Academic journal article Canadian Journal of Public Health

Canadian Health Care and Child Rights - What Are the Links?

Academic journal article Canadian Journal of Public Health

Canadian Health Care and Child Rights - What Are the Links?

Article excerpt

When the Convention on the Rights of the Child (CRC) was ratified in 1991, Canada undertook Article 24.1 obligations to provide both "the highest attainable standard of health" and Article 42 commitments to "make the principles and provisions of the Convention widely known to adults and children alike". How are health care providers following up on these promises? How did the recently completed Romanow Commission engage, or even gauge, the views of young people in the reform debate? The author presents an argument for the wider adoption of a "rights-based approach" to facilitate health care reform and health promotion for young people, and clarifies a minimum standard for establishing this claim. While the approach has been discussed in a Senate of Canada policy paper,1 the author cites qualitative findings from health promotion research in British Columbia to take the notion a step forward.2 Further comparative theoretical and empirical support is presented to illustrate why this approach is germane to health care reform debates in Canada, and contemporaneous cabinet-level initiatives planning for children's health and well-being.

Comparative theory and children's rights

While an explicit conceptual relationship connecting health and human rights has been well forged,3-6 there are both theoretical and applied knowledge deficits in the discourse supporting Canada's children.7-9 Ongoing national efforts to promote this child rights/child health nexus have been coordinated primarily in Ottawa to this point.10-13 Currently, a broad range of participants are developing and promoting children's rights through Canada's National Plan of Action for Children, with the Ontario Public Health Association a typical representative organization.14 Notwithstanding these efforts, how aware are provincial, territorial and local health providers of their own obligations under this international treaty for children?

The United Kingdom has a policy discourse in health increasingly built upon notions of young people as competent rights-bearing citizens, well founded theoretically15-18 and empirically.19-21 For example, Lightfoot and Sloper discuss research from the National Health Service on the value of consulting with chronically ill and disabled young patients - a core child rights principle. Staff reported significant changes in their own professional behaviour. "It really did change my whole outlook on nursing... [I began to ask] have we asked patients what they want?"22 In contrast, Dixon-Woods, Young and Heney report children have been given little voice in medical consultations to date, and are rarely consulted in the evaluation and planning of health services.23 They concede that children's rights will have little chance of being realized until more research on outcomes of shared decision making, competence of children, and sharing of information have been conducted. Alderson has researched effective methods for helping children as young as three years of age cope with major surgery24 and suggests that childhood theories25 are critical for health professionals to consider in issues of consent and a child's right to express their views freely.

A decade ago, critical links to child health outcomes and a child's rights to physical integrity were published by the British Columbia Institute against Family Violence.

[P]hysical punishment is ineffective as a disciplinary procedure and is harmful in its long term effects on children's social development. In an extensive investigation into physical child abuse, most cases were found to have started as physical disciplinary actions that then escalated out of control (Kadushin and Martin 1981). Strauss (1991) found that physical punishment tended to "increase the probability of deviance, including delinquency in adolescence and violent crime both inside and outside the family as adult." In a longitudinal study, Newson and Newson (1990) found, after controlling for poverty and unemployment, that frequent physical punishment as a child was associated with juvenile crime. …

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