Healthier Canadian Children

June 24, 2008



Healthier Canadian Children



DR. KELLIE LEITCH

Advisor, Healthy Children and Youth, Health Canada



Chairman: Catherine S. Swift

President, The Empire Club of Canada



Head Table Guests:



Sylvia Morawetz: Principal, S.A.M. Solutions, Treasurer, Canadian Alliance for Children’s Healthcare, and Director, The Empire Club of Canada

Kevin Bailey: Grade 12 Student, Danforth Collegiate and Technical Institute

Reverend Canon Philip R. Bristow: Senior Pastor, St. Philip’s On-the-Hill Anglican Church, Unionville

Pam Jolliffe: President, Boys and Girls Club of Canada

Mary-Jo Haddad: President and CEO, Hospital for Sick Children

The Hon. Hugh Segal: CM, BA, Senator,The Senate of Canada

Stephen Hewitt: Manager, Corporate and Public Affairs, TD Bank Financial Group, and Director, The Empire Club of Canada

Professor Judy Finlay: School of Child and Youth Care, Ryerson University

David Moran: Director of Communications, Coca-Cola Canada.



Introduction by Catherine Swift:

Although every era has its challenges, it is arguable that our current crop of children and youth are facing different issues than we faced when we were growing up. Technological change has led to an amazingly interconnected group of young people which has its positives, but also exposes them to such threats as different as online predators, obesity from sitting in front of a screen many hours a day and bombardment by information that is often not appropriate for children or young adults. The traditional family unit is not what it used to be, which imposes different stresses on children. And the reality of two working parents in the vast majority of households, and our overall fast-moving pace of life also imposes pressures on youth.



Our speaker today will be speaking about “Creating a Healthy Environment for Canada’s Children and Youth.” Dr. Kellie Leitch is currently Assistant Professor of Surgery, University of Western Ontario, with the specialty of Paediatric Orthopaedics, and is a consultant at the London Health Sciences Centre. She is also the Chair of the Health Sector MBA program at the Richard Ivey School of Business at the University of Western Ontario and Chair of the Division of Paediatric Surgery, Children’s Hospital of Western Ontario/Schulich School of Medicine. Recently, she chaired the Expert Panel on the Children’s Fitness Tax Credit for Finance Canada.



In March 2007, Dr. Leitch was appointed the new Federal Advisor on Healthy Children and Youth for the Government of Canada. Her report entitled “Reaching for the Top: A Report by the Federal Advisor on Healthy Children and Youth” was released in March 2008.



Dr. Leitch was awarded “Canada’s Top 40 under 40” in 2005, and in November of 2005 was named one of Canada’s 100 most powerful women. She publishes both in the clinical and the best practice model areas of the health-care field.



Please join me in welcoming Dr. Kellie Leitch.



KELLIE LEITCH:



Thank you. And let me thank all of you for providing me with the opportunity to speak with you at the Empire Club today.



Now if I speak too quickly you’ll have to forgive me. I don’t spend a lot of time speaking to large groups of people. I usually just have two other people with me—one who is under anaesthetic and another who wishes he was.



It was a great honour to serve the federal government as its Advisor on Healthy Children and Youth.



It was last spring that the Honourable Minister of Health Tony Clement asked me to provide advice to the government on how to help improve the health of Canada’s children and youth.



I was asked to provide recommendations in three main areas:

• First, to assess the efficacy of existing federal government programs;

• Second, to offer recommendations for new strategic directions;

• And third, to offer an opinion regarding the establishment of an office that would advise the federal government on the health of children and youth.



When I began this process, I thought that I knew a great deal indeed about the impact of children’s health policies, and the determinants of health for Canadian children. Well, it turns out that what I knew then barely scratched the surface. What I know now is that while Canada has a tremendous opportunity to be a world leader when it comes to the health and wellness of children and youth, we’ve got a significant amount of work to do.



Good public policy is not about ignoring issues when they exist. Good public policy is about finding out what’s really going on, and then taking action to address the root causes of issues. So I want to commend the federal government for having the foresight and the courage to ask me to find the truth, to understand what is really happening when it comes to our young people’s health, and to do something about it.



The Minister of Health has already taken steps to improve the health of Canadian children through banning toxic products for children and youth.



Getting the chance to help shape public policy when it comes to the health of Canadian children is both an honour and a privilege. It is also something that I take very seriously. And that’s because of my day job.



I am a paediatric orthopaedic surgeon and almost every day that I am in my clinic, or in the operating room, I see children who simply shouldn’t be there—children who have been injured unnecessarily, children who have suffered from poor nutrition and a sedentary lifestyle, and are experiencing the initial, often life-changing, stages of obesity, and children whose chronic disease challenges are overwhelming. When you see these children every day, it cannot help but get to you.



