EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, December 5, 1995

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[English]

The Chairman: Order, please.

Good morning all. We're running just a little late. I don't know what's going on. All the people from the normal part of Canada must be trying to adjust to an Ottawa winter or something.

We don't have a quorum in terms of doing business, but we do have a quorum to hear evidence. I say to our witnesses that we normally need six, but we're one short at the moment. I think we'll get under way so as to not cut into our time too much. We are glad to have with us representatives from the Canadian Institute for Child Health.

Dr. Chance, we thank you and your colleagues very much for coming. We would expect you'd have a statement you might want to make to us, and then we have some questions we'd like to put to you. We do thank you for assisting us in what we see as an important study. Maybe, Dr. Chance, you could begin by telling us who's with you and then you can proceed.

Dr. Graham Chance (Chair, Canadian Institute for Child Health): Good morning,Mr. Chairman.

With me this morning are Dr. Denise Avard, executive director of the Canadian Institute for Child Health, and Kristen Underwood, a researcher for the Canadian Institute for Child Health. I am Graham Chance, the chairman of the institute.

To introduce us, Dr. Avard will say a few words to start off with.

[Translation]

Dr. Denise Avard (Executive director, Canadian Institute for Child Health): I would first like to take advantage of this opportunity to thank you for having invited us here. We know that you have undertaken a consultation process and it is therefore very important for us to share with you today our views on this issue.

I would also like to say that our brief is unfortunately not available in French, but I will certainly be able to answer any questions members might wish to put in French. Dr. Chance will be continuing with our presentation in English. Please forgive us for having only supplied you with a unilingual version of our text, but at 11 p.m. last night we were still making photocopies. Thank you for your understanding.

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[English]

Dr. Chance: Thank you indeed for giving the Canadian Institute of Child Health the opportunity to appear in front of you today.

We're living in times of unprecedented change in the economy and for families. The consequence of increasing globalization in industrial-based economies is ultimately felt by the family, where for many jobs have become insecure, real earnings are falling, and the time for children is severely limited.

In many instances the determinants of health and ill health are recognized and preventive efforts are under way. Prevention of both physical and emotional ill health is most cost-effective when applied in early life.

The 1993 UN Human Development Report ranked Canada number two in human development. But when Canada's poor record of child poverty was factored in we fell to seventh place. The reason was simple: we spent less per capita on supporting families with children than did other industrialized countries. In a study of 20 countries, Canada ranked 16th in income security spending as a percentage of GDP, well below the OECD average.

However, we do not wish to minimize the importance of what has been achieved. Deaths from medical disorders and infant death rates have declined markedly over the years. Low birth weight babies are more likely to survive, and injury mortality rates have decreased.

But these past successes supporting and improving the health and well-being of children and youth are certainly no guarantee for the future. There is evidence of an emerging crisis. For example, suicide rates have risen progressively over the years from 1960 to 1991. By 1991, the rate for Canadian males was 23 per 100,000, and in Canadian girls the rate was 4 per 100,000. This represents a four-fold increase in both groups over the past 30 years.

Likewise, the extent of poor emotional and mental health of Canadian children and youth represents a newly recognized extent of morbidity. The disorders were recognized, but the extent is certainly of great concern.

Injuries remain the leading cause of death after the age of one. The amount of time families have for their children has declined dramatically, and the pressure on children to grow up alone in a scary world increases. Children are not small adults.

Some causes of morbidity and mortality affect particular age groups. Others affect all ages, and still others affect special populations. Particular populations such as aboriginal children and children living in poverty are at increased risk. The number of Canadian children living in poverty has risen progressively over the years from 1981 to approximately 21% of the child population by 1993.

Children of multicultural backgrounds or immigrant children have challenges that include language barriers and adjustment to a new society. Improving knowledge and technology has meant more children survive with chronic disabilities such as spina bifida, cerebral palsy, technology dependency, cystic fibrosis, muscular dystrophy, and cancer. And many children these days recover from cancer.

Despite these economically challenging times, we cannot stand by while our next generation falls behind. We have knowledge and resources to take on challenges.

This presentation looks at key issues we identified in The Health of Canada's Children: a CICH Profile, which you all have seen and have in hand, and from which facts and guiding principles have emerged. The presentation will outline the guiding principles for our prevention strategies and then discuss specific strategies for action.

Our focus will indeed be on prevention and health promotion. Primary prevention seeks to avoid the onset of disease by eliminating or at least maximizing environmental factors and healthy behaviours that decrease the risk of death, illness, and injuries. Health promotion creates the environment whereby individuals are able to reach their highest potential for health.

We will recommend we choose the route of a civic community in which a concerned, collaborative society will pay now, provide reasonable standards of social support for families and their children, and promote government and community action. We should choose this route rather than one where we pay later, which will be much more costly for the community.

Promoting early intervention is important. The first years of life are now known to be absolutely vital in determining the health and habits of the child and the future adult. The time to intervene is earlier rather than later in the life cycle. Effective interventions can improve the odds for a favourable outcome at every stage of a child's later development.

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There is a need to move beyond the health care system. A wide range of services such as recreation, education, health, and social services need to be part of the framework.

One of the most effective ways to promote early healthy child development is through home visiting. Research shows home health visitors are a great support and resource for parents. Strategies must consider biological, behavioural sciences and social needs relating to housing, physical safety, childcare, family services, education, employment, and income.

Countries with comprehensive health care and social programs, especially universally applied ones that support families through maternity leave, child and family allowances, housing provisions, home visitation, and childcare services, have low infant mortality rates. Health care is more than visits to the doctor or the hospital.

We need to adopt a universal approach that includes everyone and has a potential to reach all children, youth and families, regardless of their environments, as well as the potential to get to the risk factors and the determinants of health. There are limitations to addressing the needs of specific groups through targeted services. The programs are expensive and they stigmatize those served by them.

The problem in many instances is not too few programs but too little coordination and collaboration. There is too much competition from funding and resources, resulting in duplicated efforts. What is needed is an effort to link specialized and mainstream services. Prevention efforts require coordination and recognition. Services will not happen in isolation.

In order to reconcile the needs of children and their families in the current environment, the departments of Finance, Health, and Human Resources, as well as other departments, must coordinate their efforts to develop a comprehensive strategy.

In order to build strong communities, children, youth, families and caregivers must be included as issues are being identified, as decisions are being made, and as strategies are being planned. As members of the community, they should be partners in all aspects of development and implementation of policies, interventions, and strategies. Healthy children are the result of healthy communities, communities that work together to challenge issues of isolation, poverty, and inequality.

There is a need to adopt a life cycle strategy. There are critical points in the development of children where risks may arise, opportunities be apparent, or interventions be particularly effective. The risks, opportunities, or interventions will hinder or help not only in the present, but can also put children and youth on a pathway to the future, be it positive or negative. Child developmental needs must be nurtured through the home, health care system, childcare, school, and community.

We recommend we adopt a strong stand for children. Society must be mobilized to recognize the needs of children and the gains to be obtained for society if they are given priority. Well-nourished, healthy, and cherished children are more likely to be healthy and well-integrated adults.

Indeed, we need a ``Cherish Children'' campaign akin to the anti-drinking and driving campaign, or the anti-smoking campaign. These two programs were successful. If we raise the consciousness of whole communities regarding these issues, then why not for children? Such a campaign would need to be intensive and highly visible. It would need to give bold facts of the current disturbing trends in children's health. This campaign would also, though, celebrate the beauty, intelligence, and contributions of children to our society.

