Reaching for the Top: A Report by the Advisor on Healthy Children & Youth

2007
Cat. №: H21-296/2007E (print)
ISBN: 978-0-662-46455-6 (print)
Cat. №: H21-296/2007E-PDF (PDF)
ISBN: 978-0-662-46456-3 (PDF)
HC Pub.: 4552

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Table of Contents

• Erratum
• Letter to the Minister of Health
• 1. Executive Summary
• 2. Background: An Opportunity to Improve and Thrive
• 3. Methodology: Nation-Wide Consultation and Literature Review
• 4. Listening to Canadians: What Canadians Said About Child and Youth Health
• 5. The Role of Federal Government in Child and Youth Health: Health Canada and the Public Health Agency of Canada Functioning within a Broader Context Influencing Child and Youth Health
• 6. Injury Prevention and Safety
  1. Injury Prevention
  2. Children, Youth, and the Environment
• 7. Obesity and Healthy Lifestyles
  1. Physical Activity
  2. Nutrition
  3. Children and Youth with Disabilities
• 8. Mental Health and Chronic Illness
  1. Mental Health
  2. Chronic Illness and Disease
• 9. Creating a National Office of Child and Youth Health
• 10. Conclusion
• Appendices
  1. Social Determinants of Child and Youth Health
  2. Additional Health Indicators
• References
• Bibliography
• Record of Stakeholders Consulted
• Acknowledgements

Letter to the Minister of Health

K. Kellie Leitch MD, MBA, FRCS(C)
Chair/Chief, Division of Paediatric Surgery
Paediatric Orthopaedic Surgeon
Email: kellie.leitch@lhsc.on.ca
Tel: 519.685.8500 ext 52132
Fax: 519.685.8038
Room E2-620D

Minister:

As Canadians, we are very fortunate in so many ways. We have tremendous opportunities to reach our full potential in a free, welcoming, and ambitious country. For those of us who were born in this country, it has often been said that we are among the luckiest people in the world.

Yet, when it comes to providing the best possible health environments for our children and youth, we have the need - and the capability - to do better as a country.

During my consultations and work as your Advisor on Healthy Children and Youth, I had the opportunity to meet with over 750 people, and review more than 500 documents and reports. It was a tremendously rewarding experience and one that I shall always remember.

From this work, I have drawn three fundamental conclusions.

Firstly, that we are doing surprisingly poorly when compared to other OECD and countries in measures of the health and wellness of children and youth. Among 29 OECD nations:

• Canada ranks 22^nd when it comes to preventable childhood injuries and deaths;
• Canada ranks 27^th in childhood obesity; and,
• Canada ranks 21^st in child well-being, including mental health.

Secondly, that in today's increasingly competitive global economy, we must invest in the health and wellness of our children and youth in the same way that we invest in infrastructure or science and technology. Indeed, our children and youth are our future, and they are also fundamental to our nation's economic success in an ever more competitive world.

Thirdly, that Canada has the potential - and the ability - to be the number one place in the world for a child to live and grow up, from a health perspective. Ours is a nation that has grown strong because of great goals and bold plans. While there is much work that needs to be done to help our young people to be healthier and to stay healthy, we can, should, and must be optimistic. To succeed, we must set benchmarks and measure results. To become the world's best, we must measure ourselves against those who are the world's best today.

With these conclusions in mind, this report makes five key recommendations. They are as follows:

1. Develop and implement a National Injury Prevention Strategy for children and youth;
2. Establish a Centre of Excellence on Childhood Obesity;
3. Improve Mental Health Services for Canadian children and youth;
4. Undertake a Longitudinal Cohort Study to provide data on the health of Canadian children and youth to help understand environmental factors impacting children's health; and,
5. Establish a National Office of Child and Youth Health with a permanent Advisor.

I want to acknowledge and thank the Canadians who took the time to speak with me, and to share their views through our online survey. While I encountered many different perspectives and points of view, one thing united all of the people with whom I met: their passion and commitment to improving the health and wellness of children and youth in our country. That passion is an asset in and of itself.

Minister, there are 95 recommendations catalogued in the conclusion of my report. These should not be seen as a critique of what exists, but rather as opportunities to improve the health system, and to keep children and youth healthy and well.

I appreciate and acknowledge the latitude I have had in examining issues beyond the mandate of Health Canada and the Public Health Agency of Canada (PHAC). That latitude has allowed for a more holistic approach to be taken, and I believe it will yield better outcomes for Canadian children.

It is my belief that these recommendations will help chart a better course for the federal government's current and future programs related to the health and wellness of children and youth, and ultimately pay tremendous dividends through improved health outcomes.

