Upstream Interventions in Canada

 by Jacquelyn Burton, BSHA, MBA/HRM, NCMA

Here’s my take on how federal, state, local government and employers can do their part to make health a little more equitable in the United States.

Existing intervention in Canada to improve health inequities

Health inequities begin in the womb due to genetics, physical, and environmental factors that can affect a pregnant mother. Once the child can go to school, this can have a grave impact on how well the child performs later in life (Bezruchka, 2005). An existing intervention in Canada that is working to improve health inequities is early childhood development and education. Since 2000, the government invested $1.5 billion to the provincial and territorial governments. The funds were to support a 5-year action plan addressing prenatal and neonatal health, parenting skills, support systems for families and communities, and childhood learning programs (Early Child Development, 2016).

As recently as 2012, the government authorized The Rio Development Plan aimed at reducing health inequities. As it relates to childhood development, the Rio Development Plan seeks to foster a salubrious milieu for prenatal, neonatal, and early childhood vicissitudes (Public Health Agency of Canada, 2016). The intervention targets upstream determinants of health by focusing on 11 indicators of wellbeing; psychosocial, behavioral interactions, physical and motor skills, and literacy (Early Childhood Development, 2016).

Organizations involved

The organizations involved in the plans are the Canadian Government. The Canadian Government sponsors universal healthcare and the Canadian Health Act provides capital funding for healthcare services (Canadian Healthcare, 2016). Health Canada’s mission is for Canadians to rank number 1 in having the least health inequities in the world. Health Canada espouses an improved health population through research, outreach and prevention programs that engage communities, and policies. The Early Childhood Development program was developed by the Canadian Government (Early Childhood Development, 2016).

The agencies within Health Canada are the Public Health Agency, Chief Public Health Officer, Canadian Institutes of Health Research, and Patented Medicine Prices Review Board (Health Canada, 2016). The Ontario Ministry of Labor is involved in supporting maternal health by promoting policies that allow for maternal and paternal leave (Ontario Ministry of Labour, 2016).

Social policies enacted in the implementation of the intervention

An upstream intervention that address some of the indicators or determinants of health was done by implementing pregnancy and parental leave policies. These systems allow grant concession for pregnant mothers to take 17 weeks of maternity leave without pay and as much as 35 weeks. The policy commissions new parents to take parental leave either separately or at the same time. Pregnant mothers who did not take pregnancy leave may take up to 37 weeks of maternity leave. Fathers may take up to 52 weeks’ postnatal delivery. The pregnancy leave policy is not restricted to full-time employees, as part-time employees may use the benefit, and supports pregnant mothers who suffer bereavement due to stillbirth or spontaneous abortion. Parents may opt to use the Employment Insurance Act to receive benefits for maternal and parental leave (Ontario Ministry of Labour, 2016).

The success of intervention and lessons learned. The infant mortality rate has dropped from 27 deaths per live births to 5 deaths per 1000 live births from between 1960 to 2000. The United States has seven deaths per 1000 live births. There are still higher infant mortality rates in subsidiary income families than the wealthy and is equivocal to the overall population of the United States (Public Health Agency of Canada, 2008). Studies have shown that longer paid maternal and parental leave policies help improve the infant mortality rate. The outcomes of maternal and paternal leave policies showed that it increased job continuity, fertility, gender equity, and curtailed small birth weights. The United States does not offer any universal state-funded education preschool aged children and the maternity leave policies are much more diminutive in length at 12 weeks. The shorter leave policies and lack of quality universally state funded education for disadvantaged communities and military dependents could contribute to lower rates of breastfeeding, well baby check ups and immunizations as well as developmental outcomes (Ruhm, 2003). The Government of Canada funds preschool for First Nations, military personnel, federal prisoners, and immigrants (Atkinson Center, 2016). The United States may want to endeavor longer maternal leave policies, implement parental leave policies that are either paid by the employer or the government and develop supportive universally funded early childhood education entities.


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