Dr. Paul Kershaw University of British Columbia

Beyond Boomercentrism: Transcending a dominant policy logic to promote health
Dr. Paul Kershaw University of British Columbia Human Early Learning Partnership Government of BC Ministry of Health Services Policy Rounds December 14, 2010 Victoria, BC A Policy Roadmap to the BC we talk about, but still need to become.

Intergenerational Injustice

Fiscal Debt Australia 8% Switzerland 21% Norway 26% NZ 28% Canada 36%
Country 2009 Central Government Debt, % GDP % increase since 1973 Australia 8% Switzerland 21% Norway 26% NZ 28% Canada 36% 133% Sweden 38% Denmark Germany 44% US 53% France 61% UK 75% Source OECD CANSIM Country 2009 Central Government Debt, % GDP Australia 8% Switzerland 21% Norway 26% NZ 28% Canada 36% Sweden 38% Denmark Germany 44% US 53% France 61% UK 75% Source OECD Country 2009 Central Government Debt, % GDP Australia Switzerland Norway NZ Canada Sweden Denmark Germany US France UK Source OECD

Environmental Debt Sweden 5.0 13% Switzerland 5.7 1% France -12% NZ
Country 2008 Tonnes CO2/Capita Change in GHG, % 1990 level Sweden 5.0 13% Switzerland 5.7 1% France -12% NZ 7.7 18% Norway 7.9 -22% UK 8.3 -18% Denmark 8.8 -6% Germany 9.8 -21% Canada 16.5 47% US 18.4 16% Australia 18.5 82% Source IEA UNFCCC Country 2008 Tonnes CO2/Capita Sweden 5.0 Switzerland 5.7 France NZ 7.7 Norway 7.9 UK 8.3 Denmark 8.8 Germany 9.8 Canada 16.5 US 18.4 Australia 18.5 Source IEA Country 2008 Tonnes CO2/Capita Sweden Switzerland France NZ Norway UK Denmark Germany Canada US Australia Source IEA

Family Policy for Young Children
Family Policy Debt Country Family Policy for Young Children Score/10 Sweden 10 Norway 8 Denmark France NZ 6 UK 5 Germany 4 Switzerland 3 US Australia 2 Canada 1 Source UNICEF Country 2008 Tonnes CO2/Capita Sweden 5.0 Switzerland 5.7 France NZ 7.7 Norway 7.9 UK 8.3 Denmark 8.8 Germany 9.8 Canada 16.5 US 18.4 Australia 18.5 Source IEA

Parental Leave Child (from month 3 to 15) Lower Earner (year: 2008)
Parents both take 6 months to care. Disposable income relative to couple without children Lower Earner (takes all 12 months) Country Year Can$ (controlling for PPPs) Year Can$ Denmark 12,915 1,971 Germany 1,166 1,054 Sweden 1,105 -2,530 Quebec -2,548 Austria -3,295 -391 Czech Republic -5,945 372 Slovak Republic -6,958 -2,251 Finland -8,468 -4,694 Netherlands -8,624 -9,258 Spain -9,941 -5,641 UK -10,036 -6,274 Belgium -10,298 -6,448 Norway -10,687 -7,307 Canada (outside of Quebec) -10, ,779 -6,971 New Zealand -12,592 -18,999 Italy -15,160 -11,653 France -16,085 -8,480 Australia -16,343 -13,235 Ireland -19,044 -10,397 USA -23,119 -16,389 Japan -24,019 -10,866 NB = AB = BC = ------ Re full time employment norms: Canadian Maximum Hours of Work Before Overtime Hours Per Week British Columbia: 40 Alberta: 44 Saskatchewan: 40 Manitoba: 40 Ontario: 48 Quebec: 40 New Brunswick: 44 PEI: 48 Nova Scotia: 48 Newfoundland: 40

Employment Norms:

Public expenditure on ECEC services (0-6 years) in selected OECD countries
Denmark Sweden Norway Finland France Hungary Austria United Kingdom United States Netherlands Germany Italy Australia Canada British Columbia Currently 0.22% of GDP 0.28% with full school-day K Canada (outside Quebec) Few spaces Insufficient quality High cost Inadequate Inclusion OECD avg. 0.7% UNICEF & EU benchmark 1.0% Canada 0.25% BC 0.22% 0.28% 0% 0.5% 1.0% 1.5% 2.0% % of GDP Source: Adapted from Starting Strong ll: Early Childhood Education and Care, September 2006, p.11

