This is the Chief Public Health Officer of Canada's second annual report on the state of public health in Canada. This report covers the health of Canada's children and the influence that childhood experiences, health and well-being can have over a lifecourse. In doing so, the report highlights health issues of concern while looking at challenges and successes pertaining to these issues. From this examination, priority areas for action are identified where Canada can further foster the optimal conditions for children's health and development.
The Public Health Agency of Canada and the position of Canada's Chief Public Health Officer (CPHO) were established in September 2004 to strengthen Canada's capacity to protect and improve the health of Canadians.1 In 2006, the Public Health Agency of Canada Act confirmed the Agency as a legal entity and further clarified the role of the CPHO, including the legal requirement to report to the Minister of Health and Parliament on the state of public health in Canada through an annual report.1
The Chief Public Health Officer's reports are intended to highlight specific public health issues that the CPHO has determined warrant further discussion and action in Canada, and to generally inform Canadians about the various factors that contribute to establishing and maintaining our health. These reports do not represent Government of Canada policy and are not limited to reporting on federal activities or provincial/territorial activities; they are meant to reflect the evidence-based perspective of the CPHO on the state of public health across the country. As such, this report is not intended to be a framework for policy; it is designed to stimulate dialogue, to inform Canadians of important health issues and their potential impact on health trajectories and to highlight best practices for moving forward as a society in achieving better health outcomes. Proven and promising evidence of success among various communities and countries is outlined, including programs and activities that can serve as potential models for future consideration and inspire action and collaboration among levels of government, jurisdictions, various sectors, communities, organizations and individuals.
The Chief Public Health Officer's Report on the State of Public Health in Canada, 2008 focused on social and economic inequalities as contributors to health inequalities and how, individually and collectively, we might address the former to influence the latter. The current report considers how childhood experiences impact health over the lifecourse, and what efforts can reduce negative impacts and promote positive experiences in a number of key areas of concern.
While this report focuses on issues affecting children under the age of 12, it is truly about all Canadians. This age group was chosen because it represents the early stages in the lifecourse — a point at which effective interventions can have the greatest impact and influence across the whole of one's life. It is a time of rapid development and growth in many areas (e.g. physical, mental, emotional) and a period when establishing the conditions for good health is a sound investment with the potential for lasting positive outcomes. It is important to note that in some instances the information presented in the report includes children older than 11 years because data in the needed age range does not exist or is not readily available.
The following is a list of the chapters contained within this report and a brief summary of the topics covered within each.
Public health is defined as the organized efforts of society to keep people healthy and prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians.2
The lifecourse model is a way to study the impact of physical and social exposures at various stages in life — from the prenatal period through to adulthood — on the health of individuals and the overall population.3, 4
The Role of Public Health in Influencing the Lifecourse Trajectory. Chapter 2 introduces the lifecourse trajectory model, its value to public health and its relation to childhood. It also offers a brief history of the health challenges faced by Canadian children and the progress that Canada has made to improve children's health over the last 150 years.
The Health of Canadian Children. Chapter 3 discusses the current health status of Canadian children, including leading causes of death, ill health and disability. The prevalence of each issue is discussed, as well as its impact on health over the lifecourse.
Social and Physical Influences on Health. Chapter 4 provides an examination of the factors that can influence health either positively or negatively throughout childhood, including: social and economic determinants; environments at home, school and within the larger community; and behaviours on the part of both parents and the children themselves.
Setting Trajectories for a Healthy Life. Chapter 5 identifies six areas of concern that are either emerging or persistent: socio-economic status and developmental opportunities; abuse and neglect; prenatal risk; mental health and disorders; obesity; and unintentional injuries. Within this discussion are profiles of various successful or promising approaches that have been taken in Canada and abroad to tackle the six issues in question.
Growing Up Well — Conditions and Priorities for a Healthy Future. Chapter 6 outlines the optimal conditions for ensuring children have the healthiest start to life and a continuation of good health over the lifecourse. It also outlines four priority areas where action needs to be taken to ensure children have safe and healthy futures. The chapter concludes with the Chief Public Health Officer's own list of commitments to move forward on these issues.
The Chief Public Health Officer:
In a public health emergency, such as an outbreak or natural disaster, the Chief Public Health Officer: