PoPulationand Public HealtH etHics

esearch
such support, seen across the country, is that families with severely chronically
ill or disabled children frequently feel they must relocate to be closer
to the services for which they are eligible, often at significant personal
cost. 1
The possibility that the new screening tool will identify a different pool of
children and families is not unreasonably speculative. Purportedly evaluative
approaches that distance the aims of screening programs from their
actual impact as public health interventions are, after all, already noted
in the case itself. Consider the choice of program effectiveness indicators.
The authors mention “referrals and entry into supportive programs” as key
evaluative measures, but these are empty gauges since they do not measure
actual child-development outcomes. Worse still is that a focus on short-term
administrative indicators of program channeling may allow ministry officials
and health professionals to sidestep vexing questions about whether
the screening program makes any real difference to the lives of children
and families at risk.
Beyond concern for the stigmatizing effect of the “at-risk” label for parents,
children and communities, and the corollary concern for the generally poor
predictive value of screening tools for developmental risks, 2 it is essential
to realize that the very concept and indicators of “risk” and “support” embedded
in screening tools and social services may overstate individual
and behavioural factors and understate social ones. Poverty, for example,
is likely to be the single-most generalized and determinative risk factor
for suboptimal child development. While the decision algorithm suggests
that referrals to “appropriate programs and services” will be provided for
families at moderate and high risk, there is ample reason to question the
appropriateness and adequacy of these when it comes to eliminating or
even reducing poverty as a risk factor for poor childhood development.
After all, 22 years after both signing the Convention of the Rights of the
Child, and adopting an all-party House of Commons resolution to eliminate
child poverty, Canada is among the worst oeCD countries for children living
in poverty, with a rate between 10–15%, depending on the measure.*
That translates into 600,000–800,000 children under the age of 18 living in
poverty 3 (half of whom are not just poor compared to the average Canadian
* StatsCan totals are about one-third less than those generated by international organizations.
PoPulation anD Public HealtH etHics
48