Some of the Most Complex Needs of My Patients Stem from Poverty and not Disease Alone

Why Canadian children need a champion.

A young girl is referred to a pediatrician’s office for inability to pay attention in the classroom. The child’s teacher is concerned she has attention deficit hyperactivity disorder (ADHD), and possibly, a learning disability.

I am a second year medical student working in the clinic at the time of her visit. I am beginning to establish my approach to patient problems and complex medical illness.

As I make my way through the medical history, the child’s parents tell me they are struggling to make ends meet. Despite their best efforts combined with collections from a nearby food bank, the little girl often goes to school hungry.

The problem seems clear: how could any child concentrate in the face of hunger? When your groceries consist of the non-perishable offerings of others, how do you nourish a developing brain?

How does a physician properly evaluate a learning problem when a child’s basic needs are unmet? 

I am now a pediatric resident, pursuing specialist training in the diagnosis and treatment of childhood illness. Years later, I still can’t help but feel that some of the most complex needs of many of my patients stem from the constraints of poverty and not disease alone.

Unfortunately, as physicians, my colleagues and I do not have the therapeutic tools necessary to “cure” the social conditions that so often impact the health of our patients.

Beyond anecdotal confirmation, there is strong evidence linking poverty to poor health outcomes for children: higher levels of mental illness, accidental injury, obesity, asthma, poor brain development and more. These problems have a cost that we all bear. When children are exposed to the toxic effects of poverty, the detrimental impacts can be felt for generations – and they impact entire communities.  

In 1989, the year I was born, Canada’s House of Commons vowed to eliminate child poverty by the year 2000. Twenty-six years later, Canada’s children are still suffering. Current data suggest that over half a million Canadian children live in low in-come households.

Provincially and territorially, efforts to curb levels of child poverty have had variable success. Provinces like Quebec and Newfoundland and Labrador have significantly reduced levels of child poverty after introducing poverty reduction strategies that include enhanced early childhood education and child care. Conversely, in Manitoba where a poverty reduction strategy has been in place since 2009, levels of child poverty continue to be some of the highest in the country. The same rate holds true for British Columbia, the only province without a committed poverty reduction strategy.  

Without a coordinated effort and strong national leadership, we risk leaving too many children behind.

The time has come for Canada to adopt a child poverty reduction strategy and to appoint a Commissioner for Children and Young Persons who will guarantee its success.  If we succeed in making a federal commitment to our children, we stand to make real change.

Let’s hear what our political parties have to say about a cohesive, national child poverty reduction strategy in this election season. A number of evidence-based policy and program solutions, including, but not limited to, guaranteed minimum income and universal childcare, are at our disposal and could inform this effort.

But here’s a plea: A strategy without true accountability will put us no further ahead. Canada’s children need a non-partisan, independent, “advocate” or “champion” to represent their best interests.

A Commissioner for Children and Young Persons could report on the status of children. They would ensure all sectors consider children in decision-making. A Commissioner for Children and Young Persons could also provide a framework of accountability for a federal commitment to eliminate child poverty.

This is not a new concept to wealthy nations like Canada. Countries including Australia, Sweden and France have all established a point person or office representing the interests of the child. This concept is also well known to the Canadian government. After Canada ratified the UN convention on the Rights of the Child in 1991, more than a decade’s effort to establish a Commissioner for Canadian Children and Young Persons was set afoot. Previous governmental reports have also produced recommendations for the appointment of a federal Commissioner

Twice, the UN Committee on the Rights of the Child has called on Canada to establish an ombudsman’s office. In 2009 and again in 2012, Parliamentarians’ introduced bills proposing the appointment of a Commissioner.  Despite this, we have yet to muster the political will to establish formal representation for Canadian children.

The need for a national champion for children is clear.  Will our future leaders heed the call?

Laura Stymiest is a paediatrics resident at Dalhousie University. She previously completed training at the Coady International Institute and has been involved in research in the area of Social Paediatrics.

Elizabeth Lee-Ford Jones is an expert advisor with EvidenceNetwork.ca, and Professor of Paediatrics at The Hospital for Sick Children and the University of Toronto.