Research Blog: Child health and well-being in Canada

Periodically, the StatCan Blog publishes a guest post on research at Statistics Canada. This post is from Dafna Kohen, assistant director of the Health Analysis Division.

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The well-being of children is an important issue for Canadians. Statistics Canada has a long history of producing data on this topic. One of the first sources of information about children in Canada was the 1994 National Longitudinal Survey on Children and Youth—an extensive survey-based questionnaire that gathered information from parents, teachers and children. More recently, the agency began the Canadian Health Measures Survey, a survey that collects physical measures, such as accelerometer data, to track activity and sleep patterns.

Recent technological innovations have allowed Statistics Canada to link child survey data to administrative data, allowing Statistics Canada's analysts to follow children into adulthood and to look at education and employment throughout the life course (Findlay, et al., 2018; Vergunst et al., 2019).

The newest information on children comes from the Survey on Early Learning and Child Care Arrangements, conducted in early 2019, which focused on child care use for the youngest segment of the Canadian population: those under the age of six. This survey is part of the Rapid Statistics program, which was established to quickly answer important questions on topics such as child care.

This new survey provides information that complements other data collected by Statistics Canada to better understand the environments in which children grow, including their early child care environments, their home environments and the communities in which they live.

The early child care environment

On the topic of early learning and child care, Statistics Canada's studies have looked at the percentage of children in child care, including descriptions of who is using what type of care and provincial portraits of use (Bushnik, 2006; Sinha, 2014). One study looked at the use of child care in Quebec and the other provinces after Quebec implemented the $5 per day daycare policy.

Results showed that the lower cost of child care led to a substantial boost to child care use in Quebec. In particular, there was an increase in the use of licensed care (which included both licensed daycare centres and licensed home–based care), that was not seen in the other provinces and territories. In addition, low-income families in Quebec used licensed care more than low-income families in the rest of Canada, where low-income families were more likely to use unlicensed care such as babysitters, nannies and relatives (Kohen, Hertzman, Dahinten, 2008).

Quality of care

An important aspect of child care is quality of care. A 2010 study looked at how child care quality is related to children's behaviours (Romano, Kohen, Findlay, 2010). Child care quality was measured by whether or not it was licensed and by asking parents about the child care environment. Children in licensed child care provided in someone else's home had less physical aggression and less prosocial behaviours than children in non-licensed home daycares. However, children in home daycare environments that that were clean, safe and run by caregivers who planned and encouraged age-appropriate developmental activities (called high process quality) showed more prosocial behaviours than children not in these types of environments (whether they were licensed or not licensed).

Interestingly, these relationships differed for children from low-income families and non-low-income families. Children from low-income families had higher physical aggression and internalizing behaviour (e.g. is nervous, sad, cries a lot) if they were in a home daycare with low process quality, but for children from non-low-income families there was no difference in behaviours. In addition, being in more than one type of care arrangement, or being in an unstable or changing arrangement, was linked with poorer outcomes for children.

This study showed that child care matters for preschooler's behaviours, and high quality care appears to be particularly important. The findings also underscored the fact that child care influences do not work in isolation, but exert their influences in tandem with family influences to impact children. Taken together, these findings suggest that the accessibility, affordability and quality of child care has an important impact on young children.

Community and housing

The communities and the houses in which children live and grow up are also related to children's well-being. For example, exposure to poor housing and to environmental contaminants have been shown to negatively impact children's health.

Indigenous children are generally in poorer health than other Canadian children. Furthermore, Inuit children are more likely to live in houses that are crowded and in need of major repair, and to be exposed to second-hand smoke in the home (Bougie, Kohen & Guèvremont, 2015). Housing conditions for Indigenous children have been associated with their physical and mental health, and higher pollution exposure has been found for children in low-income areas.

Moreover, children from low income families are more likely to be exposed to second hand smoke and to have higher Bisphenol A levels (Findlay & Kohen, 2015), which in turn were associated with behavioural problems in children. Yet, the impact of housing conditions on children's health is not limited to air quality. Parental home ownership and satisfaction with their housing are also factors related to young children's health outcomes, particularly for Inuit and First Nations children living off reserve (Guèvremont, Bougie & Kohen, 2016).

The quality of community and housing environments are also related to more severe health issues, such as injuries. Poor economic circumstances have been associated with higher rates of injury requiring hospitalization, particularly for young children (Oliver & Kohen 2010) and have been associated with more frequent motor vehicle injuries to children who are occupants in cars, as well as injuries occurring when children are walking or cycling (Oliver and Kohen, 2009).

Community stability, safety and the feeling of belonging reported by residents are also factors that impact the health outcomes of young children. One study demonstrated that poor neighborhood conditions were associated with poorer mental health for mothers, which in turn influenced their parenting behaviours toward their children. This in turn influenced the children's behaviours and school readiness (Kohen, Leventhal, Dahinten & McIntosh, 2008).

These findings point to the importance of working toward a better understanding of individual neighborhoods, including their needs, and their socio-demographic and cultural make up. Additionally, a strong understanding of the availability of services, such as early learning and child care programs, early intervention programs and preventative services, will help to ensure that the appropriate resources are easily accessible to those who need them most.

Parenting

Parenting has long been considered a factor with a key influence on child development. However, few studies consider the impact that raising a child has on the parent.

Parenting is particularly challenging if a child has a disability. Several studies have shown that caring for a child with a disability takes a toll on mothers' physical and mental health (Brehaut et al., 2011; Brehaut et al., 2009; Lach et al., 2009), impacts family relationships and, not surprisingly, takes a toll on the family's economic situation. Parenting children with complex health conditions, such as neurodevelopmental disorders (e.g., cerebral palsy or autism), who also have behavioural challenges, has been associated with less positive, less consistent and less effective parenting behaviours (Garner et al., 2013).

Of course, parenting behaviours are influenced by a host of factors other than children's health conditions. Child age and sex, as well as parent and family education and income are also associated with parenting behaviours (Garner et al., 2013). Other important factors to consider in understanding differences in parenting behaviours are depressive symptoms, family functioning and social support (Arim et al., 2012).

Support from community professionals has been shown to be beneficial for the parents of children with health problems, in particular, children with neurodevelopmental disorders. Taken together, these findings raise an awareness of the impact that a child's health condition may have on the entire family unit, including parental physical and mental health, family functioning and parenting behaviours. The findings also point to the importance of considering child, family and community factors as a whole to better understand the influences on children's health outcomes.

Looking ahead

Additional data sources are important for informing policy issues for the health and well-being of children and youth. For example, the General Social Survey includes information about the households of young Canadian families and their patterns of employment and child care use, as does the Census of Population. Additional administrative and linked data holdings also include child-level information to allow for a more thorough understanding of community factors (pollution, air quality), housing, households characteristics, as well as outcomes such as hospitalizations, length of stay and cause of mortality.

With advancements to statistical, modeling and visualization methods, as well as the availability of data sources beyond traditional surveys, such as administrative, provincial, and other data holdings, there are many new and exciting opportunities to explore information about children, particularly within the context of their families, houses, communities and the neighborhoods in which they develop and grow.

Partnerships with experts, policy stakeholders and community organizers, as well as others requiring information about young children, will continue to guide research in this area. Statistics Canada continues to produce this important information to support policies and programs that contribute to the well-being of children in Canada.