Thank you for the opportunity to participate in this very important and exciting work.

Sincerely,

Dr. K. Kellie Leitch, MD, MBA, FRCS(C)

Chair / Chief, Division of Paediatric Surgery, Children's Hospital, London, Ontario
Assistant Dean (External)/Assistant Professor, Paediatric Orthopaedic Surgery,
Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario

Co-Director, Health Sector MBA, Richard Ivey School of Business,
University of Western Ontario, London, Ontario

As Canadians, we are very fortunate in so many ways. We have tremendous opportunities to reach our full potential in a free, welcoming, and ambitious country. For those of us who were born in this country, it has often been said that we are among the luckiest people in the world.

Executive Summary

Background

When you work at a hospital with sick and injured children, you passionately want to improve these children's lives - and the lives of their families. It is even better to find ways of preventing illness and injury in the first place, reducing the requirement for so many children to need hospitalization and acute care.

That's what this Report is all about - helping children to be healthier, so that they can live better, happier, more productive lives. It is also about giving every child an opportunity to achieve the same health outcomes - no matter what background they are from. Each finding and recommendation in this document is important in and of itself. But taken together, they combine to deliver what would be a quantum improvement in the health and wellness of Canadian children and youth.

This matters to children - who will then be able to spend more time playing and learning.

This matters to parents - who bear a tremendous personal and financial burden when one of their children has a debilitating illness or injury, and want nothing more than for their children to be happy and well.

And this matters to Canadian society - because healthier children will become happier, more successful adults. From a public policy perspective, investing in the health of our children is as essential to our growth as a nation as investing in infrastructure.

Seeking recommendations to help improve the health and wellness of Canada's children and youth, Canada's Health Minister, the Honorable Tony Clement, asked for this Report. It provides advice related to existing federal government programs, the need for new policy directions and programs and the concept of establishing an office for the health and wellness of children and youth.

Children's health issues, and the factors that determine their health and wellness, are multi-faceted and complex. For that reason, this Report is extensive and the analysis that contributed to it was rigorous. This work was supported by a nation-wide consultation with parents, children and youth and an extensive review of the existing literature related to the health and wellness of children and youth.

Key Conclusions and Recommendations

Canada is among the most prosperous nations in the world. We boast a universally accessible health care system, and a large number of generous social programs, many of which were conceived to help children and youth stay healthy.

Yet, Canada's standing when it comes to the health and wellness of children and youth is remarkably poor. Among 29 OECD nations:

• Canada ranks 22^nd when it comes to preventable childhood injuries and deaths;
• Canada ranks 27^th in childhood obesity; and;
• Canada ranks 21^st in child well-being, including mental health.¹

Overall, Canada only ranked 12^th out of 21 wealthy countries in the United Nations' rankings of child well-being.²

We can, and we must, do better. That starts with setting bold, visionary goals. Canada has the potential and the ability to be the number one place in the world for a child to live and grow up, from a health perspective. The recommendations and suggestions that follow are designed to help Canada achieve this goal.

Setting benchmarks and measuring results is an important theme in this report. We need to measure ourselves against the best in the world, so that we can become the best in the world.

There are many recommendations in this Report, covering a wide range of issues. However, there are five specific items that merit particular emphasis and attention. These are:

1. Developing a National Injury Prevention Strategy
2. Reducing childhood obesity by establishing a Centre of Excellence on Childhood Obesity
3. Improving mental health services for Canadian children and youth
4. Undertaking a longitudinal cohort study to provide data on the health of Canadian children and youth to help understand environmental factors impacting children's health
5. Establishing a National Office of Child and Youth Health with a permanent Advisor

Five Priority Action Items

1. A National Injury Prevention Strategy

Unintentional injury remains the leading cause of death for children ages one to fourteen. In fact, injuries account for more deaths in children and youth than all other causes of death combined.

We can take actions that will reduce the risk of severe injury among Canadian children - by preventing many of these injuries from ever happening in the first place, or dramatically reducing their impact.

Among others, key recommendations in this area include:

• Creating a Strategic Plan for Injury Prevention for Children and Youth.
  The Government of Canada should take the lead role in the development and implementation of this five-year national strategic plan to be established in the next twelve months.
• Supporting Helmet Use. Extending the Children's Fitness Tax Credit to include the purchase of protective helmets used in physical activities that qualify within the guidelines of the Children's Fitness Tax Credit.
• Eliminating Toxic Toys. The Government of Canada should enact legislation that includes restrictions on hazardous substances in products designed for children and youth, such as lead and mercury.
• Promoting Booster Seats and Protective Equipment. Encourage provinces to show leadership and make mandatory the requirement for booster seats for children aged 4-8 until they weigh 36-45 kg (80-100 lbs.) or until they are 132-145 cm (52-57 inches) in height.