(2008) Canadian Currency (controlling for purchasing power parities)

Intergenerational Justice
Fiscal Debt Enviro Debt Family Debt Country 2009 Central Gov’t Debt, % GDP % increase since 1973 2008 Tonnes CO2/Capita Change in GHG, % 1990 level Sweden 38% 5.0 13% Norway 26% 7.9 -22% Denmark 8.8 -6% France 61% 5.7 -12% NZ 28% 7.7 18% UK 75% 8.3 -18% Germany 44% 9.8 -21% Switzerland 21% 1% US 53% 18.4 16% Australia 8% 18.5 82% Canada 36% 133% 16.5 47% Source OECD CANSIM IEA UNFCCC Country 2009 Central Gov’t Debt, % GDP % increase since 1973 2008 Tonnes CO2/Capita Change in GHG, % 1990 level Family Policy for Young Children Score/10 Sweden 38% 5.0 13% 10 Norway 26% 7.9 -22% 8 Denmark 8.8 -6% France 61% 5.7 -12% NZ 28% 7.7 18% 6 UK 75% 8.3 -18% 5 Germany 44% 9.8 -21% 4 Switzerland 21% 1% 3 US 53% 18.4 16% Australia 8% 18.5 82% 2 Canada 36% 133% 16.5 47% 1 Source OECD CANSIM IEA UNFCCC UNICEF Country 2009 Central Gov’t Debt, % GDP % increase since 1973 Sweden 38% Norway 26% Denmark France 61% NZ 28% UK 75% Germany 44% Switzerland 21% US 53% Australia 8% Canada 36% 133% Source OECD CANSIM

Intergenerational Justice
Fiscal Debt Enviro Debt Family Debt Country 2009 Central Gov’t Debt, % GDP % increase since 1973 2008 Tonnes CO2/Capita Change in GHG, % 1990 level Family Policy for Young Children Score/10 Sweden 38% 5.0 13% 10 Norway 26% 7.9 -22% 8 Denmark 8.8 -6% France 61% 5.7 -12% NZ 28% 7.7 18% 6 UK 75% 8.3 -18% 5 Germany 44% 9.8 -21% 4 Switzerland 21% 1% 3 US 53% 18.4 16% Australia 8% 18.5 82% 2 Canada 36% 133% 16.5 47% 1 Source OECD CANSIM IEA UNFCCC UNICEF

of BC kindergarten children are vulnerable.
29% of BC kindergarten children are vulnerable. Vulnerable because more likely to become ill over their lives; more likely to be incarcerated; less likely to succeed in school, and less likely to be job-ready when they graduate. 24-29% for provinces with population level data, with the exception of PEI, which is almost 10 percentage points lower. Vulnerability above 10% is not biologically necessary. Most vulnerable children are not poor!

Kindergarten teachers consider
Hold pencil Climb stairs Follow instructions Get along with peers Know 10 letters

Sensitive Periods in Early Brain Development
Pre-school years School years High Numbers Peer social skills Sensitivity Symbol Language Habitual ways of responding Emotional control ‘Sensitive periods’ in early brain development – this slide is based on the following references: Doherty, G. (1997). Zero to Six: the Basis for School Readiness. Applied Research Branch R-97-3E Ottawa: Human Resources Development Canada. McCain & Mustard (1999). Early Years Study. Toronto, Ontario: Publications Ontario. Shonkoff, Jack (Ed) (2000). From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, D.C.: National Academy Press. - change colours Vision Hearing Low 1 2 3 4 5 6 7 Years Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)

Life Course Problems Related to Early Life
Early Vulnerability 2nd Decade 3rd/4th Decade 5th/6th Decade Old Age School Failure Teen Pregnancy Criminality Obesity Elevated Blood Pressure Depression Coronary Heart Disease Diabetes Premature Aging Memory Loss

Mismatch: Social Investment vs. Health Promotion Opportunity
Preschool School Post School Age Cumulative Public Investment Biological Sensitivity to Context Source: Carneiro & Heckman, Human Social Policy (2003)

Disease Fetish?

