Re-Envisioning an Early Years System of Care towards Equity in Canada: A Critical, Rapid Review

Abstract

Background: Many children in high-income countries, including Canada, experience unjust and preventable health inequities as a result of social and structural forces that are beyond their families’ immediate environment and control. In this context, early years programs, as a key population health initiative, have the potential to play a critical role in fostering family and child wellbeing. Methods: Informed by intersectionality, this rapid literature review captured a broad range of international, transdisciplinary literature in order to identify promising approaches for orienting early years systems of care towards equity in Canada. Results: Findings point to the need for a comprehensive, integrated and socially responsive early years system that has top-down political vision, leadership and accountability and bottom-up community-driven tailoring with an explicit focus on health promotion and maternal, family and community wellness using relational approaches. Conclusions: Advancing child health equity in wealthy countries requires structural government-level changes that support cross-ministerial and intersectoral alliances. Employing intersectionality in this rapid review promotes contextualized and nuanced understandings of what is needed in order to advance a responsive, comprehensive and quality early years system of equity-oriented care. Further research is needed to prevent child health inequities that are disproportionally experienced by Indigenous and racialized children in wealthy countries such as Canada. olicy and research recommendations that have relevance for high-income countries in diverse global contexts are discussed.

Models, theoretical design and formal evaluation of integrated specialist community health service provision for the first 2000 days: a scoping review

“…Governance is also supported when leaders use a sound theoretical foundation to advocate for the shared vision, and to guide strategic planning and decision-making,17 demonstrating respect and value for ‘diverse professional contributions’ 24. Consistent with the ecological systems framework, this governance support is ideally set in political leadership including policies that promote equity, and contributed to at all levels of governance 33. This must, however, be matched with active engagement with professionals, local community and families 33…”

“…Challenges to this include shifts in the direction of government structure, policy and funding, including an increased cost of providing truly integrated care 17 24 25. Sustained integrated service provision in the early years is supported by political vision and a funding commitment to addressing inequities in child health through early intervention 33. It is challenged by changing political priorities and short term funding rotations 31 34.…”

“…In high-income countries, there is a need to increase accessibility of services for families who are vulnerable through social circumstances including intergenerational poverty and trauma, and racism 2 33. Rather than being a result of personal decisions or ability, the vulnerability experienced by these families is frequently due to ecological systems of unequal power structures, from policies at government and organisational level to socially constructed attitudes that result in relational violence to others 33. For this reason, access is supported by respectful partnerships with families in care 21 22…”

“… 24 Consistent with the ecological systems framework, this governance support is ideally set in political leadership including policies that promote equity, and contributed to at all levels of governance. 33 This must, however, be matched with active engagement with professionals, local community and families. 33 …”

“… 33 This must, however, be matched with active engagement with professionals, local community and families. 33 …”