2013-06-18T02:38:26-04:00 Elizabeth Lee Ford-Jones, MD http://www.huffingtonpost.ca/author/index.php?author=elizabeth-lee-fordjones-md Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Elizabeth Lee Ford-Jones, MD Good old fashioned elbow grease. tag:www.huffingtonpost.com,2012:/theblog//3.1518607 2012-05-15T16:50:40-04:00 2012-07-15T05:12:09-04:00

Elizabeth Lee Ford-Jones, MD http://www.huffingtonpost.com/elizabeth-lee-fordjones-md/
But here at the children's hospital where I now work, a group of us meet regularly, if informally, about another pressing public health threat -- hunger.

We live in one of the wealthiest countries in the world, but hunger is something that we at the hospital increasingly see among the families that bring their children to us for medical attention.

This past week was hunger awareness week in Canada and on May 6, the United Nations Special Rapporteur on the Right to Food made a formal country mission visit to Canada. It was the first-ever visit to a developed nation by Olivier de Schutter, a Belgian law professor who became special rapporteur in 2008.

As a signatory to both the Universal Declaration of Human Rights (1948) and the International Covenant on Economic Social and Cultural Rights (1976) Canada has a legal obligation to "respect, protect and fulfil the right to food."

It's my hope that this visit -- and the recommendations in the report that de Schutter will subsequently produce -- will throw a spotlight on the disturbing truth that far too many Canadian children are hungry because their families lack access to adequate and nutritious food.

Food Secure Canada estimates that almost two and a half million Canadians live without secure access to food.

An infectious agent like West Nile poses an immediate threat as well as long-term health consequences (if almost exclusively in adults); unquestionably, the consequences of hunger and food insecurity in childhood are similar.

Why are we concerned here? Many pediatricians with community practices tell us that finding the money to feed the children is the top problem faced by many parents they meet.

We see children whose parents struggle with poverty. We admit proportionately more children from high-poverty neighbourhoods to hospital than from other neighbourhoods, and the children from poorer neighbourhoods stay longer at the hospital.

We know that childhood hunger -- which of course is linked to poverty -- has long-term impacts on physical and mental health.

For healthy growth and development, children need sufficient nutrients. Deficiencies of even small amounts during this important period could have long-term health consequences.

One thing we're seeing in recent years is an upswing in cases of rickets, a condition still prevalent in developing countries but one that I thought would be corrected in Canada through the 1970s, when I trained in Montreal.

Rickets is preventable. It is primarily caused by a lack of sunlight and vitamin D, (including Vitamin D supplementation with breast feeding), although a lack of calcium can also contribute to the condition, which causes bones to soften and become prone to deformity. Foods that contain vitamin D include vitamin D fortified milk, as well as eggs, fish oils, margarine and some other foods.

The children we see who have developed rickets are quite simply not getting adequate amounts of sunlight and nutritious food, including vitamin D supplementation with breast feeding.

As a recent report from Toronto's medical officer of health states: "Children who live in food insecure households are more likely to have growth and developmental problems, be susceptible to illness and perform poorly in school, compared to children who are food secure."

Adequate nutrition is also a key issue when it comes to mental health among youth. Psychiatrists speaking at the request of community youth in one of our priority neighbourhoods advised that the first two mental health questions that should be asked of young people are: "How did you sleep last night?" and "Have you eaten today?"

We know that in the Greater Toronto Area, the use of food banks is increasing rapidly, with a key reason being that housing costs are eating up a growing proportion of family income. Initiatives are underway to help physicians and other health care providers better link families to resources such as food banks and government services.

But while there is a perception that food banks -- as well as programs like school and community meal programs, community gardens and kitchens -- are providing the needed response to food needs, Canadian research challenges this notion.

The UN Special Rapporteur will present his preliminary findings on food security in Canada on May 16 in Ottawa. It's my hope that this will put child hunger squarely on the political agenda in Canada -- and galvanize action to eliminate it.

The above represent the opinions of Dr. Lee Ford-Jones and not necessarily the official positions of either The Hospital for Sick Children or the University of Toronto.]]> tag:www.huffingtonpost.com,2011:/theblog//3.950904 2011-09-09T16:34:09-04:00 2011-11-09T05:12:02-05:00

Elizabeth Lee Ford-Jones, MD http://www.huffingtonpost.com/elizabeth-lee-fordjones-md/
I never dreamed that after 35 years in medicine I would now find so many children in worse shape than when I started.

