The Chief Public Health Officer's Report on the State of Public Health in Canada, 2011

Chapter 2: Setting the Stage for Healthy Life Transitions – A Public Health History

Investing in continued good health and well-being, from early childhood into adulthood, is a responsibility shared by many sectors of Canadian society, including federal, provincial/territorial and municipal governments as well as non-governmental and community organizations. Over time and in part due to investments in public health and improving socio-economic conditions, Canada has set the stage for a healthy population. These sectors have also worked to promote optimal childhood development. As a result of these measures, many young Canadians are in good health and making a mature and healthy transition into adulthood.

Through select key milestones, this chapter takes a historical look at some of Canada's many successes and challenges in setting the stage for healthy transitions among youth and young adults. It explores and defines some key public health terms relevant to maintaining good physical and mental health throughout the transitions of youth and young adults. It also highlights policies, developments and difficulties that have influenced the health of youth and young adults and points to some broad challenges that lie ahead.

Public health and the lifecourse approach

The lifecourse is a path that an individual follows from birth to death.Footnote 30, Footnote 31 This path can change or evolve at any life stage and varies from person to person depending on biological, behavioural, psychological and societal factors that interact to influence health outcomes.Footnote 30, Footnote 31 Social standards, such as significant life events, cultural norms and social roles, can also mark life stages.Footnote 10 These factors interact to influence health outcomes – both positively and negatively – and can result in individuals beginning and progressing through life stages at different times and rates. For this reason, the life stages experienced by youth and young adults continue to be fluid and the boundaries between childhood and adolescence or between adolescence and adulthood vary from person to person.Footnote 31-33

Public health uses the lifecourse approach as a tool to understand the links between time, exposure to a factor or combination of factors, experiences and later health outcomes. The lifecourse approach can help identify and interpret trends in the health outcomes of a population and the links between life stages.Footnote 30, Footnote 31, Footnote 33-36 Using this approach, measures can be put in place to create conditions for optimal population health and well-being.Footnote 31, Footnote 33, Footnote 34

Lifecourse transitions of youth and young adults

The transition from childhood to adulthood is an important developmental stage. The onset of puberty (biological and psychological change and development) often marks the beginning of this period.Footnote 10, Footnote 32 It is also a time of changing social roles and relationships as individuals begin to move away from relying on the judgment and authority of adult mentors (e.g. parents, teachers) to that of peers. Young Canadians begin to foster greater autonomy and independence and develop a stronger sense of who they are and who they want to be.Footnote 32, Footnote 37 As well, the transition from childhood to adulthood is a time of changing experiences and expectations as youth and young adults progress and develop through various life stages (e.g. completing school, obtaining full-time employment).

Today, there is increasing diversity in the sequencing, timing and success of youth transitions into adulthood.Footnote 38, Footnote 39 Life transitions of youth and young adults are more fluid and less clearly defined, thus shifting the life stages and patterns most typically associated with these two age groups.31-33 Compared with previous generations, many young Canadians today are taking longer to make key life transitions and are spending more time at each life stage, ultimately delaying their pathway into adulthood. Current life transition patterns are marked by later completion of education, entrance into the full-time labour force, home leaving, marriage or co-habitation and childbearing.Footnote 37, Footnote 38, Footnote 40 These changes are consistent with the shifts taking place in most industrialized countries.Footnote 40 Today, youth and young adults have more choices and opportunities to grow, develop, learn and transition into adult roles within society. As a result, these changes have modified the life stages, opportunities and risks encountered by youth and young adults in developing and progressing into adulthood.Footnote 38, Footnote 40

However, this is not the case for all young Canadians. For vulnerable youth and young adults who face additional challenges and have fewer supports to rely on, this transitional period can be more complex (see the section "Health inequalities and vulnerable youth and young adults").Footnote 39

Factors that influence health

At every stage of life, health is directly or indirectly influenced by key determinants of health.Footnote 10, Footnote 41-44 In turn, each of these determinants are important for optimal health and well-being. Individual behaviours also influence health outcomes. Although behaviours are based on individual choices, the determinants of health can also influence the choices individuals have available to them. Further, the complex interaction among these determinants can influence the health outcomes, development and life transitions of individuals and communities.Footnote 41, Footnote 45

