Key Provincial Strategic Directions for Child and Youth Health Provincial Child Health Symposium Nov

1
Key Provincial Strategic Directions for Child
and Youth HealthProvincial Child Health
SymposiumNovember 14th, 2007
2
What are the objectives of the day?
3
The success of Ontarios children and youth
requires input from key leaders and stakeholders.

• The children of Ontario represent a unique
  population whose needs are different from adults.
• Children and youth are not simply little adults
• Services need to be tailored to their specific
  needs
• The government has identified three key themes to
  improve child and youth health outcomes. This
  responsibility is shared across several
  Ministries
• Overall well-being
• Access to services
• Data quality
• Leaders from various sectors have been brought
  together to begin a dialogue about the future
  direction for Ontarios child and youth health.
• What transformational changes can we make
  together to better serve children and youth?
• What changes would you like to see occur?
• So today, think outside the box, push traditional
  boundaries and help develop what you think should
  be the desired state for child and youth health
  in Ontario.

4
The building blocks for strategies which improve
life prospects include early intervention,
timely care and better coordination.

• Early childhood experiences make a critical and
  long-term difference in children's early
  development and in their health and well-being
  during childhood and as adults. Identifying young
  children (prenatal to six years of age) who
  require additional supports to achieve social,
  emotional, cognitive and physical health, and
  intervening as early as possible with those
  supports, can improve life prospects. Vision,
  Ontario Healthy Babies, Healthy Children Program
• The toughest thing to face, for any family, is
  when a child is sick. By investing in more
  surgeries for kids, more parents will rest easier
  knowing their children are safe from harm and
  more kids will grow up to lead healthy, active
  lives. Premier McGuinty announcing Paediatric
  Wait Times Strategy, May, 2007
• The Ministry is working with other Ministries
  and community partners to develop and implement
  policies, programs and a service system that
  helps give children the best possible start in
  life, prepare youth to become productive adults
  and make it easier for families to access the
  services they need at all stages of a child's
  development. MCYS Mission
• Habits and attitudes developed in childhood last
  a lifetime. People who eat healthy foods and are
  physically active during their childhood and
  youth are more likely to eat nutritious food and
  be active throughout their lives. Ontario Action
  Plan for Healthy Eating and Active Living (MHP)
• Ontario students will receive the best public
  education in the world, measured by high levels
  of achievement and engagement for all students.
  Successful learning outcomes will give all
  students the skills, knowledge and opportunities
  to attain their potential, to pursue lifelong
  learning, and to contribute to a prosperous,
  cohesive society . MED Vision

5
Who are Ontarios Children?
6

Ontarios children represent a diverse group from
various backgrounds.

• Children and Youth
• Represent 18 of the population (aged 0-14) 1.
• Approximately 37 of immigrants to Canada in 2006
  were children and youth under the age of 25 2.
• 62 of children in Toronto were born outside of
  Canada (aged 0-6) 3.
• Families
• Increasing alternative family structures (e.g.
  single patent families, blended families and
  same-sex families) 4.
• Education
• 73 of high school students graduated from high
  school in 2005-06 5.
• This is an increase from 71 in 2004-05 and 68
  in 2003-04 6.
• In 2005-06 13 of students were reported as
  receiving special education programs and services
  7.
• In 2005-06 approximately 5000 students were
  enrolled in educational programs in government
  approved Care, Treatment, Custody and
  Correctional Facilities 8.

• Policy Research and Analysis Branch, MCSS. Info
  Notes Age and Gender Distribution Across
  Ontario.
• Citizenship and Immigration Canada. 2006. Facts
  and Figures Immigrant Overview, Permanent
  Residents.
• McKeown, Dr. David. 2006. The Health of
  Toronto's Young Children, Volume 1 Setting the
  Context. Toronto Public Health.
• McKeown, Dr. David. 2006. The Health of
  Toronto's Young Children, Volume 1 Setting the
  Context. Toronto Public Health
• Ministry of Education, 2006.
• Ministry of Education, 2003-2006.
• As reported by schools in School October Reports,
  2005-06, Ministry of Education.
• 2007 study conducted by Field Services Branch,
  EDU (2005-06 School Boards Estimated Enrolments
  submitted to Field Services Branch EDU during
  annual application process).

7

Ontarios children represent a diverse group from
various backgrounds (contd).

• Employment Prospects
• Those with a high school diploma (aged 15-24) had
  an employment rate of 66 (2006 data) 1.
• Poverty in Ontario
• 17 of children live below the poverty line,
  which is an increase from 15 in 2001 2.
• Poverty rates for Aboriginal, visible minorities
  and immigrant families are double the average
• rate 3.
• Children with disabilities are more likely to
  live in poverty (26) 4.
• International Ranking
• Canada ranks 2nd in education and 6th in material
  well-being 5.
• However, Canada only ranks 13th on health and
  safety, 17th on behaviours and risks and 18th on
  peer relationships 6.

