Is a pan-Canadian early child development system possible? Yes, when we redress what ails Canadian culture

A "health in all policies" review of Canadian public finance

RéSUMé: OBJECTIF: Il est démontré que la santé est principalement le fruit de ses déterminants sociaux, et comme de fait, la recherche sur les systèmes de santé montre que les dépenses publiques relatives aux programmes sociaux sont souvent plus fortement corrélées à la santé des populations que les investissements dans les soins médicaux. Notre étude vise à aider les Cabinets provinciaux et fédéraux du Canada à en prendre acte en introduisant le concept de « la santé dans toutes les politiques » (Health in All Policies, ou HiAP) dans les débats budgétaires. MéTHODE: L'étude est descriptive; elle analyse des données secondaires accessibles au public sur les budgets fédéraux et provinciaux pour déterminer comment le financement public des investissements dans les déterminants sociaux de la santé (DSS) aux stades précoces (< 45 ans) et ultérieurs (65 ans et plus) du parcours de vie a évolué depuis 1976 par rapport aux investissements dans les soins médicaux. RéSULTATS: Les dépenses en soins médicaux ont augmenté de 3 983 $ par personne de 65 ans et plus depuis 1976. Cette augmentation dépasse de 45 % l'augmentation combinée des dépenses en services de garde, en congés parentaux, en aide au revenu familial, en éducation et en soins médicaux par personne pour les moins de 45 ans. De toutes les nouvelles dépenses pour les Canadiens plus jeunes, les soins médicaux ont reçu les investissements les plus importants. Alors que les dépenses médicales pour les retraités ont dépassé d'un peu plus de la moitié le rythme des dépenses en revenus de retraite, les dépenses médicales pour les Canadiens plus jeunes ont augmenté presque autant que les dépenses pour l'ensemble des politiques de DSS à leur endroit. CONCLUSION: Depuis 1976, il y a une plus grande concordance entre l'approche HiAP et le financement public du Canada pour les aînés que pour les Canadiens plus jeunes. Ces résultats offrent aux décideurs d'importantes informations rétrospectives pour évaluer les futurs investissements publics dans les soins médicaux et les déterminants sociaux de la santé pour tout le parcours de vie, ainsi que les plans de financement de ces investissements.

Parents' perceptions of obesity prevention during infancy: a qualitative study

BACKGROUND

Infancy appears to be a critical period for establishing a person's weight set point. It remains unclear which interventions during infancy may be most effective in preventing later obesity and which ones are most acceptable to parents. The aim of this study was to examine the attitudes of parents of children aged 2 years and under toward different obesity prevention messages and their preferences with regard to these messages.

METHODS

Using a qualitative research design, we conducted semistructured interviews followed by a focus group. Parents of children under 2 years of age were purposively recruited from 2 communities in British Columbia, Canada, and asked for their opinions about various health promotion messages relating to obesity prevention. A theoretical thematic analysis was used to analyze the data.

RESULTS

Thirty-three parents participated in the study. Participants reported that many of the current recommendations (no screen time, no sugary beverages) are unrealistic, unclear and inconsistent, making them difficult to follow and causing parents to feel guilty; they had a more positive response to the feeding roles message. Parents noted the importance of starting education early and targeting the broader community.

INTERPRETATION

Several important and interesting themes were identified in this study, which increases our understanding of parents' attitudes toward and preferences for the messages presented. Obesity prevention information for today's busy parents needs to be realistic, supportive and timely.

The reallocation challenge: Containing Canadian medical care spending to invest in the social determinants of health

We argue that Canadian provincial governments should contain medical care spending in order to invest more in the social determinants of health (SDH). Others have said this, many times. Doing it has not proven easy. We therefore emphasize the potential contribution of the priority-setting and resource allocation literature. This literature identifies formal tools and approaches that have built cultures of support for resource shifts, while providing pragmatic means for advancing efficiency and equity. Although reallocation towards SDH from other areas of the health care system is financially viable and supported by existing research, it will require new emphasis on the design of population health interventions that make reallocation politically expedient.

The economic costs of early vulnerability in Canada

OBJECTIVE

The study estimates the economic costs of early vulnerability in the light of population-level data showing that between 25% and 30% of Canadian children do not arrive at kindergarten meeting all of the developmental benchmarks they need to thrive both now and into the future.

METHODS

The study examines Early Development Instrument (EDI) data across Canada as of 2008/09, and across time within British Columbia since 2001. We then link the BC EDI data with school achievement results on standardized tests in grades four and seven, along with graduation records and criminal justice information.

RESULTS

The result is a synthetic cohort with which we can simulate the impact on economic growth of reducing early vulnerability in BC from its current rate of 29% to 10%, a threshold above which child vulnerability is biologically unnecessary.

DISCUSSION

Nearly three times what it should be, a rate of early vulnerability that approaches 30% signals that the country now tolerates an unnecessary brain drain that will dramatically deplete our future stock of human capital. Economic analyses reveal that this depletion will cause Canada to forgo 20% in GDP (gross domestic product) growth over the next 60 years. The economic value of this loss is equivalent to investing $2.2 trillion to $3.4 trillion today at a rate of 3.5% interest, even after paying for the social investment required to reduce vulnerability.