Closing the gap between what we know and what we do for Canada’s young children

Abstract

The impact of the early years on a child’s chances at success later in life is indisputable. Thanks to advanced understanding of the relationship between early experience, brain development and outcomes, we now know that the first years of life offer a unique opportunity, both for individual children and families, and for our society (1). Neuroscience has shown us that children’s early experiences are critical to future health, learning and behaviour. What happens to children during this time can set them on a lifelong course – for better or for worse. The Globe and Mail recently reported that 25% of all health care costs are devoted to caring for patients in their final year of life (2). End-of-life care is an indisputable marker of a compassionate society, but what do we give up to pay for this? Do we inject the same amount of economic energy into the first years of life? In January, the Canadian Paediatric Society released its biennial status report on public policy affecting children and youth (3). The report examines how effectively provincial/territorial and federal governments are using their legislative clout to promote the health and well-being of kids. We conclude that both levels of government could be doing much more, much sooner – and for a relatively modest investment – to protect and nurture the health of our youngest citizens, and to promote a more prosperous and secure society. Our standing among the world’s richest countries lays bare this neglect: Canada has not fared well in international comparisons of child health and well-being. In a UNICEF report on early learning and care (4), for example, Canada was at the bottom of the list among 25 wealthy countries, meeting only one of the 10 benchmarks for protecting children in their most vulnerable and formative years. Nobel Prize-winning economist James Heckman argues that early learning begets later learning, and that waiting until children reach school age to intervene may be too late (5). Many children start school with unidentified speech, vision, hearing or other problems, and more than 25% are considered ‘vulnerable’ in their physical, social/emotional or language/cognitive development (6). Much of this disparity can be traced back to the quality of children’s early experiences and environments. In other words, these are things we can change. Investing early has far more economic benefit than spending money after children start school. Estimates of the return to society on dollars spent in the early childhood years vary, but they are impressive – from $4 to $8 for every $1 spent (7). Dan Trefler, an economist at the University of Toronto’s Rotman School of Management (Toronto, Ontario), argues that high-quality early childhood development initiatives all but pay for themselves. Not only do early childhood interventions enhance adult employability and generate billions in tax revenues, he says, they also reduce the need for expensive remedial programs such as special education and medical treatment (8). What is the cost of doing nothing? It’s huge. Studies from other countries have shown that adverse early experiences can have negative implications throughout life – ranging from school problems and teen pregnancy in adolescence, to obesity, high blood pressure, depression and heart disease in the later years (7). Add to this the costs of the criminal justice system. And consider all the vulnerable children who are capable of making positive contributions to our country, but are destined to languish as adults on the margins of our society. Nearly every struggling parent wants a better future for their children. And whether you’re a scientist, a social activist or a fiscal conservative, investing wisely in our youngest citizens makes sense. Neither an ageing demographic, an uncertain economy nor willful policy neglect should undermine such investments. Parents need both our direct and social policy supports. In addition to enhanced investment in the early years, Canada’s paediatricians propose new national measurement tools to monitor our children’s progress, so governments can implement the most effective policies and interventions. We also propose that every province and territory have a robust poverty reduction strategy, a child and youth advocate who reports directly to their respective legislatures, and enhanced well-child visits with a health professional for all 18-month-olds. The evidence from our scientists and economists tells us we can do a much better job to close the early years policy gap with modest, cost-effective investments. Young, vulnerable children, without a voice but full of potential, need our leadership.