Historical Expense by Function (% of total spending)
BC Government Expenditure: Change over Time Historical Expense by Function (% of total spending)

Historical GDP and Revenue ($ millions)
GDP, Revenue and Expenditure: Change over Time Historical GDP and Revenue ($ millions) 200 180 160 140 120 100 80 60 40 20 ($) Billions 2008 Revenue: 15.3% of GDP 1984 Revenue: 17.7% of GDP

Healthcare ($ per capita)
Health Care Spending: Change over Time Healthcare (% of GDP) Healthcare ($ per capita) $2.2 billion for BC $ $ 0 %

Social Services (% of GDP)
Social Service Spending: Change over Time Social Services (% of GDP) Social Services ($ per capita) $ %

Medical care crowding out Social care?

Manage expectations re medical care to promote health?

What medical care we owe one another as our capacity to save increases dramatically with costly technology and drugs?

And what does it mean for a society when it spends hundreads of thousands, if not millions, of dollars to save a pre-term baby – one life – but is remarkably hesitant to invest in health promotion for the population through programs like early learning and care, housing, food?

may be good for doughnuts,
A hole in the middle may be good for doughnuts, but not for public policy.

Because there is no system of family policy…
Canadian Society is FAILING parents in fundamental ways! Time Poverty Service Poverty Income Poverty Reflects appreciation of costs imposed by residential school system; reserves, etc.

15 by15

From the Province: 15% vulnerable
BC Government Strategic Plan for 2008/ /11, p. 30

7% of BC Neighbourhoods Meet 15 by 15 Target
Vulnerable on One or More Scales >15% <15% Source: EDI Wave 2 (2004/05 – 2006/07)

Biologically, no neighbourhood should have vulnerability above 10%.
Vulnerable on One or More Scales >10% <10% Source: EDI Wave 2 (2004/05 – 2006/07)

Early Vulnerability  Quality of Labour Supply
BC: Unique Population Laboratory: Early Vulnerability  Quality of Labour Supply Kindergarten Population Grade 4 Population Grade 7 Population Grade 12 Population Criminal activity

to cut incarceration by a third
Reduce Early Vulnerability to 10%... to cut incarceration by a third

The next generation’s Human Capital
If Then University eligible grades Vulnerability At K At G.12 # of children Human Early Learning Partnership, in collaboration with Kindergarten teachers in almost all classrooms, in almost all schools, in all school districts have transformed BC into an internationally unique population observatory. Observe how children are in K. Then watch K-4; 4-7; 7-12. Re University Eligible Grade Achievement: Whether these citizens go to university does not matter. But BC will have grown the labour pool that is likely to lead technology developments in BC or adapt innovation from other parts of the world, which will power future economic growth. 29% 41.5% Low High Score on scale of EDI and % achieving university eligible grades

The next generation’s Human Capital
If Then University eligible grades Vulnerability At K At G.12 # of children 10% 55.6% Low High Score on scale of EDI and % achieving university eligible grades

What does the early vulnerability debt cost BC?

ENJOYED .63% OF GDP GROWTH MORE PER YEAR, FOR 40 YEARS
1960 – 2000: Research shows… Countries with 55% of students getting university-eligible grades vs. Countries with 42% of students getting university eligible grades… ENJOYED .63% OF GDP GROWTH MORE PER YEAR, FOR 40 YEARS

Decreased Vulnerability = Increased Growth
Reduced early vulnerability increases GDP by Reduced vulnerability (10%) 20% That’s throwing away $401.5 billion now + interest over 60 years! Status Quo (29% vulnerable) Baseline growth First cohort graduates Baseline growth plus 0.63% GDP per year First cohort of 5 year olds benefit from 15 by 15 policy We are here

Limit global warming to 2 degrees Celsius requires absolute reduction in GHG emissions, while global population grows. Option 1: Technological innovation to decouple economic growth from carbon emissions. Option 2: Move from a growth to a steady state economy and transform the meaning of well-being.