That’s why I wanted to have a broader impact. That’s why I was so pleased to have the opportunity to serve. And that’s why I wrote my report, “Reaching for the Top,” which contains a total of 95 recommendations on how to help children to be healthier, so they can live better, happier, and more productive lives.



But the report is more than just recommendations. It is a reflection of what Canadian parents spoke to me about—what their concerns are for their children. It’s about giving every child an opportunity to achieve the same health outcomes, no matter what background they are from, no matter where in Canada they grow up.



In writing this report, I travelled to every single province and territory—meeting with over 750 people. I reviewed over 500 documents and reports and received over 7,000 comments and suggestions through our online survey.



What I learned was that getting the health and wellness for our children right is an absolutely essential ingredient to the success of our country.



Nations like India, China, and others in Southeast Asia and Eastern Europe are investing tremendously in health care and education for their children and youth. They’re investing because they get that the number one source of long-term sustainable competitive advantage of their nations is to invest heavily in the health, education and training of their young people.



In Canada, we must take a similar perspective, not only because it is good social policy to invest in the health of children, but because it is also good economic policy. We need to invest in the health and wellness of our children and youth in the same way that we invest in infrastructure, or science and technology. They are our future and they are fundamental to our nation’s economic success in an increasingly competitive world.



I want Canada to be the number-one place in the world for a child to grow up in from a health perspective. We have a way to go to meet that goal, but there’s no reason why we can’t get there. We have the resources and the wherewithal to succeed, but as I stated in my report, Canada has significant opportunity for improvement.



For a nation that prides itself on being prosperous, generous, and enlightened, we can, and must, do better. So today, I want to speak with you about the three key issues—and opportunities—that I identified in my report.



First, I want to talk about the issue of injury prevention, second, childhood obesity, and finally, the improvement of mental health services for Canadian children and youth.



The statistics that drew me to these areas of focus are sobering and I recently came across new numbers that reinforce the conclusions that I drew in my report. In its report card on the child wellbeing of wealthy countries, the UNICEF Innocenti Research Centre indicated that:

• Canada ranked eighteenth out of 26 countries in terms of overall child wellbeing including mental health; and,

• Sixteenth out of 21 countries in health and safety.



When it comes to obesity, the Canadian Community Health Survey reported in 2005 that among 2–17 year olds, 26 per cent of Canadians were overweight and 8 per cent were obese.



These numbers are astonishing!



Within this sobering context, the first of the three issues I want to speak with you about is very important to me: injury prevention. As a paediatric orthopaedic surgeon, I have significant exposure to children who get injured, and for whom the extent of their injuries is often unnecessarily severe.



Let me tell you a story.



It was only my sixth week of practice, and I was educating residents when my pager went off. I was called in by Dr. Kevin Gurr, who is an excellent adult spine surgeon. He needed a paediatric specialist to help with a four year-old boy, Michael. Michael had been ejected from the back seat of the car in which he was riding with his parents, when their car was hit by a tractor-trailer truck. He experienced what we clinically call a hemi-pelvectomy; half of his lower body was torn from his torso. He was so badly injured, that portions of his broken femur had been left on the road at the scene of the accident. This four year-old boy was suffering severe trauma.



I met with Michael’s parents, who were understandably devastated. Given the severity of his injuries, we did not know if he was going to live. And even if he did survive, his parents asked me if he would ever be able to play outside, or run, or participate in physical activities. I can honestly tell you that at that point I did not know. Our main concern was to save him and do our very best to minimize any disability.



That night, the paediatric operating room team and my colleague, paediatric general surgeon Dr. Leslie Scott, and I spent six hours with Michael. And he made it.



Today, Michael is in grade three. And while he has one leg that is a bit shorter than the other one, which we laugh about now, he can play, he can run, and he participates in all sorts of physical activities with other kids his age.



But we were lucky. He was a very resilient little guy with a tremendous will to live. This accident happened relatively close to the hospital. He was brought to us within one hour. And we had a team of paediatric specialists available to take care of him immediately. Some children just don’t have this opportunity.



Emotionally, it is people like Michael that make me as driven as I am. But as an academic physician, the empirical evidence that I uncovered over the course of my work was too compelling to ignore.



According to the Injury Initiative Report, published in August 2006 by the Canadian Institutes of Health Research, preventable injuries are the number-one cause of death among Canadian children and youth.



Think about that.



Preventable injuries are the number-one cause of death among Canadian children and youth.



In 2002, the World Health Organization reported that 700,000 children were killed by a preventable injury. And many others who survive injuries live the rest of their lives with severe disabilities.



ParentsCanada reports that motor vehicle accidents cause the largest number of deaths among children, followed by drowning, and then suffocation.



And it is not just the health impact. SmartRisk’s Report, entitled “The Economic Burden of Unintentional Injury in Canada,” concluded that these unintentional injuries to children cost the Canadian economy $4 billion per year.



