Healthy birthweight
Babies born with a birth weight of less than 2,500 grams are more likely to die in infancy, experience health or development problems, and require a disproportionate amount of health care and other services.

A number of Public Health programs that improve birth outcomes as their primary goal are currently in place in the city. These include the Canada Prenatal Nutrition Program Partnership, Healthiest Babies Possible (Map 5), and the High Risk Homeless Pregnant Women Project.

The Canada Prenatal Nutrition Program (CPNP) is a comprehensive community-based program that supports pregnant women who face conditions of risk that threaten their health and the development of their babies.

The primary objectives of the CPNP are to:
a) Reduce the incidence of babies born with unhealthy birth weights
b) Improve the health of pregnant women
c) Promote initiation and duration of breastfeeding
d) Increase the accessibility of services for less adequately served high-density urban areas, and culturally or linguistically hard-to-reach at-risk mothers and infants
e) Increase partnerships, linkages and collaboration in the community to increase the recognition and support for the needs of at-risk mothers and infants.

Chart G & Chart H

Toronto Public Health works collaboratively with over 50 community agencies and Health Canada to provide ongoing weekly prenatal support programs to reach at-risk pregnant women. The CPNP provides services such as food and nutrition supplementation, education, counselling and other supports to at-risk pregnant women. Programs also provide breastfeeding and parenting support to women for three to nine months after birth.

Prior to 2000, there were 23 CPNP sites in Toronto. In 2001, there were 38 CPNP programs in 32 sites. Over 3,115 pregnant women were reached, which represents a 13.3% increase from the 2,701 women reached in 2000.

The Healthiest Babies Possible program provides nutrition education and counselling, prenatal vitamins and food coupons to high-risk pregnant women at community sites across the city. This program is delivered by Toronto Public Health dietitians in co-operation with Family Home Visitors and Public Health Nurses from the Healthy Babies, Healthy Children program.

An Early Child Development grant has allowed for the creation of a special program specifically aimed at working with youth shelters and youth-serving agencies to provide Public Health Nurse support to homeless and underhoused pregnant and parenting youth.

Children stay healthy

Healthy eating and nutrition
Nutrition is an important factor for growth and development of children. Research provides compelling evidence that under-nutrition during any period of childhood can have detrimental effects on cognitive and behavioural development in children, and can decrease their productivity in later life. Resulting impairments could have life-long effects that restrict educational and employment opportunities in the future.

A study of Ontario preschoolers found that the minimum recommendations for milk, fruits and vegetables were not being met and that "other foods" (less nutrient-rich foods) contributed to 20% of children's calorie intake.

Two of the most common nutrition-related problems in children from low-income families are iron deficiency and childhood obesity. Iron deficiency anemia is a leading cause of developmental delays in young children. Both the severity and length of iron deficiency anemia appear to determine whether these delays are reversible or not. Other consequences of under-nutrition are poor weight gain, anorexia, mal-absorption and irritability.

During 2001:
• Peer nutrition programs were facilitated in 24 different languages
  
• There were 71 locations across the city and 9 that offered Peer Nutrition Support Groups/Drop-Ins
• 2,603 children between the ages of 6 months and 6 years benefited from the program.

The prevalence of childhood obesity is increasing in Canadian children. Childhood obesity predicts adult obesity and other health consequences, including diabetes, heart disease and cancer. Environmental issues such as immigration, changes in lifestyle, access to food, food purchasing and preparation skills also influence the child's nutrition.

Parents face many challenges in feeding their families. These include:
• Lack of adequate information about traditional and cultural foods, healthy eating habits and good nutrition practices
• Limited skill in navigating through large supermarkets, understanding labels and selecting foods that contribute to a healthy diet
• Lack of support in the transition from breastfeeding and bottle feeding to solid foods, and skill in preparing appropriate foods for toddlers
• Insufficient income to purchase nutritious food, and lack of information and support in food budgeting and simple, affordable food preparation.

The Nutritious Food Basket (NFB) is a food costing tool that measures the cost of healthy eating. Calculated annually by Toronto Public Health staff, it provides information on how much it costs to buy a very economical basket of food that can be used to prepare meals for a family to meet their nutritional needs. A key finding from the NFB survey in 2002 is that the average weekly cost for a family of four is $120.99, an increase of 3% from the 2001 pricing survey. Since 1999, when the Ontario Ministry of Health mandated Boards of Health to annually conduct the Nutritious Food Basket survey, food prices have increased by more than 13%.

Peer nutrition (Map 6) is a Toronto Public Health program offered to parents and caregivers of young children with a focus on the diverse ethno/cultural communities that are often missed by traditional nutrition programs. This hands-on program provides parents with information about the importance of child and family nutrition for healthy growth and development. It teaches a number of skills including budgeting, meal planning, nutritious food selection and food preparation. The goal of the program is to enhance the nutritional status of children aged six months to six years.

