A Canada (un)fit for children?

Abstract

As you will read in this issue of Paediatrics & Child Health, Canada’s federal House of Commons voted unanimously in 1989 to “seek to achieve the goal” of ending child poverty by the year 2000. We are far past this optimistic declaration date. Since then, in spite of unprecedented prosperity and economic wealth as a nation, and despite several further promises such as the ratification of the UN Convention on the Rights of the Child (1), and A Canada Fit for Children (2), we still find one in six of our Canadian children living in poverty, increasing to one in four in the Aboriginal population. In 1989, the child poverty rate was 15.1%, and in 2003, it had risen to 17.6%, representing 1.2 million children living in poverty. There is significant variability in child poverty rates, not only across the provinces, but also within certain communities (3). Furthermore, due to the different definitions of poverty, methods of measuring it and attempts at international comparisons, the statistical story can appear varied and confusing. However, Canada’s ranking of 19 out of 26 successful Organization for Economic Cooperation and Development countries in terms of the ‘percentage of children living in relative poverty’ is shameful (4). In this special issue of Paediatrics & Child Health, we bring together a series of articles that will hopefully arm paediatricians and primary care practitioners with a broader understanding of the real face of child poverty in Canada, including the incidence, demographics, health and social impacts, as well as some special Canadian features. Further, we have optimistically presented some pathways for possible solutions (Ferguson et al, pages 701–706). The poignant article by National Chief Phil Fontaine (pages 653–655) is a must read. His description of what lies behind poverty in the Aboriginal communities is very clear. Our current laws and policies, which are rooted historically in the belief that European culture was somehow superior to the Aboriginal culture, are significantly harming Canada’s Aboriginal children because of the resultant sustained economic gap. The National Chief’s call to action for his communities must be addressed urgently. Poor children interface with clinicians more frequently than children from families of higher economic status, and poverty is a predictor of increased rates of most negative health outcomes. The increased rates of infant mortality, low birth weights, asthma, obesity, functional disabilities, poor literacy, poor school readiness, and behavioural and mental health difficulties all bring these children into repeated contact with the health care system (Gupta et al, pages 667–672). Furthermore, because the incidence of poverty is highest among our youngest children, the impact on their life successes, health and future well-being mediated through these early years is particularly critical. Paediatricians and primary care practitioners may witness the expression of poverty from a child or family point of view when it is presented uniquely in hospitals, clinical offices or communities. The families of the poor children that we see often reflect a special profile, including an increased likelihood of being a single mother, being a recent immigrant, coming from an Aboriginal family or having a disabled parent (Rothman, pages 661–665; Pagani, pages 693–697; Pagani and Huot, pages 698–700). Unfortunately, the actual level of poverty may not be recognized due to a lack of awareness or time constraints on the health care practitioner. Enhanced cultural sensitivity exposure in our training programs offers a potential approach to address this shortfall (Razack, pages 657–659). Clearly, poverty comes with considerable baggage and brings with it a significant panoply of negative events; childhood poverty limits their horizons, dreams and potentials. As is seen in the articles by Larson (pages 673–677), Gupta et al, and Pagani, the lifetime trajectory for children experiencing poverty is diminished and driven down so that other lifetime events of chronic illness, divorce, loss, etc, have enhanced traction in an already challenged environment. Without interventions and changes in our current direction, the cycle of ongoing poverty is inevitable. These interventions are particularly important during the prenatal and early years because this is the largest age group of children living in poverty. Our ability to continue to focus attention on child poverty and its impact requires ongoing measurement with creative data display and knowledge translation. The articles by Hertzman and Bertrand (pages 687–692), and Rothman, tell the real Canadian story and focus on the interface of poverty with the community.