Determinants of health

  • income and social status
  • social support networks (e.g. family, peers)
  • education and literacy
  • employment and working conditions
  • social environments (e.g. community,
    workplace)
  • physical environments (e.g. housing)
  • personal health practices and coping skills
  • healthy child development
  • biology and genetic endowment (e.g. sex)
  • health services
  • gender
  • culture (e.g. Aboriginal status, racial and cultural identities)Footnote 41

Within the broader determinants of health, socio-economic factors such as income, education or employment, often referred to as the "social determinants of health" can cause or influence the health outcomes of individuals and communities.Footnote 11, Footnote 45 These factors relate to an individual's place in society – the circumstances in which people are born, live, work, play, interact and age.Footnote 46 Often these factors are influenced by wealth, status and resources that, in turn, also influence policies and choices leading to differences in the health status experienced by individuals and populations.Footnote 46

Further, the social environment (families, schools, peers, workplaces and communities) and behaviours can influence health outcomes and life transitions of youth and young adults.Footnote 10 Positive experiences and social connections during youth and young adulthood are related to securing and maintaining overall health and well-being.Footnote 10, Footnote 47 For example, being involved in community and extracurricular activities in a variety of growth-promoting experiences has been linked to positive social development, academic success, school attachment, a sense of well-being and reduced involvement in risky behaviours.Footnote 48 Further, having close friendships with peers is associated with positive emotional health and social adjustment and may influence the degree to which young people become involved in health promoting or health-compromising behaviours.Footnote 45

Health inequalities and vulnerable youth and young adults

Health inequalities are differences in health status experienced by various individuals or groups in society. These can be the result of genetic and biological factors, choices made or by chance, but often they are due to unequal access to key factors that influence health, for example, income, education, employment and social support.Footnote 49, Footnote 55

Good health is not shared equally by all Canadians. Some Canadians face health risks and considerable social and economic challenges and, as a result, can have poorer health outcomes.Footnote 49-51 In general, health status follows a gradient where people in less advantageous socio-economic circumstances are not as healthy as those at each subsequently higher socio-economic level.Footnote 49, Footnote 51, Footnote 52 In other words, those with the lowest incomes and education levels, who live in inadequate housing, work in poorer conditions, have limited access to health care and lack early childhood support and/or social support are more likely to develop poorer physical and mental health outcomes than those living in better circumstances.Footnote 41, Footnote 42, Footnote 49, Footnote 51 They are also less likely to participate in community and extracurricular activities which have been found to be health promoting.Footnote 53, Footnote 54 These differences in health status are often referred to as health inequalities.

The effect of social and economic status and/or differential access to health care, education, employment and housing can contribute to inequalities in health outcomes at every stage of life, including for youth and young adults.Footnote 41, Footnote 56 Differences in health status resulting from poorer socio-economic circumstances may affect the lives of young people, limit or modify their choices, opportunities and challenges, and ultimately influence their ability to make successful and healthy life transitions into adulthood.Footnote 56 Further, social exclusion that can result from discrimination can also lead to health inequalities. Poorer socio-economic circumstances and social exclusion can entrench feelings of helplessness, hopelessness, alienation and mistrust among vulnerable populations and can increase the likelihood of adopting unhealthy or risky behaviours.Footnote 57-59

Young Canadians constitute an increasingly diverse sub-population marked by differences in income, living conditions, geographical location, level of education, employment, ability, age, sex, gender, sexual orientation, Aboriginal status and racial and cultural identities. These differences expose young Canadians to various stressors and risks that influence vulnerability to adverse health outcomes.Footnote 44 By addressing inequalities early in the lifecourse, it is possible to help young Canadians achieve optimal health during their developmental years, diminish and/or reverse unhealthy living practices, mitigate any risky behaviours and ease the transition from one life stage to the next, ultimately promoting positive lifelong health.Footnote 10, Footnote 60 Given that health behaviours are influenced by an individual's socio-economic environment, understanding the differences in health status is essential to identifying and implementing solutions for vulnerable populations.