To get to specific strategies, I'll mention prevention of low birth weight first. Low birth weight has declined over the years, but it remains relatively static at about 5.5% of childbirths. Low birth weight provides roughly 70% of all first-year deaths and a large proportion of infants who grow into disabled children.

We must ensure coordinated continuity of care in the health care and social services system through the use of midwives, physicians, and nurses, as well as community programs. The shift would be away from over-reliance on technology and dependence on the medical model. There is a need to implement a policy addressing the role, status, and stresses placed on women in society regarding their employment, pay equity, and other issues.

Prevention of injuries is vitally important. If we look at the data for injuries, we see they are the leading causes of death from the first year onward. Injuries account for almost 50% of child deaths from 5 to 9 years and 64% of child deaths from 10 to 14 years. In later adolescence, you see 73% of all adolescents' deaths were attributed to injuries. This represents an enormous loss of life. We must get away from referring to injuries as accidents. Most injuries are indeed preventable accidents.

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There is a need, then, to promote a community-based injury prevention program focusing more attention on preventive approaches altering the environments in which children live and play. These might include implementation and enforcement of programs such as the use of bicycle helmets, the use of restraints for passenger vehicles, the lowering of speed limits, and stiffer penalties for speeding as well as drinking and driving. Society should adapt to children. Children, especially young children, cannot adapt to society because they simply have not yet learned how to do this.

There is a need to establish an information-recording system that would include a written record describing the nature and circumstances of injuries. Recording such information can help us identify risks, especially for preschool children.

There is a need to include public awareness and to work with youth to develop injury prevention strategies that are meaningful for them.

Moving to emotional and mental health, the mental health of Canada's children is indeed very indifferent and worsening. We do not have data for the first years of life. And yet we know from reports from kindergarten teachers and small reports the first years of life are very troubled for young children. Efforts need to be made to promote positive emotional and mental health for school children.

These are data for children aged 6 to 11 years. You see 16% of males have at least one clinical mental problem and 13% of girls have at least one clinical mental problem that would be treated if these services were available. Adequate services will never be available to meet all the mental health needs of children. And hence we have to direct preventive strategies towards the population in general. In those instances, only 44% of males requiring treatment received it and a quarter of girls requiring treatment received it.

There is a need, then, to approach preschool mental health to develop an integrated and comprehensive parent education program to meet the developmental needs of preschool children.

Violence in society is of major concern. This is just one instance of violence in society. Of married or unmarried women living in a relationship with a male, 29% experience violence. In reference to this violence, 39% of children living with these women will witness this violence. Unquestionably, children living with and watching violence will learn it. And incidentally, the most potent source of violence education for children is the media, especially television. Efforts must be made, then, to promote positive emotional and mental health for preschool children.

Again regarding violence, numbers of children and adults live with violence and the fear of it. Efforts to prevent violence affecting the lives of children and youth are important. We have to develop the recognition in society that violence is an outcome of social, economic and political inequality. At present, these inequalities are worsening in Canadian society. They are, indeed, worsening and leading to an angry young generation. We must develop community-based programs taking a prevention and health promotion approach addressing violence.

The girl child has a major need for attention. This happens to be taken from the UNICEF report The Progress of Nations, but the Canadian girl child is also in need of major attention.

Developing gender identity is obviously very complex, beginning in fetal life. There is little argument, however, that gender identity determines to a large extent the choices we make and the life paths we're choosing. Understanding the influences of gender is central to any analysis of the various determinants.

Therefore, we'd recommend we conduct qualitative research to project the report on attitudes. I showed you a short while ago the data on mental health. Here is worsening mental health amongst adolescent girls at age 11. Students are often feeling lonely, but as they go into early adolescence, the approach of young women is far worse than the approach of young men. Many young women, almost a third of them at age 13, are feeling lonely.

Again, on the mental health side - the clinical mental health picture - we saw previously boys and girls were roughly comparable numbers. By the age of 12 to 14 years, the numbers in girls have more than doubled to reach 24% of young women with clinical mental health problems. As I say, it's impossible for the clinical service to rise fully to the needs of these girls and so only 15% of those girls requiring treatment actually received it, compared with 30% of boys. They are phenomenally different numbers.

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So we need to conduct research in order to discern what is behind all these difficulties with mental health and to develop a statistical profile of the health and development of the girl child to examine trends and issues of particular concern.

We need to promote family health. Children, especially young children, need safe, quality care while their parents work. Parents need supportive environments in which to live, work, and raise their children, if it's to be directed towards the promotion of emotionally and physically healthy Canadian families.

We have a little data, for example, to show the rising poverty rate. Of all Canadian couples aged 30 and below with children, 41% were living in poverty by 1992.

We have evidence of the rising proportion of dual-earner families and the impact on children. For example, 20% of all dual-earner families have both parents working more than 40 hours a week. Of families with children below the age of 3, 62% are indeed dual-earner families. In addition, 58% of all dual-earner families see both members of the couple work more than 30 hours per week.

Obviously these parents' concern for the well-being of their children is great. We see enormous hours of lost time from work as a consequence of the concern of young couples for their children.

We need to recognize that children and the task of raising children are of major importance and to take measures to overcome the time crunch. We need to provide federal financing, indeed for a comprehensive childcare system.

In our full brief you see the numbers of childcare spaces available, roughly 350,000 for the 1.2 million children who actually require them.

We need to develop enhanced childcare and family resource programs in the community, fully integrated and responsive to the unique characters of the community. We also need to develop after-school community programs to bridge the gap of the child who goes home to an empty house, the so-called latchkey child.

Twenty percent of children in Canada aged 6 to 12 are indeed latchkey children. They go home, or they stay in the plazas where they can undertake drugs. Or they stay at home to watch the television, which - if you watch it from 4 p.m. to 6 p.m. - contains extraordinary elements of so-called society; for example, Ricki and her friends on the talk shows.

We're not addressing the health needs of aboriginal children. I presented this issue to the health committee previously.

The needs of children in poverty are extreme. Poverty by family type is increasing so that, for example, by 1992, 522,000 children lived in households with female, lone-parent families. That means that 41% of all children in poverty lived in such households.

The effects of poverty on children are roughly to more than double all aspects of child ill health we like to focus on. The accidental death rate, low birth rate, infant mortality rate, school performance and psychiatric disorders all increase by at least two-fold, and many increase more than two-fold. Likewise, pregnancy, smoking, and the use of drugs are all more of a problem for children living in poverty.

Efforts need to be made to reduce the number of children living in poverty and to support poor families. We have to develop a strategy to support them.

As described by Campaign 2000, ``Investing in the Next Generation'', we need to aim to develop national strategies to develop sustaining employment opportunities for families, and to develop a supportive and responsible social security that enhances the living standards of children, especially when the children are in poverty. These strategies have been developed in other countries.

Child Health 2000 is proposing a social investment fund for children. This fund could be derived from corporate contributions and suitable tax programs. There is money in society; it has to be directed appropriately.

Let me turn finally to addressing the needs of children with disabilities. When we did the survey we hoped and thought children with disabilities were well integrated into Canadian society. The data in the child health profile demonstrated for certain that in fact they're not that well integrated in society.

Here are data, for example, for youth with disabilities, aged 15 to 19 years. We are looking at their ability to participate in society. An example would be inadequate transportation in 25% of instances of children with disability. That prevents them from participating in leisure activities, something the rest of children in society can do.

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Many examples are given in the profile. We need to provide support for these disabled children.

