Beyond Boomercentrism:Transcending a dominant policy logic to promote

health

Dr. Paul KershawUniversity of British Columbia

Human Early Learning Partnership

Government of BC Ministry of Health Services Policy RoundsDecember 14, 2010

Victoria, BC

Intergenerational Injustice

Fiscal Debt

Country

2009 Central

Government Debt, %

GDPAustraliaSwitzerlandNorwayNZCanadaSwedenDenmarkGermanyUSFranceUKSource OECD

Country

2009 Central

Government Debt, %

GDP% increase since 1973

Australia 8%Switzerland 21%Norway 26%NZ 28%Canada 36% 133%Sweden 38%Denmark 38%Germany 44%US 53%France 61%UK 75%Source OECD CANSIM

Country

2009 Central

Government Debt, %

GDPAustralia 8%Switzerland 21%Norway 26%NZ 28%Canada 36%Sweden 38%Denmark 38%Germany 44%US 53%France 61%UK 75%Source OECD

Environmental Debt

Country

2008Tonnes

CO2/CapitaSwedenSwitzerlandFranceNZNorwayUKDenmarkGermanyCanadaUSAustraliaSource IEA

Country

2008Tonnes

CO2/Capita

Change in GHG, %

1990 levelSweden 5.0 13%Switzerland 5.7 1%France 5.7 -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

2008Tonnes

CO2/CapitaSweden 5.0Switzerland 5.7France 5.7NZ 7.7Norway 7.9UK 8.3Denmark 8.8Germany 9.8Canada 16.5US 18.4Australia 18.5Source IEA

Family Policy Debt

Country

2008Tonnes

CO2/CapitaSweden 5.0Switzerland 5.7France 5.7NZ 7.7Norway 7.9UK 8.3Denmark 8.8Germany 9.8Canada 16.5US 18.4Australia 18.5Source IEA

Country

Family Policy for Young ChildrenScore/10

Sweden 10Norway 8Denmark 8France 8NZ 6UK 5Germany 4Switzerland 3US 3Australia 2Canada 1Source UNICEF

Parental Leave(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 1,971Germany 1,166 1,054Sweden 1,105 -2,530Quebec -2,548Austria -3,295 -391Czech Republic -5,945 372Slovak Republic -6,958 -2,251Finland -8,468 -4,694Netherlands -8,624 -9,258Spain -9,941 -5,641UK -10,036 -6,274Belgium -10,298 -6,448Norway -10,687 -7,307Canada (outside of Quebec) -10,353 - 11,779 -6,971New Zealand -12,592 -18,999Italy -15,160 -11,653France -16,085 -8,480Australia -16,343 -13,235Ireland -19,044 -10,397USA -23,119 -16,389Japan -24,019 -10,866

Employment Norms:

0.22%

Public expenditure on ECEC services (0-6 years)

in selected OECD countries

Source: Adapted from Starting Strong ll: Early Childhood Education and Care, September 2006, p.11

Denmark

Sweden

Norway

Finland

France

Hungary

Austria

United Kingdom

United States

Netherlands

Germany

Italy

Australia

Canada

0% 0.5% 1.0% 1.5% 2.0%

BCCanada

Canada (outside Quebec)• Few spaces• Insufficient quality • High cost• Inadequate Inclusion

British Columbia• Currently 0.22% of GDP• 0.28% with full school-day K

OECDavg.0.7%

UNICEF & EUbenchmark1.0%

0.25%0.28%

% of GDP

Norw

ayAu

stria

Denm

arkUK

Swed

enGe

rman

yAu

stra

liaNe

thJa

pan

Finl

andNZ

Fran

ceIre

land

Belg

ium

Cana

daUSCz

ech

Spai

nSl

ovak

Italy

-$5,000

$0

$5,000

$10,000

$15,000

$20,000

$25,000

NDI after housing and routine health care

Lone Mother with Toddler on Income Assistance

Canadian Currency (controlling for purchasing power parities)

(2008)

Country

2009 Central

Gov’t Debt, % GDP

% increase since 1973

2008Tonnes

CO2/Capita

Change in GHG, %

1990 level

Family Policy for

Young ChildrenScore/10

Sweden 38% 5.0 13% 10Norway 26% 7.9 -22% 8Denmark 38% 8.8 -6% 8France 61% 5.7 -12% 8NZ 28% 7.7 18% 6UK 75% 8.3 -18% 5Germany 44% 9.8 -21% 4Switzerland 21% 5.7 1% 3US 53% 18.4 16% 3Australia 8% 18.5 82% 2Canada 36% 133% 16.5 47% 1Source OECD CANSIM IEA UNFCCC UNICEF

