Discussion & Recommendations
Is “Good”, Good Enough?
The results presented in this report in response to the question “how healthy are BC’s children and youth?” lead to even more important and difficult questions that can be used to guide future action.
Data in this report demonstrate that overall, the health and well-being of children and youth in BC is reasonably good, particularly in comparison to other jurisdictions in Canada. But is “good,” good enough? Is the fact that the chlamydia rate for females is “stable” at 1,400 per 100,000 good enough? Is it reassuring that 15 per cent of kindergarten children are still found to have visible dental decay, even if it is an improvement? Is it satisfactory that 16 per cent of youth in BC fail to complete high school? Is it acceptable to call it progress when there are still more than 7 per cent of students in grades 7–12 who report they went to bed hungry because there was insufficient food at home?
This section outlines two key health equity themes, and provides five recommendations that are based on the findings presented in this report. These recommendations were established in collaboration with the Advisory Committee members that participated in the development of this report. The recommendations are offered with the aim of informing health system decision-making and the development of policy, programs, and services that benefit children and youth in BC.
Addressing Health Disparities Based on Geography
How do the evident, substantial geographic disparities in BC guide future action?
Rural areas are defined by Statistics Canada as any area lying outside of urban areas. Urban areas are defined as having a population of at least 1,000 and a density of 400 or more people per square kilometre.1 As identified in the Ministry of Health’s policy framework on rural health services in BC, “The populations of rural British Columbia are often small, dispersed, and fluctuating in number…and a large percentage of the rural population identifies as Aboriginal.”2 This situation is not unique to BC, as similar findings have been identified in rural populations across Canada.3
Rural life affords many benefits to those who live there. For example, many rural and remote communities describe characteristics that may contribute to their resiliency such as a strong sense of community.3 However, there are some unique challenges to accessing health care in a rural setting that stem from multiple factors: geographic remoteness, long distances between communities, low population densities, fewer providers, and inclement weather conditions. Generally speaking, individuals who reside in predominantly rural communities tend to have poorer health outcomes and socio-economic status compared to their urban counterparts.3 When working towards better health and well-being outcomes for all children and youth in BC, one should consider and account for geography in relation to social and environmental contexts, as well as access to health care services.
There were significant geographic disparities evident for 39 out of 51 indicators, with Northern Health and rural and remote HSDAs being identified as the health authority and HSDAs most in need. These data must prompt coordinated action at the provincial level to address these geographic disparities as well as action at regional and local levels. Additionally, it is important to learn from those areas that are doing well in many of the indicators in order to support other communities as they strive towards better health and well-being outcomes for their own children and youth.
Addressing Health Disparities Based on Sex and Gender
Why are there differences in health and well-being according to sex/gender?
It is alarming that sex and gender gaps are evident in many of the indicators of health and well-being. For example, females report lower levels of youth unemployment and self-rated mental health, experience higher rates of bullying, report significantly higher rates of sexual abuse, and are less physically active then males. However, more females passed the English Provincial Exams compared to males, but in some years slightly fewer females passed the Math Provincial Exams compared to males. These disparities are complex, and further investigation and examination is required in order to better understand the causes and therefore the potential solutions.
Addressing Gaps in Data Availability
How do we fill in the blanks?
It is imperative that government and nongovernment organizations gather, analyze, and use data to inform funding, policy, and service delivery decisions. Yet relevant, reliable, and accurate data are increasingly hard to come by. This report is foundational to addressing this issue by providing a baseline for key indicators of child and youth health in BC; however, it is essential that public decision makers invest in continued generation of the data needed to enable informed decisions on how to foster the well-being of children and youth in BC today and in the years to come. There were 17 “gap” indicators identified for which data was unavailable during the selection process for the 51 indicators presented in this report. Additionally, as a result of findings presented here that warrant further analyses and understanding, the Advisory Committee identified a need to examine additional measures within the five dimensions of health in the future that are not examined in this report, including the following: physical dimension—sleep levels; mental and emotional dimension—family functioning, stress levels; social dimension—parental abuse of alcohol and other substances; economic dimension—adequacy of child care; cognitive dimension—early childhood education received.
Pursuing Progress through Continued Collaboration
How can the energy of youth, young, families, and critical partners be used to improve the health of children and youth and address health inquiries?
During the development of this report, youth across BC have shown commitment to understanding the findings presented as well as to using these data to make a difference in their communities. This is an eager, enthusiastic, and dedicated population that needs to be supported to ensure they are equipped with the tools required to support their own health and well-being as well as that of future generations, and to drive change in their communities.
How do we commit to action?
Communities, health authorities, school boards, ministries, and children, youth, and families need to work together—by leveraging good work already underway, strengthening connections, and learning from each other—to identify ways to positively influence the health and well-being of children and youth in BC.
Commit to addressing the disparities in health based on sex/gender and geography, as identified in this report. This requires conducting further data analyses and consultations with stakeholders (including children and youth of all sexes and genders and from all geographic areas) to determine the underlying causes of ongoing disparities, and to identify actions that can be taken to better meet the needs of all children and youth in BC.
Create a provincial-level inter-ministerial leadership committee that will support actions generated from this report to improve the health and well-being of children and youth in BC.
Establish an ongoing provincial forum where youth are connected with other community stakeholders to plan and undertake initiatives to enhance child and youth health and well-being in communities.
Develop a mechanism for a coordinated approach to ongoing data collection and reporting of indicators of child and youth health and well-being in BC, and for addressing indicators with missing and/or scarce data.
Develop a mechanism to share programs and initiatives in BC that aim to improve the health and well-being of children and youth. These programs should be evaluated and demonstrate success, in order to serve as potential models for other communities.
“Good” is not good enough. We must do better for the children and youth of BC today and in the future. Improving the lives of children and youth in this province is essential to the health and well-being of the entire BC population. This report brings together data from a broad range of contributing factors to child and youth health and well-being, and establishes a comprehensive and holistic baseline to support consistent and ongoing monitoring and reporting of child and youth health in BC into the future. In doing so, it provides essential information for decision-makers, educators, planners, members of communities, and youth themselves to use to make the changes that are needed to address issues identified in this report. This report provides crucial information on the influence of early childhood experiences on a person’s health throughout life, and looks beyond physical health to consider how the social determinants of health affect the lives of children and youth in BC.
- Statistics Canada. From urban areas to population centres [Internet]. Ottawa, ON: Statistics Canada; 2011 Feb 7 [modified 2015 Apr 2; cited 2016 Jul 25]. Available from: http://www.statcan.gc.ca/eng/subjects/standard/sgc/notice/sgc-06.
- BC Ministry of Health. Rural health services in BC: a policy framework to provide a system of quality care. Cross sector policy discussion paper. Victoria, BC: BC Ministry of Health; 2015 [cited 2016 Feb 18]. Available from: http://www.health.gov.bc.ca/library/publications/year/2015/rural-health….
- Canadian Institute for Health Information. How healthy are rural Canadians? An assessment of their health status and health determinants. Ottawa, ON: Canadian Institute for Health Information; 2006 [cited 2016 Feb 18]. Available from: https://secure.cihi.ca/free_products/rural_canadians_2006_report_e.pdf.