notes, “To improve worldwide breastfeeding initiation and duration rates, the World Health Organization (WHO) and UNICEF launched the Baby-Friendly Initiative (BFI) in 1991, the cornerstone of which is the Ten Steps to Successful Breastfeeding…As of March 2016, Canada reported having 114 BFI-designated facilities (hospitals and community health services) – with the majority in Ontario (23) and Quebec (86).”
    • The CPS recommends that governments implement a BFI policy or strategy, with a designated coordinator and breastfeeding education for all health care providers, managers and volunteers working in hospitals and community services that care for mothers and babies, and that provinces and territories develop incentives to encourage and support BFI certification; track breastfeeding practices, especially initiation, duration and exclusivity rates; provide easily accessible supportive services, such as lactation consults in person or by phone/email; and provide pasteurized human milk banking for sick or premature infants.
    • 2016 status – Good (province/territory has 3 or 4 of the above components in place)
    • Recommended actions:  Provide incentives that encourage and support health facilities to become BFI-certified
    • Comments:  BC has two facilities due for BFI redesignation.  Facilities do not receive funding incentives from government to become BFI-certified
    • Newborn hearing screening
      • The report notes, “Permanent hearing loss is one of the most common congenital disorders of childhood, occurring in about two per 1,000 live births.  Universal newborn hearing screening (UNHS) leads to earlier diagnosis and intervention, which means better outcomes for children with a hearing impairment.”
      • 2012 status – Excellent; 2016 status – Excellent (province/territory has a fully funded, integrated screening program, with all babies screened by 1 month of age, diagnoses confirmed by 3 months, and interventions in place by 6 months)
      • Meets all CPS recommendations
      • An enhanced 18-month well-baby visit
        • The report notes this as an area requiring action in BC, as “well-baby visits are now recognized as key opportunities to assess growth and positively affect life outcomes.  For some families, the 18-month visit might be the last regularly scheduled visit with a primary care provider before a child enters school.”  They note that “the 18-month check-up can also be a pivotal assessment of developmental health.  Not only does it happen at an important point in a child’s development, it comes at a stage when families are dealing with formative issues such as child care, behavior management, nutrition/eating patterns, and sleep.  The 18-month assessment is an excellent opportunity to counsel and reinforce healthy behaviours, and to promote positive parenting, injury prevention and literacy.  Screening for parental health issues, including mental health, domestic abuse and substance misuse can also take place at this visit.”
        • 2012 status – Poor; 2016 status – Poor (province/territory has not initiated an enhanced well-baby visit at 18 months)
        • Recommended actions:  Initiate an enhanced well-baby visit at 18 months, with standard guidelines.  If the visit is conducted by fee-for-service physicians, they should have access to office-based tools and a special fee code.

Injury Prevention

  • Booster seat legislation
    • The report notes, “In 2013, more than 70 children under the age of 14 were killed and more than 8,900 were injured in car crashes in Canada.  Booster seats provide up to 60% more protection than seat belts alone.”
    • 2012 status – Excellent; 2016 status – Excellent (province/territory requires children to be in an approved booster seat until they reach 145 cm in height or 9 years of age and weigh between 18 kg and 36 kg.  Public education programs are in place)
    • Recommended actions:  Meets all CPS recommendations

Best Interests of Childern & Youth

  • Child and youth death review
    • The report notes, “There are currently no national standards in Canada for child death investigations, data collections around the circumstances of a child’s death, or death review processes.  Only a few provinces have formal child death review systems.”
    • 2016 status – Excellent (province/territory has a broadly representational child death review committee to review all child and youth deaths and a structured process, including reporting protocols, a linkable database for meaningful data collection, consolidation and dissemination, and an educative mechanism)
    • Recommended actions:  Meets all CPS recommendations
    • Jordan’s Principle
      • The report notes, “Because responsibility for First Nations children’s services is often shared among federal, provincial/territorial and First Nations governments, accessing certain services can be challenging…Jordan’s Principle requires the government of first contact to provide the service, and then resolve the funding issue.  As such, Jordan’s Principle is a mechanism to help ensure children’s human, constitutional, and treaty rights.”
      • The CPS surveyed all provinces and territories about their definition of and practices around Jordan’s Principle.  Not all provinces/territories responded, and amongst those who did, there were discrepancies of interpretation.  The CPS, along with other members of the Jordan’s Principle Working Group, “recommends a governmental response that is consistent with the vision of Jordan’s Principle advanced by First Nations and endorsed by the House of Commons.”
      • BC government response to CPS enquiries about application of Jordan’s Principle:  No response at time of publication

Federal Government Policies & Programs

  • Noting that the recently elected federal government has made serious policy commitments on behalf of children and youth, CPS has reserved assessment, temporarily, on a number of their regular federal reporting issues.  The report’s new online format will allow CPS to track progress on government priorities and commitments and update ratings on an ongoing basis.
  • Immunization
    • The CPS credits the federal government with recognizing the need to increase vaccination rates in the ministerial mandate letter; introducing label changes for certain homeopathic products; and investing $3.5 million over three years for ImmunizeCA (phase two), a mobile app designed to help Canadians keep their immunization information close at hand.
    • The CPS urges the federal government to work with provinces/territories to establish a national immunization registry, an important step toward providing full clinician access to all provincial/territorial registries.
    • Early Learning and Child Care/Early Childhood Development
      • The report notes, “Canada has nearly 5 million children aged 0 to 12, but fewer than 990,000 regulated child care spaces.  Spending on child care and preschool education is low in Canada compared with other OECD nations.  The vast majority of families find child care expensive and difficult to access.”
      • The report recognizes the positive first step taken in 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 report “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” that would offer equality of access “wherever children live and whatever there socio-economic status or cultural origins.”
      • Child and Youth Poverty
        • The report notes, “Nineteen per cent of children and fully half of status First Nations children now live below the poverty line in Canada.  Income and socio-economic status are prime determinants of child and youth health.”
        • The report recognizes developments at the federal level including the introduction of the Canada Child Benefit (CCB) and the reinstatement of the mandatory long-form census – “an essential tool for tracking poverty rates in specific or marginal populations”, along with the inclusion in the mandate letter of the Minister of Families, Children and Social Development of promised development of a national poverty reduction strategy and an affordable housing strategy.
        • The CPS recommends that “the government 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 strategy and a national child care program.”
        • Jordan’s Principle
          • Following on 2016 rulings from the Canadian Human Rights Tribunal, ordering 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” the federal government responded on May 10, 2016 that it had expanded the scope of Jordan’s Principle and “committed to providing the necessary resources to implement Jordan’s Principle.”
          • The CPS, along with other advocates, will continue to monitor and assess progress toward full implementation.
          • Commissioner for Children and Youth
            • The report notes that, as yet, there is no federal child and youth advocate to hold the government accountable for their commitment, 25 years ago, to the United Nations Convention on the Rights of the Child, agreeing to protect and ensure children’s rights.
            • 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, offering limited, temporary health coverage for protected persons, including resettled refugees, refugee claimants and certain other group who are ineligible for provincial/territorial health insurance.
              • Recommendations of the Truth and Reconciliation Commission
                • The report notes that the federal government ‘has committed to implement all 94 ‘calls to action’ framed by the Truth and Reconciliation Commission in late 2015.
                • The CPS urgently recommends the development of “an implementation plan, with roll-outs designed in partnership with Indigenous community leaders and provincial/territorial authorities.”

Download the full report.