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does where you're born affects your health
how about your ability to earn a decent wage
does where you're born affect your likelihood of graduating from high school?
 at a glance factors like location income and education aren't intuitively linked to health yet a
groundbreaking new Hamilton Spectator investigation shows where you're born and the
conditions that you're born into are intimately linked with your health wealth and future
prospects
 someone born into a wealthy family will naturally have more opportunities but their analysis of
half a million provincial birth records shows more adverse birth outcomes things like teen
motherhood low birth weights and lack of prenatal care are highest in Ontario where income
and educational achievements are low and poverty is high meanwhile low incidences of poor
birth outcomes are closely tied to higher levels of educational achievement, higher income and
lower levels of poverty
 analysis of Ontario's communities exposes wide gulfs in birth outcomes between the provinces
haves and have-nots hubs at the level of individual neighborhoods. The findings are even more
compelling.
o found that where you live with the inner-city can put you on a precarious path for life
even before you're born
 Code Red series which uncovered massive variations in health and wealth between Hamilton
neighborhoods like Code Red the Bourne project reveals intimate links between health and
wealth but this time on a province-wide scale.
o examination of more than half a million provincial birth records shows birth outcomes
such as teen motherhood low birth weight and poor rates of early prenatal care are not
only elevated in Hamilton's at-risk neighborhoods they're also linked to low-income low
educational achievement and high rates of poverty and communities and
neighborhoods all across Ontario
o other panelists are all individuals who are experts in their respective fields and who
have all in one way or another help Steve and I better grasp the implications of our
findings for Ontario's mothers and babies
o Neil Johnson is an epidemiologist at hamilton's Firestone Institute for respiratory health
and a faculty member in McMaster University's Department of Medicine. He's also an
expert in analyzing health data and a collaborator on the bourne series as well as Code
Red.
o Neil has been a phenomenal resource when it comes to understanding what makes
health care systems tick. His expertise and assistance was also invaluable in organizing
this massive set of statistics.
o Dr. Chris is one of Hamilton's associate medical officers of health. As a physician he
encounters maternal health issues firsthand day in and day out as a result of this
experience he was able to provide with important insight into the health of Hamilton's
mothers and babies.
o Lea caragotta who is a professor in the Faculty of Social Work at Wilfred Laurier
University. She has extensive experience studyig single and at-risk mother and she
played a role in helping Steve and I better understand some of the issues surrounding
teen motherhood
 look at these maps and instantly see what was going on in the city of hamilton and map after
map marker after marker variable after variable kept showing the same thing. These strong links
between poverty, where you lived, your health. Tat really offended a lot of people that live here
in Hamilton-it was offensive to some people to think that there are these huge disparities within
our city that there are people that are living with third world health conditions
 one way to take this code red message and expand on it was to move outside of the borders of
Hamilton and take a look at the entire province and see if these same trends that we were
seeing within Hamilton are manifested or show themselves across the province.
 made an application- received 535K of data related to four years worth of birth outcomes for
the entire province and the beauty of the born project was that like the Code Red series we
were able to break these numbers down into neighborhoods right across the entire province
 the challenge then becomes how do you tell a story that massive to an audience
 Same trends are existing right across the province that we saw in code red places that have high
levels of poverty places that have low incomes they they have much poor performances for a
number of health markers than those people who live in wealthy places. Some statistics show
that rates of teen mothers are just absolutely almost beyond belief I mean we have places
where there are thousands of women who gave birth over four years and not a single one of
them was a teen mother meanwhile we have rates of teen mothers in places such as the inner
cities of some of parts of the province that are hurting: Hamilton Thunder Bay , far north remote
fly in native serves where the rates of teen mothers are basically off the charts
 able to show that right across this province these same problems are happening
 is really quite simple let's make it a political agenda let's make birth outcomes and the
improvement of birth outcomes political -hopefully will stimulate the kind of public debate that
we need to have around this in order to motivate political action fantastic. it's important to kind
of get these kinds of messages out - it begins to create a kind of public discussion that ideally
can create some kind of political agenda to deal with these kinds of things
 research for the last 10 years has been on single mothers, social assistance
 woman's daughter comes home at sixteen and tell her mom that she was pregnant and there
was tremendous family distress because that family had had a lot of hope and a lot of
aspirations built in to kind of their plans for their daughter
 Chantelle is the young woman's name and she said actually it probably doesn't really matterthe school she went to sucks and not very many people from that high school go on to university
–
 Charlotte said she ‘loved the baby and we'll do a good job together and I've got a lot of family
support - this wasn't a family that had the resources to send their daughter off to university
there were all kinds of limitations right from the word go in that family circumstance and
structure that made teen parenting in that circumstance.