Three years ago, I was asked to set up a Social Paediatrics program at The Hospital for Sick Children (SickKids) in Toronto. Social paediatrics recognizes that poverty places children at high risk for current and future health problems.

And so we send our medical residents out on public transit to make home visits and provide care at local clinics in parts of the city -- both suburban and downtown -- where parents struggle and children are disadvantaged.

The experience is transformative. One young doctor had to examine a sick child in a dim apartment because the electricity had been cut off. She said she'd never again do an assessment or write a prescription without wondering if paying for the antibiotic might mean no food on the table.

Because we recognize the problems that some parents face, we have a free legal clinic at SickKids. For more than two years, lawyers who offer their expertise to the Family Legal Health Program have been helping parents with a wide range of issues -- from family and immigration law, to housing and employment problems.

Canadian scientists have played and continue to play a leading role in research into early brain development, the interplay between genetics and the environment, and the long-term health consequences of early childhood experiences.

But in all the excitement of these findings, I believe many of us have lost sight of what's happening to the children in our communities. We haven't acted on what we know. Perhaps most disturbingly, the gap between rich and poor is growing in Canada and one child in 10 is living in poverty.

In my role at SickKids, I've been on home visits to apartment towers where, quite frankly, I have to ask, how can we expect parents to raise healthy children in the face of next-door drug dealers, constant police sirens and bed bugs?

Certainly we've made progress in some areas. If children have access to medical care, they no longer have to be hospitalized for croup or other vaccine-preventable diseases.

But our children have new health problems and Canadian children rank embarrassingly poorly in international comparisons for many key indexes.

Recent United Nations reports place Canada 22nd among 31 Organisation for Economic Cooperation and Development (OECD) countries for infant mortality rates, and right next to the bottom of the heap of OECD countries for our high rates of childhood obesity. This is especially disturbing because children who are overweight or obese face increased health risks including diabetes and hypertension.

Those UN reports rank the situation of all Canadian children; it's obvious that children living in poverty face additional obstacles. Parents may have difficulty affording healthy foods or organized recreational activities for their children; many face challenges paying for the medicine and equipment to keep conditions such as diabetes or asthma under control.

Poor housing exacerbates asthma and parents who are financially strapped often can only afford to give their kids symptom relievers for asthma, and these are not medications which should be used regularly. Their children often end up in the emergency ward.

Attention disorders among children are rising at a disturbing rate and far too many children are simply not getting enough sleep for healthy child development.

At SickKids, many parents fail to bring their children for follow-up appointments at day-time clinics because they work irregular hours or jeopardize their jobs if they have to take time off.

Meanwhile, in the evening, large numbers of parents camp out overnight in the emergency department. They've brought their children in for medical attention, but because they can't afford cars or taxis, they're waiting for the 6 a.m. start of the subway to carry them many miles back to their homes.

The health and well-being of Canadian children growing up in poverty has to become a priority and health care has to move back out into the community.

We can't turn back the clock, but it is time to reintroduce some of the common-sense preventive health programs that used to be standard in many Canadian schools -- dentists to screen for children with dental problems, vision screening and regular nurse visits in public schools.

Of course, restoring these health initiatives can't remedy poor living conditions or close the income gap, but here are some examples of what can be done.

A joint public/private initiative at inner city Toronto schools, where poverty rates are high, provided vision tests to 16,000 children last year. About 2,000 were found to need glasses, which were provided at no charge. Hearing tests are also being introduced in schools through this program.

At least two Toronto public school have set up their own medical clinic, staffed by a nurse practitioner, so that children can be seen onsite. This spares parents, many of whom are new to Canada and face language and financial barriers, a confusing and often long trip to the hospital. At other schools, visiting nurses work in coordination with local health services.

To be fair, various levels of government across Canada have been taking some important steps to improve the lives of children, and there are some inspiring stories out there.

But disturbing questions linger. Why, when Canadian researchers have been so instrumental in developing the scientific evidence of the importance of early childhood development, have we not developed comprehensive initiatives to improve the well-being of our children?

Why do we continue to ignore the major problems faced by children growing up in poverty?

Dr. Elizabeth Lee Ford-Jones is a Paediatrician specializing in social paediatrics and Project Investigator at SickKids and Professor in the Department of Paediatrics at the University of Toronto. She is also an expert advisor with EvidenceNetwork.ca, a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada.

The above represent the opinions of Dr. Lee Ford-Jones and not necessarily the official positions of either The Hospital for Sick Children or the University of Toronto.
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