In this time of financial crisis, many aspects of the healthcare system on PEI are being reviewed. Best Start, a community-based program that assesses the parenting environment for all new borns on PEI and which offers in-home support for new parents that are having challenges is on the list for review. Millions of dollars have been already invested in this program by the Federal Government and there is a three year long agreement signed. It is the only viable intervention program of its type on PEI that works to improve many of our intractable social and health problems. As a result of this program, PEI is nationally recognized as the leader in the field and can anticipate more investment from both the Feds and from the public sector. With a cancellation, we lose not only what we have but any real future that could be gained from the success of the program. We go to the end of the line.
I acknowledge that there are many difficult decisions that face the Premier. But can this be the easy sacrifice? What will be the real cost of cutting this program?
Here is my open letter to Premier Pat Binns that makes the case from my perspective
Dear Premier
Trust and Prince Edward Island’s Leadership Position
In the many years of discussion we have had with you and many senior members of your government, we have been struck by your collective understanding of how working with the parents of the very young will give Islanders the best chance of reducing many of the drivers of social dysfunction and remedial cost that bear down upon us as a society.
We know that you understand the linkages between parenting and health, literacy and behaviour.
We are convinced that it is your support that has made it possible for us to pull in the support of the Federal Government and the research community who see PEI as the most valuable place to spearhead a national strategy. Many of the leaders in the field have met many of you and are now convinced that Canada’s best chance lies with PEI and with your leadership. Your election promise supporting Best Start in the last election campaign has provided us with the momentum to open more doors of political, business and financial support.
We are in active negotiations with senior members of the Federal Government, supported by the National Research Community and by the leadership of UPEI and Holland College to have them specify PEI as the Test Bed for a national program with all the attendant support and funding that such a decision will bring.
We understand that this is a time when very difficult fiscal decisions will need to be made. We believe that the price eliminating Best Start will be very high.
With your support, PEI has agreements in place with the Federal Government and with the 7 Family resource centres. With your support, PEI is now recognized throughout Canada as the most advanced province in the country in building a sound foundation of support for parents and children in the early years when most is possible.
We believe that to walk away from this public commitment to Islanders, to the Federal Government and to the community of parents and Family Resource Centres risks shifting Prince Edward Island from being the leader in Canada to being off the map.
We cannot see how it will be possible to rebuild the trust once it has been lost. So to save $379,000 in 03/04 and $534,000 in 04/05 what do we risk?
If you read this, please ask yourself what alternatives have your officials offered to the points raised by me? What plans do you have that are better than this to tackle the social and learning trends that have the power to take us down as a viable society?
What is the Strategic Opportunity and what are the Risks
We believe that we risk our future. The real costs to the Prince Edward Island budget which threaten our future come from a failure in the very root of our society – how well we parent in a society where the old community structures have eroded. We suffer from some really disturbing trends that drive not only a trend of remedial costs that make no difference to outcomes but which threaten the very future of society to participate in a modern economy and hence pay our way.
For as you know only too well, most of the problems of our time are subtle and chronic and do not improve with remedial action. The continuum of support for the Early Years that Best Start will provide on PEI is an approach that is proven to work on these challenging issues.
Currently Health and Social Services spends $28.8 million on remedial work in Child and Family Welfare, Mental Health and Addictions. The Attorney General spends $11.3 million on Corrections. The Department of Education spends a total of $137 million on schools. 60 T/A’s now work in the school system.
These costs are related to the following problem areas where Prince Edward Island has the unenviable record of being amongst the most disadvantaged in all of Canada and where the formal system has no work underway that can make a meaningful difference.
Family Violence - The Child Protection budget has risen from $4.0 million in 1998 to just under $8.0 million in 2002. These costs have risen by 100% in 4 years. Without an effective intervention, there is no reason for them not to continue to rise at an exponential rate. Beyond the monetary costs of Child protection – what of the human costs that a case produces?
In 1999 there were 57,971 “Child Care Days” where a child on PEI was in care. Children are taken into care when the family setting is deemed to be too risky for them to stay at home. Family violence is largely a product of people with poor coping skills reacting to stimuli that they cannot control. The costs in court time, protection, fostering are substantial for the state. The social costs to the family and to the child are incalculable.
At the heart of the Best Start approach is a focus on establishing strong parental bonding. Research in other jurisdictions shows a dramatic difference in family violence as a result of this type of intervention. There is no strategy other than Best Start that can deal with this.
Learning and Literacy – 42% of Islanders are barely literate. The worst educational result in Canada. Is this because we under fund our schools or that we have poor teachers? You know that this is not the cause. PEI spends on average $85,256 to graduate a child from high school. In spite of this investment, our schools are having growing difficulty with a group of children who find learning very difficult. The trouble is there on the very first day of school. The national percentage of those who find learning a challenge is between 20% and 30%. Boys are more vulnerable than girls. Boys who have only one female parent are most at risk. It is important to understand that this poor outcome is not the fault of the school system. This group of children enter the school system on their first day already severely prejudiced with profound learning and behavioural challenges.
