Child and Youth Health

1
Child and Youth Health Gender,
Culture/Ethnicity, and Income Influences
"Establishing Child and Youth Health Indicators
Workshop- Part Deux Montreal, November 10, 2004
2
Relevant FPT Initiatives

• FPT Council of Ministers on Social Policy Renewal
  endorsed approach to measuring child well-being
  including children and the environment. (May
  1999)
• FPT - ACPH Directions Towards Health for All in
  Canada - minimum indicator set. (June 2000)
• FMM requested public reports on outcome
  indicators on child well-being by 2002 (Sept
  2000)
• FPT - ACPH The Opportunity for Adolescence
  The Health Sector Contribution. (Oct 2000)
• FPT - ACPH Integrating Efforts The Next Step
  in Developing National Health Indicators (2001)

3
Relevant FPT Initiatives

• FPT - ACPH Mapping PIRC (Performance Indicator
  Review Committee) Indicators on to ACPH minimum
  indicator set (May 2001) and Report on Status of
  14 PIRC Indicators. (August 2001)
• FPT - ECD proposed child indicators of health
  plus family and community indicators (23
  indicators, Sources NLSCY, CIHI, vital stats,
  census) and recommended data availability for
  specific populations eg aboriginal children.
  (April 2002)
• FPT Advisory Committee on Governance and
  Accountability Framework for Indicator
  Development. (June 2003)
• FPT - ACPH Reducing Health Disparities - Roles
  of the Health Sector, A Discussion Paper, draft.
  (May 2004)

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Child and Youth Health IndicatorsA
gender-sensitive perspective

• The objective of this national initiative is to
  identify existing indicators and develop new
  indicators that will be used to monitor and
  evaluate the health of, and the health services
  provided to, infants, children, youth (BOYS and
  GIRLS), and their families.

5
Situating Child and Youth Health
G e n d e r
Culture and Ethnicity
Socioeconomic Status
Child and Youth Health
6
Why Gender?

• From childhood through adolescence, females and
  males face changing and disparate threats to
  their health and well-being including injuries,
  vulnerability to physical and psychological
  health problems, and the adoption of risky
  behaviours.
• (for example) There are more deaths by suicide in
  young men, although young women engage in more
  suicidal behaviours.
• Gender, Sex, Health and Health Care A Submission
  to the Romanow Commission
• Stewart, 2002

7
Why Gender?

• Policies and programs that support healthy child
  development, including high quality child care
  for all children and head start programs for
  young children in disadvantaged situations home
  visiting, food supplementation and counseling for
  pregnant women at risk enhanced financial,
  employment and social support for single parents
  and initiatives that invite a greater involvement
  of men in domestic and parenting roles.
• Gender, Sex, Health and Health Care A Submission
  to the Romanow Commission
• Stewart, 2002

8
Why Gender ?

• Girls may adapt more to chronic conditions but
  have lower expectations, boys want to feel in
  control.
• Boys more learning disabilities and
  emotional/behavioural problems.
• Boys more vulnerable to disease than girls but by
  adolescence, males more healthy.
• Boys more injuries.
• Girls more psychological and somatic complaints.
• Girls more positive health behaviours.
• Females report more illness and reactivity to
  stressful events in social networks.
• Adolescent girls internalize distress and report
  more depression and lower self esteem.
• Boys externalize distress through aggression.
• Gender differences stronger in adolescence.
• (Spitzer, 2003)

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Why Gender, Income and Culture?

• The most powerful determinants of youth physical
  and emotional health in 2002 Health Behavior in
  School Aged Children Survey were gender, family
  affluence, school conditions, and influence of
  peers on risk taking. (Boyce, 2004)
• The strongest predictors of health disparities
  are SES, gender, aboriginal status and geographic
  location. (FPT ACPH, 2004)

10
Gender and Violence

• Objective 4 Reduce Violence in Society,
  Particularly Violence against Women and Children.
  
• (Federal Plan for Gender Equality, 2002)
• Exposure of youth to violence leads to injuries,
  pregnancy, depression, substance abuse, anxiety
  etc.
• (FPT - ACPH, 2000)
• Childhood abuse and negative life events linked
  to substance abuse by young women
• (Spitzer, 2003)

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Gender and Income

• Familial and economic roles that contribute to
  gender inequality result in differential
  mortality rates both in childhood and adulthood.
• Children raised in poverty are more likely to
  have learning disabilities, language delay,
  anti-social behaviours, low-participation in
  sports, chronic disease, and low self-esteem.
  
