The Chief Public Health Officer's Report on The State of Public Health in Canada 2009 – A message from Canada's Chief Public Health Officer

A Message from Canada's Chief Public Health Officer

Our childhood years represent a critical stage that most strongly impact the rest of our lives, and where the greatest opportunity for positive influence lies. In this report, I have chosen to focus on the current health and well-being of Canada's children, and to identify where action is needed to make the greatest difference in their lives, now and in the future. I have looked at efforts made throughout our country's history to improve children's health and well-being and considered where we stand today as a result. Proven and promising approaches from both Canada and abroad that help children grow up well are highlighted. They include successful programs and approaches we can learn from and adopt. But I have also put a spotlight on areas of children's health that are persistent or worsening – ones that can affect children for the rest of their lives, and where prevention is possible.

The majority of Canadian children today are healthy; they live, learn and grow in healthy and supportive environments with life expectancies and potential years in good health that are among the highest in the world. Most also experience the conditions necessary for healthy outcomes, such as adequate income, food security, acceptable housing, access to early and late childhood education, and strong connections to family and community.

We have much to celebrate in Canada, but there is more we can and must do.

Within the report, I have highlighted six issues of concern that not only affect the current health of Canadian children but may also have an impact on their health as they age: socio-economic status and developmental opportunities; abuse and neglect; prenatal risks; mental health and disorders; obesity; and unintentional injuries. These issues represent worrying trends in recent years that are characterized by a lack of progress and yet, to a degree, can be prevented or mitigated. In addition, evidence shows that other countries are doing better than Canada in terms of reducing negative outcomes related to some of these issues.

Also troubling is the prevalence of these issues among certain groups of children. My first report focused on health inequalities in Canada and the fact that not all Canadians benefit equally from efforts to improve the health of the population. This report, my second as Chief Public Health Officer, shows that inequalities are evident even at the earliest stages of life, particularly among children who are Aboriginal, who have disabilities or who are part of families with low income.

I am concerned that we may fail these children and about the growing numbers who will fall behind without concerted action. More of our children will lose the opportunity to grow up in good health, and the milestones Canada has reached in terms of life expectancy and quality of life for all our citizens will be at risk. However, I am also confident that with longer-term vision, planning and collaborative action, we can do more to strengthen the health and well-being of all children, and better reach those most vulnerable.

It is a role of public health to highlight the links between exposure and outcome, and to help find collective solutions to ensure good health across the population. We know that long-term planning and investments make a difference. Our efforts following the Severe Acute Respiratory Syndrome (SARS) outbreak have paid off through pandemic planning that has better prepared us to respond to the H1N1 influenza virus outbreak in Canada. Earlier planning and expenditure in other areas – such as Medicare – have meant that in times of economic hardship, Canadians have not had to compromise their health care due to a lack of ability to pay for services.

Of course, taking action involves investments of time, money and other resources. Given the economic difficulties currently faced by many nations, including Canada, it is sometimes hard to appreciate the return on an investment if the outcome is not immediate.

Sometimes we have to ask ourselves where – with limited resources – we can make the greatest difference. It is true that the different stages of a person's life are all connected, and it is certainly possible to mitigate negative events and impacts later in life. However, it is most effective and cost-efficient for both the individual and the community at large to create positive environments, and build resiliency to negative experiences, through early intervention.

What happens to us early on – the environments and events to which we are exposed – can have immediate, delayed or long-term impacts on our health. These impacts may be compounded over time or by other events, and can sometimes be intergenerational. The importance of a holistic public health approach to early childhood in particular, must not be underestimated.

Given our wealth, knowledge and experience, I believe there are opportunities for positive change on priority issues that can set a healthy path for all our children. Throughout this report, there are many examples of what is working well, and data on the tangible, long-lasting differences that we can make in children's lives. I want to take this opportunity to recognize the people behind these and many other initiatives and the work they do every day to improve the lives of Canadians.

Whether you read this report as a parent, a teacher, a caregiver, a health professional, a decision-maker or a citizen, we all have a stake – and a responsibility – in making the early years of childhood the best they can be. There is no better investment worth making.

Dr. David Butler-Jones