Executive Summary
Introduction
Key Health Indicators
Challenges Facing Youth
Emerging Issues
Conclusion
Endnotes
Project Team/Acknowledgements
4
6
9
10
20
27
47
49
58
G
ROWING UP IN NORTH AMERICA: CHILD HEALTH AND
SAFETY IN CANADA, THE UNITED STATES, AND MEXICO
The Children in North America Project aims to high-
light the conditions and well-being of children and
youth in Canada, Mexico, and the United States.
Through a series of indicator reports, the project
hopes to build a better understanding of how our
children are faring and the opportunities and chal-
lenges they face looking to the future.
Representatives from the Canadian Council on Social Development, Red por los Derechos de la
Infancia en México (The Children’s Rights Network in Mexico), and the Annie E. Casey Foundation
have come together to create the
Children in North America Project based on our shared inter-
est in the well-being of all children. We recognize that Canada, Mexico, and the United States have
common bonds and challenges in ensuring that our children grow up healthy, not just because of
geography, but also because of increasing economic, social, and cultural interaction.
There are enormous differences in the opportunities children have both within and across coun-
tries. These differences have important implications both for their current well-being and the
extent to which they are equipped or prepared for the future. Our objective is to create aware-
ness of the continent’s children, the groups that are prospering and those that are struggling to
carve out a place in the world.
Knowing that data are a powerful tool to raise awareness and lead to action that benefits children
and strengthens families, a cross-national partnership began. The collaboration became the first-
ever tri-national project on child well-being. All three nations monitor the status of children and
youth in a variety of ways, but most of the work that is being done has a national focus. This
project widens the lens.
The Children in North America Project strives to create a social and economic portrait of North
America’s children, highlighting different dimensions of child well-being against the backdrop of
the changing environments in which children and families are living. The project’s first report,
Growing Up in North America: Child Well-Being in Canada, the United States, and Mexico, pre-
sented a basic demographic profile of children in the region. The report also introduced the three
different dimensions of child well-being that will be considered in this and future reports—health
and safety, economic security, and capacity and citizenship.
Drawing on a variety of national and international sources, the project seeks to document how
c
hildr
en ar
e faring in eac
h country and across North America; develop a baseline against which
to measure and monitor their well-being over time; and build capacity in and across the three
nations to continue the important work of measuring and monitoring the well-being of children.
Preface
4
THE CHILDREN IN
NORTH AMERICA
PROJECT
STRIVES TO
CREATE A SOCIAL AND
ECONOMIC PORTRAIT
OF NORTH AMERICA’S
CHILDREN, HIGH-
LIGHTING DIFFERENT
DIMENSIONS OF
CHILD WELL-BEING
AGAINST THE BACK-
DROP OF THE CHANG-
ING ENVIRONMENTS
IN WHICH CHILDREN
AND FAMILIES ARE
LIVING.
39 million in Mexico, and about 7 million in Canada. They account for over one-quarter of the 426
million people who live on this continent.
Their daily lives are shaped by where they live. They are residents of a continent undergoing
significant change in the way their elders cooperate, do business, and engage with the rest of the
world.
So far, the existing trilateral efforts among the governments of Canada, the United States, and
Mexico have resulted in detailed monitoring and reporting on diverse issues—from textile produc-
tion to shipping to avian flu. But fundamental issues are being ignored. There exists no such
detailed monitoring and reporting on the well-being of those who will have a significant role to play
in achieving future prosperity.
BUT IT IS NOT TOO LATE.
As the relationship among Canada, the United States, and Mexico develops, it creates the oppor-
tunity to ask ourselves if and how continental prosperity is benefiting our most significant asset—
our children.
Does a child raised on this continent have the best chance at health, education, and safety? Will
a child raised on this continent be able to face the challenges that globalization brings—today and
in the future?
Securing the well-being of our young people requires greater cooperation and information
sharing. The tri-national work done for this report through the
Children in North America Project
shows that we have only a partial picture of how our children are doing—there are significant
knowledge gaps that if better understood could help us make wise and cost-effective decisions
in support of children and youth.
Inf
ormation about c
hild health forms the basis of this report. Good health is an essential factor if
children are to live to their fullest potential. Children in North America share a number of similar
experiences when it comes to their health and well-being. While the context of their lives varies,
and ther
e ar
e some differences in the health challenges they face, there are surprising similarities
across the continent. In fact, there are a number of critical health problems that could profitably be
addressed through tri-national initiatives.
Executive Summary
6
GOOD HEALTH IS AN
ESSENTIAL FACTOR IF
CHILDREN ARE TO
LIVE TO THEIR
FULLEST POTENTIAL.
CHILDREN IN NORTH
AMERICA SHARE A
NUMBER OF SIMILAR
EXPERIENCES WHEN
IT COMES TO THEIR
HEALTH AND WELL-
BEING.
Obesity All three countries report that the rates of obesity and being overweight among young
people are too high—between 26 percent and 30 percent. However, there is a significant paradox
surrounding this health problem. In Canada and the United States, obesity rates are soaring, yet
a number of children live with hunger. In Mexico, while growing numbers of children are becom-
ing obese, malnutrition and anemia continue to be significant health problems.
Respiratory Illness Respiratory illness has become epidemic in large portions of North
America. In some regions of the continent, there has been a fourfold increase in asthma preva-
lence in the last 20 years. Air pollutants know no boundaries—making this issue of primary
concern to all governments.
Chemical Exposure Continued exposure of some children to lead in their environment—a
well-known neurotoxin—is having serious effects on their development. And experts have
increasing concerns about children being exposed to chemicals in the environment and resultant
neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD). The North
American Commission for Environmental Cooperation’s (CEC) children’s environmental health
indicators initiative was making important progress in coming to grips with the scale of this
problem. However, this important children’s environmental health indicators initiative was recently
cancelled.
Mental Health All three countries have identified depression as a serious mental health
problem among youth. They have all reported concerns about eating disorders. While the three
countries have different measures of mental health and illness, all three recognize that better data
and measures are needed to address this issue.
Cancer For all thr
ee countries
, cancer is the second leading cause of death f
or c
hildren age 5
to 14. Children in Mexico are more likely to die from leukemia (and other types of cancer) than
are children in Canada and the United States. It is critical to share knowledge and experience
acr
oss the continent to benefit the c
hildr
en of Mexico
.
Safety and Security Unintentional injury remains the leading cause of death in all three coun-
tries among children and youth over the age of one—and it takes a considerable toll on the teens
and young adults of all thr
ee nations. In 2000, more than 21,000 young North Americans age 15 to
24 years died as a result of unintentional injuries, many of which were preventable. These
accounted for 41 percent of all deaths in this age group.
7
Intentional injuries—or homicide and assault—are significant problems also. While the rates of
homicide are much higher in Mexico and the United States, Canada has reported increasing homi-
cides in recent years. Across North America, homicides claimed the lives of over 7,500 youth age
15 to 24 in 2000. Bullying also has been identified as a significant problem in both the United
States and Canada—where more than one-quarter of 11-year-old girls and more than one-third of
11-year-old boys reported bullying other children.
Health Disparities Across the continent, significant health disparities exist. In Canada,
Aboriginal children rank with many children in the developing world on several key indicators,
including infant mortality and injury deaths. In Mexico, children living in rural and indigenous
communities experience worse health outcomes than those who live in cities. And, in the United
States, children of color suffer poorer health on a number of indicators.
Children’s health and security demand our attention. The United Nations Convention on the Rights
of the Child recognizes the right of children to enjoy the highest attainable standard of health and
to have access to health care. It states that every child has the right to a standard of living
adequate for their development, including nutrition. While parents have a primary responsibility to
secure the conditions to ensure the health of their children, governments and society overall have
committed to assist parents in providing for these rights.
Decision-making without data is a recipe for costly mistakes. As leaders work to maximize the
opportunities of a North American partnership, they need to consider a key factor—the future of
the continent’s children and youth. Security and prosperity are more complex than improving
transportation across borders and developing common industrial standards. They require a sus-
tainable plan for the future of children and youth. Investing in this now will help ensure that North
America is “the safest and best place to live” for all of our children and youth.
E
XECUTIVE SUMMARY
8
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D
This report continues the story from the project’s first publication, Growing Up in North America:
Child Well-Being in Canada, the United States, and Mexico
, and presents an overview of the
health and safety of children in North America. It is based on the ecological indicator model that
was developed for the
Children in North America Project.
The project’s first publication provided an overview of the status of children within and across the
three countries in North America and gave critical baseline information from which policymakers,
politicians, and children’s advocates can make good decisions—to ensure that our children and
youth have the quality of life and the life prospects to which they are entitled. This report—the first
of three more specialized reports—examines 58 health and safety indicators, which are organized
according to the environments that influence children’s development and impact their well-being.
The complete list of indicators and a more detailed fact sheet can be found on the project’s
website at www.childreninnorthamerica.org.
This report highlights basic indicators such as infant health, death rates, and access to health serv-
ices; points to emerging and sometimes worrisome health issues in the three nations such as
mental health and nutrition; and examines some particularly challenging issues facing youth in
North America.
Introduction
9
A GOOD START IN LIFE
In 2004, more than 6,660,000 babies were born in North America. Just over 60 percent of these
babies were born in the United States, 33 percent in Mexico, and 5 percent in Canada. Between
1994 and 2004, the number of babies born in the United States increased slightly (by just over 4
percent) while Mexico and Canada saw a decrease—11 percent and 25 percent, respectively.
1,2
Health during pregnancy, birth, and infancy provides the foundation for optimal development and
well-being throughout childhood and youth. At the same time, this is a period of increased
vulnerability for women, babies, and families. Therefore, providing the conditions for healthy
pregnancies and births is a critical factor in promoting the health and well-being of all North
American children.
The continent has witnessed improvements in infant health in many areas. However, there is still
a way to go. Three important indicators provide a picture of the well-being of babies—infant
mortality, low birthweight, and breastfeeding.
Infant Mortality Infant mortality is a basic indicator of the well-being of a population and of
the health status of the children. According to data from the Organization for Economic
Cooperation and Development (OECD), a collaboration of 30 member countries sharing a com-
mitment to democratic government and a market economy, Mexico’s infant mortality rate was the
highest at 20.5 per 1,000 live births in 2003 (this is also the second highest rate in the OECD).
Canada had the lowest infant mortality rate of the three countries in 2003 at 5.3 per 1,000 live
births
. The United States rate stood at 6.9 deaths per 1,000 live births in 2003, above the OECD
average of 5.7.
3
Since 1970 there has been a dramatic decline in infant mortality rates in all three nations. Mexico’s
rate has declined 75 percent over that time period. It is speculated that this is a result of two impor-
tant factors—an increase in universal immunization coverage of babies and a decline in the rates
of respiratory and digestive infections.
While Canada’s rate has declined overall by 7
0 per
cent since 1
970, there has been virtually no
decline since 1998.
4
The infant mortality rate in the United States has also fallen greatly since 1970,
but not as muc
h as in Canada and Mexico
. After several decades of consistently falling infant mor
-
t
ality rates in the United St
ates, improvement has stalled.
5
In fact
, in both Canada and the United
States, the 2002 infant mortality rate worsened slightly—while the rate continued to fall in Mexico.
And while this may be a one
-
time blip
, it r
emains tr
oubling
. In both Canada and the United States,
an incr
easing rate of pr
eterm births (babies born before 37 weeks) is a significant contributor to
the rates of infant mortality. The preterm birth rate is trending upward as a result of a number of
Key Health Indicators
10
THREE IMPORTANT
INDICATORS PROVIDE
A PICTURE OF THE
WELL-BEING OF
BABIES—INFANT
MORTALITY, LOW
BIRTHWEIGHT, AND
BREASTFEEDING.
THE CONTINENT
HAS WITNESSED
IMPROVEMENTS IN
INFANT HEALTH IN
MANY AREAS.
HOWEVER, THERE IS
STILL A WAY TO GO.
factors—one being the use of reproductive technology leading to multiple births. Between 1990
and 2002, there was a 42 percent increase in the multiple birth rate in the United States.
6
In
Canada, the rate increased steadily from 2.1 percent of births in 1991 to 2.7 percent in 2000.
7
The
infant mortality rate is also influenced by mothers having babies at later ages, by obstetricians
intervening to deliver babies earlier when the fetus is in jeopardy, and by complications attributed
to a lack of early, consistent prenatal care for some women.
8
The two leading causes of infant death are similar across the continent: conditions that arise in the
perinatal period (the period around birth) and congenital anomalies (birth defects). However, in
Canada and the United States, the third leading cause is sudden infant death syndrome (SIDS).