o It was not as if she could compare her life outcomes to those of more privileged people
for whom that would have been a much more negative circumstance -we see through
that little illustration the way in which those kinds of cycles of poverty continued
because we have now poorly educated low-skilled single mom who's going to do a good
job of being a parent or try to do a good job of being a parent but she's not going to be
able to create the same kinds of possibilities for her kid as somebody with more
privileged. Yet the very root of that is the kind of extraordinary levels of poverty and
those the poverty that we experience in Canada remains gendered and for single
mother led families -majority of single-parent families in the country poverty is much
higher and really intractable unless we really start to invest in the kind of education
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and training that will help to move people out of poverty -that doesn't seem to be
something that we're very oriented to do it
Chris Mackay -a tough complicated issue low birth weight teenage pregnancies : these are some
really important indicators but they're also part of a larger issue and that's how well that we set
up our children and our young people for success. What kind of opportunities do we give them
what kind of start are we giving them in the life and we know that those early years are
absolutely critical for predicting how people do for the rest of their lives. it has a huge impact on
health social success economic success for the lifespan- so while there are other indicators to
look at low birth weight and looking at teenage pregnancy are really important parts of that
story
really easy to turn a blind eye and ignore the issue because for many people maybe you've had
your kids already maybe you don't see it on a regular basis -it's hard to connect low birth weight
teenage pregnancy with people's lives but the connections are real and they're strong
the series did a good job of pointing out some of those connections in terms of the impact on
health care costs.
o we know that low-birth-weight children cost eighty thousand dollars more within the
first five years in terms of health care costs
o low birth weight causes all sorts of problems in life. you've got a person that grows up
from low birth weight and become successful and every time we talk about teenage
pregnancies and how difficult it is for the mother and the child you hear stories about
well I did it with my kids and they turn out great.
o fairly obvious that health care impact social services social assistance, we're also
learning more and more about how income inequality in communities affects everybody
in those communities.
o There's now growing data showing that the more income inequality you have in your
community, the more teenage pregnancies, there'll be more murders there's going to
be more health problems in general because you know about community cohesionOver the past 15 years or so the province has made massive investments in the health care
system but birth outcomes, particularly low birth weight is not improving. it's actually getting
significantly worse
why is that happening? the health system in Ontario is good if you're in it it's second to none
in the case of pregnancy outcomes most women enter the care system obtain prenatal care in
an appropriate way and go forward to deliver healthy
it's fine to set a goal to try to achieve but if you don't put the framework into place to allow
that goal to be achieved it just becomes sort of an empty number
you know you're already pregnant so that's not going to help the teenage pregnancy issue if
you're if you're smoking that has a huge impact on low birth weight if you if you don't have
access to good nutrition that has a huge impact on the child's development as well. if we back
up a bit and ask the questions about children
Leah pointed out it - talks about somebody who didn't have opportunities didn't have an
opportunity to get a good education didn't have the opportunity to get a good job and when
you don't have opportunity why not there's no there's no risk to having kids because he left
having a child is a life-changing an event -some people want and are seeking for a life change
and we're now we now have good programs that are going through that life change to give
them the tools to be good parents through that through their child's child's upbringing and it's
so it really is an amazing opportunity to get an involved in supporting somebody to build their
resilience their capacity at empower them to make a difference in our lives the nurse Family
Partnership is one program that we're running in Hamilton it's an outreach based program that
partners a nurse with a mom -shown in numerous studies to be a really effective approach but
housing in Hamilton where teenage moms can get continue on with the high school education
and there's a bunch of outreach based and thoughtful ways of dealing with the problem that
recognize that it's not just about getting you into medical care great thanks Chris and you
mentioned the nurse Family Partnership Program that's just one of our local programs that are
designed to help sort of at-risk mothers one of the things that Steve and I sort of struggled
with because there are so few hard targets that have been set with respect to maternal care it's
who's responsible so following up on our previous discussion who Steve who's responsible for
for monitoring this and for holding people accountable for meeting you know targets if they
are set well I mean that's that's the sixty-four-thousand-dollar question I think of any of the
people on on this panel had that answer you know I think chris said it you know both during
Code Red and for this born project you know if there were simple solutions to these problems
they would have been implemented by now son of the people are fundamentally stupid and
don't know what they're supposed to do you know obviously it's a multi multi-headed problem
it requires federal intervention it's it requires provincial interventions to the extent that the
city has a role to play it it involves municipal interventions no it's fine and dandy to always
point the fingers at at levels of government it's that level of government it's this level of
government you know the feds at some point it's also all of our problem to try to figure out as a
community as well in communities across Ontario you know at some point we have to make
decisions about what's the right way to be spending our money I mean as the series pointed out
I was stunned when i went back as you know you mentioned the hard targets in 1997 the
provincial government set this hard target it wanted to get the rate of low birth weight babies at
the time it was five point seven percent it wanted to get it down to four person the government
wanted to get it to four percent by 2010 what we showed in the series that in fact not only did
four percent not be achieved it went the other way it got worse and I looked up the numbers in
1997 the health budget for the province of Ontario was 17 billion dollars in 2010 it was forty
four billion dollars 40 4 billion dosa they think of the rise 17 billion 244 billion in 13 years that's a
massive influx of money and the problem got worse you know and it's not just low birth weight
baby rates that got worse we saw wait times get worse for different types of procedures
emergency room problems I said so there's it's not-it's not that there's a shortage of money it's
the question of how are we spending that money and you know time and time again we seem to
