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Review

Too Small to See, Too Big to Ignore: Child Health and Well-being

By Leslie T. Foster, Michael V. Hayes

November 4, 2013

Review By Veronica Strong-Boag

AS THE MOST RECENT Statistics Canada reports tell us, poverty continues to stalk British Columbia’s youngest citizens. Their distress, with outcomes measured pitilessly in shortfalls in nutrition, education, and health, is directly associated with the low income of their parents. The irony of the contracting out of services at BC Children’s Hospital (2003) is obvious: the offspring of low-waged workers are disproportionately susceptible to the poor health such institutions are designed to counter. Prevention, however, as the contributions to this volume repeatedly make clear, comes second best to efforts at remedy when life has already gone badly awry for the province’s youngsters. 

As it sorts through the findings and the fallout of the 1990s in particular, this volume provides essential reading for anyone interested in the well-being of Canadians. It is an important counterpart to the valuable volume, Vulnerable Children: Findings from Canadas National Longitudinal Survey of Children and Youth (2002), edited by J. Douglas Willms. SFU geography professor Michael Hayes sets the critical tone of the BC collection in his introduction: “It behooves us as guardians of children to be mindful of seeing them, and how we see them, within the organization of social policy, given their inherent lack of competitive political advantage”(i). Contributions from “public servants, academics, and representatives from non-governmental agencies” (3) make very clear the consequences of Canadians’ failure to invest in early well-being. In his “Developing an Ecology of Children’s Health: Recent International Trends Linking Children’s Rights to Determinants of Health,” Phillip Cook locates that failure within the wider context of global disparities. Canada signed the UN Convention on the Rights of the Child, but it has no reason to take leadership for granted. Cuts to international aid and domestic transfer payments have undermined child health and augmented social disparities.

Michael J. Guralnick next explores “Contemporary Issues in Early Intervention.” His review of family-centred theory and practice demonstrates the benefits of early, and often intensive (as with children with autism), intervention and inclusive social practices. Chapter 4, “Sudden Infant Death Syndrome: A Literature Review and a Summary of BC Trends” by L.T. Foster, W.J. Kierans, and J. Macdonald, points to promising developments. The incidence of SIDS is falling, even among First Nations populations who here, as in many other areas, suffer disproportionately. Jessica Ball, Alan Pence, and Allison Benner then consider the question of “Quality Child Care and Community Development: What Is the Connection?” Drawing on capacity-building initiatives with First Nations groups in western Canada and a wide-ranging review of programs in the majority and minority world, the authors affirm how quality childcare strengthens “social cohesion” and furthers “community development” (99). Chapter 6, “Patterns and Trends in Children in the Care of the Province of British Columbia: Ecological, Policy, and Cultural Perspectives” by L.T. Foster and M. Wright, tells a much less happy story: poverty produces children-in-care, but the 1990s saw a diminished political will to increase “employment, educational opportunities, housing assistance, and child care” (134) that would have allowed more families to retain their offspring. In their “Contradictions in Child Welfare,” Fay Weller and Brian Wharf suggest what hard times have meant for many mothers: “isolation, hopelessness, distrust, and poverty” (141). 

The system’s relentless focus on individual fault, even under NDP administrations, has undermined recognition of collective jeopardy and common citizenship. C. Morton, British Columbia’s first children’s commissioner, 1996-99, a post lost in the BC Liberals’ continuing retreat from responsibility, contributed Chapter 8, “Learning from the Past: Improving Child-Serving Systems.”This earnest effort, delivered somewhat curiously in the third person, single-mindedly defends efforts to implement the recommendations of the inquiry into the death of Matthew Vaudreuil by Judge Thomas Gove in 1995. Academics Rebecca N. Warburton and William P. Warburton are less defensive in “Toward Evidence-Based Child Policy: What Money Can’t Buy,” as they come down in favour of pilot programs and quality control, notably with regard to Head Start initiatives. In Chapter 10, “Knowing the Constituency: Youth – Their Health and Behaviour,” Roger S. Tonkin and Aileen Murphy consider the diversity revealed by the Adolescent Health Survey administered to BC students in 1992 and 1998. Like several authors here, they emphasize how much young people appreciated being consulted. Marlene M. Moretti, Roy Holland, and Ken Moore next review treatment prospects for the same age group in “Youth at Risk: Systemic Intervention from an Attachment Perspective.” Here, too, evidence is available on what works with many youngsters, but the political will is not there. In Chapter 12, Joseph H. Michalski turns to “Family Dynamics, Labour Market Attachment, and ‘At-Risk’ Children.” Good jobs, he still needs to remind readers, are the best guarantees of good health in children, as in adults.

These authors confirm what we have long known: the solution to children in distress is not simple. Individual commitment, whether from children, parents, or social workers and health professionals, is not sufficient. The problems that produce Matthew and Verna Vaudreuil, both victims of Canada’s failure to nurture young citizens, are not solvable without a collective willingness to address the disparities between the haves and the have-nots. In his Epilogue, Michael Hayes offers little cause for optimism as he reviews the record of the Liberal government elected in 2002: 

“The assumption made by the powerful people making public policy appears to be that everyone has basically the same life chances, and therefore is entitled only to minimal assistance from the public. Poverty, in this view, appears to be simply the consequences of bad life choices. Disparities in life chances are underplayed, ignored, or used for iconic value – overcoming the odds of poverty is presented as the norm of hard work and successful entrepreneurialship, not the minor miracle that it is.” (276) 

This assessment, while very true, is also insufficient. It lets all citizens, and the New Democratic Party when in power, off too easily. With conspicuous exceptions, too many of us have failed the province’s children. Too Small to See, Too Big to Ignore reminds us of this tragedy. Now we need a substantive discussion of why this is so.