One specific group of children rapidly increasing in society and at present very small in numbers is a group with high needs, technologically dependent children. These children are now at home, being cared for by their families, predominantly by women - their mothers - and these women in fact have rare opportunities for respite. Enormous stresses are placed on such families. It's important that we recognize their needs.

In conclusion, then, we have to recognize that we have to respect our children. We adults are prone to blame children and youth for their activities, which often results in confusion and anger. Rather than taking this approach, rather than requesting increased costs or incarceration for disordered adolescents, we need to take a preventive approach, to recognize that the world that is changing so dramatically for us is changing even more dramatically for them.

Society's attitudes and values must acknowledge the fundamental truth that children neither determine the circumstances of their birth nor the environment in which they grow; adults determine those circumstances.

For Canada, as we know it, to survive globalization, the needs and well-being of children and their families must be given top priority. I suspect that then - and only then - will other priorities of societies be ordered appropriately.

Finally, the conclusions and recommendations we submit to you today are clearly not new. Nor indeed are they outrageous. They are simply in accordance with the 1989 United Nations Convention on the Rights of the Child. Canada ratified this in 1991, but, as demonstrated in the summer of this year, Canada, like many other countries, is still not attaining the convention.

Thank you.

The Chairman: Thank you very much.

Okay, Bernard, you're first.

[Translation]

Mr. Patry (Pierrefonds - Dollard): Thank you very much for your presentation. It reminds me somewhat of the one I had the privilege of hearing last Sunday evening. As we speak, Montreal is hosting an international conference on local community service centres, which in Quebec are called CLSCs, centres communautaires de santé. There are some 1000 participants and 400 briefs have been distributed over the last three days.

Dr. Barbara Starfield from John Hopkins University made a presentation somewhat similar to yours. The difference is that she was comparing results obtained in Canada with those of other OECD countries. Canada ranks very well as far as children in early childhood are concerned, that is to say children aged 0 to 1 or 1 to 2 years, but the situation is very different for the 5 to 14 year category, and as for adolescents, in these areas, we lag far behind. Canada ranks roughly fifth overall.

I have a few questions to ask you. My first question relates to what you say in your book on children aged 0 to 1 year. You talk about conditions facilitating positive bonding between mother and child.

Could you elaborate on these positive bonds and on what the committee might do to improve the situation for children aged 0 to 1 year?

Dr. Avard: Various things can be done. Efforts must commence at the very beginning of a pregnancy. And perhaps even before that. The whole preconception prenatal period is an important one as far as bonding is concerned because it is the period during which time the woman can devote more attention to health matters. We therefore must try to improve physical conditions at birth, by attempting to eliminate smoking and drug abuse so as to ensure a healthy pregnancy.

At the time of delivery, a lot can also be done to promote mother-child, parent-child ties and to emphasize the family aspect of childbirth. We must also promote breast-feeding because we know that it is very important emotionally. These are all prevention strategies that contribute to improving family ties during early childhood.

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[English]

Dr. Chance: There are indeed other measures that we and communities are pursuing: these are excellent early child development programs that exist in communities. They are not well funded at present, but they are programs in which women, particularly women in difficult circumstances, can learn self-esteem, and at the same time learn child parenting.

These parent-child programs exist in many communities in Canada, and indeed are currently being threatened by measures being taken by provincial governments. These are vitally important programs that we in fact have in London. They show extremely valuable outcomes for both the mother or the woman and the child.

The vital learning years are 0 to 5 - I'm sure you'll hear this from other presenters - and are so critical. To neglect those learning years, to leave children, for example, in inadequate childcare watching television....

Children very definitely learn from television by the age of 3: there's solid evidence of it.

So these programs that help women and fathers to learn to parent are critically important.

[Translation]

Mr. Patry: In the 1 to 4 year age group, there has been a marked increase in hospitalisation for pulmonary disease over the past 15 or 20 years. I would like to know if you have data linking secondary smoke to the hospitalisation of children for lung or breathing problems.

Dr. Avard: Personally, I don't have any numbers to give you, but we will certainly do a little bit of research and try to obtain this information for you if it exists. There is certainly a correlation between the two, and this hypothesis is supported by various articles. I cannot tell you here and now which studies there would be, but I will make sure this information is supplied to you. Dr. Chance might have additional information for you.

[English]

Dr. Chance: Yes, there is certainly data showing that for children coming from smoking environments, second-hand or environmental smoke unquestionably influences the health of the child.

I don't think we fully understand the total reason for this progressive increase in, for example, asthma that we're seeing in communities. There's a need for research to understand why we're seeing the rapid increase. We have to look at the environment, and suspect the cause is there.

Mr. Hill (Macleod): In your brochure you said the institute is non-profit. I note corporate funding and individual funding, but just so I can better understand your funding, could you tell me if there is any government funding at all?

Dr. Avard: No, we receive no sustaining grants, if that's called government funding. The funding we get is from a number of sources.

We sell publications, so like a small business we raise money from the materials we produce on our own. We do contracts, so that if some projects are relevant and fit with our mandate, we compete to get the contract. We have a fund-raising campaign for the institute, volunteers, and a membership category.

So money really comes from what I call five baskets.

Mr. Hill: All right. One thing I did appreciate in your program is that it looked like you're monitoring the effects of the things you suggest. You're talking about looking at outcomes.

In your presentation here you seem to suggest some countries are doing better than we do. Could you give me an indication of which countries you think are doing better than Canada?

Dr. Chance: These are some of the European countries. I'm really referring to the social services supporting children.

We're not looking at mortality rates here, although Denmark, France, Finland, and Japan have lower infant mortality rates than Canada. Death obviously is the one thing we can measure in relation to health. It's a bizarre situation, but it's the one means of measuring.

There are other means by which we can measure health, and when we make comparisons we find there are differences. In support I was particularly referring to the fact that if we follow the Canadian economy and look at the income of families in need, then those families' incomes follow the vicissitudes of the Canadian economy.

We might look, for example, at the change that took place between 1990 and 1992, a major change in family economy. In Canada, in real dollars, the change that occurred for Canadian families was a fall of 2.4% in the total income of the family. Compare that with, for example, countries in Europe, the U.K., Sweden, France, Belgium; all of those countries protected their children specifically as circumstances worsened in the economy, to the extent, for example, of the U.K. going up 20% as the economy fell.

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Now, can we show that benefits in the way of health? We can't show that directly. All we can say is we know the impact of poverty is, as I showed you, at least double many aspects of children's health. We can't show the direct correlation.

Mr. Hill: So the direct correlation is difficult to prove.

Dr. Chance: One thing I should say is that the profile you have is a unique document. No other country, we find, from UNICEF has done a comparable survey of the data available on their own children's health. In fact, we've been asked to try to coordinate the development of a similar effort.

Mr. Hill: You started your presentation by saying the family was very important. You went on to say families are struggling and then described - and I've tried to make big categories here - that families needed legislation, families needed programs, the problems needed research, and we were underfunded for those things.

If I go back to the family as being important, what things do you do and talk about to strengthen the family rather than look at programs to help the breakdown of the family? This is really a fairly major philosophical point.

Dr. Chance: If you look at the material we've provided for you in greater detail, you'll find we make suggestions to try to help families. Certainly, the evidence of the breakdown of the family is unquestioned.

You ask what can be done to help them. Primarily it's to help both mother and father or whatever family we have, both members of couples and especially the family of a single woman, to overcome the difficulties of the economic environment in which they're living at present. I pointed out a large proportion of single parents are living in poverty. In 1992, 91% of women with children lived in poverty. That's a huge proportion.

