Child health and inequality

Frank Elgar, PhDAssociate Professor of Psychiatry

Canada Research Chair in Social Inequalities in Child HealthInstitute for Health and Social Policy

McGill University

What we knowThe odds that a child is healthy, happy, and doing well in school significantly improve as social class rises

This graded social pattern is found in most cultures and areas of health

Percentage of children with serious emotional or behavioral difficulties, by age group and family incomeSource: CDC, 2009 National Health Interview Survey

What we don’t know

What happens to child health as we become more unequal?

Income inequality and school bullying in 11-year-olds in 37 countries

Source: Elgar FJ, Craig W, Morgan A, Vella-Zarb R (2009). Income inequality and school bullying: multilevel study of adolescents in 37 countries. Journal of Adolescent Health, 45(4),351-359.

Rethinking child poverty

Calton, Glasgow Delhi, India

• National perspectives on health inequality point to the need to improve health services in the most vulnerable groups.

• Global perspectives suggest that Canada could do more to tackle the structural determinants of child health that give rise to inequality in the first place.

Raise and level the bar

Attawapiskat, Ontario

+

“The 42% Problem”: Practical Challenges in the Promotion of Child Wellbeing

Charlotte Moore, MD, FRCPC, FAAPMedical Director, Canadian Paediatric SocietyAssistant Professor, Department of Paediatric Medicine, University of TorontoStaff Paediatrician, Division of Paediatric Medicine, The Hospital for Sick Children

EVIDENCE POLITICS POLICY OBJECTIVES

+Total Health Expenditure as% of GDP* Source: OECD Health Data 2012

1960 1970 1980 1990 2000 20100

2

4

6

8

10

12

14

16

18

20

United StatesCanada

+Total Public Sector SpendingProvince of Ontario *Source: Ministry of Finance Estimates

Operating and Capital Expenses

HealthEducationSocial ServicesJusticeOther

+“Health” / “Illness” Accounting

SOCIAL

HEALTH

$48B

Public Confidence inHealth Care System

LOS/Hospitalization for ASC/Readmission Rates for AMI

Rates of FluVaccination

Median Wait Time for Priority Surgeries

Investment in HomeCare (Fragile Seniors)

Scope of Practice for Allied Health Professions

+Case Study: Setting Priorities

SOCIAL

JUSTICE

HEALTH

$109,286 / 28 weeker 1

1. CIHI, Too Early, Too Small: A Profile of Small Babies Across Canada, 20092. Cohen, E. et al. Patterns and Costs of Health Care Costs of Children with Medical Complexity, (2012) Pediatrics 130;6.3. CADTH Canadian Drug Expert Review Committee Final Recommendation – Asfotase Alfa, 2016.

HEALTH

HEALTH

36%

15,771 CMC2

HEALTH

$102 / mg Asfotase Alfa 3

+Case Study: “Stop FASD”

SOCIAL

JUSTICE

HEALTH

$3400 / family 1

1. Manitoba Health

HEALTH

+Case Study: “Stop FASD”

EDUCATION

SOCIAL

JUSTICE

HEALTH

$3400 / family 1

$ 4,596 / year 2

$ 4,075 / year 3 $46,000/year 5

if incarcerated

1. Manitoba Health 2. Stade et al (2009) 3. Stade et al (2009) 5. Fuchs et al (2009)

$ 23,760/year 4

if in care

4. Fuchs et al (2008)