Youth and the National Children’s Agenda

In Canada, the federal government is responsible for setting national standards and provides the impetus for national health accords with the provinces. Therefore, the federal government has a pivotal role to play in the generation of policies that promote adolescent development and the creation of health care guidelines that ensure adolescent-friendly health services. Now that the 2000 federal election is over, it is time to dust off A National Children’s Agenda: Developing a Shared Vision (NCA) (1). It certainly did not receive much attention during the election campaign. One wonders which parts of the NCA will ever be enacted and which ones will be buried.

In 1999, the federal government announced the NCA and stated its goals. None of the four goals identified specifically refers to promoting adolescent development. However, the document identifies “interrelated areas where cooperative effort can have positive effects” (1). One of the six areas is stated as “fostering strong adolescent development”. This is a worthy emphasis, but it has received little public attention, and the major focus of federal initiatives continues to be on early childhood. When youth issues do appear on the public agenda, they are either set in a negative context (let’s get tough with young offenders) or ‘tacked onto’ discussions of nonhealth initiatives (eg, crime prevention strategies).

The situation is not much different in other countries. The field of adolescent or youth health is still struggling to make its presence felt. The World Health Organization has long pioneered initiatives in adolescent health and development. In actuality, few of its resources are earmarked for adolescent issues. More recently, the World Health Organization joined with the United Nations Children’s Fund to release an important collaborative document (2); its title, Youth Health – For a Change: A UNICEF Notebook on Programming for Young People’s Health and Development, emphasizes the need for a stronger focus on adolescents and youth.

In the Americas, the Pan American Health Organization (PAHO) has written a number of important reports that focus on the need for an ongoing, systematic adolescent health planning process (3,4). PAHO advocates for an assets-based or resiliency-focused approach to adolescent development. The reports encourage redirection from the perception of adolescents as being problems to adolescence as a period of developmental opportunities. This redirection resonates in recent federal, provincial and territorial government discussions on adolescent development (5).

Canada lacks a national youth health policy. It has neither national nor provincial standards for its adolescent or youth health care services, nor a systematic approach to gathering adolescent outcome measures. However, existing data on adolescent health status and risk behaviours allow some generalizations to be made (6,7). The data confirm that youth in Canada are healthy. However, the reports also emphasize the existence of significant unmet needs in the broad domain of mental health and in the health of high risk youth (eg, Aboriginal adolescents, youth in care and youth with chronic conditions) (8).

Adolescent health services in Canada are scarce, fragmented, unevenly distributed and often hard to identify. It is the provincial (or territorial) governments that determine program priorities and distribute funds to service programs. So far, among provincial governments, adolescent health services receive very low priority and are often folded into (ie, get lost within) the mandate of existing paediatric or adult service programs. In the absence of a clear national youth health policy or clinical standards in adolescent health, it is most likely that the situation will not change. Certainly, the NCA has not been the answer.

At the individual patient level, adolescents are on the clinical agenda. Adolescents do use both general community-based and specialized health services such as hospital inpatient units, outpatient and walk-in clinics, emergency departments, a myriad of diagnostic services, family physician and specialist offices, mental health clinics, school health services, and family planning and sexually transmitted disease clinics. In these settings, paediatricians, family physicians and other medical specialists make an effort to ensure that the best possible care is delivered. There are several tertiary care programs in Canada that are adolescent specific. Three of the 13 provinces and territories offer such services.

Training and academic opportunities in adolescent health in Canada are scant. Eight of 16 medical schools report having someone trained in adolescent medicine on staff. Yet, Canada has less than two dozen trained adolescent health physicians. Most other professional groups and training programs (eg, nursing, occupational therapy, physiotherapy, social work, psychology, dentistry) do not even identify adolescence as an area of special focus. It seems that at the university level, adolescents have not really made it onto the agenda.

Adolescent health research in Canada is seriously underfunded, and adolescent-oriented research teams are almost nonexistent. Federal policy has resulted in increased funding for health care-related research. New money offers opportunities for provincially based programs to become involved in national partnerships and research networks. Unfortunately, few of these initiatives seem to focus on or be particularly interested in research issues related to adolescence. To date, university research establishments have not taken up the challenge of adolescent health research.

The new federal government needs to be reminded about the NCA and that adolescents do not seem to be one of its priorities. National organizations such as the Canadian Paediatric Society (CPS) can exercise leadership on behalf of the NCA’s stated goals. Our leadership at the CPS must help the government to understand that including adolescent development in the NCA is commendable, but it has done little to shape debate or restore balance among competing priorities.

The NCA strategy has placed heavy emphasis on early intervention, especially in early childhood. This strategy has ignored the potential of early intervention during early adolescence. As advocated by PAHO, a strategic focus on building resilience and diverting program emphasis from adolescents as being categories of problems (teen pregnancy, substance abuse, violence) to adolescents as contributors to their own development (peer counsellors, self-help group participants, Internet networkers) has great potential for success in the early adolescent years.

Will the NCA affect youth health in Canada? I think not! It is but a stepping stone toward the creation of a National Youth Health Agenda (NYHA). It could be an important legacy of the new federal government. Canadians do not have to start from ground zero. Other countries have provided models that we may emulate and adapt to suit our national values. The United Nations Convention on the Rights of the Child (9) and a United Nations Children’s Fund report (2) provide important guidelines for addressing youths’ rights to confidentiality, consent, etc, and describe the nature of youth-friendly health services.

Paediatricians can play a leadership role in promoting the development of such an agenda. Through initiatives such as the National Training Initiative in Adolescent Health, the Joint Action Committee for Child and Adolescent Health, and papers published in Paediatrics & Child Health, the CPS is well positioned, and suitably collaborative, to begin to serve as advocates for a NYHA.

Can we agree not to wait for the NCA to be implemented? Can we learn from history and recognize that we have allowed youth issues to slide off of the national agenda? I believe we can. Paediatricians can support and advocate on behalf of a NYHA without compromising the NCA. After all, we are advocates for children and youth.