Oct 24 CAPHC National Symposium
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Transcript of Oct 24 CAPHC National Symposium
Child health and inequality
Frank Elgar, PhDAssociate Professor of Psychiatry
Canada Research Chair in Social Inequalities in Child HealthInstitute for Health and Social Policy
McGill University
What we knowThe odds that a child is healthy, happy, and doing well in school significantly improve as social class rises
This graded social pattern is found in most cultures and areas of health
Percentage of children with serious emotional or behavioral difficulties, by age group and family incomeSource: CDC, 2009 National Health Interview Survey
What we don’t know
What happens to child health as we become more unequal?
Income inequality and school bullying in 11-year-olds in 37 countries
Source: Elgar FJ, Craig W, Morgan A, Vella-Zarb R (2009). Income inequality and school bullying: multilevel study of adolescents in 37 countries. Journal of Adolescent Health, 45(4),351-359.
Rethinking child poverty
Calton, Glasgow Delhi, India
• National perspectives on health inequality point to the need to improve health services in the most vulnerable groups.
• Global perspectives suggest that Canada could do more to tackle the structural determinants of child health that give rise to inequality in the first place.
Raise and level the bar
Attawapiskat, Ontario
+
“The 42% Problem”: Practical Challenges in the Promotion of Child Wellbeing
Charlotte Moore, MD, FRCPC, FAAPMedical Director, Canadian Paediatric SocietyAssistant Professor, Department of Paediatric Medicine, University of TorontoStaff Paediatrician, Division of Paediatric Medicine, The Hospital for Sick Children
EVIDENCE POLITICS POLICY OBJECTIVES
+Total Health Expenditure as% of GDP* Source: OECD Health Data 2012
1960 1970 1980 1990 2000 20100
2
4
6
8
10
12
14
16
18
20
United StatesCanada
+Total Public Sector SpendingProvince of Ontario *Source: Ministry of Finance Estimates
Operating and Capital Expenses
HealthEducationSocial ServicesJusticeOther
+“Health” / “Illness” Accounting
SOCIAL
HEALTH
$48B
Public Confidence inHealth Care System
LOS/Hospitalization for ASC/Readmission Rates for AMI
Rates of FluVaccination
Median Wait Time for Priority Surgeries
Investment in HomeCare (Fragile Seniors)
Scope of Practice for Allied Health Professions
+Case Study: Setting Priorities
SOCIAL
JUSTICE
HEALTH
$109,286 / 28 weeker 1
1. CIHI, Too Early, Too Small: A Profile of Small Babies Across Canada, 20092. Cohen, E. et al. Patterns and Costs of Health Care Costs of Children with Medical Complexity, (2012) Pediatrics 130;6.3. CADTH Canadian Drug Expert Review Committee Final Recommendation – Asfotase Alfa, 2016.
HEALTH
HEALTH
36%
15,771 CMC2
HEALTH
$102 / mg Asfotase Alfa 3
+Case Study: “Stop FASD”
SOCIAL
JUSTICE
HEALTH
$3400 / family 1
1. Manitoba Health
HEALTH
+Case Study: “Stop FASD”
EDUCATION
SOCIAL
JUSTICE
HEALTH
$3400 / family 1
$ 4,596 / year 2
$ 4,075 / year 3 $46,000/year 5
if incarcerated
1. Manitoba Health 2. Stade et al (2009) 3. Stade et al (2009) 5. Fuchs et al (2009)
$ 23,760/year 4
if in care
4. Fuchs et al (2008)