Child well-being in Canada: How can we improve on “average”?

Last summer, UNICEF released the 11th Innocenti Report Card on child well-being in rich countries.¹ In this document, 26 indicators are used to detail five dimensions of children’s lives: material well-being, health and safety, education, behaviours and risks, and housing and environment. In a ranking of 29 of the world’s wealthiest nations, Canada was 17th, a position surpassed by Portugal and the Czech Republic and only narrowly ahead of Hungary and Poland. Despite Canada’s superior economic position (ranked 4th out of the 29 countries in Gross domestic product [GDP] per capita), the state of Canada’s children, as measured by the UNICEF indicators, is disappointingly average.

The intent of the report is to “contribute to debate in all countries about how standards might be achieved.”¹ However, the Canadian response has been one of deafening silence. Where is the debate? Why are Canadians not outraged by these findings?

While exploring why the intended national conversation did not occur, we identified issues of indicator resonance, relevance, meaning and accuracy that may have affected uptake.

Indicators are used for tracking and communicating trends, benchmarking performance and articulating agendas for change. In this era of increasing accountability, indicators are also important tools used by governments for setting goals, assigning resources and evaluating outcomes. However, high-level reports employing a narrow selection of indicators to comment on subjects as complex as child well-being have shortcomings. Indicators must balance what is of interest to the international community with data that exist to facilitate comparison. Because the 26 measures in the report are neither suggested nor adjudicated by Canadians, the report may not resonate with our citizens and may fail to reflect our most important challenges (for example, the absence of indicators measuring mental health or mental health service access is a potential disconnect). To ensure resonance, the development of indicators and the process for their selection should be based on local priorities and the concerns of regional and national leaders in the field.²

Delays associated with the collection and analysis of national data can diminish relevance. The UNICEF report draws on data that precede the recent global economic downturn. As such, policy change related to everything from taxation to social assistance, together with the impacts of investments and disinvestments at national and regional levels, would not be captured. Moreover, the Canadian jurisdiction responsible for operationalizing indicator-oriented improvement is most often the province, territory or municipality (the authorities responsible for health, public health, education, and welfare and housing), not the federal government, further diminishing relevance.

In addition, national indicators fail to dissect important regional, racial, socioeconomic status–sensitive or other differences in outcomes across and between populations, within nations. Canada is home to diverse communities — immigrant communities, First Nations communities, children and families in rural and remote areas, and those living in densely populated areas, as examples. It is important to understand Canada’s performance in this context.

Indicators that appear to be simple and objective may actually be highly complex and subject to important categorization and measurement concerns. Infant mortality is one such indicator. Substantial differences in birth registration practices noted in recent publications compromises our ability to compare national and international statistics.³ Other seemingly straightforward indicators, such as preschool enrollment rates, fail to reflect the quality of preschool education in different environments. In addition, the meaning of self-reported indicators, such as life satisfaction, is complicated to measure and interpret.

However, the international comparison offered by the UNICEF report should be recognized as an important platform to stimulate reflection, discussion and positive change, despite its shortcomings. Extensive evidence supports the value of investments in early childhood to public health. Given what is known about the intractable social dysfunction resulting from child poverty and neglect and evidence associating fetal and childhood antecedents with a multitude of chronic diseases,^4–6 securing child well-being ought to be a vital social aim. The report not only provides a statistical snapshot of child well-being, it is an aspirational document, outlining what is possible to achieve.

Canada should use the collected data in the UNICEF report to drive progress. However, outcomes are not realized in social, cultural, economic or political vacuums. Simply trying to “chase” individual representative indicators is likely to be expensive, inefficient and unsuccessful. Only in understanding the broader social and political climate, and governance structures that act as barriers to policy change, can we fully learn from international comparators. Each jurisdiction faces distinctive challenges — degrees of geographic vastness, immigration patterns, social attitudes toward children and government, understandings of collective versus individual rights, tensions between acute and primary care, and specific costs of health care. Defining appropriate agendas and targets depends on a fundamental understanding of each unique context. This requires a Canadian debate.

Canada is an economically successful nation but lags on measures of child well-being. Children are the foundation of a successful nation — a priority worthy of attention and investment. A sustained national conversation is needed, both to translate existing evidence about the value of investment in early childhood and to clarify our collective ideals related to children and families. Citizens, nongovernmental organizations and business leaders must hold political leadership accountable for critical childhood outcomes. Although Canadian politicians have embraced the powerful rhetoric of family and clearly value the votes of Canadian parents, no major parties highlight their commitment to children’s outcomes as a centrepiece of their platform, and objective records on child-specific performance are rarely debated in high-profile election forums. Our obligation to children must be profiled, measured and answered for.

We call on all political parties, at all levels of government, to explicitly profile an agenda for the well-being of children in their platform, to detail both the direct and indirect impacts of proposed policies on children and families, and to clearly articulate a plan to ensure that Canada becomes an international leader in all domains of child well-being. Moreover, all health care providers must work with governments to construct governance structures that allow for whole-of-government thinking,⁷ facilitating the flow of resources through, across and between public sector silos, to ensure that responsibility for critical outcomes in child well-being are shared by all.

Key points

• According to the leading international report card on child well-being in rich countries, Canada ranks 17th out of 29.

• Although international report cards may have issues of indicator resonance, relevance, meaning and accuracy, it is clear that Canada’s performance is average and that child well-being could be improved substantially.

• A critical examination of social and political customs in Canada, as well as existing governance models, is needed to understand current performance and design policy going forward.