• Labour force survey estimates (LFS), by
  educational attainment, sex and age group,
  annual. Table 282-0004.
• Campaign 2000, (2006). Report Card on Child
  Poverty in Ontario.
• Campaign 2000, (2006). Report Card on Child
  Poverty in Ontario.
• Campaign 2000, (2006). Report Card on Child
  Poverty in Ontario.
• UNICEF Innocenti Research Centre, Report Card 7
  (2007). Child poverty in Perspective An Overview
  of Child Well-Being in Rich Countries.
• UNICEF Innocenti Research Centre, Report Card 7
  (2007). Child poverty in Perspective An Overview
  of Child Well-Being in Rich Countries.

8
What are the challenges facing the children and
youth of Ontario?
9
Ontario and Canada are facing key challenges
related to child and youth health status.

• Poverty/Social Determinants
• Over 20 of children in Canada live in poverty
  1, while 17 of children in Ontario live below
  the poverty line2. In Toronto, children
  represent 19 of the homeless population and 36
  of those relying on food banks 3.
• Unhealthy Weights, Inactivity and Injuries
• 15-20 of Ontario children are overweight or
  obese 4. Between 1981 and 1996 the prevalence
  of obesity amongst Ontarian children (aged 7-13)
  tripled 5.
• 91 of Canadian children and youth are not
  meeting the guidelines set forth by Canadas
  Physical Activity Guides for Children and Youth
  6.
• Children are not eating the recommended amount of
  fruits and vegetables (5-10 times daily). In
  2004, 59 of Canadian children between the ages
  of 2-17 years of age consumed fruit and
  vegetables less than 5 times a day. These
  children were significantly more likely to be
  overweight or obese compared to those who
  consumed fruit and vegetables more frequently
  7.
• Approximately one in every four emergency
  department visits in Ontario is injury-related,
  and among children aged 10-14 years, this
  increases to almost one in two 8.

• City of Toronto Report Card on Children, 2006.
• Campaign 2000, (2006). Report Card on Child
  Poverty in Ontario
• City of Toronto Report Card on Children, 2006.
• Canadian Community Health Survey, 2000.
• Tremblay, MS, PT Katzmarzyk JD Williams. 2002.
  Temporal Trends in Overweight Obesity in
  Canada, 1981-1996. International Journal of
  Obesity 26(4) 538-543
• Canadian Fitness and Lifestyle Research
  Institutes, 2007.
• CCHS, 2004.
• ICES, 2005.

10
Ontario and Canada are facing key challenges
related to child and youth health status.

• Chronic Disease, including Mental Illness
• There has been a 20 increase in diabetes among
  children of all age groups in Ontario from 1995
  to 2000. The prevalence of diabetes is greatest
  among children between the ages of 5 and 9 1.
• At any given time, 14 of children between the
  ages of 4 to 17 in Canada will meet the criteria
  for a mental illness, but fewer than 25 of these
  children will receive treatment 2.
• Access to Primary Care
• There has been a decrease in the number of visits
  to general practitioners, family physicians and
  paediatricians by children in Ontario between the
  periods of 1992/993 and 2003/2004. Moreover, an
  increasing proportion of children reported no
  primary care visits within a two-year period 3.

• 1 ICES. 2003. Diabetes in Ontario Practice
  Atlas.
• 2 Waddell, Charlotte, Kimberley McEwan, Cody A
  Shepherd, David R Offord and Josephine M Hua.
  2005. A Public Health Strategy to Improve the
  Mental Health of Canadian Children. Canadian
  Journal of Psychiatry 50(4) 226-233.
• Institute for Clinical Evaluative Studies. 2003.
  Primary Care Atlas.

11
Demographics in Ontario are changing. People are
living longer and the population is growing.

• The number of people aged 65 and older will
  increase exponentially as baby boomers turn 65
  starting in 2011.
• Moreover, the population of visible minorities is
  expected to grow by 86 between 2001-2017
  (self-reported).
• The increase in life expectancy will place more
  demand to support the needs of the elderly across
  sectors.

12
Ontarios population is aging

• The demands of the aging population consume a
  greater proportion of costs and resources.

13
The Ontarian health provider work force is aging

• While the general workforce is aging, the trend
  is more pronounced in health occupations.
• An aging workforce will impact the delivery of
  services across all sectors.

14
More people are living in urban areas

• The concentration of people in urban areas will
  place high demands on the system. It is
  important that through innovative solutions
  services are provided outside of the GTA to
  ensure access regardless of geography.

15
These challenges are complicated by the unique
nature of child and youth health, dispersed
responsibility, demand outpacing capacity, and
inadequate information and planning data.