Decreased Vulnerability = Increased Growth
Reduced early vulnerability increases GDP by Reduced vulnerability (10%) 20% That’s throwing away $401.5 billion now + interest over 60 years! Status Quo (29% vulnerable) Baseline growth First cohort graduates Baseline growth plus 0.63% GDP per year First cohort of 5 year olds benefit from 15 by 15 policy We are here

Smart & Green Family Policy

Gender Inequality Sources: World Economic Forum and UNICEF 2008
2008 Family Policy Country Score/10 Sweden 10 Norway 8 Finland Denmark France New Zealand 6 Netherlands 5 UK Germany 4 Switzerland 3 US Australia 2 Ireland 1 Canada 2008 Gender Gap Ranking 3 1 2 7 15 5 9 13 11 14 27 24 8 31 Sources: World Economic Forum and UNICEF

Smart Family Policy 0 to18 months Time: improve parental leave
Services: monthly access to health check-ins and parenting support 0-18 months

Children, parents and families
Where are they now? Strong Start Schools Homes Childcare Neighbourhood Hubs Community Services Libraries Family Resource Program Aboriginal ECD Child & Family Services Friendship Centers Clinics Hospitals Public Health Services Personal Physicians Maternal Child Health Programs

Welcoming, supportive, accessible environments providing Healthy Child Check-ins (HCC) and Parental Supports (PS) HCC & PS trusted people HCC & PS trusted people Strong Start Childcare Neighbourhood Hubs Community Services Libraries Family Resource Program Aboriginal ECD Child & Family Services Friendship Centers Homes Schools HCC & PS Clinics Personal Physicians HCC & PS Public Health Services Hospitals Maternal Child Health Programs HCC & PS trusted people HCC & PS

Smart Family Policy 0 to18 months Time: improve parental leave
Services: monthly access to health check-ins and parenting support 0-18 months 18 months to six years Time: re-think ‘full-time’ work Services: early learning and care 18 months to school entry (with HCC & PS) 0 to six years Low-income: make work pay Low-income: increase welfare

The price of smart family policy...
For each BC adult: Smart family policy costs less per day than the price of a coffee and doughnut at Tim Hortons.

$3 Billion /Year The cost of reducing vulnerability?
Funding for Community Services $1.6 billion Funding for Parents Time $648 million $3 Billion /Year Resources $750 million Less 5%, because of the progress made, despite recession = $1.4 billion

$3 Billion Increase in Spending?
Provincial Health Care Spending ($ Billions) $3B /5 years $3B /5 years We need to manage British Columbians expectations re medical care.

The same policy hole costs BC Business now!

Absence of Smart Family Policy costs BC employers…
Productivity: $293 million Retention: $674 million Insurance premiums $ 15 million Parental leave top up $ 20 million Sub-total $1 billion Minimum wage… Profits to ECEC suppliers & maintenance

The same policy hole costs Government now!

Absence of Smart Family Policy costs Government
Child welfare: $157 million W/L stress  GPs, emerg, hospitalization: $299 million Prescription drugs $ 26 million Less labour supply & taxes $122 million Sub-total $604 million ECEC pay equity  taxes W/L stress  depression  unemployment Early vuln  K-12 costs Poverty  health care costs

The same policy hole costs Society.

Annual crime reduction savings grow to $500 million,
Reduce Early Vulnerability to 10%... Annual crime reduction savings grow to $500 million, Year 4-11

But Will We Pursue this Bold Ambition?
Smart Family Policy= Smart Economics A Just Cause Health Promotion But Will We Pursue this Bold Ambition? This is not a research question. It is a cultural question.

Not a Research Question
It’s a question about being Canadian in BC!

Trusted Professions in Canada (2007)
Fire Fighters 97% Nurses 94% Farmers 92% Teachers 89% Doctors 87% Politicians 15%

British Columbians believe myths, not reality
82% under-estimated or did not know early vulnerability rate. 86% overestimate how generous Canadian family policy is.

Distracted by Boomercentrism?

Result: many don’t see smart and green family policy as…
Productivity policy Recruitment & Retention policy Crime reduction policy Health policy Gender equality policy Debt elimination policy Sustainability policy

Result: Many don’t see the cost of maintaining the status quo.
Another generation of vulnerable children, and an economy and (unhealthy) society to match.