Canada's history of promoting healthy life transitions

Examining Canada's many successes and challenges in establishing healthy life transitions for youth and young adults is a complex undertaking. It is important to consider all of the broad public health improvements and social investments over the last 100 years for the population as a whole as well as those specific to children, as these have had the greatest cumulative effect on health outcomes across the lifecourse.Footnote 30 Events, experiences and changes that affect health are important throughout an individual's life, but childhood is the most critical period in which to establish the foundations for good health and well-being. As explored in The CPHO's Report on the State of Public Health in Canada, 2009, establishing good health in the earliest stages of the lifecourse can make it easier to maintain a positive health trajectory. Canada has made substantial progress in supporting healthy starts for children and, as a result, in improving and maintaining healthy transitions for youth and young adults.Footnote 30 Canada has also made considerable progress in directly improving the health and well-being of youth and young adults.Footnote 30

This is not a complete historical account of all public health advancements. For a more detailed history of public health in Canada, see The CPHO's Report on the State of Public Health in Canada, 2008, 2009 and 2010.Footnote 30, Footnote 36, Footnote 49

1900-1950

Rising concern for the health and well-being of children and youth in Canada goes back to the early 1900s, with the growth of public health education, improvements in hygiene and sanitation, immunizations and implementation of medical inspections within the school system.Footnote 30, Footnote 36, Footnote 49, Footnote 61-63 During this time, many diseases and/or injuries in youth and young adults were also associated with unsafe workplaces or hazardous occupations. Measures were introduced to help regulate the conditions and standards of employment and to protect the health and safety of workers.Footnote 64 Labour laws concerning the employment of children and youth were established to both protect young Canadians from harsh working conditions and to encourage them to pursue an education.Footnote 65, Footnote 66 In addition, by 1910, many provinces across the country had implemented compulsory school attendance.Footnote 67

During the First World War, the threat of sexually transmitted infections (STIs) – mainly syphilis and gonorrhea – were a major public health concern since diagnosis and treatment were often insufficient and ineffective. As a result, a number of public health education initiatives were introduced to help mitigate this issue, including the establishment of the Canadian National Committee for the Control of Venereal Diseases in 1919. Proposals to educate young people in schools and universities on sexual health, including STIs emerged across North America, however at that time, there was much debate about whether sexual health education should be introduced into school curriculums.Footnote 61

Fuelled by the devastation of the First World War and the Great Depression, priorities for public health in the 1920s and 1930s were driven by demands for improvements in child and maternal health; sanitary conditions at home and in schools; food safety (e.g. pasteurization of milk); managing infectious disease outbreaks (e.g. tuberculosis, typhoid, diphtheria, polio); and continued efforts to implement broad sexual health education and prevention programs across the country. As Canada's social and economic foundations continued to change and evolve, with industrialization and the transition from a rural to an urban society, the health of children and youth living in rural communities gained greater attention. Rural communities had limited public health services, schools received fewer medical inspections, and home sanitation and plumbing were usually poor or non-existent. Although the public health challenges were evident, the Great Depression had slowed industrialization and modernization, which in turn also hindered the provision of public health services and infrastructure. Many of these health concerns persisted and/or worsened into the next decade.Footnote 61

During and after the Second World War, many Canadians struggled to access and afford good quality food.Footnote 61 Canada's first national food guide, then called the Official Food Rules, was introduced in 1942 to help prevent nutritional deficiencies during wartime food rationing and improve the health of Canadians.Footnote 68 Concern over the production, processing and distribution of food products, especially of packaged, ready-to-eat food was growing. Public schools were once again used to educate youth, this time on food preparation and sanitation. However, assessing the safety of food grew increasingly complex as new chemical, biological and technological tools were being used to preserve the quality and shelf life of food. Along with nutrition initiatives, a broad national health education and physical fitness initiative was launched to promote healthy living among children and youth. In 1943, the government implemented the National Physical Fitness Act, established the National Council on Physical Fitness and provided grants to the provinces for local health education initiatives.Footnote 61

