Quebec’s Children at Risk: Doctors Sound Alarm Over Underfunding and Systemic Neglect
A growing chorus of medical professionals in Quebec are warning that the province’s ongoing healthcare reforms are failing to adequately prioritize the health and well-being of children and adolescents, potentially rendering them “invisible” within the system.
Published at 9:00 a.m.
Children and adolescents represent almost 20% of Quebec’s population, yet they embody 100% of its future. The stark reality is that, historically, one in four children in Quebec did not survive their first birthday. While that statistic has thankfully improved, a new crisis is emerging: today, one in four young people suffers from a chronic illness, whether physical or mental. The vulnerability of childhood hasn’t disappeared; it has simply transformed.
The concerns, spearheaded by pediatricians Dr. Julien Roy-Lavallée and Dr. Catherine Dea, along with five co-authors and numerous co-signatories, center around the implementation of Law 2 and its impact on pediatric care. According to the group, children are being “well hidden under green pellets” – a metaphor for being deemed not vulnerable and therefore not prioritized within the new framework.
“Our uneasiness goes well beyond the method of remuneration of doctors,” a leading physician stated, “and extends to several directions of the current reform which forget our youngest citizens.”
The core issue lies in the performance objectives driving the reforms, which fail to recognize the unique needs of children and adolescents. While programs like Act Early, youth protection, vaccination, and certain social services are acknowledged as important, they are deemed insufficient to address the broader spectrum of pediatric health. Children’s physical and mental health are significantly underrepresented in the indicators used to guide investments and clinical priorities. Currently, the metrics in place do not adequately assess the quality of care, the experiences of families, or the health inequities faced by young people.
The medical professionals warn that a flawed system of measurement can have damaging consequences. “What gets measured gets better,” is a common refrain, but as one expert noted, “any poorly calibrated measure or disconnected from clinical needs creates perverse effects, accentuating inequalities, demobilizing teams and blinding decision-makers.” The risk, they emphasize, is that children and adolescents will become invisible within their own healthcare system precisely when they need it most.
Canada currently ranks 19th out of 36 high-income countries in terms of youth well-being, according to a recent UNICEF report. In Quebec, spending on individuals aged 0-19 accounts for a mere 10% of total health expenditure, including hospitals. This proportion shrinks even further when excluding postnatal care expenses. However, research consistently demonstrates a strong return on investment in pediatric services, suggesting that increased funding could ultimately strengthen the economic viability of the entire healthcare system.
On the ground, healthcare providers are facing multiplying dashboards and funding cuts to teams deemed “underperforming.” This is occurring alongside increased centralization of power and broader budget cuts in both health and education. These decisions, the group argues, are not supported by scientific literature or expert consensus, and represent a significant departure from a care approach focused on the needs of children and families.
Six Unifying Courses of Action
To address this critical situation, the group proposes six key areas for action:
- Recognize the Specificities of Youth Health: Acknowledge the unique health needs of children and young people, as well as the specialized expertise of their caregivers.
- Ensure Youth Representation: Promote policies that systematically include the voices of children and their caregivers in healthcare decision-making processes.
- Increase Pediatric Funding: Increase and protect the proportion of funding dedicated to pediatric care, encompassing medical, professional, and material resources, to achieve greater intergenerational equity.
- Invest in Prevention: Invest massively in child health prevention initiatives within clinical settings, daycare centers, schools, municipalities, and community organizations.
- Adapt Performance Indicators: Mobilize health teams around performance indicators tailored to the realities of childhood and adolescence, fostering continuous improvement and interdisciplinary collaboration, rather than control or financial penalties.
- Strengthen Information Sharing: Enhance the sharing of clinical information between young people’s living and care environments to improve efficiency and continuity of services.
Children and adolescents are among the most vulnerable members of society and deserve to be at the heart of healthcare priorities today, not tomorrow. A shift away from a purely accounting-based view of health is urgently needed, along with a fundamental rethinking of the healthcare network to benefit future generations. The question remains: will Quebec, a province that prides itself on its love for children, rise to the challenge and scale pediatric care to the height of its youth’s needs?
Co-authors: Dre Audrey Lafontaine, pediatrician, complex care; Dre Marie-Claude Roy, pediatrician; Dre Marie-Joëlle Doré-Bergeron, pediatrician, complex care and pain; Dre Mariève Tétreault-Deslandes, family doctor; Dre Michelle Houde, doctor specializing in public health and preventive medicine
See the full list of co-signers
- Consult the UNICEF Innocenti 19 report, 2024.
- Read National Health Spending Trends, 2024 — Quick Analysis.
- Read “A future for the world’s children?” (in English).
- Lisez « Family-centred care research in paediatrics : A scoping review » (en anglais).
What do you think? Participate in the dialogue.