In spite of all the effort of dedicated teachers and social workers, most of this group will leave school without the attainment and skills to make a living in modern society. Poor social skills, an inability to listen and to comprehend, are the prerequisites of being able to learn. These skills are developed in the very early years of childhood.
Much of the work of Best Start on focuses on opening up these learning pathways and setting children up to be the best that they can be.
Massive investment in remedial effort in the US Public School system has had no impact improving poor literacy. There is no reason why we should believe that the answer is further investment in the classroom. The issue is what has happened at home before the child reaches the age of 4.
The research community have made a breakthrough in recent years showing that literacy and the lifetime trajectory for learning depends on the type of parental interaction with the child from birth to 4 years.
We also now know that it is not simply those that are “poor” that struggle but it is the ‘Poor in Spirit’
The majority of vulnerable children are middle class. Wilms’ research is clear. To make a difference we have to extend a helping hand to many middle class parents.
Without Best Start as a foundation, what is your alternative? What is the risk? Without a major intervention how will Prince Edward Island have enough capable and coping young people to carry us forward?
Prince Edward Island, has one of the lowest birth rates in Canada and will have the second most aged society in Canada. By 2015 more than 50% of Islanders will be over 50 and 30% will be over 65. If we do not get a grip on the problem of readiness to learn in the next decade, we will not be able to get through this demographic hurdle. Young Islanders who cannot learn are condemned.
Employability - PEI persists in having one of the higher rates of unemployment in Canada. There are many causes for this complex situation but poor attainment at school and low employability are important drivers. People with a poor experience at school are most at risk. The 1996 census shows that 42% of adults on PEI had not graduated from high school. This compares to the national average of 34%. Again the only effective time to make a difference to this pattern is in the early years.
Juvenile Crime - In 1999, there were 8,912 days spent in corrections on PEI by young men. Young men with low self-esteem and with no hope for a better future tend to commit most of our crime.
Until recently, our response has been to invest more in the justice system. California spends more on prisons than on schools. The insights of the Early Years inform us that we can make a difference to juvenile crime by supporting the parents of young children. Self-esteem is a product of effective parenting and of warm family environments. This linkage is the reason for the support of the National Crime Prevention Centre for Best Start and their decision to invest in strategic prevention.
Teen Pregnancy - In 1999 on PEI there were 5,000 single parent families. Most of these, over 4,000, were headed by women and most of these were young women. As with boys who commit crime, the evidence suggests that teen pregnancy is often also a product of poor self-esteem.
The costs of teen pregnancies are considerable both in direct terms of social support but also in human terms. In most cases there is a direct correlation between single parenthood and poverty. In many cases, the cycle of poor self-esteem continues into the next generation. The best time to work on esteem issues is in the early years and the best way to help a mother regain her own self-esteem is to help her become an excellent mother herself.
Smoking and Addiction - PEI is ranks second, at a rate of 33.6%, in Canada, with the highest rate of smokers who are aged between 15-24. Smoking drives a significant later burden of poor health, chronic illness and early death. PEI has the highest death rate from lung cancer in the nation. Research tells us that smoking is not as much an individual issue of will power but is a societal issue largely driven by environmental and control issues. Smoking is one of the significant factors in poor health that we can identify. Changing smoking habits is very difficult. As with all addiction, common sense and information have little impact on the addict’s ability to change powerful habits. Smoking is strongly linked to self-esteem and to place in the social order. So again the root for taking much effective action is in the early years where an intervention with parents and in the home has a chance of working.
Obesity and Diabetes - One of the trends of modern society is obesity. Atlantic Canada and PEI have the dubious distinction of being the most obese part of Canada. PEI with 59% of its population overweight, is the fattest province in Canada. In Canada, 29 per cent of boys are now overweight, almost double the 1981 rate of 15 per cent. Among girls, the rate rose to 24 per cent from 15 per cent in the same period. The number of children considered obese now tips the scales at 14 per cent for boys and 12 per cent for girls, almost triple the 1981 rate of 5 per cent. Poor nutrition is directly related to obesity which in turn drives a pathway for a significant series of health-related outcomes, such as diabetes and Coronary Heart Disease.
There is no “cure” for the diseases of obesity and there is no adult way of sustaining a significant weight loss. We can however intervene at the foundation of obesity.
How and what we eat at home as young children sets up exceptionally powerful lifetime habits. By 6 the pattern for eating and meals is set for life. If supported, parents can develop the skills and the habit off eating well when their children are young and so set a different pattern and a different pathway.