Thank you. Paul Kershaw, Ph.D. The University of British Columbia
College for Interdisciplinary Studies Human Early Learning Partnership (HELP)

Parental Leave Target: $-1,532 Child (from month 3 to 15) Lower Earner
(year: 2008) Child (from month 3 to 15) Parents both take 6 months to care. Disposable income relative to couple without children Lower Earner (takes all 12 months) Country Year Can$ (controlling for PPPs) Year Can$ Denmark 12,915 1,971 Germany 1,166 1,054 Sweden 1,105 -2,530 Quebec -2,548 Austria -3,295 -391 Czech Republic -5,945 372 Slovak Republic -6,958 -2,251 Finland -8,468 -4,694 Netherlands -8,624 -9,258 Spain -9,941 -5,641 UK -10,036 -6,274 Belgium -10,298 -6,448 Norway -10,687 -7,307 Canada (outside of Quebec) -10, ,779 -6,971 New Zealand -12,592 -18,999 Italy -15,160 -11,653 France -16,085 -8,480 Australia -16,343 -13,235 Ireland -19,044 -10,397 USA -23,119 -16,389 Japan -24,019 -10,866 Target: $-1,532 NB = AB = BC = ------ Re full time employment norms: Canadian Maximum Hours of Work Before Overtime Hours Per Week British Columbia: 40 Alberta: 44 Saskatchewan: 40 Manitoba: 40 Ontario: 48 Quebec: 40 New Brunswick: 44 PEI: 48 Nova Scotia: 48 Newfoundland: 40

Leave  $24635 in Parental Time in year 1
$12618 in Parental Time year 2 Supplemented by Healthy Child Check-Ins & Parenting Support ($1,583)

Public expenditure on ECEC services (0-6 years) in selected OECD countries
Denmark Sweden Norway Finland France Hungary Austria United Kingdom United States Netherlands Germany Italy Australia Canada British Columbia Currently 0.22% of GDP 0.28% with full school-day K Canada (outside Quebec) Few spaces Insufficient quality High cost Inadequate Inclusion OECD avg. 0.7% UNICEF & EU benchmark 1.0% Canada 0.25% BC 0.22% 0.28% 0% 0.5% 1.0% 1.5% 2.0% % of GDP Source: Adapted from Starting Strong ll: Early Childhood Education and Care, September 2006, p.11

ECEC  more parents synchronize earning and caring
Household Income above $40k: annual fees = under 3: $5,100; 3-5: $3,400 But propose Employment Standards to reduce yearly hours (and later retirement). 40  35 hours * 2 parents: trade $6k for 500 hours Subsidized by $7-$16k in services One earner couple: 40  35 hours * 1 parent; ECEC  additional employment time for parent 2.

Low-Income Policy

40% of poor children live with an adult who works full-time full-year.
Chart adapted from the 2010 Child Poverty Report Card, First Call: BC Child and Youth Advocacy Coalition

Lone Parent, Child: 0-12 months Working Poor
(2000 Hours in employment year grosses $26,600) Before SFP Hours $ Earning Child Caregiving (23428) After SFP Earning Min leave benefit: $440 NCBS*4 Service Investment: $1,583: Healthy Child Check-ins & Parent Support

Lone Parent, Child: 24-36 months Working Poor (2000 Hours in employment year grosses $26,600)
Before SFP Hours $ Earning Child Caregiving (0) After SFP Earning Child Caregiving (2928) +$2804 Pre SFP 7863 $ Incentive to increase hours of work Pre SFP 7.86 net hourly wage: transition from half average earnings to average earnings because shift from 20 to 40 hours per week After SFP 3847 $ Incentive to increase hours of work After SFP 5.13 net hourly wage: transition from half average earnings to average earnings because shift from 20 to 35 hours per week plus 250 more caregiving hours NCBS*4  +$4.5k ECEC  +$1.5k Australia+$7890 Target = $6160, rank 3rd Service Investment: $11,695: ECEC, Healthy Child Check-ins & Parent Support

(2008) Canadian Currency (controlling for purchasing power parities)

Income after Average Prov. Urban Rent and Routine Health:
Lone Mother + Child Age 2 on Social Assistance (2008) Province Yearly Can$ Quebec 10,615 Newfoundland 9,478 PEI 8,686 Saskatchewan 8,438 New Brunswick 7,378 Manitoba 6,617 Nova Scotia 5,342 British Columbia 4,638 Ontario 4,110 Alberta 2,916 Target: Child 0-12 months $16,386 Leave/Rental Assistance + HCC & PS Target: Child months $14,303 NCBS/Shelter allowance International ranking 4th + ECEC (with HCC & PS) Quebec is behind 10 OECD countries, including Australia (11320) and the UK (16070). Incentive to leave welfare Before SFP: $11,808 After SFP: $5,060 Leave only for 2 children; must look for work/school when child age 18 months

Dr. Paul Kershaw University of British Columbia

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