1. The early years – Health equity from the start May 28, 2014 Patricia Daly Chief Medical Health Officer Vancouver Coastal Health

2. Our Health Care Report Card 30 measures of overall health system performance and population health Early Childhood Development Index Time frame: 2011-2013 Target: ≤ 29.5% Year to date: 33% http://www.vch.ca/about_us/accountability/report_card/report_card

5. Vancouver EDI

8. Vulnerability Rates BC & Vancouver 2001-2013

9. Vancouver EDI – 2011-2013 ScaleVancouver - LowVancouver - High Physical Health & Well-Being 4% Marpole, Uni Lands 28% G/W, Strathcona Social Competence 6% Kitsilano 27% Kerrisdale Emotional Maturity 6% University Lands 25% Strathcona Language & Cognitive Development 1% West Point Grey 16% Grandview Woodlands Communication Skills & General Knowledge 8% Kitsilano 30% Renfrew Collingwood Kitsilano: 18% Strathcona: 52%

11. Developmental Trends - VCH Physical health & well-being Social competence Emotional maturity Language & cognitive development ↑ Communication skills and general knowledge

12. Language & Cognitive Development “Strong Start” programs Early literacy coordinators in every community Libraries Pre-schools and daycares

13. VCH Early Childhood Development Framework 1.Creating healthy environments

14. VCH Early Childhood Development Framework 2.Facilitating community capacity

15. VCH Early Childhood Development Framework 3.Prevention, early risk identification and intervention

16. Issues - Access Can vulnerable clients access services? Strategies: –Earlier referrals –Outreach strategies: Toddler Assessment Program for immigrant and refugee groups –Cultural competency –Client supports: Meals, transportation –Friendlier formats

17. Issues – Identifying the Vulnerable Can we find vulnerable mothers and children? Strategies: –Pre-natal classes, physicians, midwives –Targeted and universal approach: Most vulnerable children are not in vulnerable neighbourhoods –Proportionate universalism? VCH Objective: Reduce health inequities in the populations we serve

18. Issues – Enough Support Do we provide enough services for long enough? Strategies: –Services for children 1-5 years –Parent infant groups –Parent education and skills –Parent mental health services –Collaborative, multidisciplinary approach

19. VCH – Target Population 9,500 births per year –Healthiest Babies Possible Support up to age 18 months Newcomers, mothers living in poverty –Yippee Support up to age 2 years Mothers ≤ 24 years old –Nurse-Family Partnership Support up to age 2 years First time mothers living in poverty } 500 – 600 babies per year 72 babies per year at target }

20. Lessons Learned  Public health not enough Helps individual children and families  Community capacity building important  Broad policy changes essential Investment in early child care

21. Acknowledgements Joanne Wooldridge – Regional Leader, Early Childhood Development Lianne Carley – Policy Consultant, Population Health John Carsley – Medical Health Officer