Health Care for Children and Youth

1
Health Care for Children and Youth

• A National Perspective

2
Key Themes in Health Care

• Fragmentation of Service
• Turf intense
• Institutional
• Professional
• Regional

3
Key Themes in Health Care

• Public frustration
• Political suspicion
• Black watch
• Budget battles

4
Environmental Scan - Societal

• Children at highest risk live in families that
  are themselves at least somewhat disenfranchised
• Societal instinct is to protect children
• Their inherent value
• Their vulnerabilities
• They hold the future

5
Environmental Scan Population / Demographics

• The determinants of health of children
  predominantly reside outside of care models
• Very complicated
• Children decreasing in proportion of population
• Mortality is decreasing

6
Environmental Scan - Political

• Dont vote themselves not a constituency
• All of health care is seen as an interest group
• Child health care sector is an interest group
  within the larger group
• We use children to manipulate the system
• Politicians fear child health issues

7
Environmental Scan System

• People in child health are nice people

8
Environmental Scan

• Should be opportunities to support the needs of
  children.

9
Magical Thinking

• Federal Government
• Essentially a Provincial problem
• Provincial Governments
• We should maintain delivery system status
  quo
• if system management was better, we could
  make it work

10
Magical Thinking

• Public
• We can afford it all
• as long as my taxes dont increase
• Health Authority
• If we work fast enough, we can fix everything.

11
Magical Thinking

• Hospitals
• If we had control and more resources we could
  each meet all demands of our populations
• Community
• If we had more resources, we could reduce the
  demands

12
Parallel Play

• Government - budget process es
• Health Authorities and Delivery Sites
• for the most part, work independently within a
  single framework
• can share from time to time
• as long as theres enough space and toys to
  accommodate all

13
Getting Child Health on the National Agenda
Define your Agenda
Build Consensus
Get to the Table

• Position your Issues

14
Getting Child Health on the National Agenda

• Define your Agenda

• Focus on high-risk groups
• Use Evidence

15
High Risk

• Aboriginal Children
• Immigrant / Refugee Children
• Children with Chronic Diseases
• Prevention / Promotion

16
How to get to the Table

• Define your agenda
• High risk groups
• Must be priority
• In an equitable world, relative risk should be
  more important that attributable risk
• (has never been accomplished)

17
How to get to the Table

• Define your agenda
• Prevention through healthy lifestyles
• Diabetes
• Nutrition
• Exercise
• Prevention of Injuries
• Mental Health

18
Using Evidence
19
Using Evidence
20
Using EvidenceSocio-economic Factors
MCHP
21
Using EvidencePYLL Males
Age-adjusted rate of PYLL per 1,000 males age 1 -
74
MCHP
22
Using EvidenceInjury Mortality Rates
MCHP
23
Using EvidenceBreast Feeding Rates
Percent of newborns breastfeeding at hospital
discharge
MCHP
24
Using EvidenceInfant Mortality Rates
Rate of death per 1000 infants (age less than one
year)
MCHP
25
Aboriginal Child Health
Infant Mortality Northwest Territories 1966 - 72
26
Aboriginal Child Health
Neonatal and Postnatal Mortality / 1,000 Reserve
and Non-reserve 1976 - 82
27
Canadian infant mortality trends
5 year average per 1,000 live births
28
Using EvidenceImmunization Rates MCHP
Crude 1 year old immunization percent with
complete immunization schedule for children born
1994 - 1997
Registered First Nations
All Other Manitobans
MCHP
29
Aboriginal Child Health

• Injury
• Hyperbilirubinemia
• Rheumatic Fever
• Congenital Heart Disease
• Otitis Media
• Pneumonia
• Meningitis
• Tuberculosis
• Type 2 Diabetes

30
Aboriginal Child Health

• Glutaric Aciduria
• Rickets
• Metabolic Disease
• Congenitally Dislocated Hips
• Glomerulonephritis
• IgA Nephropathy
• Suicide / Depression

31
Relative Risk for Hospitalization for 30 Leading
Causes 1992 Status Indian vs. Other

• Relative Risk

Risk Higher
Risk Lower
32
Aboriginal Child Health

• Below the Curve
• Eating Disorders
• Cystic Fibrosis
• VU Reflux

33
Immigrant and Refugee Families

• About 62,000 immigrant and refugee children
  arrive in Canada each year.
• In 2001, Canada received 26,513 refugees (based
  on well-founded fear of persecution, often
  displaced for their own protection without option
  to remain)
• Of 10 million worldwide refugees in 1997
• 5.7 million from the Middle East
• 2.9 million from Africa
• 2 million from Europe
• 1.7 million from Central America

34
Immigrant and Refugee Families

• Epidemiology
• Tuberculosis and Hepatitis B
• Primary Care
• Anemia, dental caries, intestinal parasites,
  nutritional deficiencies and immunization
  irregularities in newly arrived refugees from
  developing countries

35
Immigrant and Refugee Families

• Mental and emotional health problems are the
  major burden of illness
• Migration stress
• Loss of personal and cultural identity
• Depression
• Post-traumatic stress disorder

36
Immigrant and Refugee Families

• Cross cultural differences in diet, smoking,
  information-seeking patterns, communication
  styles, perceptions about the risk of acquiring
  HIV, and ideas about the prevention of diseases.
• Cultural impact on health beliefs and taboos may
  be more profound in the areas of mental health
  and reproductive health.
• cmaj/vol-159/issue-4/

37
Children with Chronic Diseases

• cancer
• asthma
• type I diabetes

38
Using Evidence

• The need for more research is self evident
• however while research helps to quantify outcomes
• the real need is for meaningful interventions

39
Getting Child Health on the National Agenda
Build Consensus
Get to the Table

• Build consensus
• Get involved
• Bring what you uniquely offer
• Stop being victims

40
Build a Consensus

• Fragmentation is a dream to politicians and
  bureaucrats
• It supports the status quo
• Allows decision-making to be deferred
• Hammer it out inside the tent

41
Build consensus

• Focus on
• Integration and Accountability
• NOT
• Autonomy and Control
• Find balance

42
Building an Accountable Organization
Mark Samuel Impaq
43
Build consensus

• Be open to change
• You cant make it better
  without changing it.

44
Build consensus

• Define Common Standards of care
• Create Seamless Transitions
• Improve measurement / Standards process
• Low volume / high risk
• Volume and Outcome are Linked
• Break down Silos

45
Goals

• Integration
• Manage continuum / seamlessness
• Improve standards
• Improve accountabilities
• Find efficiencies
• No Gaming

46
Getting Child Health on the National Agenda
Position your issues

• Need to serve children
• Need to serve politics

47
Get involved

• Child and youth health professionals need to
  participate
• Avoid Isolation
• National and Local Organizations
• Infiltrate

48
Get Involved

• Bring the strengths of Child Health
• Family centred
• Focus on patient safety
• Integrated Care
• Multi-professional roles / teams

49
Get involved

• At every possible table
• At every point of leverage
• Get your elbows up. Stand up for yourself.
• Dont use children

50
Position your issues

• Need to serve children
• Need to help politicians serve children
• Teach the public
• Teach the media

51

• Thank-you
• Questions?