Ontario’s rapidly expanding wait list for children’s health care will have long-term consequences for health and increase costs to the health-care system, experts say.
“Every prolonged day is hindering (children’s) abilities to meet developmental goals,” says Ronald Cohn, CEO and president of Toronto’s Hospital for Sick Children. “As children develop, the interventions become much more complicated, whether that’s a surgical intervention or a mental health intervention. The earlier we intervene, the better the outcome for almost all cases in pediatrics.”
“Today, only one in three kids receives community-based rehabilitation services within the clinical standard while the majority wait almost three years to access care,” says Jennifer Churchill, CEO of Empowered Kids Ontario. “These numbers are significant; each patient is a child at risk of missing treatment during critical-care windows.”
Tatum Wilson, the head of Children’s Mental Health Organization, says wait times for mental health currently average nine months across the province and in some places can be as long as 2.5 years.
The wait list at Sick Kids has reached 5,000 children, which is horrific and historically unprecedented, says Cohn, who notes the crisis has a spillover effect on pediatricians and other health-care providers.
“Something that’s often lost in the discussion is that (delays in pediatric care) have caused enormous amounts of moral distress for us as health-care providers,” he says. “To realize that no matter how hard you work, how many hours you put in, how many ways you try to innovate, try to work within the current parameter of what’s possible, you realize it’s still not enough to provide what you think you need to be providing to your children who are waiting for services.”
Yet, the situation is prevalent across Canada.
The 2020 UNICEF Report Card places Canada 30th among 38 countries with similar socio-economic statuses in the well-being of children and youth under age 18. Terence Hamilton, a policy specialist at UNICEF Canada and a director at the Canadian Coalition for the Rights of the Child, explains that Canada spends just two thirds of the average across high-income countries on programs for children, making it apparent that Canada is not using its wealth for better childhoods.
Canada is not using its wealth for better childhoods.
Compared to many of the social democracies at the top of the list, like Sweden, Norway and Finland, Canada lacks a robust governance structure, specifically for children, a structure that would hold the government accountable to children, says Hamilton.
Hamilton says establishing robust governance structures federally and provincially is essential because “if you have the thoughtful processes built into your governance structure, then the results will flow from it.”
For example, establishing an office for a Children’s Commissioner as an independent office of government would mandate young people’s involvement and amplify the platform for young people. However, Ontario shut down its Child Advocate (Advocate’s Office) in 2019, transferring its responsibilities to the province’s Ombudsman, removing an advocate for children’s rights.
“[Closing of Ontario’s Child Advocate Office] was obviously a big concern, as Ontario has a large population and sets the tone for how other provincial governments work,” says Hamilton.
Another tool that UNICEF is advocating is the child rights impact assessment that forecasts the impact of any proposed law, policy or budgetary allocation affecting children and their rights. The assessment tool is used by several countries in the European Union, including the Netherlands, Denmark and Sweden.
The UNICEF report card indicates Canada needs a reset to create a health strategy that encompasses a continuum of care for children at home, at school, in the community and in hospital to create a universal and complete health-care approach.
To tackle this inadequacy highlighted in the UNICEF report, Children’s Healthcare Canada engaged a wide range of stakeholders, including youths, parents, researchers, educators, service providers and community and business leaders to co-create Inspiring Healthy Futures.
The most commonly identified need is to create a “network of networks” to connect the diverse communities of people who study, mobilize, advocate for and work with children, youth and families, a first step toward a national hub to foster connection and integration across research, policymaking, system-building and advocacy services.
The report highlights five key needs for children to thrive:
The basics of life, meaning reliable income, food security, good housing, safe environment, clean water, learning and literacy, development support and child care, access to the internet;
Accessible mental and physical health-care services;
Feeling love, a sense of belonging and opportunities for leisure and play;
Racial, gender and structural equity;
Listening to the voices of children, youth and families.