1950-Present

Following the Second World War, Canada experienced unprecedented growth in both the labour force and the rate of industrialization in Canada. New technologies, coupled with a decline in unskilled jobs, created increased demand for skilled workers.Footnote 40, Footnote 61, Footnote 69 Workplace restructuring required workers to be better trained or else multi-skilled and flexible, to support economic growth and greater productivity.Footnote 70 For many young Canadians, more education and training was necessary after high school to acquire the knowledge, experience and skills needed in the employment market and to secure a job.Footnote 70 However, as time progressed, many youth and young adults struggled to afford post-secondary education and find employment upon graduation.Footnote 37

Education was, and continues to be, an expensive investment in a young adult's future.Footnote 37 As demand for and cost of post-secondary education grew, federal and provincial/territorial governments took a more prominent role in helping Canadians pursue and finance post-secondary studies. The Canada Student Loans Program was established in 1964 to help post-secondary students who demonstrated financial need pay for their education.Footnote 71 Financial support, in the form of loans, scholarships and bursaries, was also made available through provincial/ territorial governments, private-sector contributions and financial institutions nation-wide.

Upon completion of school, many graduates had difficulty finding jobs, in part due to their lack of sufficient work experience. Young Canadians faced a common dilemma: not getting hired due to a lack of work-related experience, which in turn resulted in not gaining the necessary work experience.Footnote 72 This situation was exacerbated during times of economic crisis, when there was more competition for jobs.Footnote 73 Job creation initiatives, such as the Service Canada Centres for Youth, were introduced in 1968 to assist students and recent graduates in developing skills and work experience.Footnote 74

As more young Canadians entered the workforce – either part-time to help supplement the cost of post-secondary education while in school or full-time upon graduation – there was greater need for measures to protect young workers from injuries in the workplace. Each province and territory enacted laws and regulations prohibiting or restricting the employment of children and youth from work likely to be harmful to their life, health, education, and physical development. Provincial/territorial legislation also provided for mandatory school attendance (until at least 16 years of age), restricted hours of work and set minimum wages for employment.Footnote 75, Footnote 76 In addition, federal workplace health and safety legislation such as the Canada Labour Code, Canada Occupation Health and Safety Regulations, Canada Labour Standards Regulations and the Workplace Hazardous Materials Information System (WHMIS) were established. Organizations, such as the Canadian Centre for Occupational Health and Safety (CCOHS), were created to promote health and safety in workplaces across Canada through education and training.Footnote 77-82 More recently, initiatives (e.g. Young Workers Zone) have been developed to educate young workers on safety and to prevent injuries in the workplace.Footnote 77, Footnote 83

In the 1960s, there were mounting concerns about safety on the roads due to the increasing incidence of motor vehicle collisions.Footnote 61, Footnote 84 Throughout the 1970s and 1980s, a wide range of road safety measures were introduced, such as mandatory seat-belt use, safe driving campaigns and traffic law enforcement initiatives. This contributed to a reduction in road traffic fatalities in the following decades.Footnote 85, Footnote 86 Many provinces such as British Columbia, Alberta, Ontario and Nova Scotia introduced a form of graduated licensing to allow new drivers to gradually learn and establish safe driving practices. Provincial/ territorial governments also set a legal driving age to enhance road safety for all road-users, with most restricting the minimum driving age to 16 years.Footnote 87-91 New drivers were encouraged to take accredited driver training programs that taught road safety and good driving skills. More recently, provincial/territorial governments such as British Columbia and Ontario have developed a series of improvements and stronger standards for beginner driver courses, driving schools and driving instructors.Footnote 92-95

Campaigns against drinking and driving also gained increased momentum and attention during this period. Social marketing techniques and awareness campaigns, for example, Ontario's Reduce Impaired Driving Everywhere (RIDE) and arrive alive DRIVE SOBER programs, were launched to encourage Canadians to obey road safety regulations and driving laws and to change perceptions on the acceptability of drinking and driving.Footnote 61, Footnote 96, Footnote 97 North American organizations such as Mothers Against Drunk Driving (MADD) and Students Against Destructive Decisions (SADD) were formed to create networks of leaders, educators and peers dedicated to delivering awareness-raising activities and prevention.Footnote 98, Footnote 99 Despite these efforts, impaired driving continues to be an issue among young drivers.Footnote 100, Footnote 101 More recently, some provincial/territorial governments have implemented traffic regulations against the use of hand-held mobile devices while driving to reduce the number of injuries and fatalities as a result of driving distracted.Footnote 102