Fiscal Debt Enviro DebtIntergenerational Justice

Country

2009 Central

Gov’t Debt, % GDP

% increase since 1973

Sweden 38%Norway 26%Denmark 38%France 61%NZ 28%UK 75%Germany 44%Switzerland 21%US 53%Australia 8%Canada 36% 133%Source OECD CANSIM

Country

2009 Central

Gov’t Debt, % GDP

% increase since 1973

2008Tonnes

CO2/Capita

Change in GHG, %

1990 levelSweden 38% 5.0 13%Norway 26% 7.9 -22%Denmark 38% 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% 5.7 1%US 53% 18.4 16%Australia 8% 18.5 82%Canada 36% 133% 16.5 47%Source OECD CANSIM IEA UNFCCC

Family Debt

Country

2009 Central

Gov’t Debt, % GDP

% increase since 1973

2008Tonnes

CO2/Capita

Change in GHG, %

1990 level

Family Policy for

Young ChildrenScore/10

Sweden 38% 5.0 13% 10Norway 26% 7.9 -22% 8Denmark 38% 8.8 -6% 8France 61% 5.7 -12% 8NZ 28% 7.7 18% 6UK 75% 8.3 -18% 5Germany 44% 9.8 -21% 4Switzerland 21% 5.7 1% 3US 53% 18.4 16% 3Australia 8% 18.5 82% 2Canada 36% 133% 16.5 47% 1Source OECD CANSIM IEA UNFCCC UNICEF

Fiscal Debt Enviro DebtIntergenerational Justice

Family Debt

of BC kindergarten children are vulnerable.Vulnerability above 10% is not biologically necessary.

29%

Most vulnerable children are not poor!

Kindergarten teachers consider

Hold pencilClimb stairs

Follow instructionsGet along with peers

Know 10 letters

Sensitive Periods in Early Brain Development

Vision

0 1 2 3 7654

High

LowYears

Habitual ways of respondingEmotional

control

Symbol

Peer social skillsNumbers

Hearing

Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)

Pre-school years School years

Language

Life Course Problems Related to Early Life

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

Early Vulnerabil

ity

Biological Sensitivity to Context

Preschool School Post School

Age0

Mismatch: Social Investment vs. Health Promotion Opportunity

Cumulative Public Investment

Source: Carneiro & Heckman, Human Social Policy (2003)

Disease Fetish?

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

Historical GDP and Revenue ($ millions)GDP, Revenue and Expenditure: Change over Time

1984 Revenue: 17.7% of GDP

2008 Revenue: 15.3% of GDP

200

180

160

140

120

100

80

60

40

20

0

($) B

illion

s

Healthcare (% of GDP)Healthcare ($ per capita)Health Care Spending: Change over Time

$2.2 billion for BC$

$

$

$

$

$

$

$ 0

%

%%

%

%%

%

%%

%

%%

%

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

$

$

$

$

$

$

$

%

%%

%

%%

%

%%

%

%%

%

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? 

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 PovertyService PovertyIncome Poverty

Reflects appreciation of costs imposed by residential school system; reserves, etc.

15 by15

From the Province:

15%vulnerabl

e

BC Government Strategic Plan for 2008/09 - 2010/11, p. 30

7% of BC Neighbourhoods Meet 15 by 15 Target

>15%<15%

Vulnerable onOne or More Scales

Source: EDI Wave 2 (2004/05 – 2006/07)

Biologically, no neighbourhood should have vulnerability above 10%.

>10%<10%

Vulnerable onOne or More Scales

Source: EDI Wave 2 (2004/05 – 2006/07)

BC: Unique Population Laboratory:

Early Vulnerability Quality of Labour Supply

Kindergarten Population

Grade 4Population

Grade 7Population

Grade 12Population

Criminalactivity

to cut incarceration

by a third

Reduce Early Vulnerability to 10%...

