weeklycheckup-brett-taylor-52

Dr. Brett Taylor

Brett Taylor is an associate professor of pediatrics and emergency medicine at Dalhousie University. He works as an emergency paediatrician and researcher at the IWK Health Centre in Halifax. He is in the process of obtaining a Masters in Health Informatics, also through Dalhousie. His website for parents is available at www.thevirtualpediatrician.com.


I have a bias, you see. I like children, making any article I write about the election from the perspective of an emergency pediatrician a trifle one-sided.

Politicians like children too, as long as there are cameras around; just this week, we saw footage of both NDP Leader Jack Layton and Liberal Leader Stéphane Dion knee-deep in daycare tots.

Conservative Stephen Harper posed with a few kids himself to declare his efforts to ban candy-flavoured tobacco products. It seems, however, that as soon as the bright lights go down and the media goes home, children become a forgotten nation within our borders.

We love our kids, and we try our best to feed, clothe, house and raise them, but we just don't vote as though they matter very much, leaving one to wonder why.

My job exposes me to the cracks in our medical and social systems, and I am a father. Sometimes, these characteristics lead to a certain impatience with the "seen and not heard about" attitudes so often demonstrated by our leaders about our children and youth.

So I have a bias, and it is probably best to just get it out there, right off the bat, by stating what will become the key question of this piece: When it comes to the social and medical health of children, where the heck is Harper?

For instance, just what is going on with daycare in Canada? Competent daycare decreases the incidence of child abuse and neglect in our communities, and is an enabler, allowing parents (very often women) to seek employment and thus escape from the trap of poverty that so often accompanies single parenthood.

Three years ago this month, Harper announced a child-care subsidy of $100 per month for parents of young children, stating that he expected this would "help parents find that balance" between raising a child and making a living. Harper predicted that this plan would create 125,000 new daycare spaces across the country.

Well, that hasn't happened; daycare spaces in Canada are nearly as hard to come by today as they were in 2005. The Liberals, NDP and Greens have all announced measures to provide a federally funded daycare program. On the Conservative website, the only mention that I could find of a national child-care strategy was a restating of the 2005 program.

Some can't afford medications

And what about ensuring that parents can actually buy the medications physicians prescribe for them?

It is common to meet working poor parents in our emergency department, parents who often have great difficulty affording the medication we prescribe. For a condition like asthma, for example, it is vitally important to continue maintenance medication, even when the child seems to be well, so that these midnight visits to the ED can be prevented.

Further, many working poor families rely on their own extended family for daycare, and negotiating smoke-free space for their child can be challenging when grandpa's house is the only game in town.

In a health-care system — no, scratch that — in a society that worked, these children would be in affordable, licensed child care while their parents were at work, and so wouldn't be exposed to secondhand smoke. Their preventative medication would be provided at a cost that parents could afford.

There would, in other words, be an implicit recognition that it takes much more money to have these kids visit the emergency department and be admitted to hospital than it does to simply provide them with the drugs to keep their disease at bay. Not to mention the benefits to children, who get to stay well.

No party has stepped up to the plate to deal with this issue. Both the NDP and the Liberals have announced packages that would go some distance in protecting Canadians against catastrophic drug costs, but neither would address the daily needs of working poor families. (Here's a hint, folks, for some families $50 to $100 per month for medications, even for a few months, is catastrophic.) The Greens would investigate better buying practices and would study the feasibility of a national pharmacare program.

But from the Conservatives?  Not a peep.

In order to get the prescription, you need to see the doctor. But there are issues too with access to medical care. Recently, the CEO of my institution was on the radio, decrying the fact that the wait time to see a child psychiatrist in our province is roughly one year from time of referral.

The rest of the story

While appalling, that isn't the whole story. Children who have significant school issues and need specialized psychological assessment can wait months or even years to see an educational psychologist, unless the parents have the money (roughly $1,000) to pay for a private assessment.

By the time the child who struggles in Grade 2 is seen in Grade 4, her self-image and attitude toward school are often significantly damaged. Mental health services have always been underfunded compared to services for physical illness.

A party that concerns itself with improving the national health-care system needs to address the mental health issues of all Canadians, particularly our children.

But there is a bigger threat to not just mental health care, but all health care for children: a looming shortage of qualified workers. In my workplace, for instance, of 15 physicians who routinely do "charge" shifts, 11 are in their late 40s or early 50s.

Ten years from now, these physicians will be off the roster, either retired or working at a dramatically reduced rate. Where will the replacements come from? Pediatrics is not the only specialty to face this coming worker shortfall, and nursing and other health-care professions will be affected just as severely as physicians. This is a major crisis, and very little has been done to address it.

The Liberals, NDP and Greens have stated their desire to increase the number of medical and nursing trainees and the availability of foreign-trained physicians; the NDP and Liberals have announced specific plans to do so. The Greens have said that they would increase transfer funding for ambulatory mental health issues in children and youth. So far, the Conservatives have not made an announcement on either issue.

It would be wonderful if, over the next few weeks, serious, thoughtful proposals would emerge from all parties, particularly the Conservatives, on the issues that matter to children. It would be great if, rather than simply being the background to another announcement, children became an election issue in and of themselves.

But, as there is no magic wand in my pocket, I really don't think I will get my wish. Instead, I will be satisfied if, perhaps, I could convince Harper that, while I appreciate that a Conservative government would stop candy flavours from being added to cigarillos, maybe there are bigger fish to fry.