If we look at those families, then, and the families I mentioned, 41% below the age of 30 with children are living in poverty. Many of those are families who aren't, as we've heard, welfare bums. Thirty-five percent of those families have members of the family who have actually had either college or university education. So it's not totally a matter so much of education. For these families in this economic climate...obviously we have to improve their employment in order to be able to provide an economic background so they can bring their children up in reasonable circumstances.

That being said, there are measures by which we could improve the availability of work and the availability of time for women especially. Women, we all recognize, still carry the primary burden in society of childcaring. Parent caring - the sandwich generation - falls upon women.

We can find ways to help them to improve their own ability to care for their children. It's especially those first years of life where we need to help. Childcare then becomes vitally important. The ability of women to job share, the ability of anyone to job share, the ability of people to work part-time and yet obtain benefits - all of these will improve their ability to integrate as a family.

Then we look at the earning families, and I presented information on that. Earning families are desperately in many instances trying to either stay above the poverty line or give their children more than they had, which is extraordinarily difficult these days. Many families are indeed unable to provide family time. Measures to provide family time have to be brought into society.

Mr. Hill: All right. Finally, I'd like to go specifically to the low birth weight infant. One of our colleagues is presenting a private member's bill to try to prevent fetal alcohol syndrome by labelling alcoholic beverages specifically. Could you give a comment on that?

Dr. Chance: Yes, indeed. Appropriate legislation for alcohol would be to call it a hazardous drug. It needs to be dealt with through the Hazardous Products Act, not through a system that regards it as a - I guess I'm speaking rather extremely.

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We can look at the damage to society that alcohol causes, especially when one realizes that by the age of 13 young girls and boys are drinking on a regular basis. A lot of those accidents I demonstrated in late teenagers are indeed alcohol based.

So if we look at fetal alcohol syndrome in specifics, it has to be regarded as hazardous to the fetus. Fetal alcohol syndrome itself is not very common in society. It's difficult to put a number on it, and it depends very much on the environment one is talking about. In our aboriginal communities, it runs in high proportion. Fetal alcohol syndrome affects far more infants, far more children.

If one watches a child growing with fetal alcohol syndrome and the family experiencing that child with fetal alcohol syndrome, it's an extraordinary difficult life for the child and the family. So I wouldn't regard it as anything other than hazardous, and I would support the private member's bill to say this is a dangerous substance for the fetus and child.

The Chairman: We're essentially out of time, but I am going to allow three brief interventions. First from Hedy, then Sharon, then Andy.

Ms Fry (Vancouver Centre): I want to apologize for coming late. We had a conflict with another meeting I had to attend for the B.C. caucus.

I'm sorry I missed the bulk of your presentation although I have the paper here. I want to congratulate you on some of the work you have been doing. I agree with you that alcohol should be declared a hazardous drug. I think that's the only way to deal with it because there can be safe alcohol levels. Therefore, it falls under the Hazardous Products Act.

I'm not being facetious, but I wanted to comment on a question that was asked by my colleague, Dr. Hill. Do you have programs that contribute to the break-up of a family?

Dr. Avard: If we have, I wasn't really clear what the answer was or at least what the meaning of the question was. If we talk about societal programs, whether it's because some legislation is supporting a child benefit or some family, then I would not see this as leading to the break-up of the family but rather as supporting families. So, no.

Ms Fry: I just wanted to clarify that question. I was referring to Dr. Hill's question, which I may have misunderstood. I thought he was presupposing you had programs that contributed to the break-up of the family. What you are saying is that you do have programs that recognize the reality out there that a lot of the children at risk actually come from poor, single moms and that you need to do everything you can to support them.

Dr. Chance: Yes, indeed. I'm sorry I didn't quite follow the question either.

Mr. Hill: I wouldn't want it attributed to such a train of thought. That was nothing to do with what I was approaching.

Ms Fry: All right, thank you.

Dr. Chance: A lot of the institute's effort is indeed to focus on the integrity of the family and especially the mother-child relationship.

Ms Fry: What is the most important thing you would think this committee can do? What is the most important recommendation you think this committee can make?

Dr. Chance: I suggested we should, as Canadians, as Canada, cherish our children. I really believe that's not part of the total love and concern for children. I think we need a campaign to resurrect the child and the family. I really am serious about this.

If we can reduce drinking and driving by having campaigns for the public, we need to engage the public to recognize the difficulties children are going through, especially children, in the current economic climate and the changes rapidly taking place, not only in the economic climate but also in the emotional, the psycho-emotional climate. We need to recognize that children are indeed suffering through all of this.

We have to learn to cherish our children again. I would suggest a cherished children campaign would bring out, as we've suggested in the text, with bold facts, the current situation for Canadian children, their mental health. I suspect we'd start to see not only families concerned - families are concerned - but corporations and taxpayers on the other side concerned for children.

Ms Fry: I have just one more quick question. Do you think it would be worthwhile if under the heading of cherishing the child or valuing the child in Canadian society we set up clear objectives?

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You have some figures here that suggest that 22,000 babies are born weighing less than 2,500 grams. Could one set clear measurable objectives for, say, the year 2010 that we could achieve? So instead of 22,000 babies being born with low birth weight, we could bring that to 1,100 and then list strategies. Do you think that's valid?

Dr. Chance: To reach 1,100 - 11,000 is not possible. But other countries, for example, have a low birth weight rate of 4% or even lower. Those countries have applied particular measures - and in fact those are under way now in Canada - to attempt to reduce low birth weight rates. What was proposed in the province of Ontario, for example, is that the low birth weight rate by the year 2000 should be reduced to 4%.

Key objective features are the sort of things you're talking of. We've come up with some of those suggestions in the child health profile as well.

Mrs. Hayes (Port Moody - Coquitlam): To follow up, what is our percentage of low birth weight rate now?

Dr. Chance: The most recent figure I have is 5.5%. That's combined male and female. It's higher for males.

Mrs. Hayes: I'll just going back to a couple of questions. Actually I agree with you that our children are not cherished enough in a sense. Some of that is certainly stress on families. People don't have time to cherish their children and, as you were saying, it certainly needs to be addressed.

Your solution to poverty - and poverty certainly seems to be a thing you've brought forward - is to improve the employment of parents. My concern is that people actually are having to work too hard. Forty-seven percent of family income goes to taxes and that kind of thing.

I look at some of the things you're proposing, whether it be a cherish the child campaign, or an information system of child injuries, or a social investment fund for children. Could you comment on how much money is being taken out of families as opposed to being left in their hands to try to reduce the demands on the family?

Dr. Chance: Yes, you rightly suggested that excess sums are being taken, especially from families who have poor earnings. When we moved to three tax bases instead of ten, that was not a good thing for families. It was an excellent for thing for those with wealth. So we should look at the way we are distributing wealth.

You picked out one particular aspect; that is, improve the employment opportunities for families. Not to drive families as they're driven, but when we can see in one proportion of the population both members of a dual family working more than 40 hours a week, we know 41% of people are living in poverty and 65% of those are without work. Then there has to be a redistribution of work.

Mrs. Hayes: Yes, I have a feeling we have families like mice on a treadmill. You just have to run faster and run faster. We have to fix the treadmill. That would be my feeling. Rather than having more employment, let's maybe back off and see if we can change their participation so they don't have to work in that sphere and they can cherish their children.

