Child health research in Canada: Alive and well?

This issue of Paediatrics & Child Health provides an important opportunity for everyone concerned about the health of Canada's children and youth to take the pulse of child and youth health research in our country, and to celebrate the achievements of our colleagues from a wide range of disciplines! Under the impetus of Drs Noni MacDonald and Elizabeth Ford-Jones, and with help from Dr Ronald Gold, we have undertaken an exploration of the literature published in 2003 involving children and youth that featured at least one Canadian author. The goal of this special issue is to recognize the range and diversity of research in our field done by Canadians, and to highlight certain interesting content and methodology.

Note that this edition of the journal is neither a research prize-giving exercise nor a popularity contest. Rather, the issue is designed to identify themes that are current in the areas of expertise of the three guest editors (my own emphasis being on developmental and behavioural paediatrics), and hopefully, to stimulate colleagues to recognize how much Canadian researchers are adding their perspectives to improving the well-being of children and youth through research in Canada and around the world. Note as well that the scope of the search undertaken by Dr Gold to retrieve the papers to which we had access focused particularly on clinical rather than basic science research.

Many years ago (too many!) while studying for the paediatric fellowship exams, I often spent time scanning the titles of journal articles specifically to get a feel for what the ‘hot topics’ might be, those on which I should probably spend my time. Thus, as I reviewed the titles and abstracts of papers harvested for this review, made possible through Dr Gold's efforts, I took somewhat the same tack.

In selecting the papers that have been included on developmental and behavioural issues in child health, my intent was to highlight several issues gleaned through scanning the titles and abstracts of approximately 600 papers retrieved through the search outlined in the paper by Dr Gold (pages 385–387). The papers I eventually chose to highlight were in some cases selected based on the facts and evidence they provide, while others were selected because of the importance of the methods that were used.

For example, among the approximately 600 papers harvested are reports from studies based on large data sets, especially population-based surveys. The advantages of such data sets are the epidemiological (hopefully relatively unbiased) nature of the information obtained and, usually, the scope of the available data, including a mix of clinical and demographic details. Large data sets make it possible to explore relationships among factors, taking advantage of the power of numbers and the diversity that inevitably exists when one makes any inquiry across a broad community. Whereas a controlled clinical trial attempts to minimize differences across groups, other than those involved with exposure to the ‘active’ ingredient that is being studied in the randomized controlled trial, the methods used in large epidemiological surveys celebrate and exploit variation and diversity to understand what influences that variation.

On the other hand, as anyone who has ever used population-based data sets knows, there are always fewer ‘clinical’ details available than if one were actually seeing these same children and youth in a clinical setting, where more information would be sought and annotated as a guide to clinical decision-making. This can lead to a degree of apparent superficiality in what is studied, and at times, to some frustration! The trade-off need not be seen as an ‘either/or’ challenge; rather, the value of epidemiological information should be recognized as a way to see the ‘big picture’ from a perspective other than the one gained in the clinic. This perspective can then provide a basis for further explorations in both the clinic and the community. The interrelationship between these apparently contrasting approaches to research needs to be recognized and used to move the field forward.

What else struck me as I reviewed the titles and abstracts of these papers? There are a number of exciting developments in the field of child and family health and well-being that speak to the broadened scope of our focus and interest. People are recognizing the importance of understanding the impact of illness and disability on children and families (1–3). There is increasing attention paid to the compelling, if complex, issue of the ‘quality of life’ of people with illnesses and disabilities. In addition, as paediatricians, we are becoming uncomfortably aware that many childhood disorders, including developmental and some behavioural conditions, do not disappear in the teen years. The metaphor of youth ‘dropping off the cliff’ has been expressed by parents whose adolescents no longer qualify for paediatric services and have no natural medical ‘home’ in the adult system (4,5).

What we call things and how we classify them is a perennial challenge in many areas of medicine, and certainly in the areas in which I work. As the biomedical underpinnings and genetic mechanisms of complex disorders are unravelled, our ability to classify and group conditions has become even more important than ever. The ‘clinical-pathological’ correlations that are becoming possible depend importantly on our ability to be specific. Based on personal research interest and a familiarity with the need for effective ways to communicate, I was interested to note papers that are exploring these issues and bringing some clarity to the difficult but fascinating world of the language we use to talk about our patients' conditions (6,7). Experience suggests that when we use the same terms in the same way we can improve communication between physicians and families, and between colleagues and researchers.

A final thought concerns what I see as exciting developments in the nature and scope of child health research. Longitudinal studies (8–10) provide us the opportunity to look at issues in a way that is simply impossible with cross-sectional explorations of an issue. In a longitudinal study, it becomes possible to describe within-person change, providing us with a level of understanding that cannot be assumed when we compare different children at different ages and try to sew together an understanding of trajectories of development or disease patterns. Another important opportunity that is increasingly being realized in Canada is that multisite collaborative inquiry brings people and perspectives together, something that is particularly important when medical or developmental conditions, or innovative treatments, are relatively rare (11–14).

In summary, there is much to celebrate in Canadian child and youth health research, and many lessons to be harvested. At the same time, we need to pay attention to the areas of child and youth health that are not described and are seriously absent from Canadian child and youth health research. For example, where are the leading-edge studies in aboriginal health, or the exploration of the health, well-being and adaptation of children and youth new to Canada, especially those from developing countries who arrive in Canada having experienced war, deprivation, and perhaps, trauma. We hope that these overviews will stimulate interest in what we know (and what we still need to learn) about child and youth health in this wonderful country. We also hope that these perspectives will be used by clinicians, researchers and funders to recognize areas where much progress remains to be achieved and where Canadian child and youth health scientists can lead the way.

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Author notes