The numbers are staggering. But there are constructive ways of reducing them.



In my report, I recommend that the federal government establish a National Child and Youth Injury Prevention Strategy. This is not my idea. Organizations like SmartRisk, Safe Kids Canada, and the Canadian Child and Youth Coalition have long supported a national, strategic approach. This strategy would mandate Health Canada and the Public Health Agency of Canada to work with the provincial and territorial governments, health care experts, non-government organizations, and community organizations to develop and fund a five-year national, evidence-based strategy for injury prevention in children and youth.



Beyond the strategy, I also make recommendations that offer very tangible, concrete things we can focus on to reduce preventable injuries. Things like supporting helmet use, eliminating toxic toys, and promoting booster seats and protective equipment for children and youth.



So we put the big piece in place, the national injury prevention strategy, and then we support it with initiatives that tackle specific problems. That’s how we get these numbers down.



The second issue I want to speak with you about today is childhood obesity.



When Ontario’s former Chief Medical Officer, the late Dr. Sheela Basrur, issued her “Healthy Weights, Healthy Lives Report” in 2004 it contained this alarming statistic: “The percentage of overweight children in Canada has tripled in a generation.”

Tripled!



There are a number of causes—all connected. It starts with bigger food portions—food choices that don’t follow the Canada Food Guide—with too much snacking on junk food, the prevalence of trans-fatty acids and less outdoor play.



The bottom line? Our kids need to eat fewer cookies and more carrots. Children need to get away from the Playstation and back out to the playground.



During the round tables I hosted across the country, I heard several things about childhood obesity.



First, part of the problem is that parents are scared to let their children play on the street and in their neighbourhoods the way most of us did growing up.



Second, among those who are obese, many will go on to develop diabetes and or cardiovascular disease. These overweight children at risk for diabetes and cardiovascular disease will continue to have chronic co-morbidities as they become adults, putting even more pressure on a health-care system working as hard as it can to accommodate aging baby boomers. Many of these children will eventually die of these chronic diseases.



So how do we fix this?



In my mind, too many commentators make all of this overly complicated. It all comes down to children eating better and getting more exercise. It is as simple as that.



I also had the opportunity to provide advice to the federal government regarding the rules and parameters of the Children’s Fitness Tax Credit, which I understand is having its intended impact of increasing participation in physical activity.



One of the purposes of the Children’s Fitness Tax Credit was to help get children and youth playing and sweating. We made no apologies for not recommending eligibility for some activities like archery or bowling. Improving one’s aiming skills wasn’t the point. The point was to get children into the habit of regular, rigorous physical activity.



We need action. More after-school programs. More organizations—like the YMCA and the Boys and Girls Clubs of Canada—being supported to promote play and physical activity. And parents taking their kids to the park to run around, play and get active.



I also want to encourage the federal government to establish an obesity target. Let’s reduce the rate of childhood obesity from 8 per cent to 5 per cent by 2015.



This can only be done if we all become agents of change, demanding better food choices in our restaurants, encouraging better eating habits and making physical activity a daily part of our kids lives.



The last major issue I want to discuss with you today is children’s mental health. This issue is not getting the attention it deserves.



As articulated in the Canadian Paediatric Society’s 2007 Status Report on Canadian Public Policy, there are many problematic gaps in child and youth mental-health services.



At the provincial level, responsibility for mental health has been variable. In some provinces it rests with the Ministry of Community and Social Services and in others the Ministry of Health. In some it rests with both.



The result has been a lack of ownership, meaning mental health hasn’t had the leadership it needs, nor has it been a focal point on the health agenda at any level.



Part of the challenge is that there are multiple entry points into the system for paediatric mental-health patients. They can get referred into the system by a teacher, a social worker, or a parent.



There are good reasons for allowing these patterns of referral, but they are unique, and create some challenges. And the result—all too often—is that young people who need psychiatric care simply get lost in the system. A large number of children and youth who suffer from some form of mental illness do not get the care they need. Children with mental-health problems are identified and referred into the system too late and their problems get worse with time.



In fact, the Sunlife Financial Chair on Adolescent Mental Health reported in 2006 that only one in five children who need mental-health services currently receive them. That is the kind of statistic that should stop you in your tracks. Only one in five gets the help he needs. The results of this gap in services are numerous, and include the burden of a massive cost to our society.



Now—the good news.



If we catch paediatric mental-health problems early enough, we can help people to lead happy and productive lives. Early diagnosis means we gain productive, contributing members of society, and we save taxpayers’ dollars that would otherwise go to social assistance and treatments. Yet if we fail to catch these cases, and fail to help these children, then their problems become society’s problems.



Part of the solution is in the establishment of a paediatric mental-health wait-times strategy.



Right now, we don’t really know how long children are waiting for mental-health services. The result is less effective, slower access and interventions.