Ms Fry: You'd need some money to do that.

Dr. Chance: Yes. I think in essence of trying to save time, we perhaps -

Mrs. Hayes: You have to leave the money in the hands of the families. Could I just go back to another -

Dr. Chance: I'd like to comment on that one point you made.

The Chairman: Let's not forget the purpose of this exercise, ladies and gentlemen. Sharon has the floor. She can ask all the questions she wants. They can give the answers. If you have answers, save them for your time.

Sharon.

Dr. Chance: Perhaps I could just comment on that one point. In essence of trying to save time, we did indeed focus on a few very vital points. But if you read the greater text, you'll find that indeed we are not suggesting the family should work harder but rather the distribution of families' work should be changed.

Mrs. Hayes: With regard to your organization and the funding of that, could you give us some indication of the type of contracts you receive and who those contracts are from? I'd be curious to know who it is who hires you.

Dr. Avard: We do some work with Health Canada and Environment Canada. The nature of the contracts varies on topics that are probably of great interest for this committee, topics such as low birth weight, mental health issues and supporting parents. The Nobody's Perfect program is an example of an institute program contracted by Health Canada. The post-partum support program is also a program to support mothers during pregnancy. Child abuse is another area we work in.

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Mrs. Hayes: Would it be possible to get a list of some of the contracts you've had and who they've been with?

Dr. Avard: We could send you our annual report.

Mrs. Hayes: Yes, I would be interested in that.

Dr. Chance: Contracts are primarily with the federal Department of Health. That's where the primary contract funding comes from.

Mrs. Hayes: Are all the slides you showed with your presentation from the book?

Dr. Chance: No, not all of them are from the book.

Mrs. Hayes: Is it possible to get a copy of the slides? They were very interesting.

Dr. Chance: We can certainly send a copy of the slides to you. Some were taken from the literature, some from The Canadian Fact Book on Poverty put out in 1994 by the Canadian Council on Social Development.

Mr. Scott (Fredericton - York - Sunbury): There was reference to a medical circumstance that doesn't seem to be following the general trend towards improvement. This was the area of respiratory health. Particularly, there's a reference to asthma. I'm curious about any information you have or any research you've done that would speak to the question of chemical sensitivity and whether there is any link there.

I have two or three other comments. Maybe I'll just unload them all and then you can respond.

I commend you for your specific reference to the distribution of work and very specific reference to the limitation on overtime. I think the Donner report done by Human Resources Development Canada or the report commissioned by the minister came to the same conclusion, and I hope at some point we can generate some momentum around the objectives outlined in this report. I appreciate your reference and encourage you to continue bringing it forward.

Thirdly, and finally, there is a reference to adolescence, isolation, self-inflicted injury, and all those kinds of things. I'm curious to know how much information there is indicating how urban-rural indicators affect this research. Very specifically, I'm curious as to whether there is any distinction in the research between what I would consider to be a large urban city centre kind of phenomenon and then the urban suburb circumstance. I'm curious about what impact where you live in Canada has on isolation.

Dr. Chance: Thank you for those specific questions. In relation to chemical sensitivity increasing, we don't have data in the profile and I don't have the data to specify particular aspects of chemical sensitivity. There are data, but I'm afraid I'm an neonatologist by training and practice so I can't answer this question for you in specifics. But there certainly are data and there is research going on in this area. Pollens and mites in the house are particular sources of allergic phenomena. But for chemical sensitivities in the community, it has been suggested some of the plastics we use are sources of chemical sensitivity.

I'd like to address the limitation of overtime. The curious fact about the data is they show people are working such enormous hours - employers encourage overtime because it's rather cheaper - and yet at the same time those same employers lose $13 billion a year in Canada, 30% of which is based on family stress. According to the Conference Board of Canada, 30% of lost time is based on stress within families and this is costing the country $13 billion a year.

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With regard to the information on rural versus urban adolescents, we don't have specific data. There are data. The fact is what used to be more prominent was the urban - especially the poverty urban - versus the rural. This is now changing quite quickly. Rural children, possibly because of bussing through school systems along with other factors, are now beginning to experience exactly the same problems as those of the urban people.

Dr. Avard: If I can add to this, the acute side of the rural, and perhaps the isolation, is evident in the aboriginal communities where you see the magnitude of the effect.

The Chairman: Well, we're out of time. We would like to spend a lot more with you, but hopefully we'll have an opportunity down the road to talk to you again. We are certainly grateful for the time you've taken and for the specific nature of the recommendations and the points you've addressed.

Again, thank you so much Dr. Chance, Dr. Avard, and Ms Underwood for coming.

Dr. Chance: Thank you, Mr. Chairman. Thank you, ladies and gentlemen.

The Chairman: Since we are running a little bit behind, we're going to go directly to our next witness. I would ask Professor Keating to join us at the table when he is ready.

We now welcome, from the Canadian Institute for Advanced Research, Dr. Dan Keating.

It's good to have you. We assume you have a statement first and you're going to leave some time for us to ask you a lot of questions.

Professor Dan Keating (Director, Human Development Program, Canadian Institute for Advanced Research): I'll leave time for questions. I'll make some brief comments, and I'll be happy to chat with you about any of those or questions you would like to address further.

I should point out my job is made quite a bit easier by the first presentation, which covered a lot of territory I can now presume to be known for the purposes of this discussion.

I should point out within the Canadian Institute for Advanced Research my role specifically is as the director of the Human Development Program. Our focus, then, is on the broad range of issues and the conceptual frameworks helping us to understand the nature of human development in the contemporary world and some of the issues arising from this. Our primary focus, of course, is on research within this context.

What I want to do is just make a few points on what some of this research is telling us with respect to issues of health and human development. I will then just make a few general observations about things of possible interest in terms of pursuing aspects of strategy, which may be of some value in dealing with some of the issues that I'll comment on and that have been commented on already.

I guess the first thing I want to emphasize is certainly not a new part of the story, but I want to emphasize it fairly strongly. That is, with respect to health both during the childhood and adolescent years and in fact throughout the life cycle, there's an extremely critical role of early child development. The outcomes resulting in terms of health and a population level very clearly can be traced to a range of things happening in early child development.

I want to emphasize these are in terms of both behavioural and mental health issues, many of which show up during the childhood and adolescent years. This shows up more so in terms of epidemiological rates than in physical health issues, but it also does show up in the physical health area. Long-term issues that arise in early childhood and how they're resolved have a substantial impact on the individual's immune system and how they will respond to challenges to health throughout life.

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The second thing I want to emphasize is that it probably has a lot to do with coping skills. It has a lot to do with the kinds of things that prepare individuals to deal with the stresses of everyday life, and we've heard a fair amount about the stresses perhaps increasing in some respects.

Coping is the general term that we use to describe how individuals deal with this, not only in terms of the behavioural coping mechanisms, but also in terms of the psychoneuroimmune system and how individuals are prepared to respond to stress, and how their physiological system responds to stress.

A variety of surveys, including some fairly large surveys in Quebec by Richard Tremblay at the University of Montreal, and by Dan Offord at McMaster University in the Ontario child health study, suggest that we have some substantial problems in the early childhood period in terms of how we are fostering the coping skills of young children.

Along with the material that you heard this morning, I would suggest that the broad socioeconomic changes that we're undergoing as a society are increasing stresses for families and may be responsible for some of the problems that we're observing in the early childhood period.

