When children do well, we all do well: Insight from the CPHA Conference Hertzman Dialogue Session

HELP, the Canadian Institute for Advanced Research (CIFAR), and the Canadian Institutes of Health Research - Institute of Population and Public Health (CIHR-IPPH) organized a panel session entitled The early years - Health Equity from the Start at Public Health 2014, the Annual Conference of the Canadian Public Health Association, which took place from May 26-29th, 2014 in Toronto. The session was one of several events planned this year in memory of Clyde Hertzman as part of New Frontiers in Population Health toward Equity from the Start: Dialogues inspired by Clyde Hertzman. The information below is the final article from this session.

Jean Clinton, Associate Clinical Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University

Dr. Clinton grounded her presentation in Dr. Hertzman’s work for the WHO Commission on Social Determinants of Health Report, “Closing the Gap in a Generation,” Chapter 5 “Equity from the Start,” and expressed the need to invest in upstream interventions that promote early childhood development (ECD), as the evidence suggests ECD is itself a determinant of health. She discussed the concepts of biological embedding and monitoring and measurement.

Biological embedding refers to the activation or silencing of gene expression based on early life experiences that persist over the course of a lifetime and influence health outcomes. Both positive and negative experiences from childhood “get under the skin” and influence health and human development for many years to follow. Research has shown that these changes can even persist across multiple generations.

With this knowledge, investments should be made in tackling upstream determinants that impact health such as the quality of very young children’s environments, including relationships, working conditions and poverty, rather than individual lifestyle factors, in order to diminish the burden of chronic disease.

There is a need to monitor and measure how we’re doing with respect to the state of early childhood development using pre-defined indicators and whether we’re making improvements through interventions being implemented. This includes the need for numeracy skills to interpret findings.

Joanne Schroeder, Deputy Director, Human Early Learning Partnership, University of British Columbia

Ms. Schroeder shared knowledge translation activities and tools being developed and implemented by UBC’s Human Early Learning Partnership (HELP) for policy makers, communities, and others to promote health equity and early childhood development. Underpinning her presentation was the maxim: “No data, no problem, no action.”

The Early Development Instrument (EDI) is used to collect data on all kindergarten-aged kids in BC and includes measurements on physical health and well-being, social competence, emotional maturity, and other health indicators. The instrument is being used in most Canadian provinces and territories and in other countries around the world.

Unfortunately children in BC aren’t doing as well as we’d hope. One-third (33%) of children are vulnerable province-wide, with 4%-56% (sic) vulnerability across different regions and neighbourhoods. There is a need to monitor change over time and the impact of interventions.

Critical success factors for locally-driven initiatives include:

•    Strong intersectoral leadership
•    Focus on research
•    Address barriers to increase equitable access to services (proportionate universality)
•    Alignment between early childhood efforts and the K-12 school system.

Patricia Daly, Chief Medical Health Officer and Vice-President, Public Health, Vancouver Coastal Health

Dr. Daly focused on Vancouver’s local health authority, Vancouver Coastal Health (VCH), and how the region uses data to inform programs being delivered and to reduce health inequities. VCH tracks performance using a Health Care Report Card. EDI scores are integrated into the report card to measure early childhood performance. Across the region, 33% of children are rated as vulnerable on at least one domain of the EDI. This figure is more than 10% higher than the target performance of 29.5%. However there are significant gradients across the 55 neighbourhoods that comprise the region with a range from 6%-59% vulnerability.

Dr. Daly continued to describe the difference between targeted and universal approaches to delivering health programs. While real health inequities exist at the local level, the EDI data show that vulnerable children also live in wealthy neighbourhoods. If efforts only focus on the most vulnerable neighbourhoods, there may not be a significant change in outcomes at a population level, so both a universal approach to reduce vulnerabilities in all neighbourhoods and targeted initiatives are needed.

Dr. Daly concluded with three lessons learned from the perspective of a health authority promoting early childhood development:

  1. Public health is not enough, i.e. other sectors need to be engaged, including non-governmental organizations, school boards, municipal governments, and provincial and federal ministries providing health and social services
  2. Community capacity-building is important
  3. Broad policy change is essential and will entail investment in early child care.