In the following decades, a number of public health challenges emerged and/or grew. By the early 1980s, human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS), first appeared in Canada among the gay male population and those infected through contaminated blood. In response to the health crisis, measures were created to improve the safety of the blood supply.Footnote 103 While a number of small, community-based organizations were founded, such as AIDS Vancouver and the AIDS Committee of Toronto, initial public health responses to AIDS were fragmented, unco-ordinated and ineffective. There was also a reluctance to act due to the social tensions and attitudes around homosexuality, condom distribution in schools and sexual health education.Footnote 61, Footnote 103 As the threat of HIV and AIDS grew, governments at all levels, health-care professionals, researchers, non-governmental organizations and community volunteers became involved.Footnote 103, Footnote 104 Globally, an AIDS pandemic led to public information and awareness campaigns and the development of medical treatments that helped to manage the health-related conditions of people with HIV and AIDS.Footnote 61, Footnote 103-105 However, it had also become evident that the spread of HIV – and its impact on individuals – was influenced by social, economic and political factors as well as biological conditions.Footnote 103 By the early 1990s, the federal government had recognized the need for a more solid, strategic and interconnected approach to HIV and AIDS and launched the National AIDS Strategy, which was replaced by the Canadian Strategy on HIV/AIDS in 1998.Footnote 106

Since the Second World War, the rates of teen births and teen pregnancies slowly declined.Footnote 107, Footnote 108 The decline in teen births and teen pregnancy can be attributed to several factors including an increase in the availability and use of contraceptives, legalized abortion, changing social values and an increase in awareness of risks associated with unprotected sex.Footnote 61, Footnote 109-112 Departments of health across the country established, conducted and supported sexual and reproductive health programs as an integral part of comprehensive health care. These programs provided information, counselling, education and services to all individuals, including young men and women.Footnote 109 Advocacy organizations, such as Planned Parenthood Federation of Canada (now known as the Canadian Federation for Sexual Health), were founded to advance education and awareness on sexual and reproductive health issues.Footnote 113

In addition, with social investments in education and employment, it became more common for young adults to postpone marriage and starting a family.Footnote 38 Young men and women pursued higher levels of education to obtain knowledge and skills that would secure employment and build financial stability.Footnote 32, Footnote 37, Footnote 38, Footnote 70 Enrolment by women in post-secondary institutions has been increasing steadily since the 1960s.Footnote 114 In fact, in more recent decades, women have been participating in post-secondary education at rates higher than men, and their increased participation in education and employment has shifted the age pattern of childbearing and, overall, delayed first childbirth.Footnote 37, Footnote 38, Footnote 114 There have been significant changes in the age-specific fertility rates in Canada over the past 50 years (see Figure 2.1).Footnote 108, Footnote 115, Footnote 116 Since the early 1960s, the fertility rate of young women has been decreasing. This has shifted the age of first childbirth for women into their thirties.Footnote 108, Footnote 115, Footnote 116

Figure 2.1 Age-specific fertility rate by select age groups, Canada, 1930 to 2008Footnote 108, Footnote 115, Footnote 116

Figure 2.1 Age-specific fertility rate by select age groups, Canada, 1930 to 2008

Note: Data for Yukon and Northwest Territories is not available prior to 1950; Newfoundland excluded 1930 to 1960; No data available for 1998 and 1999.

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Birth Database, Statistics Canada.

[Click to enlarge]

[Figure 2.1, Text Equivalent]
1930 1960 2008
15 to 19 years 30.5 59.8 14.3
20 to 24 years 143.0 233.5 53.0
25 to 29 years 176.0 224.4 102.0
30 to 34 years 148.0 146.2 107.4
35 to 39 years 106.7 84.2 50.1

Footnote:

Data for Yukon and Northwest Territories is not available prior to 1950; Newfoundland excluded 1930 to 1960; No data available for 1998 and 1999.