have the same discussion we seem reluctant to spend that little bit of money on the front end
relative little bit of money on the front end for the prevented you know for the prevention and
yet we will spend limitless amounts of money on the back end to try to fix problems that have
already developed you know but you know as you know we're talking really about the social
determinants of health here I mean a lot of these problems that show up as being medical
problems really had a fundamental basis perhaps a long time ago in issues that had nothing to
do with medicine and how do you fix those problems wish I knew and I'm quite happy with the
other three trite give a better answer than that I'd love to comment I have to say and I'm glad
you added what you did there Steve because I think the issue is that we are trying to kind of
address a problem that is a deeply structural economic problem with healthcare dollars and I
don't think we're going to ever be able to kind of have enough health care dollars to address
that and these problems arise because of poverty and you know youth unemployment in
Ontario is now an average twenty four percent and so if you think about what that means
because that's a flattened figure where we average the unemployment of a group of 22 and 23
year olds who are coming out of university with a first degree and those people like many of the
young women having lows low birth weight babies who perhaps are 16 and 17 and don't have
completed high school and so obviously for that latter population youth unemployment is much
higher than that twenty four percent so when you think about what the opportunities are for
those young people they're pretty minimal and yet we have a federal government that isn't
really trying to address that kind of structural unemployment we have a kind of economic
system that really isn't acknowledging increasing inequality as as the study points out the kind
of increasing inequality that creates the kind of haves and have-nots and so I think if we really
kind of want to see that needle move toward decreasing down to four percent or even much
less than that kind of people having low birth weight babies we obviously have to deal with
kind of structural poverty that is among us everywhere and you know if you think about the
reality of somebody who's a single parent on social assistance you know they're getting perhaps
and I don't know the Hamilton statistics exactly but relatively comparable I'm sure to those in
Toronto where you're probably bringing home thing in the order of a thousand to eleven
hundred dollars a month for a single mother with one or two children depending on where
they're living etc and it's impossible on that level of income to ensure a nutritious diet so right
off the bat the kinds of key social determinants are going to shape the outcomes for those
children We certainly have lots of women in our study who talked about never being able to
afford fresh fruit and vegetables for their children and we you know the who's to blame again
absolutely government is to blame on every level but but all of us are also demanding you
know a 44 billion-dollar health care system and when you think you know if you took half a
billion dollars you could lift every teenage mom out of pride of poverty in Ontario every
teenage mom in ontario would be out of poverty half a billion dollars and you know if you
instead of just giving that money out you put it into programs that we know our long-term
effective payback five six dollars to one you not only be saving the government money you'd
you'd be you'd be making enormous differences in people's lives and empowering ways to give
them the skills that they need for success so so absolutely it's it's a it's a political question it's
also a value question and you've got you've got some ideology some value systems that are
going to ignore every fact on this issue and they're not going to trust the studies and they're
going to say well it's their own fault it's their own decisions pull themselves up by the bootstraps
well we can take that attitude we can turn our backs on you know low-income our teenage
moms if we want to but those are costs so we're going to have to pay it sooner or later you
know we'll pay it in health care will pay it in social assistance will pay it in terms of the gradual
decay of our sense of community of our you know the strength of our society so why not invest
a little bit now now Chris just mentioned investing team bring them out of poverty wondering if
there are any other sort of first steps that we can talk about to take us towards correcting these
poor maternal health outcomes Neil why do you always choose me for as you look smart I'll
have plastic surgery my own expense um actually you know I I'd like Chris to address that one
please all right Chris whew boy again you know there is these solutions would be done by now
so I mentioned the nurse Family Partnership this is a this is a program where before the child is
even born about 20 weeks gestational age so halfway through the pregnancy the mom gets
partnered with a nurse and that person supports them throughout up to the child's second
year birthday and the whole goal is to empower people to be excellent parents to be using the
attachment style parenting that we know makes a big difference to be engaging the kids
stimulating the childhood again they get on the right trajectory prepare them better for school
but also to help the mother take control over home life often these really high-risk moms that
haven't had a real friend in their lives they haven't had a good family I'll bringing themselves
they don't know what it's like to be loved and the relationships that build with the nurse over
that two years same person every visit really powerful now this is an intervention that's
targeted at a really high needs group so low income first time teenage moms but but there's
also you know I like to think of it in terms of a dose of prevention for the appropriate don't you
know the appropriate dose of prevention so so for for other moms I mean my wife has had a
couple of babies in the last couple years and and we had the opportunity to speak with a public
health nurse and and and both of those times it you know you get answers to questions that you
might otherwise want to be able to find there's so much garbage on the internet that yeah you
can go looking on the internet and find a thousand wrong answers but you get somebody with
credibility you can ask a question so I think you know an FB nurse Family Partnership is one end
of the spectrum but we need a spectrum of care and support for the spectrum of needs that are
out there I really think that outreach is powerful because it gets the people who need it most
who aren't going to come and seek the passive system that we have in the healthcare system
and and an empowerment model is really powerful as well you know for the people that want
want teenage moms to pull themselves up by their bootstraps well let's make sure they have
boots with straps you know let's give them those tools rather than just giving a fish let's let's
teach them how to fish and give them tools to to absolutely and take control of their own lives
and and be the you know the good parent that they want to be but you know Chris there's also
an element of myth-busting that has to be done you know not just in our community but in
other communities I was surprised you know there have been comments to the series
comments to me I'm surprised by the sort of vitriolic response that an issue like teen mothers
raises with certain people they're people who who look at this as some sort of bizarre moneymaking operation that's going on across the city that there's some cabal of pregnant teens that
