Doctors on the Front Lines of the Health Equity Battle

Health equity is created when individuals have the opportunity to achieve their full health potential. Conversely, equity is undermined when preventable and avoidable systematic conditions constrain life choices.

Physicians see the impact of health inequities every day in their clinics and emergency departments, and are committed to pushing for action to address issues of health equity in Canada.

In 2013, the Canadian Medical Association hosted a series of town halls across Canada to ask the public about which determinants most affected their health and the health of their communities. The final report identified four main areas; including early childhood development.

Research shows that adult health is pre-determined in many ways in early childhood and even by events occurring before birth. The early years are the time when crucial developments in physical, social, cognitive, emotional and language domains take place. Disruptions during this period can influence how systems such as the cardiovascular are developed, influence behaviour- including later risk taking; and even change the ways that certain genes are expressed. Negative experiences such as poverty, parental violence, or a lack of parental support can alter a child’s health trajectory indefinitely. Even without these barriers; there can be problems in the early years; more than one quarter of Canadian children start kindergarten vulnerable in at least one area of development. These deficiencies if properly addressed can be completely eliminated or drastically reduced with evidence suggesting that fully two thirds of the deficiencies in readiness for school can be considered preventable.

In recognition of this critical time, the CMA undertook a policy development process to identify the areas in which physicians and other stakeholders can be involved in supporting healthy early childhood development. While there is a need to take action at the government level; i.e. a national early childhood development strategy; support for parents; and poverty reduction strategies, there is also a role for physicians both through medical education and clinical intervention.

The medical community needs to focus more attention on the roots of adult diseases and disabilities and focus prevention efforts on disrupting or minimizing these early links to later poor health outcomes. The science of early brain development and biology is rapidly evolving and there is a need for current and future physicians to have the information they require to address these needs in their patient populations. To support this end, CMA has partnered with the Canadian Paediatric Society to develop an online CME for physicians that will outline some of the science as well as practical clinical interventions. This will be released later in 2015.

While many of the threats to early childhood development lie outside of the hospital or medical clinic, there are a number of ways that physicians can help to address this important determinant of health within their practices. Physicians are in a unique role as they are the health professional most likely to have contact with children in their earliest years. Data from the Institute for Clinical Evaluative Sciences, suggests that 97% of Ontario children aged zero to two are seen by a family physician. Through this contact they can screen for early signs of developmental issues; coach parents; and link parents and children with resources that are available in the community. One program that integrates all of these components is the 18-Month Well-baby visit in Ontario. Physicians use a standardized set of tools to identify potential issues and then meet with parents to discuss any possible interventions.

Another area where physicians can support early childhood development is by encouraging early literacy. Studies have demonstrated that when physicians discuss literacy with parents and provide them with appropriate resources, such as developmentally appropriate children’s books, increases in reading frequency and preschool language scores have been found.

The early years provide an excellent opportunity to address population health in Canada. Canadian physicians have a role to play in identifying children at risk, supporting their parents to encourage healthy childhood development, and advocating for communities that ensure all Canadian children have the opportunity to grow up happy and healthy.

By Christopher S. Simpson MD,FRCPC, FACC, FHRS, President of the Canadian Medical Association.