This is not the appropriate committee to go into detail, but I want to emphasize just how broad and deep those structural changes are in the economy. They have to do with technological changes and changes in the broader society. We do not entirely understand those issues, nor can we entirely predict the course they will take in terms of their impact on families, and thus their impact on children.

Without going into detail, the consequence is that if we're going to deal with them over any lengthy period of time, we need to begin thinking about how to structure a system that is adaptable to changes as they happen. We're not in a position to design a blueprint of how we can cope with all of these issues at this time. We have to design systems that are adaptable. I'll come back to that later on.

One of the things that I want to emphasize that's coming out of the research literature in the last decade, in particular, is that this connection between early childhood experiences and development and subsequent health during childhood, the adolescent period, and throughout adulthood - we're beginning to understand the mechanisms of that much more deeply, particularly the research in neuroscience and brain development, and the research on the neuroimmune system and its responsiveness to early experiences. People familiar with this literature are using phrases like neurosculpting, where individuals' experiences create specific kinds of networks and pathways at the neural level that have tremendous impacts on health.

One of the reasons that we need to tend to this even more - clearly, we ought to have been attending to it all along - is that we're beginning to understand how deep and long-lasting those effects are, and that they are very difficult to address as time goes by.

You've probably seen some of the literature that talks about the notion of cost-benefit ratios with respect to early childhood interventions of one sort of another. I won't go into that in detail, but I want to point out that we should be thinking about two kinds of cost-benefit ratios there. The one kind that gets a lot of press, and deservedly so, is the cost-benefit ratio that says how much early childhood intervention will save us in subsequent services not having to be provided.

There have been a variety of attempts to put some cost dollars on this, but I think we have to be cautious about that. You've probably heard about the Michigan study that came up with the invest $1 to save $7 ratio in terms of early childhood intervention for high-risk kids - the Perry pre-school project. That saved expenditures. Whether that's the right amount or is somewhat less or more, is really not the point. There is some evidence, though, that it's a good investment.

The other side is the more positive side that I think we don't emphasize enough, which is that when we talk about the new economies, we have to think about what's the available potential in the population. The available potential in terms of the ability to cope and the competence, learning capacity, and health of the population is going to be rooted in the kinds of experiences and hence the health outcomes later in life for young children. So when we think about cost-benefit ratios we should be thinking not just about how much in special services we will save later, but in terms of an investment for what we are going to need as a society in terms of the health, well-being, and competence of the population.

So I want to emphasize that critical role of early childhood. I know it's not a new story, but I think it remains an important one.

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The second point I want to make is that these kinds of outcomes show up quite clearly in terms of social class gradients of health. When we look at cross-national comparisons, the gradient of health to social class is quite clear. It's also quite clear that where that gradient is steeper, the overall health of the population tends to be lower, when we're making OECD comparisons. So generally speaking, the stronger the SES gradient as it distributes itself across health, the overall health of the population will be lower. That would suggest that there's a broad impact in terms of coping skills. That is to say, these effects are not disease-specific or injury type-specific. They cut across and look quite similar across various kinds of negative health outcomes.

The point here is that it appears to be the case that these are rooted not necessarily in specific features such as specific lifestyle features, although they play a role, but it's quite broad in terms of population health effects when we look at those kinds of SES gradients.

As well, although it is clear that poverty has a substantial negative impact on health, as we've heard about this morning, we ought not assume that it is just a poverty effect. The social class gradient on health that I'm talking about continues monotonically throughout the population. We are not simply talking about the overall well-being of a poverty class as if it is a threshold, we are talking in a sense about the whole population. This shows up where you have dual-earner households, for example, where individuals have to work enormous amounts of time in order to maintain their standard of living, and even though they may be middle class by SES gradients, that can have negative impacts on kids.

So the point that I want to make here is that we're not just talking about poverty effects when we look at these social class gradients of health.

The third general point that I want to make is that when we talk about these issues around health, we need to think quite broadly, and we can probably think best about it in terms of what resources are available to safeguard and promote the health of children. When we think about these issues we have to think broadly, and a useful way of thinking about this is in terms of what resources are available to the individual, to the family, and to the community. By enhancing each of them but in particular by trying to enhance them as a group, we are most likely to have a positive impact on the health of children and on their health throughout their lives. What I'm talking about is a healthy circumstance for the individual's development, particularly early in life, so that they have the coping skills to deal with stresses as they come along.

For family resources, we're talking about the availability to the family of high-quality childcare. Whether that is inside the family or outside-the-home care, the availability of high-quality childcare by a variety of mechanisms that give families some choice in this matter seems to be a very important component.

The availability to families of the resources they need is a very important point. The fact that we have apparently had a generational redistribution of wealth away from families with young children is troubling, and we ought to be looking at that. If we are redistributing wealth away from families with young children, that is certainly a concern if we have a longitudinal and human development perspective on health.

I want to talk a bit more about community resources in terms of what we might do. I think they're very underrated in terms of what they're able to do. When we look at community resources, often it is the community to which the family has to look in order to supplement the resources it needs for healthy development. We're talking both about formal systems of social service delivery, and informal systems in terms of extended family support, neighbourhood support, and so on.

One of the most important things to be aware of in this context is that when we ask what happens to kids who have high-risk factors - is there nothing left, is it all over if we don't take care of them in early childhood? - that's certainly not the case. Although it is more difficult to deal with problems that have been created early in life, there is a body of evidence that talks about kids who beat the odds. When we look at those kids who beat the odds, one of the factors almost universally found in the research is that a buffering factor is provided either within the extended family or within the local community. The buffering factors we're talking about here are individual adults who are close enough to the child to provide supports for that individual, and to provide the kind of support that makes up for some of these issues that may have been problematic early in life.

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If the support occurs during the early period we're probably even better off, and here we would look to things such as home visitation programs or programs that provide for the building of local social support networks for single moms. There is some interesting experimental work in that area, and various people have asked whether we can create social support networks among moms who are in a similar circumstance, but where they can provide support to each other.

So there are a variety of different things we need to look at here, but the community area is one where we need to begin thinking more carefully, particularly as we look around and see various things that may be causing the erosion of community and social fabric.

With that as background, let me talk briefly about a few strategies or solutions that we might think about. These are not at the level of specific policy, but at the level of general things that I think we need to look at.

The first of these is in the area of community initiatives. In response to the kinds of challenges that we're talking about here, the challenges that are coming from the deep structural changes in our economy and our society - communities throughout Canada are responding to these sorts of issues. There was a conference in Winnipeg at the beginning of this month at which 24 communities throughout Canada came together and talked about the kinds of things they're doing and the creative and innovative responses they're making to a variety of these sorts of issues.

It was interesting to see how creative, innovative, and diverse these local community-based solutions were, but also to see how much the people who came from those communities believed that they were benefiting from learning about what was going on in other communities. Although we are able to generate a huge amount of innovation and creativity in local communities, we do not diffuse those practices very effectively throughout Canada.

Those folks felt that they need to have a mechanism whereby they can communicate with each other, learn from each other, and innovate collaboratively. One of the issues that's worth looking at is figuring out how we can create some sort of network where people in communities don't have to wait for the word to come down from on high as to how to deal with these issues, but where they can talk with each other through horizontal networks of communication, collaboration, and innovation.

When we talk about those broad socioeconomic changes we usually think about technological innovations as being the driving factor of change, and certainly in the economy they are, but history shows that there's a direct feedback loop to social innovation. Social and technological innovation are in a dynamic feedback loop. We have to pay attention to our ability to innovate socially at the same time that we pay attention to our ability to innovate in the technology area, if we're going to have both a strong society and a strong economy. This was an example of fascinating innovation. Those individuals can use some support - not necessarily in the form of direct support, although they need that. One of the things they need is the ability to work on their own innovative directions.