are doing this as some sort of get rich quick scheme when the realities you know I mean this you
know liat mentioned you know single teen mom's living on a thousand eleven hundred dollars a
month can you possibly imagine what it must be like to try to live your life as a parent on that
kind of monthly income I mean it's it's horrifying and yet we still have this sort of myth in the
community that that people are doing this as some sort of money-making scheme that they're
somehow you know you know getting rich and and you know pulling the wool over all of our
eyes when you know really it's you know nothing of the sort and and you know that sort of
speaks to this whole issue of you know what almost seems like social Darwinism you know
where we just you know we have a path we can choose to go down a path where we support
each other I know this sounds very socialistic or we have this pathway it's just basically everyone
fends for themselves it's survival of the fittest and you know if I make it great if you don't make
it too bad for you and and I don't know how you break those myths thanks to you before we
take a quick break I just wanted to raise one more topic that I'm hoping this you might be able
to touch on a bit more i'm going to move outside of hamilton now we had an opportunity to fly
up to some remote native reserves in Ontario's far north and in those areas of the province
some of these connections between poor birth outcomes and poverty low educational
attainment low-income are extremely pronounced I'm wondering if maybe you could just
address some of the barriers that would exist to to helping to resolve these issues in the far
north yeah you know you know I thought a lot about this since we made our trip up there in
September obviously you know the issue of remote native reserves has been top of mind for a
lot of people with the situation in Attawapiskat with the the housing situation but you know
both Terry nights it was my it's my first I've lived in the North before but never have I been up to
the sort of the remote fly in part of the north where the only way in or out for much of the year
is on an airplane and when you go there it's you can't help but land in the plane and think good
lord you know the only way in and out is by a plane how it just seems so foreign to us down here
where you can hop in your car hop on the bus hop on the train wherever go wherever you like
there's no barrier to to your travel I can't even imagine what kind of mindset you would have to
live in a community where basically at you know at the end of your community the road comes
to an end and that's it and you know if you want to drive your car out you wait till the middle of
January when an ice road is built and it's 12 hours to get from in our case big trout lake down to
pickle lake which is civilization you know to live in a place where you look at a community like
sue look out as being the big city you know where most people here wouldn't know where sue
look out is to people in big trout lake that's going to the city you know they have a hospital there
Wow good lord you know i can't i can't imagine so i I mean so many of the issues that they deal
with in these remote fly in reserves seem to be based primarily on just this lack of attachment to
you know the rest of the province I mean when that is your only community and those are the
only people that you know it's no wonder that you have huge highly elevated rates of teen
mothers substance abuse problems and you know why a lot of these issues are coming to light
right now and I don't know what the solution is oh yeah just just one sort of follow-up question
we're so detached from them I mean in terms of geography and in terms of culture how do we
make people here in central Ontario care about improving maternal health outcomes yeah
well I mean you know it's at some point it's back to sort of what Neal was saying in the first
place you know the children of this province are the children of all of us and you know I I don't
think that we can divorce ourselves from that I mean at some at some point we either all
equal citizens or we're not and if we're not then you know that's a far bigger discussion that
we need to have Terry if if I could just add a bit soundly I worked in a and northern Native
reserve town of about 500 people and when I was a medical student in Manitoba and what you
see there is what you see around the world in at places with you know similar socio-economic
circumstances if people don't have opportunities they have children and you know there's an
expression the rich girl richer the poor Grove children and you know it's it's it's it's part of
human nature to want our family to do well and if we can't do that by you know going to
school getting a job in providing a stable foundation then the other route is to have lots and
lots of children and a couple that are going to survive well enough to you know take care of us
when we're old and that's a pattern you see around the world and in every country we have
developing you know developing world conditions you see the birth rate being extremely high
and and over over time as as nations develop and you know and lives become more stable and
and opportunities become greater you see that birth rate drop off and that's been consistent
absolutely everywhere in the world though the one place that kind of on the one hand
exception but on the other hand proves the rule is is the country Cuba where you still have in
terms of gross domestic product in terms of income levels you have you know third world
conditions but what they've done is they have invested in children they have invested in
community-based health care that reaches out to people in neighborhoods and they've also
investing in education so that there's no there's no illiteracy there for example and every every
person that wants to go on and get secondary education can there's no barriers there so they
have opportunities and they actually are doing as well as Canada in many cases better on
things like you know teenage pregnancy absolutely low birth weight even you know the tiny
impoverished nation of Cuba does does better than you know North America so there there are
solutions there and and you know at their core they are political decisions and political solutions
can I just add one tiny thing to just second something to Chris head and I think that is the
importance of education in all of the understanding of this piece and I'm not surprised to hear
that Cuba does better from a health outcomes perspective because of their investment in
education and I haven't perhaps look closely enough at the maps but if you were to then lay
over the maps that were done as a part of this series the percentage of kids who graduate from
high school in each of those high schools in those poor neighborhoods I think one would find a
continuing correlation that suggests that in those neighborhoods education is not available
equitably and the kind of quality education that actually moves people into places where they
can actually get job opportunity and you know one-third of the Canadian workforce now and
this is a pretty stunning figure especially in a country like Canada one-third of the Canadian
work fairs is now without employment standards protections so what that means is that we've
gone from a highly unionized highly regulated workforce where we were all protected when we
went to work to now one third one out of every three workers has none of the protections that
ensure that they don't have to work in less over time that they don't have to kind of that they
