Healthy Child Development & Reduction of Child Mortality

1. Healthy Child Development & Reduction of Child Mortality Presenter tool – revised fall 2013

2. Outline • Objectives • TED Talk • Definitions • Global Context • Local Context • Role of Primary Care • Discussion / Activities

3. http://www.un.org/apps/news/story.asp?NewsID=39567&Cr=child+health&Cr1http://www.un.org/apps/news/story.asp?NewsID=39567&Cr=child+health&Cr1

4. Objectives • To define childhood mortality and name 3 main causes of childhood mortality • To give 3 examples of how SDOH can influence childhood development and mortality • To give 2 examples of how primary health care providers can influence childhood development and mortality – at a local and global level

5. Ted talk Emmanuel Jal: The music of a war child (18:03) • For five years, young Emmanuel Jal fought as a child soldier in the Sudan. Rescued by an aid worker, he's become an international hip-hop star and an activist for kids in war zones. In words and lyrics, he tells the story of his amazing life. • Emmanuel Jal's hypnotic voice rises from hellish origins as a beacon of hope for those caught in seemingly endless cycles of war and despair.

6. What to pay attention to… • Factors in Emmanuel's childhood that interfered with his health and development • Importance of education • Solutions Emmanuel offers to help his people and Africa

7. Ted talk

8. Discussion after ted talk… • What factors in Emmanuel's childhood interfered with his health development? • (violence, lack of security, poverty, war, unstable housing, no food security etc.) • Why does Emmanuel think education is so important? How does education influence child development and child mortality? • What solutions does Emmanuel offer to help his people and Africa? • (education, invest in capacity building, invest in women, invest in educating women, care about the people in Sudan/Africa) • Emmanuel advocates through his music. As a family physician, how can you advocate for your patients to ensure they have healthy development and there is a reduction in child mortality? • (prenatal care, educating patients, providing support to patients, families, children, caring and being patient-centered, connecting patients to resources in the community)

9. http://webgovernments.wordpress.com/2011/11/17/increasing-child-mortality-rate-in-africa/http://webgovernments.wordpress.com/2011/11/17/increasing-child-mortality-rate-in-africa/

10. Key facts • Child mortality • Under-5 mortality rate – probability of dying by age of 5 years • Infant mortality rate – probability of dying by age of 1 year • Leading indicator of the level of child health and overall development in countries • MDG indicator. • Neonatal mortality • Accounts for a large proportion of under-5 deaths; • Proportion of neonatal deaths is expected to increase as countries continue to witness a decline in under-5 mortality rate. • Child mortality, by cause • Reducing child mortality continues to be a global priority and achievement of the MDG of child mortality is possible only if the major causes of deaths are addressed by maternal, newborn and child health interventions.

11. Child development & mortality + SDOH • Early child development as a powerful determinant of health • New evidence on the effects of early experiences on brain development, school readiness and health in later life • Other determinants of health affect the physical, social, mental, emotional and spiritual development of children and youth. • For example, a young person's development is greatly affected by: • housing and neighborhood, • family income, • level of parents' education, • access to nutritious foods and physical recreation, • genetic makeup, • access to dental and medical care. …

12. Audience Participation • Pictures in Prezi present – give examples of effect of the following on child development, health and mortality • housing and neighborhood, • family income, • level of parents' education, • access to nutritious foods and physical recreation, • genetic makeup, • access to dental and medical care. …

13. Housing & Neighborhood http://theonlinephotographer.typepad.com/.a/6a00df351e888f88340120a87acfd3970b-popup

14. Family Income (1) http://theonlinephotographer.typepad.com/the_online_photographer/2010/02/Haiti-between-death-and-life.html

15. Family income (2) http://recruiterpoet.com/2010/09/14/hewitt-associates-named-to-the-2010-working-mother-100-best-companies-list/ http://articles.timesofindia.indiatimes.com/2012-02-26/parenting/30670136_1_mental-health-education-pathways http://recruiterpoet.com/2010/09/14/hewitt-associates-named-to-the-2010-working-mother-100-best-companies-list/

16. Level of parents education http://digitaljournal.com/article/268425 http://www.beyondaccess.net/2012/03/22/chilean-library-reading-corners-aid-efforts-to-reduce-child-mortality/

17. access to nutritious foods http://www.trust.org/alertnet/news/ethiopian-child-mortality-malnutrition-rates-drop/ http://www.toonaripost.com/2012/01/us-news/usda-releases-school-meal-nutrition-standards/

18. Access to physical recreation http://www.health.gov/paguidelines/blog/post/Innovative-Physical-Activity-Joint-Use-Agreements.aspx http://www.flickr.com/photos/havserve/5362329960/

19. genetic makeup http://www.etftrends.com/2009/02/if-you-love-risky-etfs-blame-it-on-your-dna/ http://www.geneticsawareness.org/familyhealthhistory

20. Access to medical & dental care (1) http://www.nationalityforall.org/rohingya-from-burma

21. Access to medical & dental care (2) http://blog.patrickbeland.com/category/nunavut

22. Global context (MDGs)

23. Global context (MDG) MDG Goal 4: Reduce Child Mortality

24. global (MDG) • Targets by 2015: • To reduce child mortality by two-thirds, from 93 children of every 1,000 dying before age five in 1990 to 31 of every 1,000 in 2015. • About 29,000 children under the age of five –  21 each minute – die every day, mainly from preventable causes. • Two-thirds of deaths occur in just 10 countries. • An Ethiopian child is 30 times more likely to die by his or her fifth birthday than a child in Western Europe

25. http://thelargest.net/child-mortality-rate/child-mortality-in-chadhttp://thelargest.net/child-mortality-rate/child-mortality-in-chad

26. Global cause of child death What are the 6 major causes of child mortality • More than 70 per cent of almost 11 million child deaths every year are attributable to six causes: • diarrhea, • malaria, • neonatal infection, • pneumonia, • preterm delivery, or • lack of oxygen at birth. • Malnutrition and the lack of safe water and sanitation contribute to half of all these children’s deaths.

