REACHING FOR THE TOP A Report by the Advisor on Healthy Children & Youth Dr. K. Kellie Leitch The views expressed in this Report are those of the author and do not necessarily represent those of the Government of Canada. Published by authority of the Minister of Health. Reaching for the Top: A Report by the Advisor on Healthy Children & Youth is available on Internet at the following address: http://www.hc-sc.gc.ca Également disponible en français sous le titre : Vers de nouveaux sommets : rapport de la conseillère en santé des enfants et des jeunes For further information or to obtain additional copies, please contact: Publications Health Canada Ottawa, Ontario K1A 0K9 Tel.: 613-954-5995 Fax: 613-941-5366 E-Mail: [email protected] © Her Majesty the Queen in Right of Canada, represented by the Minister of Health Canada, 2007 HC Pub.: 4552 Print Cat.: H21-296/2007E ISBN: 978-0-662-46455-6 PDF Cat.: H21-296/2007E-PDF ISBN: 978-0-662-46456-3 REACHING FOR THE TOP A Report by the Advisor on Healthy Children & Youth Dr. K. Kellie Leitch K. Kellie Leitch MD, MBA, FRCS (C) Chair/Chief, Division of Paediatric Surgery Paediatric Orthopaedic Surgeon Email: [email protected] 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 countries in measures of the health and wellness of children and youth. Among 29 OECD nations: • Canada ranks 22nd when it comes to preventable childhood injuries and deaths; • Canada ranks 27th in childhood obesity; and, • Canada ranks 21st 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. 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.” Table of Contents 1. Executive Summary......................................1 2. Background An Opportunity to Improve and Thrive .........................11 3. Methodology Nation-Wide Consultation and Literature Review...............19 4. Listening to Canadians What Canadians Said About Child and Youth Health .............23 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 .....31 6. Injury Prevention and Safety............................69 I. Injury Prevention ..........................................71 II. Children, Youth, and the Environment..........................85 7. Obesity and Healthy Lifestyles..........................95 I. Physical Activity..........................................100 II. Nutrition ...............................................110 III. Children and Youth with Disabilities ...........................116 8. Mental Health and Chronic Illness ......................125 I. Mental Health...........................................127 II. Chronic Illness and Disease.................................137 9. Creating a National Office of Child and Youth Health....153 10. Conclusion.............................................159 Appendices................................................173 I. Social Determinants of Child and Youth Health ...................174 II. Additional Health Indicators.................................178 References.................................................179 Record of Stakeholders Consulted .........................186 Bibliography................................................206 Acknowledgements ........................................218 1 Executive Summary “This Report is all about helping children to be healthier, so that they can live better, happier, more productive lives.” Executive Summary BacKGROUND And this matters to Canadian society – because healthier children will become happier, more When you work at a hospital with sick and successful adults. From a public policy injured children, you passionately want to perspective, investing in the health of our improve these children’s lives – and the lives of children is as essential to our growth as a their families. It is even better to find ways of nation as investing in infrastructure. preventing illness and injury in the first place, reducing the requirement for so many children Seeking recommendations to help improve to need hospitalization and acute care. the health and wellness of Canada’s children and youth, Canada’s Health Minister, the That’s what this Report is all about – helping Honourable Tony Clement, asked for this children to be healthier, so that they can live Report. It provides advice related to existing better, happier, more productive lives. It is federal government programs, the need for also about giving every child an opportunity to new policy directions and programs and the achieve the same health outcomes – no matter concept of establishing an office for the health what background they are from. Each finding and wellness of children and youth. and recommendation in this document is important in and of itself. But taken together, Children’s health issues – and the factors that they combine to deliver what would be a determine their health and wellness – are quantum improvement in the health and multi-faceted and complex. For that reason, wellness of Canadian children and youth. this Report is extensive and the analysis that contributed to it was rigorous. This work was This matters to children – who will then be able supported by a nation-wide consultation with to spend more time playing and learning. parents, children and youth and an