have some job security etc and that's a major shift that's happened in the last 20 years in
Canada and so for people who do get jobs at that lowend low-skilled work it's at minimum wage
and it's without those kinds of employment protections many of the women we interviewed if
they are working are working at two to three jobs they're juggling the kind of part-time work
across the time span which is obviously pretty difficult if you've got kids at home and we don't
have a national day care program so I think education is really harp of how you kind of start to
build equality and we used to have more of that and we've really lost it and it's just a slight
illustration of that we were on social assistance in Ontario cannot access OSAP the Ontario
Student Assistance Program because that seamless double dipping so the very benefit that
would help people move into post-secondary education and get some skills that would let them
get secure employment is prohibited so I think education really is an important starting point
thanks so much later when we come back we're going to be taking public questions so so think
about those we're now moving into the portion where we're going to take some questions from
the audience so we'll get started with this this lady with the green sweater on I did enjoy the
article that I was a bit disappointed in that there wasn't any mention of the Canada prenatal
nutrition program which is a federally funded program it started in 1994 and targets the risk
groups that you mentioned in your article and within Hamilton there are actually three
projects an aboriginal project francophone project and the Hamilton prenatal nutrition project
which I coordinate and we have over 500 participants per year and we do have varied ranges
of Ages of mums with some very young mums attending and we the program addresses the
social determinants of health participants receive ten dollar gift certificate to help some
purchase nutritious foods weekly and also learn cooking skills we do have public health staff
involved in educational sessions at the the group's and our results are more women
breastfeeding and for longer duration and we also have lower numbers of low birth weight
babies so my question is was it overlooked because it's federally funded and you're focusing
on provincial programs or were you not familiar with the Hamilton prenatal nutrition project I
don't think it was so much a case of it being overlooked I mean as you know this is a you know
wasn't intentionally overlooked in the sense that you know we just decided not to incoming
there was lots of areas that we could have delved into I mean we've we've heard similar things
from some of the agencies that deal with teen moms and you know this wasn't intended to be a
retro you know a list of every single resource that's that's available for any potential teen mom
in the city it was more to give a flavor about you know what's what the problem is and you know
and then of course the third part of the of the series did look at some of the solution so it
certainly wasn't intentionally overlooked and I'm glad that you've had the opportunity to to at
least talk a bit a bit about the program well thank you and I'm glad that you were familiar with
the program and recognize the value of the program to the City of Hamilton it has been here for
over 15 years and the public health agency of Canada is always commenting us for the great jobs
that we're doing in the city and so even though we are working with just 500 women we could
easily handle more so if anybody is aware of high-risk women who would enjoy participating
we would serve love to have them and certainly build so a lot of social support for the women
so thank you thank you thank you I think it's kind of interesting in this city that we hold the
newspaper accountable for solving some of our problems i think the spectators done a really
fantastic job of highlighting this issue and that's their role and it's up to the rest of us to to you
know put the political pressure on and to run the programs the great programs like cpnp that
we do to address the problem thanks Chris okay go ahead hi my name is Erica I work at the
social planning and research council and I support a collaborative the young parent network and
I think I sort of want to echo the message that just came before me regarding some of the
success stories that are happening there are lots of stats out there but there are stories and
there are success stories happening in this community and I just want to highlight that the
young parent network they're seeing really great outcomes with a young parents they work
with I would encourage you to maybe chat with us and follow up with us and they include
angeles place grace haven in st. Martin's manners so they're really working with sort of a core
group of young parents and I'm really appreciating this series and the panel today was great and
bringing up the social determinants of health because so the purpose of the young parent
network is to acknowledge that it's it's beyond health it's about education it's about
employment it's about eating supportive housing and but of course health care is a very
important aspect of that so I guess I just want to really emphasize that there's a lot of work
happening and we need to maybe bring more attention to that and to bring more support to
that so I guess another piece of what I kind of am wondering is if we're talking about making
our governments more accountable how do we maybe go about doing that to engage them
more we would certainly appreciate having more of that support so that's sort of my thought
and I'm also kind of wondering in terms of next steps what do you think would maybe be
some other ideal sort of next steps to happen yeah so I'll leave that thought with you to
respond to well there's one thing I'd like to address right off the bat because we've heard from
the young parent network in the wake of the publication of our series and there's just
something I want to try to clear up because at no point in the series did we say that being a teen
mother is akin to a death sentence or that this it's as if you've acquired some sort of fatal
disease you know obviously we've heard from people around the city who are you know the as
Chris mentioned you know these success stories we never suggested for a moment that there
aren't success stories the purpose of the series was to show very clearly that there are certain
trends happening in certain places we didn't say that if you become a teen mother then you're
automatically sentenced to death that's not it at all we're just pointing out that like it or not this
is this is the way the maps look this is where these problems are happening these are the trends
these are the connections that we're seeing and it's very clear that you're not seeing some of
these same things happen in other places and you know but that doesn't mean that there aren't
teen moms in the Sherman Wentworth Barton Street area that aren't going to make it and
aren't going to survive but the fact remains it's going to be very difficult for certain for people in
certain neighborhoods to to do that will will some of them do it yes absolutely Arthur supports
out there that will help them absolutely you know we certainly did talk about grace Haven and
st. Martin's manner and angela's place that's in fact where we conducted some of our interviews
so but it's it's this ID you know yes people will will strive our will thorough thrive it's just good
more difficult in certain places niall you want his way in on that no I just would comment there
are many agencies engaged in this area let's call it reproductive care for wonderful better
