The Next Wave of Health Care that No One is Talking About

Jonathan Kates

In a classic Simpsons episode, Bart is having trouble in school and starts acting out – what else is new – but his teacher, Mrs. Krabappel, realizes the cause of his behaviour isn’t psychological, but physical: Bart can’t see the chalkboard. The next day he arrives to class wearing thick-inched glasses and voilà! He can see the board.

Bart’s case is not unique and the reality is that many young students have unresolved vision and auditory issues that are impeding their development and education. It is troubling that only 14 per cent of children under the age of six in Canada receive professional eye care. The College of Optometrists in Vision Development reports that 10 per cent of American children have a vision problem significant enough to hamper their learning, and that children with vision problems are often misdiagnosed with attention deficit-disorder (ADD) and attention deficit hyperactivity disorder (ADHD).

But back to Mrs. Krabappel, Bart was lucky that his teacher was experienced and knew of the various reasons why a child’s learning processes could be impeded. Unfortunately, most parents don’t, especially when the parents of young children are young themselves. Family demographics are incredibly important too. The most recent TDSB Student and Parent Census, conducted in 2011-2012, found that 67 per cent of students come from families in which both parents were born outside of Canada. It also found that English is the sole language for only 45 per cent of TDSB students. Language barriers, precarious labour that does not provide benefits for dental/eye coverage, and income inequalities all contribute to—and exacerbate—the poor medical treatment that some children are receiving.

To combat this slippery slope of absent care, misdiagnosis, harmful medications, and communication boundaries, the Toronto District School Board (TDSB) launched a pilot program in 2010 that brings medical professionals into pre-selected elementary and high schools. It is called the Model School Paediatric Health Initiative (MSPHI) and was born after 10,000 inner city students had their vision and auditory capabilities examined and the results were troubling. Of these 10,000 students “75 per cent of students with auditory referrals did not receive the services they required following the assessment [and] nearly 30 per cent of students referred for further vision or auditory services did not have coverage through the Ontario Health Insurance Plan (OHIP).”

Between November 2010 and 2011, three in-school health clinics opened at Sprucecourt Public School, George Webster Elementary School, and Brookview Middle School, all to great success. These clinics combined medical attention, language interpretation, and information sharing between medical practitioners and educators to tackle students’ problems with a multi-disciplinary approach. The program expanded in 2012-2013 to include Gosford Public School and Willow North Albion Collegiate Institute (NACI). NACI was staffed almost entirely by a nurse practitioner and the main functions were more relevant to adolescent students. Some of the initiatives included: immunizations, annual physicals, mental health concerns, nutritional counselling, and sexual counselling. Also of concern was that 19 per cent of the visits at NACI in the first year were “unattached” students, meaning they had no primary health care provider. These clinics provide a one-stop opportunity for students who have a variety of unmet needs to, well, have those needs met.

Most recently, the TDSB continued its existing partnership with St. Michael’s Hospital when it added Nelson Mandela Park Public School in Regent Park to its mandate. Rather than focusing on sight and sound, the medical team at Nelson Mandela Park decided that focusing on developmental health issues like ADHD and autism would more foundationally address students’ problems in that particular school. Proper diagnosis of sensory and developmental issues at a young age can help alleviate the exhaustive pressures that students face as their class material becomes more difficult, especially in cases where English is not the student’s first language.

It is clear that in-school medical programs work. Besides the growing number of in-school clinics, these clinics are also used by surrounding schools building out the program’s community aspect. The TDSB reports (figure 8) that two elementary school clinics served 19 feeder schools in 2010-2011; by 2012-2013, five clinics were serving 66 feeder schools. Subsequently in that period, the number of registered students in those schools’ clinics grew rapidly from 606 to 3,270. In the United States, school-based health centres (SBHC), as they are known, are widely popular. As of November 2009 there were over 1900 SBHCs across the country, but only 12 per cent were sponsored by school boards. The rest were funded by community health centres, hospitals, or local health departments.

To the TDSB’s credit, these clinics are also surprisingly inexpensive to set up and operate. A one-time investment of $7,000-$10,000 is required to convert a classroom into a clinic and equip and supply it. Additionally, the operation cost is about $30,000 annually for a “part-time Clinic Co-ordinator to operate and support [the] in-school clinic”.

By giving medical and teaching professionals a communal space where they can share information and expertise, the TDSB is immediately increasing the quality of education of its students while also alleviating pressure on parents and teachers. Other school boards should take note. After all, one would be hard-pressed to think of a better use of taxpayer money than setting up quality clinics that address the physical and mental problems plaguing elementary and secondary students.


Jonathan Kates is a is a 2017 Master of Public Policy candidate at the University of Toronto’s School of Public Policy & Governance. He holds a bilingual Bachelor’s degree in International Studies and Sociology from Glendon, and his areas of interests are education, social policy, cities, and government accountability. His favourite food group is pizza.


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