• Childhood is a period of intense development and
  change, with narrow windows of opportunity for
  intervention during the various stages of
  development. Children and youth differ
  significantly from adults in their physiology,
  diseases and disorders and capacity to comprehend
  and participate in care.
• Many government Ministries, sectors and providers
  are involved in providing funding and planning
  for child and youth health services. This makes
  it difficult for clients to seamlessly access
  services and for providers to effectively plan
  for and deliver well-coordinated services.
• Advances in maternal (including fertility) and
  child health care have resulted in a
  significantly expanded demand for services which
  have not kept pace with capacity to provide
  services, including demands related to
  increasingly complex care needs.
• Currently, there is no single comprehensive
  inventory of maternal and paediatric data
  holdings. Moreover, there are gaps in data needs
  for internal and external stakeholders. The lack
  of adequate data creates significant challenges
  for effective planning for child and youth health
  services.

16
What is the government doing?
17
Moving forward, the Ontario government has
identified several key themes and associated
areas of action to improve outcomes for children
and youth.
Key Areas of Action
Themes

• Poverty Reduction Equity
• Improved Health Outcomes
• Healthy and Active Living
• Economic Supports
• Improved Educational Prospects

Improved Child Health and Well-Being

• Education Social Services
• Access to Primary Care
• Specialized Paediatric Care
• Mental Health Services

Better Access to Child and Youth Services

• Data Convergence
• Data Quality
• Reduce Gaps in Data
• Evidence-Based Decisions

Improved System Planning
18
The first theme looks to improve child and youth
well-being

• Poverty Reduction Equity
• Combat child poverty through Ontario Child
  Benefit
• Provide dental services for low income families
• Address health equity, including Aboriginal
  health strategy
• Improved Health Outcomes
• Reduce childhood obesity through health promotion
  and disease prevention
• Provide healthier food choices and ban trans fats
  from school cafeterias
• Prevent diabetes and help children and youth
  living with diabetes through technology and
  specialized services
• Develop a prenatal and perinatal health strategy
• Develop a fertility treatment policy
• Healthy Active Living
• Encourage daily active living (including tax
  incentives)
• Expand intramural activities and create an
  Ontario Fitness Challenge program
• Economic Supports
• Develop a long-term strategy for affordable
  housing
• Create partnerships with financial institutions
  to help low-income Ontarians own their own home,
  pay for their childrens education or run their
  own business

19
The second theme is to provide better access to
child and youth services.

• Education Social Services
• Increase capacity to meet the needs of students
  in regular and self-contained classrooms (e.g.
  primary classes with 20 students or fewer)
• Develop and fund full-day pre-school program
• Offer supports to children from at-risk
  neighbourhoods
• Close gaps in performance for Special Education,
  Aboriginal and English language learners (ELL)
  student populations
• Increase post-secondary opportunities by
  providing grants at the beginning of the school
  year rather than waiting for the post-secondary
  education tax credit at the end of the year
• Primary Health Care
• Develop interdisciplinary care models including
  paediatric and maternity care
• Chronic disease prevention management (e.g.
  Diabetes)
• Enhance capacity issues for 18 Month Well-Baby
  Visit
• Specialized Child and Youth Health
• Address paediatric surgical wait times
• Address wait times for developmental/behavioural
  services
• Conduct mapping exercise of child and youth
  mental health services and programs (to support
  existing framework)
• Review and update the role of Paediatric Academic
  Health Science Centres (AHSCs)
• Address capacity issues of neonatal intensive
  care units (NICU) Level III
• Review paediatric critical care and
  transportation

20
The third theme is to improve the system through
the effective use of data.

• Data Convergence
• Develop a comprehensive inventory of maternal and
  paediatric data holdings
• Create an inventory of existing paediatric data
  holdings
• Develop common definitions to support data
  alignment and provide clarity
• Data Quality
• Improve the quality of Ontario data, which has
  been excluded from federal reports (e.g. Canadian
  Perinatal Surveillance System) in the past
• Gaps in Data
• Consult internal and external stakeholders on
  their data and information holdings and needs
• Evidence Based Decisions
• Ensure that funding of research assists in policy
  formation
• Make data widely accessible and available
• Use data to support the development of strategy,
  policy and practice

21
We will be working collaboratively across
government and with our partners in the community
and health facilities to advance these key themes.

• We are working together across government
• A cross-Ministry reference group including MCYS,
  MHP, MEDU and MCSS has been established to
  consider child and youth health strategies and
  policies across government.
• LHINs are a key partner on child and youth health
• Many LHINs identified child health issues in
  their Integrated Health Service Plans.
• We are working closely with PCCH
• MCYS, MOHLTC and LHINs sit on PCCH.
• Todays symposium and your discussions will
  inform our ongoing work we look forward to
  hearing from you!

22
As you continue your day, keep in mind

• Innovative solutions
• Transformation
• Desired outcomes
• Challenging paradoxes
• Opportunities to bring about real change