Can health care reform provide a future for our children?

Health care and the provision of program services for Canadians, and especially, children, are on a collision course in Canada. A recent report published in the Fraser Forum (1) noted that in Canada, health care spending is growing at a faster pace than total spending on social programs. In addition, data provided by Statistics Canada (2003) (2) indicate that unless significant changes are made by the year 2040, each province will spend its entire budget on health care with no funds remaining for critical programs such as education, social services or infrastructure support. For the provinces of Manitoba and Newfoundland, the funding crisis may be reached as early as 2021 – only 16 years away. What does this mean for the future of children in this country and what needs to be put in place to prevent this potential catastrophe? The Canadian Institute for Health Information (CIHI) tracks estimates of total provincial and territorial government health expenditures by age and sex in Canada (3). In 2001, the age group of birth to 19 years of age received 13.9% of provincial and territorial government health care dollars. The CIHI data do not include federal health care expenditures, but the provincial and territorial jurisdictions account for 91% of the total funding for health care, so the CIHI figures are of critical importance. Thus, approximately 86% of the health care budget is directed to adults. In the United States, end-of-life medical care consumes at least 12% of the total health care budget (4). As children represent our future, what are the implications of these sobering facts? If rising health care costs result in further cuts to education programs and higher education becomes unaffordable for most young people, the economy will surely suffer, and with this, revenues for health care will also decline. In a recently released report (5), Campaign 2000 (an advocacy antipoverty group in Canada) found that greater than 15% or over one million Canadian children were living in poverty, especially Aboriginal children. It is well known that poverty, low standards of living, environmental destruction and substandard education lead to impaired health and adversely affect the economy (6). When the health care funding crunch hits the wall, how will paediatric programs be adversely affected and, at the same time, where will the funding come from to support the burgeoning disciplines of stem cell and gene therapy? I predict that the greatest cuts will be to programs addressing behavioural and developmental disabilities, as well as chronic disease disorders including programs that provide support for the medically fragile infant and child. The multiple and complex health care issues of these children are the most prevalent of all paediatric conditions and the most difficult to manage. Because there is no specific curative therapy for the majority of these problems, the needs of these children will quickly fall under the knife of the health care budget executioner focused on acute care and adult needs. Adult-related health care funding will remain the priority of governments because adults hold the vote, even though the health care needs of the child with a chronic illness are at least of equal importance as those of adults nearing the end of life. To circumvent the problems that are sure to surface in paediatric health care funding during the next two decades, paediatricians must take an active role in health care reform to ensure that the paediatric health care agenda is not compromised. While this task will present multiple challenges, the risk of complacency or inaction will have dire consequences for the future of our children and our grandchildren. Whether we are providing health care for children and youth in a hospital, in a regional or district program, in the community or in a private office setting, all of us have seen the impact of cuts to the health care system on child and youth programs over the past decade. Yet, as the headlines and politicians regularly remind us, the costs of health care are ever rising in spite of the cuts that have already occurred. However, the increased dollar requests for health means less dollars for other programs crucial for children and youth, such as education. We are on a collision course. In the following editorial, Dr Robert Haslam highlights the consequences of the political decisions we are making for the children of today and those of tomorrow. At Paediatrics & Child Health, we welcome response and dialogue on this critically important issue. As paediatricians, we cannot sit idly by while our children's futures are bankrupted. Drs Noni MacDonald and Elizabeth Ford-Jones, Co-Editors-in-Chief

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