Beyond Boomercentrism : Transcending a dominant policy logic to promote health

1. Beyond Boomercentrism:Transcending a dominant policy logic to promote health Dr. Paul Kershaw University of British Columbia Human Early Learning Partnership Government of BC Ministry of Health Services Policy Rounds December 14, 2010 Victoria, BC

2. Intergenerational Injustice

3. Fiscal Debt

4. Environmental Debt

5. Family Policy Debt

7. Employment Norms:

8. Public expenditure on ECEC services (0-6 years)in selected OECD countries Denmark Sweden Norway Finland France Hungary • British Columbia • Currently 0.22% of GDP • 0.28% with full school-day K Austria • Canada(outside Quebec) • Few spaces • Insufficient quality • High cost • Inadequate Inclusion United Kingdom United States Netherlands Germany Italy Australia OECDavg.0.7% UNICEF & EUbenchmark1.0% 0.25% Canada Canada BC 0.22% 0.28% 0% 0.5% 1.0% 1.5% 2.0% % of GDP Source: Adapted from Starting Strong ll: Early Childhood Education and Care, September 2006, p.11

9. (2008) Canadian Currency (controlling for purchasing power parities)

10. Intergenerational Justice Family Debt Fiscal Debt EnviroDebt

11. Intergenerational Justice Family Debt Fiscal Debt Enviro Debt

12. of BC kindergarten children are vulnerable. 29% Vulnerability above 10% is not biologically necessary. Most vulnerable children are not poor!

13. Hold pencil Climb stairs Follow instructions Get along with peers Know 10 letters Kindergarten teachers consider

14. Sensitive Periods in Early Brain Development Pre-school years School years High Numbers Peer social skills Language Symbol Sensitivity Habitual ways of responding Emotional control Vision Hearing Low 1 2 3 4 5 6 7 0 Years Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)

15. Life Course Problems Related to Early Life Early Vulnerability 2nd Decade 3rd/4th Decade 5th/6th Decade Old Age • School Failure • Teen Pregnancy • Criminality • Obesity • Elevated Blood • Pressure • Depression • Coronary Heart • Disease • Diabetes • Premature • Aging • Memory Loss

16. Cumulative Public Investment Post School Preschool School 0 Age Mismatch: Social Investment vs. Health Promotion Opportunity Biological Sensitivity to Context Source: Carneiro & Heckman, Human Social Policy (2003)

17. Disease Fetish?

18. Historical Expense by Function (% of total spending) BC Government Expenditure: Change over Time

19. GDP, Revenue and Expenditure: Change over Time Historical GDP and Revenue ($ millions) 200 180 160 140 120 100 2008 Revenue: 15.3% of GDP ($) Billions 80 60 40 1984 Revenue: 17.7% of GDP 20 0

20. Health Care Spending: Change over Time Healthcare (% of GDP) Healthcare ($ per capita) $2.2 billion for BC $ % % $ % % $ % % $ % $ % % $ % % $ % $ 0 %

21. Social Service Spending: Change over Time Social Services (% of GDP) Social Services ($ per capita) $ % % $ % % $ % % $ % $ % % $ % % $ % $ %

22. Medical care crowding out Social care?

23. Manage expectations re medical care to promote health?

24. What medical care we owe one another as our capacity to save increases dramatically with costly technology and drugs?

25. And what does it mean for a society when it spends hundreads of thousands, if not millions, of dollars to save a pre-term baby – one life – but is remarkably hesitant to invest in health promotion for the population through programs like early learning and care, housing, food? 

26. A hole in the middle may be good for doughnuts, • but not for • public policy.

27. Canadian Society is FAILING parents in fundamental ways! Because there is no system of family policy… Time Poverty Service Poverty Income Poverty Reflects appreciation of costs imposed by residential school system; reserves, etc.

