A Health Surveillance Update on Canadian Children and Youth

Introduction

It is estimated that in July of 1999, over 8 million Canadians or 26.1% of the population will be children and youth aged 19 years and younger.⁽¹⁾ The health status of this population is of great interest to policy makers, health professionals and the general public. Several reports have been produced that attempt to capture the health status of children and youth at provincial, national and international levels.^(2,3,4) They have, without exception, highlighted both the undisputable gains as well as the remaining barriers facing children and youth today.

It is well recognized that a variety of factors interact to determine the overall health and well being of children. Poverty is one important determinant that has been inextricably linked to the health of children and youth. Almost all facets of health are worse among impoverished children than among children from affluent families.⁽⁵⁾ The impact of the environment on child health has also been studied extensively. Research demonstrating persistent health effects among children exposed to low levels of environmental contaminants is particularly worrisome.⁽⁶⁾ The importance of early childhood education and development is being increasingly recognized. Hertzman and Weins highlight the accumulation of evidence for a profound and long-lasting impact of childhood experiences on subsequent health status.⁽⁷⁾ In addition to these broad determinants of health, subjective indicators of well being, such as self-rated health status, add an important dimension to our picture of child health.

While acknowledging the important role of these determinants and other factors, the aim of this report is to highlight the surveillance of a limited number of important health outcomes of Canadian children and youth. The information in this report is the product of various national surveillance programs of the Laboratory Centre for Disease Control (LCDC), Health Protection Branch, Health Canada.

The task of public health surveillance requires more than the presentation of tables of numbers or figures of data. A successful surveillance program features an ongoing cycle of comprehensive data collection followed by thoughtful analysis and interpretation, ultimately leading to an effective public health response. In a recent commentary on injury surveillance, Halperin and Horan identify this latter component, the provision of information that guides effective public health programs, as the overarching goal of public health surveillance.⁽⁸⁾

How then can this report contribute to effective public health programming? First, the collection of a limited number of important child health outcomes from various surveillance programs into one comprehensive document will serve as a valuable and accessible resource on the health of Canadian children and youth. Second, the presentation of these child health outcomes at the national level enables important comparisons to be made between Canada and other nations. Finally, subsequent surveillance reports on child health will track the trends of these child health indicators, thereby providing the evidence base for child health policy and program development and evaluation.

This surveillance update is presented according to the following categories: infant health, childhood cancer, vaccine-preventable diseases, respiratory health, child injury, and HIV and sexual health. Each section presents an overview of the topic, followed by the key surveillance indicators that demonstrate its impact on the overall health of Canadian children and youth. Careful interpretation of the most recent available data, as well as a discussion of data limitations, accompanies each indicator. In addition to trends over time, where possible, international comparisons are highlighted. Finally, future developments in national child health surveillance by LCDC are presented.

	LCDC's surveillance programs are undertaken in collaboration with other federal government departments, provincial and territorial governments, health care providers, hospitals, national non-governmental organizations and university-based researchers. We thank these partners for their invaluable contribution to our programs for national surveillance of the health of Canadian children and youth.

1. Statistics Canada. Annual demographic statistics, 1996. Catalogue 91-213-XPB.

2. British Columbia. Provincial Health Officer (1998). A report on the health of British Columbians: Provincial Health Officer's annual report 1997. Feature report: The health and well-being of British Columbia's children. Victoria, BC: Ministry of Health and Ministry Responsible for Seniors.

3. Canadian Institute of Child Health. (1994) The health of Canada's children: A CICH profile (2^nd ed.). Researched and prepared by L Hanvey, D Avard, I Graham, K Underwood, J Campbell, & C Kelly. Ottawa, ON: Canadian Institute of Child Health.

4. UNICEF (United Nations International Children's Emergency Fund). (1998). The state of the world's children 1998. Oxford and New York: Oxford University Press.

5. Reading R. Poverty and the health of children and adolescents. Arch Dis Child 1997;76:463-67.

6. Needleman HL, Schell A, Bellinger D, Leviton A, Allred EN. The long-term effects of exposure to low doses of lead in childhood. N Engl J Med 1990;322:83-8.

7. Hertzman C, Weins M. Child development and long-term outcomes: A population health perspective and summary of successful interventions. Soc Sci Med 1996;43:1083-95.

8. Halperin W, Horan JM. Surveillance of injuries. Public Health Reports 1998;113:424-26.

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