The Canadian Paediatric Society (CPS) applauds the federal, provincial and territorial governments of Canada for centring their attention on issues involving children and youth. We share the optimism that a focused and coordinated federal-provincial-territorial approach will improve the health and well-being of our future generations. What follows is a brief summary of some of the key child and youth health issues (together with solutions) identified by the CPS. Mental health, poverty and injury prevention are the top priorities. However, all issues are important to the health and well-being of Canadian children and youth. It is our hope that the next federal budget and the National Children’s Agenda will squarely address these issues.
MENTAL HEALTH
Canadian health care practitioners are concerned about the growing and unmet mental health needs of children and youth (1). The CPS proposes that the National Children’s Agenda focus on the factors that cause our children and youth to have behavioural and mental health problems. Ideally, a group of paediatricians, child psychiatrists, family practitioners, nurses, psychologists, social workers, parents and youth would be convened to identify the antecedents to mental health problems and develop preventative strategies and, as necessary, treatment guidelines. This group would create regionalized networks of expertise and knowledge to optimize the care of our children and youth. This project to develop a framework for ‘shared care’ for our children and youth would reflect the best standards in both prevention and intervention.
A key outcome of this project would be to create parenting courses based on research, such as the Systematic Training for Effective Parenting (STEP) program (2). Through such courses, families could be taught the best possible methods by which to raise their children. It would also allow for the early identification and intervention for children with developmental issues who require more intensive therapy.
POVERTY
The lack of both wealth and opportunity is a serious problem for the 1.4 million Canadians under the age of 18 years who live in poverty (3). The CPS proposes that a group of professionals with expertise in dealing with all aspects of poverty is formed to create a program dedicated to early identification, intervention and prevention of developmental problems caused by poverty. This would involve health, education, nutrition, mental health, safety and social development. The goal would be to create programs that intervene during the earliest possible stages to preclude the negative effects that a lack of wealth and opportunity can have on child and youth. The program would also have a strong educational component for parents and professionals who deal with children and youth affected by poverty. It is our belief that, through a coordinated multiprofessional approach, the existing critical situation can be significantly improved.
INJURY PREVENTION
Injury is the leading cause of death in Canadian children and youth. Furthermore, the long term quality of life for individuals who sustain serious injuries is greatly diminished, and health care costs are significantly increased. The CPS proposes that a National Injury Prevention Centre be established as part of the National Children’s Agenda. Such a centre would coordinate research and develop public policy strategies surrounding the causes and prevention of injuries.
EARLY INTERVENTION PROGRAMS
The CPS supports continued investment in the conditions that optimize early child development and parenting. Research has shown that early identification and intervention can significantly benefit children with developmental and behavioural challenges. Therefore, the CPS encourages the federal and provincial governments to build on the foundation set by initiatives such as Brighter Futures, a federal program that encourages the development of community action projects. Continued research using pilot programs should guide the promotion of effective, evidence-based intervention programs.
IMMUNIZATION
Although Canada has made great progress in the area of immunization against childhood diseases, concerns still exist. Currently, there are 12 different provincial and territorial vaccination schedules that are confusing and lead to many children missing needed immunizations. At the 1998 National Immunization Conference held in Calgary, there was consensus that a national immunization registry is also required. We urge the federal and provincial health ministries to work towards a national harmonized immunization schedule (4).
TOBACCO
Tobacco addiction is a major paediatric disease with terrible consequences. Annual tobacco-related deaths now number 45,000 Canadians/year and are climbing. The incidence of youth smoking is rising. Most smokers begin their habit before the age of 18 years. Approximately 250,000 Canadian children and adolescents will start smoking this year. The CPS proposes that the National Children’s Agenda and the federal budget focus on smoking prevention in children and youth, as well as cessation for those who have already started. Further work is needed in the areas of research and education (both public and professional). The federal government passed the Tobacco Act in 1997. Regulations have yet to be tabled. Strong regulations are needed, and are critical, if we are to keep tobacco away from our children (5,6).
ABORIGINAL HEALTH
The health of Canada’s Aboriginal people and especially their children has long been an area of concern. At the 1999 meeting of the CPS, Aboriginal leader Ovide Mercredi challenged the CPS and its partners to hold a summit on Aboriginal child heath. The summit would offer focused and achievable strategies for improving the health of Canada’s Aboriginal children. Participants would include Aboriginal leaders, health care professionals, government representatives and youth. We encourage the federal government’s leadership to support this initiative.
BIRTH DEFECTS
Solid evidence exists that adequate maternal intake of folic acid around the time of conception can reduce the occurrence of spina bifida and other neural tube defects by up to 75%. Every year, between 400 and 800 Canadian children are born with spina bifida and other serious spinal cord defects (7). It is unlikely that educating women of childbearing age to consume more folic acid through their diets will be effective. We urge the federal and provincial governments to initiate a large scale trial to assess the impact of fortifying flour with folic acid, to provide an average daily intake for women of child bearing age of between 0.5 and 1 mg/day. If this trial demonstrates the effectiveness and safety of fortification, this practice should be adopted as a national policy. There is also evidence that this may reduce the incidence of cleft lip and palate, and heart disease and cancer in the adult population.
YOUTH
The National Children’s Agenda has goals to improve the health of children as well as youth. The CPS welcomes an opportunity to continue to work with partners on street youth issues, which pose a significant challenge. The CPS also asks the federal government to support the National Training Initiative for Adolescent Health, a comprehensive multidisciplinary training program for professionals working with youth that has great potential benefit if delivered on a national level.
INTERNATIONAL CHILD HEALTH
Former Canadian prime minister Lester Pearson helped advance the idea that the health of Canadian children is inevitably tied to the health and well-being of children in all countries. Tens of thousands of the world’s children die each day from preventable diseases, and many-fold more suffer from malnutrition, lack of education, and exploitation and abuse. We applaud the Canadian government for increasing its overseas assistance by $120 million this year, but remain concerned that our current foreign aid budget is still below the levels of the early 1990s (8). We urge the federal government to continue to support and expand initiatives such as the Canadian International Immunization Initiative, and increase developmental aid through the Canadian International Development Agency and Canadian overseas nongovernmental organizations.
PAEDIATRICIAN RESOURCE PLANNING
Paediatrician resource surveys suggest that there is a very vulnerable balance in the numbers of paediatricians in Canada. Certain areas of the country are not training enough residents to replace paediatricians lost through attrition and retirement. A significant shortfall of paediatric subspecialists is anticipated in the near future. We urge the federal and provincial health ministries to collaborate with the CPS to develop a national paediatrician resource strategy quickly (9).
REFERENCES
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