Participation rates in post-secondary education have increased significantly as programs from public and private institutions, offering a selection of credentials (e.g. degrees, diplomas, and certificates), have become more available.Footnote 114, Footnote 117, Footnote 118 Over 163 recognized public and private universities (including theological schools) and over 183 recognized public colleges and institutes currently operate in Canada.Footnote 119 The Canada Millennium Scholarship Foundation was launched in 1998 with a 10-year mandate to increase access to post-secondary education by helping to offset the financial costs of such education, especially among students facing economic and social barriers.Footnote 120, Footnote 121 To replace existing grant programs, the Government of Canada introduced the new Canada Student Grants Program (2009), made available to support students from low- or middle-income families, with dependents or with permanent disabilities and to provide financial grants to youth awarded based on need and academic achievement.Footnote 120, Footnote 122

Rates of post-secondary education enrolment and completion by Aboriginal youth have been steadily increasing over the last two decades. Nevertheless, Aboriginal youth are still under-represented in post-secondary institutions across Canada.Footnote 123 Historical barriers to education, due to broader socio-economic factors, cultural sensitivities and environmental barriers, including the lack of schools in rural and remote areas as well as the impact of the Residential School System, have negatively influenced the educational attainment of Aboriginal youth. This has had a cumulative reinforcing effect over generations.Footnote 123 Founded in 1985 in response to the need for support and engagement for Aboriginal youth, the National Aboriginal Achievement Foundation, in partnership with Aboriginal peoples and private and public stakeholders, was developed to deliver programs that encourage youth to stay in school and to help students with career planning, developing connections with industry sectors and employment opportunities. The non-profit organization has also awarded numerous scholarships and bursaries since 1985. These have provided the tools necessary for Aboriginal peoples, in particular youth, to further their education and career goals.Footnote 124 In 1997, the Youth Employment Strategy (YES), encompassing programs such as Young Canada Works and the First Nations and Inuit Summer Work Experience Program, was developed to help Canadians aged 15 to 30 years obtain career information, develop skills, find good jobs and stay employed.Footnote 72, Footnote 125, Footnote 126

As years passed, more researchers became interested in studying physical activity habits, food consumption patterns and the prevalence of nutritional deficiencies and diseases among Canadians.Footnote 61 One of the driving factors was the recognition that the physical activity and fitness levels of young Canadians had decreased.Footnote 45, Footnote 127 In response, a number of services and programs were initiated to encourage and promote lifelong healthy living practices and behaviours (e.g. making healthy food choices, staying physically active and maintaining a healthy weight). Canada's Physical Activity Guide for Youth (2002) was created to encourage youth to adopt healthier lifestyles by explaining the importance of regular physical activity and suggesting ways of taking the necessary steps to become more active.Footnote 128 More recently, the Canadian Society for Exercise Physiology (CSEP) developed new physical activity guidelines, including the Canadian Sedentary Behaviour Guidelines for Youth (2010).Footnote 129-132 The Government also introduced the Children's Fitness Tax Credit (2007) to support the participation of children under 16 years of age in fitness programs while also promoting active living and tackling risk factors for childhood obesity.Footnote 133, Footnote 134 Long-established organizations such as the YMCA and YWCA, Boys & Girls Clubs of Canada and ParticipACTION, along with Sport Canada, have continued to promote healthy, active living in young Canadians through participation in recreational and organized sports and activities within communities.Footnote 135-138 In addition, the Government of Canada launched a revised Food Guide in 2007, Eating Well with Canada's Food Guide, as well as a version tailored for First Nations, Inuit and Métis people.Footnote 139

Promoting healthy behaviours and lifestyles in young Canadians also required investments in recreational activities and organized sports, including better standards of care and safety. Sport and recreation injuries were a health concern, particularly for school-aged youth and young adults. Interventions and public health initiatives to prevent and/or reduce risk of injuries in sports and recreational activities (e.g. organized sport regulations, recreational safety rules and guidelines and the use of protective equipment) emerged over the past several decades.Footnote 140-143 Safety legislation was introduced in many provinces to help protect youth; for example, bicycle helmet laws for bicycle-related head injuries and death.Footnote 144-147 Organizations such as the Canadian Red Cross Society (Red Cross Water Safety Services), SMARTRISK, Safe Kids Canada and Think First Canada were founded to promote the physical activity and safety of youth and young adults through research, education and advocacy.Footnote 148-151