Second, in addition to our ability to monitor how we're doing in terms of child health and child well-being at a national level, we need to have a data collection and monitoring information system that gives information back to communities at the local level so that they can see how they're doing relative to similar communities, and how they are doing across time.

When we look at the feedback loop that we have for information systems in the economy and how well developed and sophisticated they are, our lack of information systems in the human development and health area is quite appalling. We can begin thinking about how to build the kind of information systems that provide usable information to communities on how they're doing. The national longitudinal survey of children may be a base upon which some of that work can be done.

Finally, we talk a lot about intersectorial collaboration and the necessity of providing integrated or seamless services to children at the local level. I think that needs to be strengthened. It certainly needs to be supported. To the extent that there are barriers that we can remove, we need to be attending to how to remove those barriers to intersectorial collaboration. Intersectoral collaboration, by the way, happens a lot more easily at the local and community levels than it appears to happen at central government levels. I think we need to find out ways of getting that ability for communities to innovate effectively out to them.

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In this regard, I think when we look at the general array of things that we might do, whether we're starting at the intervention level, prevention kinds of programs, health promotion programs, or universal programs, we need to be sensitive to the cost-benefit ratios that apply across them. I think it's fairly clear that the highest cost with the least feedback is generally in the intervention crisis area.

Some argument can be made that at the universal level we get, in a sense, the inverse of that. We get a much higher ratio of return to investments when we create programs that are broadly available. This tends to also fit fairly well with the notion that child health is not just merely a poverty issue; it's an issue increasingly throughout the whole population.

I think I'll just stop there. Basically what I want to do is talk about some general conceptual frameworks that we need to keep in mind as we look at this issue, and then talk about a few of the broader kinds of strategy initiatives that we might want to keep in mind as we look at some of those issues that are contributing to the problem. Then maybe we'll look at some of the sources of solutions.

The Chairman: Sharon, then Hedy, please.

Mrs. Hayes: Thank you, Mr. Chairman.

I thoroughly enjoyed your presentation, which is a different look at things. I have just a couple of questions. I'll try to be brief.

You mentioned the stresses that are coming about with the structural economic changes and how we have to be adaptable to them. In looking at the issue of particularly our economic situation and how it addresses the social needs of the country, in the last 20 to 25 years there's been a move toward social program development, support, and cost, actually, within government programs. So we have a record of 25 years of family health.

Say we take a benchmark now. We're probably looking at a change in other directions because of economics and financial situations. I think that's what you were referring to.

I'm wondering, do you have a comparison of...? I would say that 25 years ago, families and communities were more directly responsible for their own well-being. It's moved towards more government programs to support that.

If we have to move back again, do we have a comparison of how family health was doing 25 years ago, as compared with now, or maybe 2 years ago or whenever? What do you see that coming back to? Is my question clear?

Prof. Keating: I think I understand the question. I think one of the things we don't have is an excellent record system that permits us to be able to address a variety of these questions, most particularly from the point of view of the interests of child health and the outcomes for adult health from child health.

One of the things that would be absolutely essential would be a longitudinal database to be able to address that question. We don't have that. We're not alone. We're actually one of the first countries to get on-board with having a longitudinal survey at a national level.

The reason is that it's not necessarily a direct correspondence between what we might measure as stress on the family or family well-being, and the outcomes in terms of child health. That's because families and communities are very creative in being able to respond to a variety of the stresses that occur.

So one of the things is that a direct correspondence between a particular social program, let's say, and the outcomes for child health is a very difficult link to make. Actually, in terms of the data systems we now have available, they're impossible links to make, because we don't have the longitudinal consequences of changes that have happened.

I think it behoves us to have that. That's because, as we are going through major experiments of the sort that we are obviously engaged in at this time - whether we choose to be or not, we're engaged in them - we need to see the impact on those various kinds of things.

Here's the other thing that I'd point to in thinking about this issue. Fraser Mustard and I have used the phrase on a number of occasions: experiments in civilization.

What we are engaged in is an experiment in civilization. The reality is that it's not planned. Nobody is planning it. The changes that we're talking about are very broad and deep. They engage changes in attitudes, cultural values, labour markets, the nature of the economy, and the impact of technology on the economy.

These things are vast and complex and beyond Canada specifically. They're obviously global processes in a variety of ways.

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I guess the point that I would want to emphasize is that these changes are happening in a very rapid and very unpredictable way. If we're going to keep on top of trying to protect children from the negative consequences of those changes, and we know that vulnerable groups in society tend to be at risk when we go through dramatic changes, we need to have a way of trying to both monitor what's happening and enable creative responses to happen, ideally at the community level, I would suggest, to be able to respond to that.

I think it would be very difficult to tie changes in specific programs to specific changes in family stress to specific outcomes in child health, because there are so many other factors going on in a very large kind of dynamic system. But we could find out some of those kinds of things if we were monitoring as we ought to be in terms of the longitudinal consequences for experiences in early childhood and later health.

Mrs. Hayes: Okay. It might be more likely to have an answer now that we have a longitudinal study data and - -

Prof. Keating: I think we will be able to at least ask some of the interesting questions.

Mrs. Hayes: Good.

Here's another question. You mentioned the SES gradient and expanded a bit on that. You said that everything cannot be related directly to poverty. There are other things, it's broader than that, and it goes across different income levels and whatever, as far as family health is concerned. Have any studies been done, for instance, on the effect on health or the well-being of families between dual-income and single-income two-parent families?

Prof. Keating: Maybe I could ask you to just elaborate on where you're headed with that, because I'm not entirely sure of it. Obviously, there's an income-to-outcome relationship there. You're asking whether it's moderated by whether it's a two-earner or a single-earner family. Is the division made at that level?

Mrs. Hayes: Yes. You were saying you can't decipher the difference simply based on poverty, but you did mention, for instance, that dual-income families cross over into other income levels. Because of the dual income, you see some of the same effects. I guess I'm trying to strip away to see if, in fact, it's perhaps as serious as poverty might be when there's a dual-income type of stressful situation within a family.

Prof. Keating: I see.

Mrs. Hayes: That's if both parents are working 40 hours a week, for instance. Has there been a comparison between having one parent at home as opposed to having -

Prof. Keating: In terms of the specific SES gradient to health data, there have not been to my knowledge studies of that sort. That is in the sense that across national health and wealth data, it's essentially household income, so it wouldn't break it down by type of household when you look at that gradient.

On the other hand, we do know that single-income parents tend to be at the bottom of the gradient overall. That is, the single-income parents are going to be piled up at the bottom rather than in the middle. So if we use that basis, we would assume that there's some advantage to having more income, even if it means that there are two parents, both of whom are working. By inference, we could assume that they're probably going to be somewhat better off.

On the other hand, I think the issue in which it does tend to show up is in some of the data you heard this morning and other data that is supported as well. This is the number of hours that the parents are outside the home for work and/or study. Particularly when we're talking here about families with young children, we do know that has shown a substantial increase over the last 20 years or so. The number of hours that parents with young children are outside of the home for work and/or study has definitely increased over time.

The data I'm talking about may reflect that at some later time. We're talking about timeframes here in which going from past to future makes a difference. It is certainly the case that dual-income parents have stresses on them in terms of the amount of time they have available and presumably, therefore, the amount of psychological and nurturing resources they have available. We don't yet know what the longitudinal outcome of that would be for their children as their children age and have various health problems that would show up.