# o

f chi

ldre

n

Score on scale of EDIand

% achieving university eligible grades

Low High

29% 41.5%

University eligiblegradesVulnerability

If Then

At K At G.12

The next generation’s Human Capital

# o

f chi

ldre

n

Score on scale of EDIand

% achieving university eligible grades

Low High

10% 55.6%

University eligiblegradesVulnerability

If Then

At K At G.12

The next generation’s Human Capital

What does the early vulnerability debt cost

BC?

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

0 10 20 30 40 500

200

400

600

800

1000

Years

BC GDP($Billions)

First cohort of 5 year olds benefit from 15 by 15 policy

First cohort graduates

Status Quo (29%

vulnerable)

Reduced vulnerability

(10%) That’s throwing away

$401.5 billion now + interest over 60

years!

We are here

Reduced early vulnerabilityincreases GDP by

20%

Baseline growthBaseline growth plus 0.63% GDP per year

SFP

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

0 10 20 30 40 500

200

400

600

800

1000

Years

BC GDP($Billions)

First cohort of 5 year olds benefit from 15 by 15 policy

First cohort graduates

Status Quo (29%

vulnerable)

Reduced vulnerability

(10%) That’s throwing away

$401.5 billion now + interest over 60

years!

We are here

Reduced early vulnerabilityincreases GDP by

20%

Baseline growthBaseline growth plus 0.63% GDP per year

Smart & Green Family Policy

 2008

Family PolicyCountry Score/10Sweden 10Norway 8Finland 8Denmark 8France 8New Zealand 6Netherlands 5UK 5Germany 4Switzerland 3US 3Australia 2Ireland 1Canada 1

2008 Gender Gap

Ranking3127

1559

13111427248

31

Gender Inequality

Sources: World Economic Forum and UNICEF

Smart Family Policy0 to18 months

Time: improve parental leaveServices: monthly access to health check-

ins and parenting support 0-18 months

Stron

g Sta

rt

Scho

ols

Clinics

Hospitals

Public Health Services

Personal Physicians

Mat

erna

l Chi

ld

Health

Prog

ram

s

Homes

ChildcareNeighbourhood Hubs

Community Services

Libraries

Family Resource Program

Aboriginal ECD

Child & Family Services

Friendship

Centers

Children, parents and familiesWhere are they now?

ChildcareNeighbourhood Hubs

Community Services

Libraries

Family Resource Program

Aboriginal ECD

Child & Family Services

Friendship

Centers

Stron

g Sta

rt

Scho

ols

Clinics

Hospitals

Public Health Services

Personal Physicians

Mat

erna

l Chi

ld

Health

Prog

ram

s

Homes

Welcoming, supportive, accessible environments providing Healthy Child Check-ins (HCC) and

Parental Supports (PS) HCC

& PS

HCC & PS

HCC & PS

HCC & PS

HCC & PS

HCC & PS

trustedpeople

trustedpeopletrusted

people

Smart Family Policy0 to18 months

Time: improve parental leaveServices: monthly access to health check-

ins and parenting support 0-18 months18 months to six years

Time: re-think ‘full-time’ workServices: early learning and care 18

months to school entry (with HCC & PS)0 to six years

Low-income: make work payLow-income: increase welfare

The price of smart family policy...

Funding for Parents

=$1.4

billion

Funding for Community

Services$1.6 billion

Time$648

millionResource

s$750 million

$3Billion/Year

The cost of reducing vulnerability?

Less 5%, because of the progress made, despite recession

$3 Billion Increase in Spending?

Provincial Health Care Spending($ Billions) 1998 - 2008

$3B/5 years

$3B/5 years

The same policy hole

costs BC Business now!

Absence of Smart Family Policy costs BC employers…

Productivity: $293 millionRetention: $674 millionInsurance premiums $ 15 millionParental leave top up $ 20 million

Sub-total $1 billionMinimum wage…Profits to ECEC suppliers & maintenance

The same policy hole

costs Government

now!

Absence of Smart Family Policy costs GovernmentChild welfare: $157 millionW/L stress GPs, emerg, hospitalization: $299 million Prescription drugs $ 26 million Less labour supply & taxes $122 millionSub-total $604 million

ECEC pay equity taxesW/L stress depression unemploymentEarly vuln K-12 costsPoverty health care costs

The same policy hole

costs Society.

Annual crime reduction

savings grow to $500 million,

Year 4-11

Reduce Early Vulnerability to 10%...