Continued investments in healthy living practices and behaviours also included initiatives to reduce the prevalence of smoking in Canada, especially among youth and young adults. Canada's success in reducing the rate of smoking was due in part to combined investments at all levels of government. As well, attitudes towards and social acceptance of smoking changed as evidence emerged that tobacco use was an addiction that harmed smokers and those exposed to second-hand smoke.Footnote 61 This shift in public acceptance and attitude initiated a response from the Government of Canada to implement a plan of action to address the impact of tobacco use on an individual's health and to help curb start-up rates of smoking among Canadians, particularly youth and young adults.Footnote 152, Footnote 153 In 1997, the Tobacco Act was enacted to regulate the manufacture, sale, labelling and promotion of tobacco products.Footnote 154 The Act provided standards for the promotion of tobacco and set rules for enforcing the tobacco laws. Tobacco companies could no longer target young people in their advertisements or sponsor any youth activities or events.Footnote 155 Since the development of the Federal Tobacco Control Strategy (2001), a variety of tobacco control legislation and strategies have been put in place, such as education, taxation laws, the introduction of smoking by-laws, regulations that included retail display bans and a minimum age of purchase. To further encourage healthy living practices, a number of initiatives were created to support smoking cessation.Footnote 153, Footnote 156-159

Recently, there has been an increase in reported STIs in the Canadian population, particularly among Canadians under 30 years of age and vulnerable populations (e.g. Aboriginal youth and street-involved youth).Footnote 23, Footnote 160-165 Chlamydia, gonorrhea and syphilis are an increasing public health concern in Canada. Human papillomavirus (HPV) is a common STI that has been linked to certain types of cancers, skin lesions and other negative health outcomes.Footnote 166 Publicly funded immunization strategies to prevent infection for four common types of HPV for females aged 9 to 26 years old are now in place across Canada.Footnote 166, Footnote 167 In 2006, the Canadian Guidelines on Sexually Transmitted Infections was updated as a resource for clinical and public health professionals, policy makers and educators for the prevention, diagnosis, treatment and management of STIs.Footnote 168 This was followed in 2008 by the Canadian Guidelines for Sexual Health Education to offer direction in the development and improvement of sexual health education policies, programs and curricula that address the diverse needs of Canadians and ensure that sexual health education is made available to all Canadians. Both of these documents are continuously under review to reflect current conditions and risks.Footnote 22 In addition, initiatives such as the Federal Initiative to Address HIV/AIDS in Canada, including Leading Together – Canada takes action on HIV/AIDS (2005-2010), and the Canadian HIV Vaccine Initiative have been created to provide safe and effective diagnosis, care, treatment and support for all Canadians with HIV and AIDS, to prevent the spread of HIV and to contribute to global efforts to fight the pandemic and find a cure.Footnote 104, Footnote 105, Footnote 169-171

Moving forward

In the 21st century, attention to issues concerning youth and young adults has continued to gain momentum. Efforts have been made to encourage and promote healthy life transitions and to advocate for public health issues relevant to youth and young adults in the areas of healthy living, sexual and reproductive health, injuries and supportive environments as well as social initiatives in education and employment.

Establishing initial good health during youth and young adulthood can help reinforce and maintain the importance of healthy living throughout life.Footnote 30, Footnote 31, Footnote 36 Canada continues to focus on building and supporting positive early life experiences and investing in initiatives to foster healthy transitions for young Canadians. Notably, underlying the advancement of public health initiatives for children and youth in Canada is the United Nations Convention on the Rights of the Child (see the textbox "Canada's role in the United Nations Convention on the Rights of the Child").Footnote 172

Canada's role in the United Nations Convention on the Rights of the Child

In 1991, Canada ratified the United Nations Convention on the Rights of the Child and made a commitment to promote and protect the health and well-being of all Canadians under 18 years of age. Based on the principle of the "best interests of the child," the Convention protects children and youth's rights by setting principles and standards in health care, education and legal, civil and social services, ultimately laying the foundation to ensure basic needs and the right to survival, life and healthy development are supported and sustained.Footnote 172, Footnote 173