umbrella term obviously there's public health is social planning and research council and there's
there's many many others some are highly focused and some some not but as you sort of travel
through the health system and it this is common to a great many other of the major health
issues facing society what you have is a jam session as I put it i think in one of the things i wrote
it's a jam session because you have all of these deeply committed people trying to achieve
objectives and many of them do achieve objectives at a local level with sometimes small
numbers of people and that's great but when you look at the number of agencies all with their
different governance systems and accountabilities and everything else it's a jam session
everybody's doing their own thing and i would argue that one of the things that would perhaps
lead to more coherence in this would ultimately benefit everybody if all of these agencies were
in a position if that was possible to sort of bring it together so that there wasn't that wasn't
duplication I'm not suggesting that you duplicate what other people do I'm saying that the
possibility exists if there isn't that coherence and the waste that that potentially can introduce
into things as well so let's um let's go back I know you're asking a question about government
accountability so how how do we motivate I take you mean the provincial government any level
of government how do we motivate the government to get involved so we were taking off so I
mean I work in governments you know there's there's many many people in government that
are motivated by altruistic means both elected and you know on the on the civil servant side
they're they're limited in many cases by the support that they do or don't get from the
community and if somebody in government were to change the world to solve this problem in
a way that community didn't support they wouldn't be in the government for very long gather
you know loser job or they become unelected so it is really about us and our the values that we
share as a community and how we do or don't choose to spread this message how we do or
don't choose to make our voice heard so that you know we may be just one person but if we if
we're speaking loudly we can make it clear that we hold you know we all this issue is a high
priority so you know again when we're pointing fingers there's always at least three
sometimes four pointed back at ourselves and I think you know if if we want to change on this
issue we need to as a community make it really clear that we want that change force knocking
out thanks thank you hi I'm Kayla I have three kids of my own IM mano w and I get three
hundred dollars to live on and they take all my child support away from me and they do not give
me a cent for my kids I have a comment towards Leah i we i run a young moms group and we
didn't like the fact that you said we didn't have really any aspirations that wise it was okay for us
to get pregnant I do have a lot of aspirations a lot of our mothers do have a lot we did take the
wrong turn in life and we did get pregnant but you know what we finished high school I want a
lot of us all have businesses or we are attending to get employment as a September I will be
open to my own daycare with three kids who have medical issues may I response to my
profound apologies if i gave you a message that i think that teen moms over any single mom
whether on a social assistance or not has no aspirations I simply meant to suggest that the
aspirations that all young people feel get Fort Hood for people who are growing up in poverty
because they don't necessarily see that they can realize them so the last thing I would ever
suggest ever is that people don't have those aspirations but I think that we've got a system
where there's such extraordinary levels of inequality that many people feel like there really isn't
much hope in terms of being able to kind of manifest their aspirations they're not going to be
able to actualize them so that's what I was suggesting not that not that people didn't have them
and I thank you for raising the issue around child support I mean I don't know the extent to
which the audience some recognizes that in Ontario we have a system where child support if
you're on Ontario Works which is the social assistance system and for a single parent eighty-five
percent of whom are single moms if the child's father our children's father are paying child
support that's deducted from the Ontario Works benefit dollar for dollar so for those family
even though the father is contributing there's no net benefit to the family they're just as poor as
if the father didn't contribute at all so it creates a real disincentive for fathers to contribute and
also leaves mother's very vulnerable to abuse where we have one of the women that we
interview her ex-partner the father of her kids has for 18 years not paid a cent in child support
and that's deducted from her check because he threatens that if she ever reports that it's not
paid he'll beat her up so she duly reports that she receives the child support that has it cut from
her check so there's a real problem in many many ways with the way in which the social
assistance system is structured including the fact that child support gets deducted from from a
check so I thank you for raising that issue and also we don't class ourselves as living in poverty
we have a family we are loved and we also have a roof over our head and we could provide for
food on the table for our children and ourselves so we're not living in poverty thanks good
evening my name is Dave Carson I got sort of that I'd like to hear some comments from the
panel and also suggest where studies might go in the future with respect to food and food
education while we have this massive bill for our provincial health care we have as we here at
oncoming epidemics in terms of both diabetes and obesity and a lot of I perceive a lot of it is
because people don't eat right we have large quantities of sugar and salt in our diets I was
happen to be in a store in the north end just recently and four of the five aisles were basically
packets of chips and cookies and large rows of drink coolers so I guess Mike I got questions first
of all and then perhaps an opportunity here we're currently working on a food charter for
Hamilton which is trying to look at what should be the healthy affordable culturally acceptable
food that should be available to everybody and we're trying to look at what should it take to put
that in place my question perhaps would be first of all for Leah would be in your interviews do
you perceive full awareness of the pitfalls of the types of food that people and this is not just for
people in poverty of course it's a whole population is is eating wrong in many respects so
education in terms of what it takes the nutrition in the schools to me is a great very importance
and can do a lot to free up healthcare dollars to spend in the right place so that I'd like to hear
your comment on the level of education and understanding of our general population on a
pension and then offer to Steve and respect that there's an opportunity here to look into this in
much more detail and talk about what should be put in place for a healthy food system in
Hamilton landed Ontario I certainly thank you for the for the question I mean the whole food
security issue is it's much more salient in the lives of people on social assistance then I think
most of us can even imagine him and my work has his focused in poverty and long before I
became an academic I did frontline work with with homeless people so I thought I knew but we
