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Wednesday, March 21, 2012

Social Pediatrics in Saskatoon: More than Medicine

It is no secret that, in recent years, health care costs have been spiraling out of control, yet the state of Canadians’ health is not keeping pace. At a time when necessity is prompting more open discussion around health innovation and governments are demanding lower costs, a call can be heard for investment in preventive care. Today, an emerging initiative in Saskatoon—social pediatrics—offers a glimpse of the potential return on that investment.

Social pediatrics is an innovative medical approach that falls outside the boundaries of traditional medicine or social services.  It provides multidimensional, targeted care to children and their families who are likely to develop chronic illness. “These are children who do not get the care they need in busy clinics, the ‘problem’ children who are frequently abandoned by the system,” wrote Canadian pediatrician Dr. Gilles Julien in his flagship book A Different Kind of Care: The Social Pediatrics Approach.

Chronic health problems such as HIV/AIDS, type 2 diabetes, and mental illness are endemic to modern cities, and their etiology for most begins in childhood – practically at birth. Statistics reveal that residents of Saskatoon’s six poorest neighbourhoods are nearly 15 times more likely to commit suicide and nearly 20 times more likely to use illegal drugs than their more affluent counterparts. Further, their infant mortality rates parallel those of developing nations. Yet, the consequences of failing to care for at-risk youth do not lie solely within the realm of health outcomes. These same individuals are also at increased risk for dropping out of school, detention in the juvenile justice system, addictions, and chronic unemployment—social problems that exacerbate a cycle of poverty and disease. To envision and then promote a healthy population rising from these circumstances requires unusual insight and dedication.

In 2007, a partnership between the University of Saskatchewan Department of Pediatrics, the Saskatoon Tribal Council, and the Greater Saskatoon Catholic School Division precipitated a social pediatrics clinic at St. Mary Community School. There are now three such school-based clinics (St. Mary, St. Mark, and W.P. Bate), all focused on improving access to care for inner-city youth and tending to both their medical and psychosocial health needs. A pediatrician is directly available to all families without the need for referral from a family physician. To date, over 1000 children and adolescents have accessed these clinics, and most continue to follow-up. A fourth clinic will open at E.D. Feehan High School later this year.

One of the main goals of the social pediatrics approach, says Dr. Maryam Mehtar, a Saskatoon pediatrician involved with the clinics, is the creation of social capital. “When you or I get sick, we have no limit to the places we can go or the people who can help us. Intergenerational poverty simply doesn’t afford people the necessary resources to cope, and social exclusion compounds the problem.”

By immersing herself in the environment of her patients, Dr. Mehtar takes an essential step toward understanding their needs. She believes that neglect due to poverty creates an environment that adversely affects childhood development and carries considerable weight in establishing chronic disease in future adults. This lies at the heart of improving the standard of medical and social care for Saskatoon children and adolescents.

Now is the time for innovation to shape the future of health care in Canada. The success of our health care system depends less on our challenges than on our response to them. Thanks to an imaginative partnership that established school-based health clinics in Saskatoon, our city can take some credit for the development of an economical and effective medical advancement – the social pediatrics approach. It is an example of what preventive medical care can look like for young people across the country. Those with an eye to the future of primary health care, take note.

Alexander Dyck and Ingrid Wirth are medical students at the University of Saskatchewan who were shortlisted in our Health Innovation Challenge. This op-ed was also featured on the StarPhoenix.

Key Words: Health Innovation Challenge, Primary Health Care

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