2. Reducing Childhood Obesity

According to the World Health Organization, being overweight due to poor nutrition and lack of physical activity is one of the greatest health challenges and risk factors for chronic disease in the 21^st century. Over-consumption of unhealthy foods has been called the "new tobacco" based on its increasingly negative impact on people's health.

Many life-long diseases begin in childhood. Given the prevalence of childhood obesity, and given its contribution to many diseases, this is the first generation that may not live as long as their parents. Obesity is now having a huge life expectancy impact, which was not foreseen ten years ago.

Action can be taken that will help children and youth live longer, healthier, more productive lives.

Among others, key recommendations in this area include:

• Setting Obesity Targets. The Government of Canada should seek to reduce the rate of childhood obesity from 8% to 5% by 2015.
• Promoting After-school programs. The federal government should show leadership by being the driving force supporting organizations that provide excellent after-school programs to support able-bodied and disabled children.
• Creating a Centre of Excellence on Obesity. Focusing experts from multiple fields on this challenging issue.
• Increasing physical activity. Achieve a 20% increase in the number of Canadian children and youth who are physically active, eat healthily, and are at healthy body weights by 2015.
• Banning junk food advertising to children. The CRTC should examine the option of banning the advertising of junk food on children's programming targeted to children under 12 by 2010.

3. Improving Mental Health Services to Canadian Children and Youth

Eighty percent (80%) of all psychiatric disorders emerge in adolescence, and are the single most common illness that onset in the adolescent age group. Unfortunately, only one in five Canadian children who need mental health services currently receives them.

The national mental health strategy being developed by the Mental Health Commission includes a focus on children and youth mental health issues, as mental health problems among children and youth are predicted to increase by 50% by the year 2020.

Among others, key recommendations in this area include:

• Improving access to paediatric mental health services. This is a complex issue with no simple solutions. To explore the best way to proceed in greater detail, an Expert Panel on access to paediatric mental health services should be established and be tasked with specifically examining health human resource issues as they relate to mental health services for children and youth.
• Establishing a Wait Time Strategy for paediatric mental health. It is recommended that a National Wait Time Strategy for child and youth mental health services be developed in the next twelve months.
• Addressing health human resource constraints through training. Governments should work with non-governmental organizations (NGOs), academic organizations and health care institutions to increase the training capacity of the entire spectrum of mental health professionals and ensure that this training includes specific clinical instruction on child and youth mental health issues.

4. Longitudinal Cohort Study

To determine the success of programs and policies that help improve the health and wellness of Canada's children and youth - and then subsequently adjust those programs to make them more successful - high-quality data and information is essential.

Today, Canada does not have a tracking study in place to successfully measure changes in the environment that impact on the health of children and youth.

The key recommendation in this area includes:

• Establishing a longitudinal cohort study. Implement a cohort study to provide longitudinal data on the health of Canadian children, neonates to age 8, monitoring their health status and outcomes over ten years.

5. National Office of Child and Youth Health

At present, there is no prism to examine the impact legislative issues, policies or programs are having on the health and wellness of children and youth. This Report therefore recommends:

• Creating a National Office of Child and Youth Health with a permanent Advisor. This Office and Advisor would report to the Minister of Health on the health status of Canadian children and youth.

The Approach to the Analysis within this Report

This Report was the result of:

• A consultative process of roundtables and meetings with parents, children, youth, key stakeholders, provincial representatives, and stakeholder organizations;
• An extensive analysis of the programs and policies currently provided by
  Health Canada and the Public Health Agency of Canada;
• A detailed review of existing reports, studies, and papers from Canada
  and around the world on child and youth health; and,
• An online survey that received thousands of responses.

Based on this work, a number of child and youth health challenges were uncovered. However, it is in Canada's grasp to be the number one nation in the world for a child to live and to grow up from a children's health perspective. With the federal government's leadership - and the collective commitment of provincial and territorial governments, organizations, parents, and children themselves - we can achieve this goal.

The Role of the Federal Government

In addition to the role the federal government plays in providing health services to children and youth within Canada's First Nations on reserve and Inuit populations, there are six specific federal roles that Canadian parents and child/youth organizations believe will help improve the health and wellness of Canadian children and youth. These are:

• Providing leadership;
• Setting national standards;
• Fostering collaboration and networking among NGOs, industry, governments, and parents;
• Data collection and dissemination;
• Encouraging research - and especially promoting the need for translational and
  knowledge transfer research in collaboration with NGOs,  and industry; and,
• Undertaking and supporting social marketing activities to communicate and promote healthy behaviors and activities.

