Child and Youth Health – Child and Youth Health – Gender, Culture/Ethnicity, Gender, Culture/Ethnicity,

and Income Influencesand Income Influences

"Establishing Child and Youth Health Indicators Workshop-

Part Deux“

Montreal, November 10, 2004

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)

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)

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.

Situating Child and Youth Health

Child and Youth Health

Socioeconomic Status

Culture and Ethnicity

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

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

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)

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)

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)

Gender and Violence

• 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)

Gender and Income

• 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)

Income and Gender

Assessment Interviews with 18 service

providers and 36 homeless youth (many aboriginal)

Health ConcernsDiscrimination

PovertyAbuse/Violence

Diminished sense of identityTransience

Lack of shelterInadequate life-skill training

Intervention

Peer & professional mentors

Group and one-to-one support, mentoring,

recreational activities, and meals

Support Intervention for Homeless YouthSupport Intervention for Homeless Youth

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

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

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)

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)

• 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)

Ethnicity/Culture

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 children’s services

– concern re: children back home

• Supports Needed – employment & life skills training

– youth programs

– family liaison/mediation

– counselling

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

Literacy, Gender and Culture

• Rural women’s 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)

Relevant IGH Funded ResearchSelected Examples

Access and Equity for Vulnerable Populations

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 women’s 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)

Relevant IGH Funded ResearchSelected Examples

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

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)

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)

Relevant IGH Funded ResearchSelected Examples

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 people’s roles, how they view and use health care services, and how they respond to different programs and approaches to care.

Research in such fields as population health, public health, health services delivery, clinical practice guidelines, early child development, and women’s 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.

Kirby Report, 2002

Speech from the Throne, October 2004

• Help low income families provide for children’s 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

For more Information…

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