• (Spitzer, 2003)
• Rates of infant mortality in poorest
  neighbourhoods remain 2/3 higher than richest.
• Low SES linked to low self esteem and high risk
  behaviours.
• Food insecurity, linked to poor health, is
  greatest in aboriginal people, lone mothers.
• (FPT-ACPH, 2004)

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Income and Gender

• 20 of children in Canada live in poverty and low
  income families most likely to live in
  substandard housing with environmental problems.
• Children in low income families and poor housing
  at increased risked for poor health outcomes.
  (FPT ACPH, 2000)
• Mortality rates among homeless youth in Montreal
  are nine times higher for males and 31 times
  higher for females.
• Homeless youth in Canada are at risk for HIV
  infection due to prostitution, injection drug
  use, learning disabilities, inadequate diet,
  irregular sleep, exposure to violence.
• Street youth are at high risk for addictions,
  STDs, unplanned pregnancy, viral hepatitis, etc.
  (Frankish, 2003)

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Support Intervention for Homeless Youth

• Assessment
• Interviews with 18 service providers and 36
  homeless youth (many aboriginal)
• Health Concerns
• Discrimination
• Poverty
• Abuse/Violence
• Diminished sense of identity
• Transience
• Lack of shelter
• Inadequate life-skill training

• Intervention
• Peer professional mentors
• Group and one-to-one support, mentoring,
  recreational activities, and meals

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Low-Income Consumers Perspectives on
Determinants of Health Services Use

• Interviews
• 252 low-income people
• 19 service providers
• 22 advocacy groups
• 16 policy influencers
• Services needed by parents
• Child care and respite care
• Headstart
• Family counseling
• Recreation and extracurricular activities for
  children

15
Left Out Isolation/Belonging and
Inclusion/Exclusion in Low-income Populations

• Interviews with 148 low-income and 60 higher
  income people
• Barriers to inclusion and participation
• - lack of child family programs
• - high cost recreation programs for youth
• - inaccessible programs - transportation
• - lack of child care
• - inadequate health care coverage
• - cost of healthy foods

16
Income and Culture

• Rates of poor health, hyperactivity and delayed
  vocabulary development higher in children in low
  income families and poor outcomes persist.
• Infant mortality rates among First Nations and
  Inuit 2 to 3 times higher than Canadian rate.
• (Improving the Health of Canadians CPHI, 2004)

17
Culture and Income

• Although poverty is one of the major risk factors
  for the mental health of children, and although
  immigrant children are almost three times more
  likely than their non-immigrant counterparts to
  live in poverty, immigrant children enjoy better
  mental health and evidence fewer behavioural
  disturbances. (Beiser, 2003)
• Language and cultural barriers make accessibility
  difficult for some youth in Canada (FPT ACPH,
  2000)

18
Ethnicity/Culture

• Forced removal of Aboriginal children into
  institutions or far away from their families and
  communities, inadequate services to those living
  on reserves
• Hepatitis A is 12 times higher in First Nations
  children than the national average and intestinal
  illness is 20 times higher.
• Poverty contributes to respiratory diseases and
  hearing loss in Aboriginal children
• Infant mortality rate in First Nations is two
  times higher than the Canadian rate. First
  Nations infants with lower birth rates experience
  higher mortality
• Suicide and self-inflicted injury is the leading
  cause of death in Aboriginal children ages 10 -19
  (Adelson, 2003)
• Injury death rate among aboriginal infants and
  preschoolers 4 to 5 times the Canadian rate (FPT
  ACPH, 2004)

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Multicultural Meanings of Social Support

• Interviews
• 30 service providers, 30 policy influencers,
• 60 Somali refugees, 60 Chinese immigrants
• Challenges Faced by Immigrants and Refugees
• inadequate and costly child care
• incomprehensive health care coverage
• social isolation in school system
• lack of information on childrens services
• concern re children back home
• Supports Needed
• employment life skills training
• youth programs
• family liaison/mediation
• counselling

20
Literacy, Gender and Culture

• All kinds of literacy are or could be linked in
  the literature to a number of determinants
  including education, early child development,
  aging, personal capacity, living and working
  conditions, gender, age, and culture.
• Rootman, 2003