28. 15 by15

29. From the Province: 15%vulnerable BC Government Strategic Plan for 2008/09 - 2010/11, p. 30

30. 7% of BC Neighbourhoods Meet 15 by 15 Target Vulnerable onOne or More Scales >15% <15% Source: EDI Wave 2 (2004/05 – 2006/07)

31. Biologically, no neighbourhood should have vulnerability above 10%. Vulnerable onOne or More Scales >10% <10% Source: EDI Wave 2 (2004/05 – 2006/07)

32. BC: Unique Population Laboratory: Early Vulnerability  Quality of Labour Supply Kindergarten Population Grade 4 Population Grade 7 Population Grade 12 Population Criminal activity

33. Reduce Early Vulnerability to 10%... to cut incarceration by a third

34. The next generation’s Human Capital Vulnerability If Then University eligible grades At K At G.12 # of children 29% 41.5% Low High Score on scale of EDI and % achieving university eligible grades

35. The next generation’s Human Capital Vulnerability If Then University eligible grades At K At G.12 # of children 10% 55.6% Low High Score on scale of EDI and % achieving university eligible grades

36. What does the early vulnerability debt cost BC?

37. Countries with 55% of students getting university-eligible grades • vs. • Countries with 42% of students getting university eligible grades… • ENJOYED .63% OF GDP GROWTH MORE PER YEAR, FOR 40 YEARS 1960 – 2000: Research shows…

38. Decreased Vulnerability = Increased Growth Reduced early vulnerabilityincreases GDP by Reduced vulnerability (10%) 20% That’s throwing away $401.5 billion now + interest over 60 years! Status Quo (29% vulnerable) Baseline growth First cohort graduates Baseline growth plus 0.63% GDP per year First cohort of 5 year olds benefit from 15 by 15 policy We are here

39. SFP

40. Limit global warming to 2 degrees Celsius requires absolute reduction in GHG emissions, while global population grows. Option 1: Technological innovation to decouple economic growth from carbon emissions. • Option 2: • Move from a growth to a steady state economy and transform the meaning of well-being.

41. Decreased Vulnerability = Increased Growth Reduced early vulnerabilityincreases GDP by Reduced vulnerability (10%) 20% That’s throwing away $401.5 billion now + interest over 60 years! Status Quo (29% vulnerable) Baseline growth First cohort graduates Baseline growth plus 0.63% GDP per year First cohort of 5 year olds benefit from 15 by 15 policy We are here

42. Smart & Green Family Policy

43. Gender Inequality Sources: World Economic Forum and UNICEF

44. Smart Family Policy 0 to18 months Time: improve parental leave Services: monthly access to health check-ins and parenting support 0-18 months

45. Children, parents and families Where are they now? Strong Start Homes Schools Family Resource Program Aboriginal ECD Clinics Community Services Personal Physicians Neighbourhood Hubs Public Health Services Libraries Hospitals Child & Family Services Maternal Child Health Programs Childcare Friendship Centers

46. Welcoming, supportive, accessible environments providing Healthy Child Check-ins (HCC) and Parental Supports (PS) HCC & PS trustedpeople HCC & PS trustedpeople Strong Start Homes Schools Family Resource Program Aboriginal ECD HCC & PS Clinics Community Services Personal Physicians Neighbourhood Hubs HCC & PS Public Health Services Libraries Hospitals Child & Family Services Maternal Child Health Programs Childcare Friendship Centers HCC & PS trustedpeople HCC & PS

47. Smart Family Policy 0 to18 months Time: improve parental leave Services: monthly access to health check-ins and parenting support 0-18 months 18 months to six years Time: re-think ‘full-time’ work Services: early learning and care 18 months to school entry (with HCC & PS) 0 to six years Low-income: make work pay Low-income: increase welfare

48. The price of smart family policy...

49. The cost of reducing vulnerability? Funding for Community Services Time Funding for Parents $648 million $1.6 billion Resources $3 Billion /Year $750 million Less 5%, because of the progress made, despite recession = $1.4 billion

50. $3 Billion Increase in Spending? Provincial Health Care Spending($ Billions) 1998 - 2008 $3B /5 years $3B /5 years