Policy patchwork hurts kids

Protecting the health and safety of Canadian children and youth is a collective responsibility. It starts with parents and caregivers making informed decisions that foster their children's growth and development and keep them safe. At the broadest level, it involves governments creating public policy that safeguards and enhances the health and safety of their youngest citizens. Legislation and public policy cannot address every child and youth health issue, but there are many areas where government action is critical, indeed, where it can save lives. Consider the impact of seat belt laws, or of measures to fortify certain foods with disease-preventing vitamins and minerals. Public policy is a powerful tool to promote health and safety. However, all too often the needs of children and youth fail to make it to the top of the public policy agenda. Consider the absence of child health issues (eg, mental health) in the recent federal government waiting list initiative. To encourage policy-makers to examine their own progress on child and youth issues and to foster discussion among Canadians, the Canadian Paediatric Society (CPS) issued its first-ever status report on public policy affecting children and youth in June 2005 (1). The most striking finding was the patchwork of legislation that exists across the country. The extent to which the health of kids is protected or promoted by provincial/territorial legislation depends largely on where you live. Do you want to ensure that your child is fully protected against vaccine-preventable diseases? Consider moving to Alberta, where all recommended childhood immunizations are publicly funded. Do bike injuries concern you? Try British Columbia or the Maritimes, where mandatory use of helmets is enforced by fines. Or are you more worried about the growing childhood obesity epidemic? Then Ontario – where daily physical activity is compulsory through grade 8 and junk food is banned from schools – is probably the best place for you. However, if you want to live in a province or territory that always puts the well-being of children and youth at the top of the public policy agenda, then you might as well stay put because, overall, there really is not much difference among them. Although we can commend some provinces and territories for specific efforts, none of them gets it right all of the time. First, the good news: provincial and territorial governments are doing some creative, encouraging things. In September 2005, for example, Ontario becomes the first province to make car booster seats mandatory for children up to eight years of age. The law applies not just to primary caregivers, but to other adults driving with small children in their vehicles. Most provinces and territories have, or are planning, a new-driver graduated licensing system, a measure proven to reduce the risk of injury and death. As well, all governments have made at least some progress toward publicly funding new childhood vaccines. Still, there is so much more to be done. Consider childhood obesity, a growing problem with potentially debilitating health effects that turn up in adulthood, such as high blood pressure, heart disease and diabetes. The solution is deceptively simple: more physical activity and better nutrition. However, despite good evidence (2), few governments have elected to make quality daily physical activity mandatory for all students, and even fewer have addressed the issue of healthy food choices in schools. Governments also have a leading role to play in preventing injuries – the leading cause of hospitalization among children older than 12 months of age – yet much of the existing legislation shows a woeful lack of understanding of the risks to children and youth. In Prince Edward Island, for example, children as young as six years of age can operate an all-terrain vehicle (albeit under the supervision of an adult). These machines weigh up to 273 kg. The average six-year-old child weighs about 20 kg. Provincial and territorial governments are not alone in being accountable to the nation's children and youth. The federal government plays a critical role in providing leadership to benefit Canada's youngest citizens. The CPS status report (1) suggests that when the Canadian government assumes that role, kids come out ahead. Immunization is one example. Since 2003, the federal government has announced $345 million toward a National Immunization Strategy. The most recent $300 million, announced in the 2003 federal budget to allow provinces and territories to purchase childhood vaccines, has been vital in ensuring that Canadian children have equal access to all recommended vaccines. All provinces and territories have now used those funds to initiate new immunization programs. Still, there are significant differences in the childhood immunization schedule across jurisdictions, which can lead to confusion and missed vaccines. At the other end of the spectrum is injury prevention. Unintentional injury is the leading cause of death, morbidity and disability among Canadian children and youth. One estimate puts the cost of unintentional injuries at more than $8.7 billion annually. For years, experts have called on the federal government to implement a national injury prevention strategy, yet progress continues to be stalled. Once and for all, Canada needs a national injury prevention strategy – a comprehensive plan with communications and outreach initiatives, legislation at all government levels, a national surveillance system, and research into prevention and program evaluation. In part because of the absence of a national injury prevention strategy, provinces and territories are missing opportunities to save the lives of children and youth. So, are we doing enough? The short answer is no. When it comes to protecting children and youth, there is always more we can do. Start with the patchwork of strong and weak child health policies across provinces/territories. Then consider the scarcity of school-based health centres, weak environmental protection legislation and an emerging crisis in health care human resources. Children do not have the political power to make their voices heard on Parliament Hill or in provincial/territorial legislatures. They have us. Let us make sure we get it right for them.

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