Evaluation of Existing Programs

A core aspect of the mandate of this Report was to analyze existing programs provided by both Health Canada and the Public Health Agency of Canada targeted to children and youth.

Among others, key recommendations within this Report related to existing programs include:

1. The need for appropriate data management and surveillance
2. The expansion of Aboriginal Head-Start
3. The re-orientation of the Centres of Excellence for Children's Well-Being to ensure they are focused on these key priorities including injury prevention and safety, obesity and healthy lifestyles, and mental health.

1. Data Management and Surveillance

Data and information management are fundamental. Data collection, management, and surveillance are the basic building blocks of research. This data, if it is substantive, comparable, and "clean", is invaluable in the development of public policy and programs which can have a meaningful impact on child and youth health. It is only with appropriate and substantial data that evidence-based decisions can be made.

Better coordination is required among the national data collection agencies and large research projects associated with child and youth health. Throughout the consultations, three significant issues with respect to data were raised:

1. Access to data is tedious, and often not achievable;
2. Data sets are not linked; and,
3. Data sets are often not comparable.

Appropriate data collection and dissemination ultimately results in better decision-making. When there is more reliable, high-quality data available, better results on the front-line can be achieved. The data collected for evaluative, research or surveillance needs must become more accessible.

Among others, a key recommendation in this area includes:

• Standardizing data sets. Mechanisms of coordination and improved access must be created between Statistics Canada, the Canadian Institute for Health Information, Health Canada and the Public Health Agency of Canada in order to create appropriate comparable data sets that are easily accessible to clinicians, researchers, and organizations that are involved with child and youth programs and policy development.

2. Aboriginal Head Start

There are increasing amounts of data that confirm the benefits that can come from investing in early childhood development. Current Head Start programs designed to support Aboriginal children have been successful.³

Therefore among others, a key recommendation in this area includes:

• Expanding Aboriginal Head Start programs to reach 25% of the eligible children on and off reserve.

3. Centres of Excellence for Children's Well being

Today, the federal government supports four Centres of Excellence for Children's Wellbeing. There are some excellent activities occurring at these Centres. However, they need to be truly internationally ground-breaking in their work, and more focused on the issues that are most critical to Canadian parents, children, and youth.

Among others, a key recommendation in this area includes:

• Centres of Excellence redefining their focus. Specifically, they should deliver outcomes and champion best practices that will address injury prevention and safety, obesity and healthy lifestyles, and mental health.

Additional Recommendations

Based on the input and analysis undertaken in this Report, a number of opportunities were identified that will have a tremendous impact on the health of Canada's children and youth.

In addition to the key recommendations previously cited, the following are additional recommendations focused not only on helping Canada become a world leader in the health of its young people, but also on making a real difference in children's lives ... one child at a time.

Disabilities

• Increase opportunities for children and youth with disabilities to participate in physical activity, and specifically:

  • Provide infrastructure support for the development of skills development and recreation facilities that allow children with disabilities to fully experience recreation and sport activities; and,

  • Create an incentive for NGOs to operate programming that is accessible to children with disabilities.

• Introduce income splitting for parents with a child or youth with disabilities to reduce their tax burden.

Chronic Illness and Disease

• Incent parents to immunize their children by linking the National Child Benefit to immunizations;
• Emulate the approach taken by the province of Ontario to ensure that all children can access and administer their necessary medications in class, such as Epi-pens, insulin, and asthma puffers;
• Include support for insulin pumps within the Canadian Diabetes Strategy;
• Increase the length of the Employment Insurance (EI) benefit availability for Compassionate Care leave for parents with a child with a terminal illness; and,
• Develop a template for Emergency Preparedness for national emergencies (e.g. SARS) to be available to all schools, NGOs, and paediatric hospitals.

Aboriginal Children and Youth

• Undertake tuberculosis surveillance in Northern Canada and introduce appropriate Public Health interventions to control this surprising and potentially catastrophic epidemic; and,
• Apply Jordan's Principle, whereby the health care needs of aboriginal children are addressed regardless of the jurisdiction of the health provider organization. One approach to the administration of this principle would be for the federal government to pay up front, and then recover costs through transfer payments to the provinces that would be reasonable to expect provincial governments to pay.

In Summary...

This Report makes bold recommendations, because Canadian young people are bold. They want to be healthy. They want to succeed. They want a better tomorrow for themselves, for their families, and for the country they are proud to call home. Many of these recommendations are substantial because the progress we need to make is substantial - and we are not where we can or should be based on existing programs, systems, and structures. That's why things need to change.

This country can and should be home to a more prosperous tomorrow and a bright future for our next generation.

Let that future begin today.

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