9
SIDS deaths are strongly associated with socioeconomic and environmental conditions. In Mexico,
respiratory diseases and infectious diseases rank third and fourth—these conditions may be a
reflection of social and environmental conditions and limited access to health care.
1
0
Within this context of declining infant mortality rates in all three countries, there are disparities.
For example, in Mexico, infant mortality in the poorest southern states (Chiapas, Oaxaca, and
Guerrero) is about 50 percent higher than the rate of Mexico City and the state of Nuevo León in
the north. In the United States, the infant mortality rate for African Americans is more than twice
the rate for non-Hispanic whites.
11
In Canada, the infant mortality rate among the First Nations
12
population is 1.5 to 2 times that of the general Canadian population.
13
And Canadian babies born
to women in low-income
neighborhoods are 1.6
times more likely to die
in their first month of
life than those in high-
income neighborhoods
.
14
Low Birthweight Low
birthweight is a key
determinant of infant sur
-
vival, health, and devel-
opment. Babies born
weighing less than 2,500
grams (
about 5.5 pounds
)
have a high pr
ob
ability of
having dis
abilities
.
15
T
hey
ar
e mor
e likely to die
during their first year of
11
INFANT MORTALITY RATE (DEATHS PER 1,000 LIVE BIRTHS)
CANADA, MEXICO, AND THE UNITED STATES — 1990 TO 2003
Source: OECD Health Division, www.ecosante.fr/OCDEENG/11.html.
1990 ’91 ’92 ’93 ’94 ’95 ’96 ’97 ’98 ’99 2000 ’01 ’02 ’03
MEXICO
UNITED STATES
CANADA
5
0
10
15
20
25
30
35
40
20.5
6.9
5.3
life. For example, in the United States the risk of dying during the first year of life for low-
birthweight babies is nearly 25 times that for babies of normal birthweight.
16
The rate of low birthweight has slowly but steadily increased in the United States—by 18 percent
between 1984 and 2003. In fact, the 2003 rate (7.9 percent) was the highest since 1972.
17
In
Canada, in 2001, 5.5 percent of babies born were low birthweight. The rate of low-birthweight
babies has not decreased appreciably in Canada since 1979.
18
The biggest contributor to this sit-
uation (as mentioned earlier) is an increase in preterm births in both Canada and the United
States.
The proportion of Mexican babies with low birthweight has been consistently decreasing—from
9.5 percent in 1999 to 6.1 percent in 2001. However, researchers and experts advise that these
figures should be interpreted with caution, since in many situations the baby’s weight is
estimated.
19
Breastfeeding Breastfeeding is an important contributor to children’s health. Breastfed babies
are more likely to have healthy brain and nervous system development and be protected against
infectious diseases. They are less likely to die from sudden infant death syndrome (SIDS), or
develop diabetes, asthma, and obesity.
20
,21
While the way each country measures breastfeeding differs, it appears that Mexico has the highest
rates of breastfeeding, followed by Canada and then the United States. It is encouraging that in
all three countries the rate of
breastfeeding is increasing.
Once again, there are varia-
tions within the countries.
Mothers who live in rural
Mexico and those who speak
an indigenous language ar
e
more likely to breastfeed
than ar
e those in urb
an ar
eas
and those who ar
e not indige
-
nous.
22
The most educated
women ar
e slightly less likely
to br
eastf
eed than the least
educated. However, in the
12
K
EY HEALTH INDICATORS
BREASTFEEDING IN CANADA, THE UNITED ST
ATES, AND MEXICO—TRENDS
OVER TIME
CANADA* 1995 2003
Percentage of women age 15 to 55 who had a baby in 75% 85%
the previous five years and initiated breastfeeding
UNITED STATES** 1990 2003
Percentage of women with a baby between one and 12 months 52% 66%
of age who breastfed their infant in the hospital
MEXICO*** 1972 1997
Per
centage of infants who have been br
eastfed consistentl
y— 83% 90%
that is received only mother’s milk
Sources: *Public Health Agency of Canada, Making Every Mother and Child Count: Report on Maternal and Child
Health in Canada, Ottawa: Public Health Agency of Canada, 2005. **Ross Products Division of Abbott
Laboratories, “Breastfeeding Trends: 2003,” accessed online at www.ross.com/images/library/BF_Trends_2003.pdf,
on July 26, 2006. ***Estimations of the Consejo Nacional de Población (CONAPO), based on the ENADID, 1997.
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