The kids aren’t all right
TheStar.com – opinion/editorialopinion
Published On Sat Sep 03 2011. Elizabeth Lee Ford Jones
In the last quarter century there’s been an explosion in our understanding of child development. Unfortunately, all that new knowledge hasn’t translated into improved child health. The fact is, far too many of our children are not doing well — not at all well.
I never dreamed that after 35 years in medicine I would now find so many children in worse shape than when I started.
Three years ago, I was asked to set up a social pediatrics program at the Hospital for Sick Children (SickKids). Social pediatrics recognizes that poverty places children at high risk for current and future health problems.
And so we send our medical residents out on public transit to make home visits and provide care at local clinics in parts of the city — both suburban and downtown — where parents struggle and children are disadvantaged.
The experience is transformative. One young doctor had to examine a sick child in a dim apartment because the electricity had been cut off. She said she’d never again do an assessment or write a prescription without wondering if paying for the antibiotic might mean no food on the table.
Because we recognize the problems that some parents face, we have a free legal clinic at SickKids. For more than two years, lawyers who offer their expertise to the Family Legal Health Program have been helping parents with a wide range of issues — from family and immigration law to housing and employment problems.
Canadian scientists have played and continue to play a leading role in research into early brain development, the interplay between genetics and the environment, and the long-term health consequences of early childhood experiences.
But in all the excitement of these findings, I believe many of us have lost sight of what’s happening to the children in our communities. We haven’t acted on what we know. Perhaps most disturbingly, the gap between rich and poor is growing in Canada and one child in 10 is living in poverty.
In my role at SickKids, I’ve been on home visits to apartment towers where, quite frankly, I have to ask, how can we expect parents to raise healthy children in the face of next-door drug dealers, constant police sirens and bed bugs?
Certainly we’ve made progress in some areas. If children have access to medical care, they no longer have to be hospitalized for croup or other vaccine-preventable diseases.
But our children have new health problems and Canadian children rank embarrassingly poorly in international comparisons for many key indexes.
Recent United Nations reports place Canada 22nd among 31 Organization for Economic Cooperation and Development (OECD) countries for infant mortality rates, and right next to the bottom of the heap of OECD countries for our high rates of childhood obesity. This is especially disturbing because children who are overweight or obese face increased health risks including diabetes and hypertension.
Those UN reports rank the situation of all Canadian children; it’s obvious that children living in poverty face additional obstacles. Parents may have difficulty affording healthy foods or organized recreational activities for their children; many face challenges paying for the medicine and equipment to keep conditions such as diabetes or asthma under control.
Poor housing exacerbates asthma and parents who are financially strapped often can only afford to give their kids symptom relievers for asthma, and these are not medications which should be used regularly. Their children often end up in the emergency ward.
Attention disorders among children are rising at a disturbing rate and far too many children are simply not getting enough sleep for healthy child development.
At SickKids, many parents fail to bring their children for follow-up appointments at daytime clinics because they work irregular hours or jeopardize their jobs if they have to take time off.
Meanwhile, in the evening, large numbers of parents camp out overnight in the emergency department. They’ve brought their children in for medical attention, but because they can’t afford cars or taxis, they’re waiting for the 6 a.m. start of the subway to carry them many miles back to their homes.
The health and well-being of Canadian children growing up in poverty has to become a priority and health care has to move back out into the community.
We can’t turn back the clock, but it is time to reintroduce some of the common-sense preventive health programs that used to be standard in many Canadian schools — dentists to screen for children with dental problems, vision screening and regular nurse visits in public schools.
Of course, restoring these health initiatives can’t remedy poor living conditions or close the income gap, but here are some examples of what can be done.
A joint public/private initiative at inner city Toronto schools, where poverty rates are high, provided vision tests to 16,000 children last year. About 2,000 were found to need glasses, which were provided at no charge. Hearing tests are also being introduced in schools through this program.
At least two Toronto public school have set up their own medical clinic, staffed by a nurse practitioner, so that children can be seen on-site. This spares parents, many of whom are new to Canada and face language and financial barriers, a confusing and often long trip to the hospital. At other schools, visiting nurses work in coordination with local health services.
To be fair, various levels of government across Canada have been taking some important steps to improve the lives of children, and there are some inspiring stories out there.
But disturbing questions linger. Why, when Canadian researchers have been so instrumental in developing the scientific evidence of the importance of early childhood development, have we not developed comprehensive initiatives to improve the well-being of our children?
Why do we continue to ignore the major problems faced by children growing up in poverty?
Dr. Elizabeth Lee Ford-Jones is a pediatrician specializing in social pediatrics and project investigator at SickKids, and a professor in the Department of Pediatrics at the University of Toronto. She is also an expert adviser with EvidenceNetwork.ca, an online resource designed to help journalists covering health policy issues in Canada. The above represent the opinions of Dr. Lee Ford-Jones and not necessarily the official positions of either the Hospital for Sick Children or the University of Toronto.
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