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Diagnosing a blind spot: children's health care Add to ...

As the debate over health-care reform heats up again, the time has come to address an important gap: a vision for children's health.

As many parents know (and as I can attest from my post as president of Toronto's Hospital for Sick Children) our kids are having more and more problems getting in to see the doctor. Sick children, if not healed properly, become sick adults, often with far more complicated and costly problems. If we don't strengthen the children's health-care system now, the health-care system in general, and Canadian society, will pay a hefty price.

Yet national health-care reform strategies ignore children. While they target adult wait-times for cancer care, heart care, hip replacements, and cataract surgery, our children wait for subspecialists like pediatric neurologists and pediatric oncologists.

Children who should wait no longer than 90 days for counselling on genetic disorders like cystic fibrosis are waiting 18 months. In Toronto, a boy or girl with anxiety disorder has to sit patiently for a year and a half to see a child psychiatrist. And when a six-month old has to wait six months for surgery, it's a lifetime. The baby who ultimately arrives in the operating theatre after a six-month wait has a different body and physiology than the one who was diagnosed. Tens of thousands of Canadians aren't getting care at the point when it could make the greatest long-term difference to their health.

Investing in children's health care gives us the chance to make the best long-term health investment possible. Every dollar invested in children saves $3 in future societal costs, including health care, according to the World Bank. And unlike the sprawling adult system, the children's system is compact. Ontario, for instance, has only five hospitals capable of handling acute child care. We can turn this around quickly if we start now.

First, we must understand that children's health care is fundamentally different than the adult system. An adult MRI clinic can scan a dozen patients in a day, with only a technologist there to run the machine. A children's MRI clinic needs more staff to scan half that number. Babies need to be sedated by an anesthesiologist, supported by a medical team, and then monitored on a ward afterwards. Children's hospitals also have to re-build medical equipment to fit little kids and must create drug formulations to suit tiny bodies.

Children's hospitals have extra costs that simply don't exist in the adult system, but health-care reform doesn't acknowledge the difference. Of the 47 recommendations in the Romanow report, not one mentions the children's health-care system. When the first ministers signed a "10-year vision" for health care last year, aside from an immunization strategy, they did not mention children.

Second, we must better integrate pediatric systems, co-ordinating our investments among different hospitals (with science, not prestige or political capital determining what equipment we buy and where we put it) and co-ordinate them with the evolving local health networks.

Finally, let's support research in the children's system. Research is essential because less is known about kids' disease than adult disease, and because clinical trials can be well co-ordinated within the relatively compact children's system. Yet government funding doesn't recognize the full-cost difference between running a general hospital and running a research hospital, whose patients tend to have far more complex problems.

If we can get this right, the children's health-care system will respond quickly. Think of how we've turned the tables on child cancer: In the 1970s, the chance of a child surviving more than five years with cancer was only 10 per cent. Today, 77 per cent of all children diagnosed with cancer will be cured.

That is a mind-blowing turnaround. That's how fast the kids system can move. It's also why it is critical to begin shaping a vision on children's health today and to work collaboratively with government, hospitals and other health-policy leaders to find the best way to address the gaps in health care for children.

Mary Jo Haddad is president and CEO of Sick Children's Hospital in Toronto.

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