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Monday, 15 April 2013

Canadian scores on public health report cards – Children, women and hospitals

UNICEF released its 11th annual child wellbeing report card looking at rich countries.  Canada ranked a dismal 17 of 29, although the US ranked 26th.  The Netherlands topped the rankings and followed closely by most Scandinavian and then European countries.  

If you dig into the details several points in defence of Canada should be noted.  Canada was the highest ranked non-European country, and the US was the second highest non-European country.  All the other developed countries globally were not ranked due to lack of data, so how Canada stacks up to its other Anglophone peers of Australia and New Zealand cannot be determined. In addition, there are many indicators for which neither Canada or US data were available for ranking. 

The scale is based on five dimensions, Material wellbeing, Health and Safety, Education, Behaviour and risks, and Housing and Environment. Canada ranking mid range (11-16) on four of the scales, and a poor 27th on Health and Safety.  The US ranking poor on all five dimension. Each dimension other than Behaviour and risks is based on four indicators, the Behaviour and risk dimension being based on 10 indicators.

Canada scoring poorly on childhood poverty (no surprise there), infant mortality rates, immunization rates, participation in post high school education, childhood obesity, being bullied, homicide,  .  Canadian youth scored poorest by having the highest rate of cannabis use in the past year at over 25%, and nearly 5% higher than the second poorest ranked country

Canada did score very well on educational achievement by age 15, and fruit consumption  ranking second, third lowest in youth smoking,  and seventh in exercise and air cleanliness.  There is a good discussion of the use of the Early Development Index in Canada as a best practice and its adaptation by Australia. 
The full report is available at UNICEF report on state of child

Another report card on gender equity from late 2012 is worth reviewing World economic forum report on gender equity that uses a similar approach to multiple indicators build into four dimensions.   This report ranks 135 countries and places Canada 21st, as well as providing multiple years for comparison.

The third report card that has garnished considerable interest nationally is the CBC Fifth estate CBC Fifth estate rate my hospital.  Disappointingly has been the reaction of the hospitals and provinces to the release of the information.   This is Canadian Institute of Health Information (CIHI) data that is provided to hospitals routinely, and perhaps finally when given to the media, a level of accountability might be attained.  Most hospitals have either used the data to make a statement of pride, or dismissed the data as not relevant to their service areas.  

Efforts to ranks and hold administrations, governments or providers accountability for their actions are to be commended.  It is only through transparency and public discourse will veiled problems be brought to the surface and addressed.  It was the efforts of groups that began comparing specific intervention outcomes between hospitals that led to quality improvement.  Such efforts were initially dismissed, and not are embraced as quality improvement efforts.  The big question, is our leaders big enough to stand up and embrace these reports as challenges to drive local and national improvement activities? 

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