Utilization of the Health System - Healthcare costs are rising faster than our economy can afford. Health Canada warns that Canadian healthcare costs could double in the next 10 years. An aging population, the increasing costs of drugs and of new technologies will drive these costs. Most of the costs, particularly the geometric increase in the use of drugs, are driven by the heavy user.
The profile of the heavy user includes the poorly educated, the poorly nourished, heavy smokers, the over-weight, the under-employed and those with poor social support systems. The expressions of poor health in this group tends to include, circulatory disorders, respiratory disorders, back pain and non-specific chronic pain. Obesity also is driving an epidemic of adult-onset diabetes which weakens the overall immune system opening up other avenues of health problems a high incidence of Coronary Heart Disease. None of these problems are easily and cheaply dealt with by the healthcare system. They tend to be chronic and require constant intervention
The research informs us that this group became high risk as young children. Intervening in the early years gives us a chance to reduce the pool of heavy users.
The Immediate Political Risks of Shutting Down Best StartIt would be so easy in a budget meeting to write off $379,000 that is spent on 15% of the most vulnerable in our society. But to do so means that we also write off the opportunity to make a difference to trends that have the power to take us down. In this context, you have to put on the table for your officials the question of what they will do instead to make a difference in the time left to us to the educational, health, employability and social trends that we have described above.
In addition, we think that you need to consider the more immediate repercussions.
A broken promise - Children, parents, families participating in Best Start geographically represent every electoral district across PEI. How can it be explained that the provinces commitment to working to improve the starting point of Islanders cannot be fitted into a system that spends nearly $40 million to fix the unfixable? If we know that the game is lost or won in the fist three years of life, how do we explain that you cannot afford this work? How can your government be trusted in the future?
Employment - Twenty-nine (29) full and part time staff are currently involved with the coordination and delivery of the Best Start Program. An additional thirteen (13) staff are to be hired to support the program in achieving it’s maximum caseload province wide in the next two years. Having to let this number of staff go would have a major economic impact in every community across PEI. This would be one of the highest lay-offs in PEI directly related to a broken government promise to children.
As a past senior corporate communications executive, I cannot think of how I would be able to describe this is any way that would not be politically damaging.
Missing the Federal Boat and a chance to renew Atlantic Canada– Paul Martin has been a major supporter of the ideas promulgated by Dr Fraser Mustard . His view of the Early Childhood agenda matches our own – that it is an important foundation for economic and social development. It is clear that this aspect of the agenda will be built upon in the next 4 years. Prince Edward Island is positioned as the leading place to experiment on making a tighter link to development. We are tightly coupled to the principal actors who will do this work. Breaking our commitment to the Feds and losing the foundation will take Prince Edward Island out of the running. It will thus also take Atlantic Canada out of the running for a systemic effort to fix our problems by fixing ourselves.
The foundation that Best Start provides in supporting the critical infrastructure for an early childhood system of intervention across PEI would crumble. There is no coming back later from such a decision. There is no drive to expand the effectiveness of the interventions. There is no support from the Federal Government nor from the research community. There is no support from the Community.
Setting up greater costs and social failure in the future - Expenditures in health and education would continue to escalate and compound. With no improvement in the social education and health trends, we would not have the human capital available to take us forward as a viable society beyond 2020.
A recommendation for how to deal with your challenge
We acknowledge that your government is faced with a very difficult situation. In this context, we offer some advice. The real issues surrounding the deficit are primarily retaining the confidence of the rating agencies by doing the “right thing” and in having the cash flow to support the debt.
When a business is in real trouble, it is because it has a systemic problem. Trimming here and there will not save it. So it is with us.
Prince Edward Island has a structural problem related not to its physical assets but to its human capital . We have too large a segment of our population that do not have the skills or the culture to work in the modern economy nor to solve the problems that confront us such as a failure of the commodity system. We are not a magnet site for immigration and we will have the second most aged society in the country. Our only chance of building sufficient Human Capital is to build it ourselves.
All the trends that show both the degradation of human capital and which show the exponential trend in linked costs are moving quickly the wrong way. If PEI was a business, which in a way it is, any analyst could see that we face a “tipping point” in 10-15 years where there is no coming back. What the street will have to look at is whether we know what our problems really are and if we are doing work that has a reasonable chance of fixing them. Trimming will not get you the support that you need.
Having more than 40% of Islanders dependent on seasonal work and EI will not give you the tax base that we need either.
Our only chance of making it in the next 15 years is to make Human Development the centrepiece of our focus. Coming to grips with this situation is the only sustainable way out. The number one rule with dealing well with your banker is to come clean about what is really the problem and then having a plan that can deal with the problem
Yours truly
Rob Paterson