Smart Family Policy= Smart Economics

A Just CauseHealth Promotion

But Will We Pursue this Bold Ambition?

Not a Research Question

It’s a question about being Canadian in BC!

Trusted Professions in Canada (2007)

Fire Fighters97%Nurses 94%Farmers92%Teachers89%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 policyCrime reduction policy

Health policyGender equality policyDebt 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)• http://www.earlylearning.ubc.ca/PaulKershaw.htm• e-mail: paul.kershaw@ubc.ca

Parental Leave(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 1,971Germany 1,166 1,054Sweden 1,105 -2,530Quebec -2,548Austria -3,295 -391Czech Republic -5,945 372Slovak Republic -6,958 -2,251Finland -8,468 -4,694Netherlands -8,624 -9,258Spain -9,941 -5,641UK -10,036 -6,274Belgium -10,298 -6,448Norway -10,687 -7,307Canada (outside of Quebec) -10,353 - 11,779 -6,971New Zealand -12,592 -18,999Italy -15,160 -11,653France -16,085 -8,480Australia -16,343 -13,235Ireland -19,044 -10,397USA -23,119 -16,389Japan -24,019 -10,866

Target: $-1,532

Leave

$24635 in Parental Time in year 1$12618 in Parental Time year 2

Supplemented by Healthy Child Check-Ins & Parenting

Support ($1,583)

0.22%

Public expenditure on ECEC services (0-6 years)

in selected OECD countries

Source: Adapted from Starting Strong ll: Early Childhood Education and Care, September 2006, p.11

Denmark

Sweden

Norway

Finland

France

Hungary

Austria

United Kingdom

United States

Netherlands

Germany

Italy

Australia

Canada

0% 0.5% 1.0% 1.5% 2.0%

BCCanada

Canada (outside Quebec)• Few spaces• Insufficient quality • High cost• Inadequate Inclusion

British Columbia• Currently 0.22% of GDP• 0.28% with full school-day K

OECDavg.0.7%

UNICEF & EUbenchmark1.0%

0.25%0.28%

% of GDP

ECEC more parents synchronize earning and

caringHousehold Income above $40k: annual fees =

under 3: $5,100; 3-5: $3,400But 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 servicesOne earner couple: 40 35 hours * 1 parent;

ECEC additional employment time for parent 2.

Low-Income Policy

Chart adapted from the 2010 Child Poverty Report Card, First Call: BC Child and Youth Advocacy Coalition

40% of poor children live with an adult who works

full-time full-year.

Before SFP Hours$

Earning 0 12542 Child Caregiving 2000

(23428)

After SFP Earning 0 22695 Child Caregiving 2000

(23428)

Lone Parent, Child: 0-12 months

Working Poor (2000 Hours in employment year grosses $26,600)

Service Investment: $1,583: Healthy Child Check-ins & Parent Support

Min leave benefit: $440NCBS*4

Lone Parent, Child: 24-36 months

Working Poor (2000 Hours in employment year grosses $26,600)

Before SFP Hours$

Earning 2000 16559 Child Caregiving 0(0)

After SFP Earning 1750 19363 Child Caregiving 250 (2928)

Australia+$7890

Target = $6160, rank 3rd

+$2804

Service Investment: $11,695: ECEC, Healthy Child Check-ins & Parent Support

NCBS*4 +$4.5kECEC +$1.5k

Norw

ayAu

stria

Denm

arkUK

Swed

enGe

rman

yAu

stra

liaNe

thJa

pan

Finl

andNZ

Fran

ceIre

land

Belg

ium

Cana

daUSCz

ech

Spai

nSl

ovak

Italy

-$5,000

$0

$5,000

$10,000

$15,000

$20,000

$25,000

NDI after housing and routine health care

Lone Mother with Toddler on Income Assistance

Canadian Currency (controlling for purchasing power parities)

(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

Income after Average Prov. Urban Rent and Routine Health: Lone Mother + Child Age 2 on Social Assistance (2008)

Target: Child 0-12 months $16,386

Leave/Rental Assistance +HCC & PS

Target: Child 24-36 months

$14,303NCBS/Shelter allowance

International ranking 4th + ECEC (with HCC & PS)

Incentive to leave welfareBefore SFP: $11,808

After SFP: $5,060Leave only for 2 children; must look for work/school when child age 18

months