Wednesday, 6 July 2011

SIDS: Canada: The issue of poverty

Dr. Randall F. White, (psychiatrist and medical writer) :  June 28, 2011
Nine years before, the family was the object of attention when they suffered the death of a 19-month-old girl who was killed by her great uncle. Provincial child-welfare authorities had placed the child in the care of her great aunt and her spouse, although the man was known to be violent.
Mary McNeil, minister of children and family development, called the infant's death this month tragic. Although the cause of death is under investigation, some media reports suggest sudden infant death syndrome. SIDS is a no-fault condition, but it occurs more often to infants of poor women who are more likely to struggle with drug addiction, lack of prenatal care, and limited education.
SIDS is rare - in 2009, the year with most recently available statistics, six B.C. babies died of SIDS. Premature birth causes more than ten times as many infant deaths.
Risk factors for prematurity are largely the same as those for SIDS. Those factors include poverty, teenage pregnancy, poor nutrition and substance abuse.
Being born into poverty, however, does not usually result in death during infancy. Rather, it sets the stage for chronic illnesses in childhood and adulthood that result in disability, costly medical care and a shortened life span.
During the years when the body and mind are forming, the influence of an unhealthy environment and habits takes shape. Poverty's effects do not inevitably lead to disease, but the combination of toxic exposures and social problems such as school failure and child abuse create slowmotion tragedies. Unlike the sudden death of an infant, the media and politicians seldom take notice of these losses. For instance, prematurity can result in mental retardation, seizures and lung disease. Premature babies may later have learning disabilities and attention deficit disorder, which require special education interventions.
Having a child with such problems adds stress to a family struggling to get by; this stress may result in abuse or neglect. But even without dire medical problems that begin at birth, poverty is associated with chronic disease and a higher risk of death.
Injuries are the most common cause of death in B.C. Disadvantaged children are more likely to suffer from injuries such as burns, vehicle accidents and drowning. Fortunately, only 13 B.C. children died of injuries in 2009; many more were treated and recovered. In the long run, however, most disabilities and untimely deaths result from common diseases of adulthood that have roots in childhood.
Because severe malnutrition is almost exclusively a disease of dire poverty, it is uncommon in Canada. We are more likely to develop obesity with its complications of diabetes, high blood pressure,and heart disease. In North America, people with low income have a greater tendency to be overweight than people with high income. This probably relates to less physical activity and more unhealthy food intake among the poor.
The unhealthy influences on children growing up in poor neighbourhoods can be put together by a thought experiment.
Imagine a low-income corner of town. It's probably near busy roads where traffic contributes to noise and air pollution. The quickest place to get a cheap meal is the convenience store or fast-food restaurant. Access to parks and playgrounds is difficult because children have to cross a highway, and it may not be safe to go outside after dark. Drug dealers may lurk nearby. It's easier and safer to stay indoors and watch TV.
If the building is not well maintained, children may encounter hazards indoors, such as unsafe stairs, exposed wiring or vermin. If the parents have to work two shifts to pay the bills, who makes sure the children stay out of trouble?
The economic and human costs of childhood poverty are immense, but the government seems almost blind to this. According to Statistics Canada, British Columbia has had the highest rate of childhood poverty in Canada for 11 years. As of 2009, 100,000 B.C. children lived in poor homes. If politicians really want to reduce childhood deaths and control health care costs, they need to get serious about protecting children from growing up poor.
Nurse-Family Partnership, a recently announced program in B.C. designed to support at-risk women during pregnancy and after, is a good start. The program has been piloted in U.S. communities and its benefits on the well-being of poor women and their children is documented by research.
A coalition of organizations has called for a poverty-reduction strategy in B.C. Several other provinces have adopted such plans; B.C. should be the next.

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