Honorable Diane Marleau, Minister of Health, Canada; previously held municipal and regional posts in the Province of Ontario


Good morning and welcome to Vancouver, and for many of you, welcome to our beautiful country Canada. A special welcome to my colleagues from around the world. I bring warm greetings from our Prime Minister, Right Honorable Jean Chrétien and echo his wishes for an enjoyable and productive Congress. Child Health 2000 is an important event for everyone working on behalf of the world's children. It's a unique opportunity to share information on works best for children and youth and to focus our attention on common goals. This second Child Health 2000 Congress builds on the momentum of our first Congress three years ago. Your presence here indicates how effective our global partnership for children and youth has become. Our work on behalf of children today will help to determine the kind of world these children will create thirty to forty years from now.

Each year some 145 million children are born into the world

Each year some 145 million children are born into the world. By the year 2000 one of our partnership goals is to immunize at least 90% of the children under one year of age against diseases preventable by vaccine. Our present immunization rate is approximately 80% world wide. Here we've made progress. Our global immunization program which began in its current form in 1974 is one of the most significant preventative medicine initiatives ever undertaken. It has resulted in 1.3 million fewer child deaths in 1993. This represents a 35% reduction in the number of deaths over 1985. Regrettably though, that's not enough. Close to 2.4 million deaths among children under 5 years of age in 1993 were due to diseases preventable by vaccine. There are worrying signs that our successes in immunization are being eroded by adverse social and economic conditions in many developing countries.

I use the example of immunization because its successes and frustrations demonstrates something important we've learned about health issues over the past two decades. We've learned that our progress is very much affected by social, economic, environmental factors not immediately associated with health care. Income and social status, social support networks, education, employment and working conditions and physical environments all play a role. These factors must be worked into a strategy if we are to really effect health outcome. The broad determinants of health are important because they provide a solid framework for acting on national and global health issues. As we approach the year 2000 I believe this model will be the key to effective long term action on health care issues affecting children.

Aboriginal peoples' health problems exceed Canadian averages

As I speak about health determinants and the need for a population health approach you will be thinking about population groups in your own country. Here in Canada there are 6.5 million young people. The vast majority of whom are healthy. But you know Canadians have no reason to be complacent. Consider the aboriginal children of Canada. Aboriginal peoples are amongst the most socially and economically disadvantaged in our country. Their health problems and those of their children exceed Canadian averages in most areas. Although there has been much improvement in recent years, infant death rates, death rates from injuries and suicides remain higher among aboriginal peoples than the national average.

In Canada there are also children who are at risk because they experience neglect or abuse and poor living conditions. Other groups include youth who are having difficulty making the transition to adulthood and a number of them experience depression, abuse alcohol and drugs or even turn to crime. By focusing on health determinants we are developing national health strategies to improve all aspects of children's physical and mental health. One of our effective strategies is the community action program for children which addresses the need for healthy child development. This program funds community groups to establish and determine services to meet the health and development needs of at risk children, ages zero to 6 years of age. It enables federal, provincial and territorial governments to work together with community groups across Canada in addressing children's health and social well being. This kind of collaboration increases the efficiency of program delivery, reduces duplication of services and insures the best return on our investment in the health of our children and youth.

Canada's federal government has been consulting with communities across our nation to establish national goals for the healthy development of Canadian children and youth. These goals are to enhance the involvement of children and youth in maintaining and improving their own health. They can have a say in that as well. To ensure that all children in Canada have access to the necessary living conditions required for optimal health and growth. To promote healthy behaviors and reduce the incidence of preventable deaths, visibility, injury and illness. To foster strong and supportive families, care givers and communities. To ensure safe sustainable, physical environments for all children and youth. To develop an intersectoral and coordinated approach to improving health outcome for children and youth.

Prenatal nutrition program in place

The goals emphasized that all levels of government, communities, families and individual Canadians share the responsibility for the well being of children and youth. I would also like to highlight two of the Canadian government's most recent population health strategies which are designed to improve child development. The first the Canada prenatal nutrition program. It's aimed at improving the health of pregnant women who's babies are at risk. Food supplementation is a key element accompanied by nutrition counseling, support and education. Counseling on lifestyle issues such as smoking, substance and alcohol abuse is also provided.

The second strategy which I had the privilege to launch here in Vancouver yesterday is the aboriginal Head Start program. This program is designed to help aboriginal children in urban centers and large northern communities to get off to a better start in life. Aboriginal Head Start provides early intervention to preschool children and their families to help overcome the debilitating effects of economic disadvantage and social marginalization. It empowers aboriginal communities to improve their overall health by helping children and parents work towards long term health goals and health lifestyles.

Ladies and gentlemen as well, many of our health strategies are directed at influencing youth to adopt healthy behaviors and lifestyles. One of our health promotion strategies centers on tobacco use. Our single most preventable health problem. This strategy takes a comprehensive approach to teen smoking, including legislation, research and public awareness. Canada's commitment to reducing conditions of risk and disadvantage extends beyond our national borders. We are a major contributor to UNICEF through the Canadian international development agency. My own department works closely with the World Health Organization and the Pan American Health Organization whose maternal and child health programs provide advice and assistance to countries developing programs to improve child health. Canada contributes over 50 million dollars annually to these organizations.

Canada supports global immunization

As part of our commitment to global immunization Canada through the Canadian public health association support immunization programs throughout the world. Last September I participated in the ceremonies making the eradication of the polio virus from this hemisphere a truly remarkable achievement. This achievement would not have been realized had countries and the regions not made it a priority. In addition Canada's official development assistance program works in many countries to address the effects of poor living conditions on children. It does this in many ways including policies and programs to alleviate poverty. Programs to provide basic shelter and housing. The provision of temporary housing, water and sanitation to victims of conflict and natural disasters and urban development activities to improve the quality of life.

As we learn more about the broad determinants of health and develop effect population health strategies for children and youth, domestic and international collaboration will assume greater importance. Collaboration is the key to sharing valuable information and resources on what works best.

As we approach the year 2000 all countries face challenges but only broad social awareness and action can address. I trust that your discussions over the next five days will continue to strengthen our global partnership to create a healthier future for all of our children. It's important. I wish us all much good work in that area. Thank you all for participating.

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