In paediatric surgery, we’ve been able to make tremendous progress in identifying problems and bottlenecks since the implementation of our paediatric surgery wait-time strategy, which was recently expanded by Minister Clement based on the positive successes to date.



It has identified problems we didn’t even know existed! The same can—and should—be done for mental health.



A National Mental Health Strategy that focuses on the whole range of issues affecting children and youth is urgently needed. First, because Canada is the only member of the G8 who has not formally adopted such a strategy and second, because mental-health problems among children and youth are predicted by the Canadian Paediatric Society to increase by 50 per cent by the year 2020.



So today, I’ve brought you some sobering statistics. The statistics indicate that the health and long-term wellbeing of too many children are at risk. That’s bad for them, and it’s bad for Canada.



But I am excited about what the future holds. That’s because I know that there are many things all of us here in this room—as well as people from across the country—can do to have a positive and lasting effect on the health of our children.



When I spoke with people across this country, I heard one thing again and again: “We all have a responsibility to help improve the health of all Canadian children and youth.”



Helping our kids to be healthier—helping people like Michael from getting so badly hurt in the first place—needs to be a team effort. No single person, no single organization, and no single government can do it alone. It requires all of us to work together, and to work in complementary ways. It requires the different levels of government not to worry about what is in whose jurisdiction but to work together toward common goals.



Enough with the excuses. It is time to take action on these issues!



It requires NGOs to keep working hard and to continuously improve the programs they already offer, while challenging themselves to develop new ones.



It requires individuals like myself to do more than simply practise good medicine, but also to educate parents. I now tell every single parent, who brings kids through my clinic, that they MUST get their kids helmets for biking, and winter sports. I didn’t do that in the past.



It requires professional associations to step up to do things like encourage doctors to ask about family history regarding obesity, or for engineering associations, to promote children’s safety in the design of products and equipment that could be made safer.



It requires industry leaders to play a role, get involved, and make a difference.



I spoke recently to engineers and executives in the automotive industry, at their Auto 21 conference. And I described to them what happens when small children are ejected from cars involved in accidents.



You could hear a pin drop in the room when I shared with them the picture of children ejected from cars and you could see on their faces how helpless they felt, even though they wanted to do more—something, anything—to help prevent these terrible accidents.



Some of them asked me: “What can we do? What impact can we possibly have?”



I told them that I wanted industry and NGOs to work with government to be leaders in injury prevention to put me, as a surgeon who deals with injuries to children, right out of business.



Nothing would please me more than to never meet another child like Michael, and his parents, in the emergency department again.



There is so much they can do just as there is so much that those of you who are here from industry today can do as well:



• Fund R&D into safer equipment and appliances for children.



• Develop a social marketing campaign designed to teach people how to install child car seats properly.



• Sponsor an after-school program for at-risk kids.



•Raise awareness of the child safety cause. Work with Safe Kids Canada and SmartRisk to help them with their initiatives.



•Work with others. Be a part of the solution.



Your voices matter. Governments pay attention to the people and organizations from whom they hear. So write letters. Call your MPPs and MPs. Send e-mails to government ministries at both the federal and provincial levels. Speak up. Be heard. Because believe me, it does make a difference.



There is no other country in the world that has the resources, talent and the potential that Canada has. It will take planning. It will take action. It will take the desire to change long-standing systems. And most importantly, it will take commitment on all of our parts.



Reaching for the Top provides a path forward to do that. It gives a voice to the thousands of people who participated in its process, and points the way for Canada to become a global leader in the area of health outcomes for children and youth.



For each of the key factors that I’ve talked about today—injury prevention, childhood obesity, and children’s mental health—there are actions that must be taken that will make a difference.



The issues that affect the health of our future generations are of the utmost importance now, and they will remain of the utmost importance into the future. We need to make this a priority, and keep it a priority.



No great achievement was ever accomplished that began with a timid goal. So let’s make our goal to establish Canada as the world leader in children’s health.



There is no reason why Canada should not be the number-one place in the world for a child to grow up in from a health and wellness perspective. Our country should be an example that others follow; our programs and services should serve as the benchmark for other countries around the world.



We have both the resources and the potential to accomplish this goal. So I urge you. Speak up. Take action. Make an impact—one child at a time.



I keep a beautiful quotation on my desk at home to remind me what’s at stake. It reads: “One hundred years from now… It will not matter What kind of car I drove… What kind of house I lived in… Or how much I had in my bank account. But the world may be different, because I was important in the life of a child.”



With your help, and with the help of other organizations and people across Canada, we can make an impact. We can make Canada the number-one place in the world for a child to grow up in.



Thank you very much.



The appreciation of the meeting was expressed by Stephen Hewitt, Manager, Corporate and Public Affairs, TD Bank Financial Group, and Director, The Empire Club of Canada.