Since 1991, Canada has taken a range of actions to support, strengthen and monitor the principles of the Convention, and has implemented legislation, programs and policies that have resulted in positive health outcomes for young Canadians.Footnote 75, Footnote 173-175 Regarding health in particular, Canada has developed a set of common services for children and youth and their families to fulfil the provisional rights set forth in the Convention, including Article 24 – the right to health care. These rights place an obligation on the State to take appropriate measures to ensure that children have equal provision of and access to necessary health care, and to develop preventive health-care services and support for parental child-rearing activities.Footnote 75, Footnote 172, Footnote 174, Footnote 175

While Canada has made great strides in investing in public health initiatives to improve and enhance the health of young Canadians, considerable challenges remain. The continued prevalence of unhealthy lifestyles and behaviours (e.g. poor nutrition, lack of physical activity, smoking) places the health and well-being of young Canadians at risk – not only in their youth but also into adulthood and old age. Adopting healthy lifestyles and behaviours is a lifelong practice that can help to reduce the risk of chronic diseases and poorer health later in life. One of the challenges in moving forward will be for Canadians to find ways to live healthier lives by staying socially connected, increasing their levels of physical activity, eating in a healthy balanced way and taking steps to minimize their risk of injury.

Despite Canada's success in reducing the rate of smoking, challenges remain. Adolescence was – and still is – a period when many young Canadians experiment with smoking.Footnote 176, Footnote 177 Canada needs to continue its efforts to educate young Canadians about the associated impact on health of smoking in an effort to curb start-up rates and reduce tobacco use. In addition, sexual attitudes and behaviours are established during the transitional years. Continued efforts to raise awareness and educate young men and women on sexual and reproductive health are needed so that young Canadians can make healthy choices, protect themselves and avoid risky sexual behaviours that may predispose them to an unplanned pregnancy and STIs, including HIV and AIDS.Footnote 178 Also, while the specific health concerns of sexual minorities are recognized in Canada, more work needs to be done to provide appropriate programs and services.

Continuing to invest in and create initiatives that provide more opportunities for education and training, career planning, skills development and employment can help to support, improve and enhance the healthy transitions of young Canadians. Education is one of the biggest social investments that can be made for youth and young adults as well as an important and valuable stage in the healthy transitions of young Canadians. Young Canadians spend a substantial portion of their lives in school settings and their experiences strongly influence their social and emotional health and development. Positive school experiences, learning and development can help to secure and maintain health and well-being throughout the lifecourse.Footnote 47 As well, education can also influence the health outcomes of young adults, including their financial future and opportunities for employment, inclusion and active participation within society.Footnote 37

Providing positive and nurturing support to young Canadians as they transition into adulthood is essential to their development and securing good physical and mental health. Recognition and consideration of the social environments and social support networks that can influence the health of youth and young adults is important. Today, many social networks outside of the family influence young Canadians, for example, peers, school, employment and social media. As these networks play a greater role in the lives of young Canadians, it will be important to keep up-to-date on the changes and ways in which they may shape the behaviours of youth and shift the focus to how they can be used to promote and encourage healthy behaviours among young Canadians.

Young Canadians today represent an increasingly diverse sub-population and transition patterns from childhood into adulthood are not homogenous. Certain sub-populations may be more vulnerable to particular health issues and may face greater challenges, obstacles or interruptions that can affect their ability to transition into adulthood. Looking forward, Canada will need to consider ways to promote the healthy transitions of all young men and women. This will require an examination of the health status of youth and young adults within the context of the broader determinants of health and their influence on health outcomes, development and life transitions. All Canadians must have opportunities at all stages of their life to have, maintain and enhance good physical and mental health.

Summary

While the lifecourse patterns of young Canadians have changed over the last century, the majority of youth and young adults are healthy and transition smoothly into adult roles and responsibilities. Canada has made significant progress in improving the health outcomes of youth and young adults as a result of the many initiatives that promote good health and well-being. Regardless of the many successes, challenges remain and will continue to emerge, particularly for vulnerable youth and young adults. Chapter 3 explores the current health status of Canada's youth and young adults, including socio-economic status, physical and mental health, and health behaviours.


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