For many of Toronto's families, the increasing costs of other basic necessities, particularly rent costs, leaves little if any money left for food purchases. In its 2002 annual survey of food recipients, the Daily Bread Food Bank found that after paying the rent each month, households with children relying on food banks have just $3.65 a day per person for all other living expenses, including food.

Physical activity
The health of Canadian children continues to be undermined by high levels of physical inactivity. Two-thirds of school-aged children are not active enough for optimal health and development. This is most strikingly reflected in what health experts have defined as an epidemic of childhood obesity. Between 1981 and 1996, the prevalence of overweight children more than doubled from 11% to 33% in boys and from 13% to 27% in girls, and there was a four- to five-fold increase in obesity from 2% to 10% in boys and from 2% to 9% in girls.

Obese children tend to become obese adults, facing an increased risk of diabetes, heart disease, orthopedic problems and many other chronic diseases. During childhood, they face both health and psychological problems related to their obesity.

Physical activity is an essential component in addressing this situation, and in enhancing the health and vitality of all children. Participation in physical activity is required to achieve physical fitness, and is a key factor in achieving optimal health and weight. People who establish the skills and habits for physical activity in childhood are more likely to live longer, healthier lives.

The City has been a leader in developing, implementing and disseminating effective programs, resources and models to support increased children's physical activity through:

• The Rainbow Fun Physical Activity Program for Young Children
• "Outdoors: the Ultimate Playground"
• The booklets "Moving on the Spot" and "Fun and Physical Activity for Families and Caregivers with Children 0 - 4 Years"
• The Family Fit Kit
• A model to increase children's physical activity in ethno-racially diverse and socio-economically disadvantaged communities in South East Scarborough.

Respiratory hospitalizations
In 2001, Ontario's environment ministry issued seven smog advisories for Toronto for a total of 20 smog days. As of the beginning of August 2002, there were already 15 smog days recorded in the city, which means Toronto could once again reach record numbers of smog days in 2002.

A smog alert (advisory) is called when there is a strong likelihood that there will be widespread and elevated levels of smog within the next 24 hours. The main source of air pollution in Toronto comes from the burning of fossil fuels such as oil, gasoline and coal. Air pollution is linked to reduced lung capacity in children and increased hospital admissions for asthma, chronic lung diseases and respiratory infections.

Respiratory disease is the leading cause of hospitalization among children aged 1 -4, with infants less than one year of age having the highest rate of hospitalization.

Respiratory illness is related to the determinants of health including income, housing and environment. Environmental contaminants affecting outdoor and indoor air quality (e.g., chemical pollutants, tobacco smoke, allergens from dust mites, pollens, pets and moulds) are key factors (Toronto Public Health. Patterns of Child Respiratory Illness in Toronto, May 2000, p.9).

In 2000, there were 2,824 hospitalizations of children aged 0 -14 for respiratory disease (asthma, croup, bronchitis and pneumonia) compared to 3,244 hospitalizations in 1999. A child will be counted more than once if they were hospitalized on more than one occasion in the same year. Trends in hospitalization are influenced by many factors, including hospital admission policies and access to care, and do not necessarily reflect changes in morbidity.

Bronchitis was the most common cause of respiratory hospitalization among infants (64%), while asthma was the most common cause among children aged 1 -14 (56%). Respiratory hospitalizations only partially reflect the full extent of respiratory illness in the community. Studies estimate that only one in 10 children who report having asthma are hospitalized.

Toronto Public Health launched "20/20 The Way to Clean Air", a social marketing campaign that challenges the community to reduce their household energy and vehicle use by 20%. This campaign hopes to lower energy use thereby reducing air pollution that causes health problems and climate change. In addition, Toronto Public Health provides education and outreach to the community related to the health effects of smog. New education materials about exercise during heat and smog alerts was recently distributed to child care centres, sports associations and libraries.

Emerging child health issues
Toronto Public Health has initiated strategies to improve children's mental heath and early childhood tooth decay (ECTD).

A children's mental health needs assessment and review of best practices was conducted by The Centre for Studies of Children at Risk at McMaster University. The purpose of the needs assessment and best practice review was to inform Toronto Public Health on ways to improve children's mental health. The needs assessment reviewed data that suggest levels of emotional-behavioural problems in children have increased and that a number of child-related, family and neighbourhood characteristics are linked to emotional-behavioural problems in children. Research also shows that emotional-behavioural problems in children are moderately to strongly correlated with children's social relationships, academic performance and physical functioning.

The incidence and severity of early childhood tooth decay has also been identified by Public Health as a cause for concern. ECTD is related to diet and improper feeding practices. The length of time that sugary snacks or drinks stay in the mouth and the frequency of exposure to these foods and liquids are also important factors. An Early Childhood Dental Decay Prevention Program is being initiated.