27. Lack of safe water & sanitation http://veganfeastkitchen.blogspot.ca/2007_08_01_archive.html http://jssozi.wordpress.com/tag/dirty-water/

28. low-tech, evidence-based, cost-effective measures http://www.aafp.org/online/en/home/publications/news/news-now/vaccine.html

29. Research shows that over half of children die of preventable causes. Name some interventions that can reduce child mortality.

30. Research and experience show that six million of the almost 11 million children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as: • vaccines, • antibiotics, • micronutrient supplementation, • insecticide-treated bed nets, • improved family care, • breastfeeding practices. • Canada is the world's leading provider of vitamin A for developing countries, with more than $300 million in contributions to vitamin A

31. SDOH – global (MDG) • Examples of Canada’s Impact: 2011 Deauville Summit • Canada scaled up efforts to reduce the gaps, in the area of maternal and child health care and voluntary family planning, an estimated US$ 1.5 billion. • Clearly demonstrated at the G8, under Canada’s leadership, launched the Muskoka Initiative on Maternal, Newborn and Child Health- a comprehensive approach to accelerate progress towards Millennium Development Goals 4 and 5.

32. SDOH – global (MDG) • Canada is currently supporting the Government of Malawi in scaling-up and institutionalizing the Community-Therapeutic Care approach to identifying and treating severe acute malnutrition of children at the district and community level, through the Africa Health Systems Initiative (AHSI). • Canada is among the largest donors to the One UN in Tanzania (CAD$12 million, FY 2007-2008)- working with the Government of Tanzania and other national partners to reduce maternal and newborn deaths. • By improving participatory planning, budgeting, monitoring and data management, ensuring adequate equipment, supplies and skills are in place to provide comprehensive and emergency obstetric and newborn care, and strengthening referral systems for emergencies, this support has resulted in declines in facility- based deaths and a marked increase in referrals from peripheral communities to district hospitals in emergencies in the target communities.

33. How does Canada help reduce childhood deaths?

34. SDOH – local context

35. SDOH – local context

36. SDOH – local context

37. In September 2000, First Ministersreached an important agreement on early childhood development to foster the well-being of Canada’s young children • Government of Canada is providing $500 million per year to help provincial and territorial governments improve and expand early childhood development programs and services. How do you see these funds impacting your community? Are there gaps? • Provincial/territorial governments have agreed to invest the funding transferred to them by the Government of Canada into any or all of four key areas for action, depending on their particular priorities: • Promote healthy pregnancy, birth and infancy • Improve parenting and family supports • Strengthen early childhood development, learning and care • Strengthen community supports

39. Relation to Primary Care (1) • Experiences from conception to age six have the most important influence of any time in the life cycle on the connecting and sculpting of the brain's neurons. • Positive stimulation early in life improves learning, behavior and health into adulthood. • Tobacco and alcohol use during pregnancy can lead to poor birth outcomes. • A loving, secure attachment between parents/caregivers and babies in the first 18 months of life helps children to develop trust, self-esteem, emotional control and the ability to have positive relationships with others in later life.

40. Relation to Primary Care (2) • Neglected or abused Infants and children are at higher risk for injuries, a number of behavioral, social and cognitive problems later in life, and death. • Research shows a strong relationship between income level of the mother and the baby's birth weight. • Factors such as coping skills and sense of control and mastery over life circumstances also come into play. 

42. Discussion / Activity (1) http://www.warchild.ca/about

43. Discussion / activity (2) • Case Discussion: • A 14 year old boy becomes your patient. You are a family physician in a Family Health Team. His accompanying aunt informs you that he has just arrived from his home country, after being held captive as a child soldier for 5 years. • Large Group question: • What Social Determinants of Health have come to affect this child’s development? (…)

44. Discussion / activity (3) Small Group Question (2-3 individuals) (One SDOH per Small Group) • Provide 3 examples of the effects of conflict / war on a child’s development • As his family physician, provide 3 examples of ways to address these effects

45. Action plan Group Discussion: • After today’s workshop, make a list of tangible action plans to implement in your respective practices.

46. Social determinants of health

47. Additional Resources • Department of Family and Community Medicine – University of Toronto, Draft – DFCM Core Competencies • Google Images • Public Health Agency of Canada • Ted Talks. http://www.ted.com/talks • The Central Intelligence Agency (CIA). https://www.cia.gov/ • The Sphere Project - Humanitarian Charter and Minimum Standards in Humanitarian Response. (2004). • Unicef • United Nations Development Programme. http://www.undp.org/content/undp/en/home.html • War Child • What Makes Canadians Healthy or Unhealthy? (2003). Public Health Agency of Canada http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php#income • WHO