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Relevant IGH Funded ResearchSelected Examples
Access and Equity for Vulnerable Populations

• Rural womens experience of maternity care
  (2002-3)
• Responding to rural communities Building a
  program of research in maternity care (2003-4)
• Strengthening and building sexual health of
  aboriginal youth and young adults (2002-3)
• Distance intervention for rural depressed
  mothers (2002-3)
• Development of migration and reproductive health
  studies (2002-3)
• Development of a quality of life instrument for
  homeless persons and street youth (2003-4)
• A pilot study of local responses to the food and
  nutrition needs of homeless youth (2003-4)
• International conference on the impact of
  globalization on women and children (2003-4)

22
Relevant IGH Funded ResearchSelected Examples
Promoting Positive Health Behaviours

• Long term consequences of prenatal exposure to
  maternal cigarette smoking on brain structure,
  function and mental health in adolescents role
  of genes and environment on brain development
  (2001-2)
• Fetal alcohol syndrome oxidative stress and
  innovative therapies (2001-2)
• Fetal alcohol syndrome and womens health
  (2001-2)
• Identifying childhood predictors of adulthood
  obesity (2003-4)
• Teen girls and smoking (2001-2)
• Impact of child maltreatment on adolescent and
  adult health outcomes (2002-3)
• Power and compassion helping abused parents
  deal with aggressive teens (2002-3)

Gender and the Environment

• Multifaceted potential of the school as a
  setting for health promotion (2002-3)

23
Relevant IGH Funded ResearchSelected Examples
Promoting Health in Context of Chronic and
Infectious Conditions

• Autism spectrum disorders pathways to better
  outcomes (2003-4)
• Adolescent females, obesity and asthma an
  inflammatory state (2003-4)
• Women and children last building an
  international team and developing methods to
  study inequity in eye care (2002-3)
• Diagnosing mental disorders associated with
  childbearing (2002-3)
• Exploration of the cognitive behavioral model of
  health anxiety during pregnancy (2003-4)
• Gender differences in child development
  vulnerability to chronic pain (2002-3)
• Neonatal sex differences in responses to pain
  and pain therapies (2002-3)
• A qualitative study of the experiences of women
  living with HIV/AIDS as they engage with the
  prevention of mother to child transmission
  program in Lilongwe, Malawi (2003-4)
• Pain in child health an innovative,
  transdisciplinary, cross Canada research training
  program (2001-2)

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Relevant IGH Funded ResearchSelected Examples
Gender and Health across the Lifespan

• Understanding and fostering healthy
  developmental trajectories A multi-dimensional,
  longitudinal, and experimental approach (2003-4)
• Influences of smoking and ETS on pregnancy
  outcomes and infant's health and evaluation of
  intervention measures after birth in China
  (2002-3)
• Infrastructure for Canadian participation in a
  mother child health international research
  network (2002-3)
• Canadian child and youth health research
  clinician-scientist development program (2001-2)
• Canadian Institute of Child Health National
  Symposia gender, mental health and spiritual
  well-being (2001-2)
• Child and youth health congress (2003)
• Healthy pregnancy for great life beginnings
  (2002-3)
• Enhancing research capacity in child and youth
  health (2002-3)
• Canadian birth cohort study (2003-4)
• The future of health care Valuing children,
  youth and families (2003-4)
• Motherisk research update (2003)

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Romanow Report, 2002

• Equity means that citizens get the care they
  need, without consideration of their social
  status or other personal characteristics such as
  age, gender, ethnicity or place of residence.
• Issues related to gender, language, and cultural
  background have a profound impact on peoples
  roles, how they view and use health care
  services, and how they respond to different
  programs and approaches to care.

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Kirby Report, 2002

• Research in such fields as population health,
  public health, health services delivery, clinical
  practice guidelines, early child development, and
  womens and Aboriginal health should be given the
  highest priority.
• The federal government should provide
  additional funding to health research aimed at
  the health of particularly vulnerable segments of
  Canadian society.

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Speech from the Throne, October 2004

• Help low income families provide for childrens
  education
• Create national system of early learning and
  child care based on accessibility
• Address high rates of FAS and teen suicide in
  Aboriginal communities
• Extend affordable housing initiatives

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For more Information

• CIHR Website
• www.cihr-irsc.gc.ca
• The IGH Researcher Registry
• www.igh.ualberta.ca
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