have lots of women who talk about the fact that these are people who are on social assistance
single mums that they don't have enough money left from a welfare check and from the
National Child Benefit to actually buy food the food that they rely on to feed their families
comes from the food banks and food banks do a great job but food banks can't provide fresh
fruit vegetables and so people are reliant on canned food often people are worried about food
past best before dates it's difficult if you don't have internet access to know just how risky that
is you can't do very much research on it so people are scared about food and we certainly have
many many many women talk about I mean a woman by the name of Janet's comment
resonates still we end our interviews by asking people what they'd like what they kind of wish
for for their families and Janet says what I really love is to have a fridge with food in it all the
time for my kids and most of us think about fridges having food I'm not having fridges that are
empty maybe a little bottle of old mustard as all that's in many many people's fridges so people
were very cognizant though of the need to give their kids fruit and vegetables to buy fresh food
but had a real kind of issue with affordability and lots of people talked about the kind of stress
that they felt in terms of managing volunteering part-time work the kind of being the sole
caregiver for their children and the need to kind of save somewhere and that's where the bags
of chips come in that it's easier it's faster they feel kind of stressed at the end of a day and so
the preparation of a healthy meal was more than they could cope with just just to echo that
Hamilton public health does a fair bit of work on food security and and you know the obesity
epidemic is a major concern of ours and on this issue like many issues education is is part of
the solution but accesses is a much bigger part so whether its financial access or whether it's
because you know that that's store that you walk through in the north end has you know for
four rows worth of stuff that we would barely even classify as food oh you forgot to mention
chocolate bars there was probably a row of that so but you know if you can't if you can if you
don't have a car you can't afford taxing you can't get to a place where there is good quality food
that's a huge issue if you're you know your welfare check is five hundred ninety dollars a month
and you're rent is 510 dollars a month you know that buys a lot of chips from not a lot of apples
so access is a huge huge part of that and that's how much you know more complicated issue to
solve well my name is Pat I am a born and raised Hamiltonian and loved this city and went into
education at a young age and spent 25 years working with kids with in his system I'm not a
person who fits within the box and found it necessary to leave the system because I also saw in
spite of wonderful teachers a lot of kids suffering some children just cannot work with in a box
in the last 10 or 12 years in community work I am putting a plea here to Hamilton because I will
agree with the panel on many things but one in particular because I have chosen to step out of a
career that that certainly did well from a payment perspective to a career where I'm competing
and often viewed to be a threat with so many people holding the cards close to their chests with
organizations and agencies loaded with wonderful people and they're hard in the right place but
sadly with an attitude that they need to protect and defend and there's two things I really would
just end with a comment to the Hamiltonians we can be competitive or we can be collaborative
but we can't be both would anyone on the panel like to speak to the issue maybe of
collaboration yeah I mean it was actually the first Code Red series that that but our attention in
public health in part to low birth weight issue because it was highlighted there although not to
the same degree and we're actually working with a number of community partners right now
agencies of the community trying to figure out how we can collaborate better because you
know i think neil has really pointed out that we're you know jam session I think we'd rather be in
orchestra with you know conductor and all playing from the same same song book so so that's
that's a big part of solution it's on you know we know there aren't going to be any major new
injections of funding in the short term certainly we're provincial and federal governments are
with the deficit situation is going to be very difficult so so collaboration is one of the ways we
can take the few resources that we have and stretch them even further so I think that speaker
made a great point thanks Chris we're going to take these two two final questions we should
have time for those thank you my name is May I'm a I'm imported from Scotland a hundred
years ago um I'm you see before me a low birth weight baby i was born full-term low birth
weight to a toxic mother and when she grew up when I I was old enough and when i was doing
midwifery training I got her Stanford history I got it it's the obstetric history of most of the
females and the extended family also but mother's diet would make your hair stand on end
because this was nineteen thirty-five and life wasn't that good anyway as you can see I survived
so if you have you know met somebody who got wrapped in cotton wool and put in a drawer
and fed in with cream not milk anyway here I am I have a few things to say I guess from my from
my experience and that's it for my own history but um I taught obstetric nurse thing for for
some years here in North America also was an America periodically so I have sort of both
Canadian and American experience I think one of the things you need to think about is is the
culture the call difference between some of your patients or clients and and and the the worker
who is trying to give the service whatever it is over the years I've found some people who can
interact very well with some of the I'm of my experience as patients rather than students are in
another workplace but some kind of can get into the head of the the person more so than
others so I I don't know what we do about that except if you know that you're very good you're
quite good at it then maybe that's what you should do if you know that you're not find a way of
getting somebody else to assist that person with that particular problem I'm pleased that no the
Ontario government is acting on the the study the early education study that was spearheaded
by Frazer mustard because I think part of what we need to do is get the beginning of education
started sooner I think that will help both the people who would have processed their child well
anyway but also the people who have not the same opportunities to process the child they have
a better chance with some sort of head start program than they have sitting at home with the
child also i think when i was doing a course and boston we the other nurse and I followed a
group of mothers and that's fairly typical of what you tend to do prenatally and so on and I
found that some of the mothers really use that so most of the pregnancy that we had them they
were getting extra information from us in fact one one young woman did it I thought she was
really smart I we asked her how she got her information when everything was finished and she
said well if it was the beginning of the week and I was going to see you or your partner I gave I
asked this question and if it was the end of the week the public health nurse was coming to see
me and I did that and I thought that was really good another thing about that experience the the