Mrs. Hayes: Commenting on the statistics you gave, some 90% of single-income families are at the poverty level.

Prof. Keating: Yes, I heard that this morning. I didn't realize it was that high, but I knew it was high.

Mrs. Hayes: This is going to skew that single-income judgment of family health, because such a large number are in that poverty and within the stresses of that category.

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Can you strip the ones who can have a dual-parent situation but choose to have one parent? That type of health in the family, I guess, is something.... Would you agree that this would be an interesting comparison?

Prof. Keating: I think it would be an interesting comparison. I would put into the comparison the community availability of high-quality alternative care, because that will obviously make a difference as well. To the extent that there's high-quality alternative care available, the evidence would tend to suggest that this would moderate it, but we don't have a study at that level of detail on a population base, as least that I'm aware of, such that we could piece it together from various other kinds of studies.

But if we're going to look at the mix of what's happening within those families, I think we need to think of family resources. I would agree with what you're suggesting, which is that we need to look at family resources as more than just income resources. There are lots of different kinds of family resources, and families can call on them. I think we would need to look at the various ways different families in different communities try to cope with those kinds of stresses.

The Chairman: We're almost out of time.

Hedy.

Ms Fry: I want to thank you very much for an excellent presentation. I was glad that you defined health as more than just the definition of the World Health Organization, which is mental, physical, and social well-being. I'm glad that you defined it as the ability to cope, because I think that is a far better definition for health. It's the ability to cope of the individual and, obviously, of the population in general.

I wanted to ask you a question. You talked about the quality of available childcare. I think what I heard you saying is that poverty is probably the single greatest determinant of health.

There are other factors involved. The one you've identified as number one is, of course, poverty. How other things mitigate will obviously depend on how you look at some of those other things.

My question is this. You talk about childcare, as does everyone. I'm concerned that no one talks about child development as being inclusive of childcare.

Consider many parents who work and have childcare. It turns out that someone may just sit there to ensure that the child gets food, does not fall down the stairs, does not burn themselves, etc. But there's never talk about child development. Could you comment on childcare and child development as one component, please?

Prof. Keating: I'd be happy to. I think the appropriate way to think about this is to think about the notion of what we might call a childcare system or a child development system.

This is what we have. As a society, we evolve a variety of ways of attending to the nurturing needs of young children. There are a variety of ways we do that. There are a variety of ways other societies do that. There are a variety of ways societies have done that across time. There are many different ways of doing that.

What we do know very much about are child development needs. Through scientific research we now understand that much of it validates what we would already know, but basically we have a very clear idea of what the developing child needs in terms of the basic support to have good coping skills, good health later on, and so forth.

If we think of it as a child development system, if you will, which is society's system for dealing with these issues, how can we arrange the optimal mix that provides that nurturing we know is needed for the good development of young children? It seems to me that when we think of it in those terms, we really need to begin thinking about a fairly dramatic level of social innovation about how to deliver that under changed social and economic circumstances. Many of the things that we had relied on, for one reason or another, are not there to be relied on, and many things continue to change.

For example, when we talk about intersectoral collaboration, the relationship between, let's say, health and the education system is a very interesting one. We might think about reconfiguring schools as child development centres within which the whole range or gamut of issues that affect child development might be taken up.

As for this kind of intersectoral collaboration and reconfiguring of what we think of as specific kinds of service delivery, which we initially thought of as a set of specific needs, let's design a delivery system to meet each of those specific needs.

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Evidence suggests, history suggests, that that runs into problems. There are all kinds of bureaucratic problems. People who are out there in the trenches run into difficulties of how to get the right kinds of resources for individuals.

So we need to begin thinking about a childcare or child development system that takes account of the fundamental needs for healthy child development, and how we are going to deliver them.

That may actually take on a different character in different communities. It's probably not going to be the same in North Bay and Montreal. We need to think about how those things are going to actually happen in those various kinds of circumstances.

So I would take your point that we need to think about it as a broader system. We know much about the needs. We need to think about how to reconfigure our social institutions, to be able to delivery things that will meet those needs, and to empower communities and families to do it.

Ms Fry: Do I have a second question, a quick one?

The Chairman: Quickly, yes.

Ms Fry: At the moment, there is a lot of evidence showing that families with children suffer more, in terms of the socioeconomic approach. Even middle-class families with children suffer more than, say, a middle-class family without children.

When we look at developing a society that values the child, do you see any merit in discussing how we can get families without children to support the child, period, not the child as somebody else's child, but the child as a potential for Canada itself in the future? Do you see any merit in that?

Prof. Keating: I think there's enormous merit in that. You point to one of the most difficult issues we have to confront as a society, and that is the issue of how we respond in a way that sees the provision of those fundamental needs for child development as a society and community responsibility, rather than exclusively as the responsibility of the family that happened to have that child.

In Canada we have a history of that kind of collaborative perspective, but I think in changing circumstances we need to figure out how to renew that commitment.

The notion of a cherished children kind of perspective is one I would certainly endorse. It would be interesting to actually see that substantiated in some way, so that any kind of social policy people are instituting, whether it's in the public sector through government or the private sector through corporate decision-making....

Perhaps they should have someone whose job is to review the impact of this policy, this activity, on children, on the children of our employees, on children in this community, this province, and this country.

One of the things we might do to actually substantiate it is to create some sort of a formal mechanism whereby we review various decisions taken in the social sector, whether private or public, in terms of its impact on children, because otherwise we tend to ignore it.

It is perhaps human nature that we're self-interested, and children tend not to have much of a voice in that context. So in order to be able to deal with that, perhaps we need to be able to have the children's voice heard, being represented for them.

Ms Fry: Thank you.

The Chairman: Now we have one other intervener. I'm going to recognize him in a second. I ask that he be very brief, because we want to accommodate the report from two subcommittees this morning, or else we're going to have to set down a special meeting.

So, Grant, could you just make it very brief?

Mr. Hill: Hedy said that in your presentation you said poverty was the single most important health determinant. Did you say that?

Prof. Keating: I did not specifically say that poverty is the single most important health determinant. I would not disagree that it would certainly be very high up on the list.

I think it's hard to allocate variance to particular kinds of factors. It is a very substantial factor. Other factors are also quite important, but it certainly is a very substantial factor.

Mr. Hill: I have one other thing. Could we get a copy of your annual report, so that I know where your funding comes from, the sort of individuals you employ?

In fact I would beg this to be a standard thing. When groups come in here, we should have some way of assessing that, even if it's just to be deposited with the clerk.

A voice: Sure.

Mr. Hill: I don't want to ask this of every group that comes in, but I will, if it's not available.

Prof. Keating: Just for your information, it's a blend of private, federal, and provincial support, through CIAR, the Canadian Institute for Advanced Research.

The CIAR then basically turns around the money, and funds scientists with fellowships to continue their research and participate in research networks. It doesn't actually fund direct research.

Mr. Hill: Could that be available to us to look at, please?

Prof. Keating: Yes.

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The Chairman: Thank you, Dr. Keating, for an excellent presentation. I'm sure we will have occasion to call on your resources again.

Prof. Keating: I look forward to it.

The Chairman: Now, committee, we have another committee coming in here at 11 a.m., so please don't wander off. We need all of you for a quorum, and we're going to take just 30 seconds for the transition, because we have to go in camera.

[Proceedings continue in camera]