clients in the in the prenatal clinic that I was learning from used the nurses to get some
information they rarely used the obstetrical residence the social class difference seemed to
make it difficult for them to speak to them even when the language was easier for them
because there was a lot of Spanish American patients doing this so I think that's something we
all need to think about how we can bridge any cultural gap that there is I think I could go on but
I think that's probably enough actually it's something that we encountered when we visited six
nations they have some wonderful programs yes yes I've known about that for sometimes we're
going to take that and in some of the places up north because I was up north for a while they do
fairly well for others not quite so well but it's very bad to have to bring your mother down to a
major center and quite a number of weeks before they expected to have the baby because the
social break with the extended family is possibly from their point of view worse than anything
they gain by coming down thank you very much those are all really valuable points even think
this one last question before we wrap up our public forum for the night my name is Mel I i'm
proud to live in a city where we can have a discussion like this tonight what i think is important is
as has been identified that it is actually is a political issue that has to be dealt with at the
political level as well as at the personal level and it seems to me that one of the problems that
we have as a society is that by and large and in judge speaking very broadly the people who vote
don't have the direct experience with the kind of poverty that you've talked about in the Code
Red and the people who do have that kind of experience by and large are not voting and the
same kind of proportion as the rest of us I happen to be a numbers guy and I love data and I'll of
statistics and it means something to me I can get the picture I think in order to be successful
with this kind of issue we need the narratives we need to put a real face on this we need to have
the kind of interviews that leah is doing in the stories that she's talked about and some of the
stories that that you have covered in in the spectator so I'm wondering if it would be possible
and I don't know whether this is asking too much you know that are going off the cuffs thing all
right are there some really powerful narrative stories you've already told us a couple tonight
Leah are there other some more that you could share with us because I think that's really
important in making the political changes that are necessary we interviewed a hundred and
forty women across the country five times over five years so we have many many stories and
and they're all equally rich and just just to pick up on on one and we've talked a little bit about
education before but this is a story from Terry who's a First Nations woman living in downtown
Vancouver on the Downtown Eastside the Vancouver which is one of the poorest
neighborhoods in North America and Terry talked about the fact that in her family her extended
family no one has ever finished high school and she talked about the fact that because we
interviewed over that long period of time and we hired single mothers on social assistance and
train them as peer interviewers so they developed a relationship with people that they were
interviewing and we had very little attrition fall off over that period of time because the women
we were interviewing began to kind of want to be a part of our project they wanted to tell their
stories and so we'd have them call to say I've moved so when you come to interview US in a few
months you know I want to make sure that you know where to find me and and back to Terry
over the course of that period of time just because she had this opportunity to kind of reflect on
her life circumstance and being an environment where there were some supports for her she
began to reflect on her own children and there are opportunities for education and over that
five-year period of time she moved her two children to a different high school at an
extraordinary amount of cost and hassle out of her local school where it was a kind of data in
school there wasn't an expectation on the part of teachers that kids would graduate that they
would go anywhere and she began to talk eloquently about the fact that her kids were going to
be the first in her extended family to graduate high school and the experience of course the kids
because it's you know this is a family with a family dynamic and as those kids began to kind of
see their educational futures differently they began to kind of work on their mother about what
they ate and what kinds of household they wanted to live in and why there weren't books and
so you know there are those kinds of stories that give you just kind of little glimmers of how
families can change when they get just a little bit of support we brought a group of 17 women
just it's a plug for the ontario trillium foundation that supported us to develop a little pilot
project where we brought 17 or 18 women together and they meant once a month through the
whole life of the project and they're only the only task or goal of the group was for those
women to support each other and over the course of that we saw women who managed
successfully to overcome addictions people do really extraordinary things so there are many
stories that are extraordinarily rich that give just a little bit of insight into what kind of possibility
when people get the kinds of supports that they need and when they get a message of value
marchesan talks about the fact that one of the impacts of poverty isn't just material deprivation
but a lack of feeling of worthiness to be in the public realm and with that lack of feeling of being
worthy one doesn't feel like one can make a case one can't say hey we need to do something
about inequality one doesn't vote one doesn't feel equal as a citizen and I think those are some
of the kinds of issues that we need to take hit on no I'll tell one quick little anecdote here maybe
to wrap it up you know when I did the first Code Red project I spoke to a young woman she was
20 or 21 at the time and she had four children which in and of itself is a challenge I can't even
imagine and just we were chatting and she sort of had a throwaway line as we were discussing
something and she said oh yeah because we were talking about the cycle you know this cycle
that we just have such a tough time breaking of Teen Mom becoming you know the children of a
teen mom becoming a teen mom and you know on and on it goes and she just sort of casually
said to me oh yeah my my kids have a great great grandmother and I thought I can't even
imagine living in a family where your kids could have a great great grandmother that just shows
you how that cycle doesn't get broken in you know i'm i'm very proud that that terry and myself
and Neal and Chris have been part of both projects here too you know I'm very proud that like
you said that you know that that we can have this kind of discussion in this city i'm i'm very
thankful that the spectator has been able to shine a light on this but you know there's only so
much that we can do and at some point that has to move away from the newspaper and out
into the general community and you know i think that's that's a good place to leave it it's up its
up to everyone in the community to try to figure out a solution to this thanks to you thank you
all so much for coming tonight that's all we're going to have time for thank you also to our
panelists and have a fantastic evening