Department of Social & Preventive Medicine, École de santé publique, Université de Montréal, Montréal, QC H3N 1X9, Canada.
Direction Régionale de Santé Publique, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC H2L 1M3, Canada.
Int J Environ Res Public Health. 2019 Aug 14;16(16):2915. doi: 10.3390/ijerph16162915.
There is strong consensus about the importance of early childhood development (ECD) for improving population health and closing the health inequity gap. Environmental features and public policies across sectors and jurisdictions are known to influence ECD. International comparisons provide valuable opportunities to better understand the impact of these ecological determinants on ECD. This study compared ECD outcomes between metropolitan Melbourne (Australia) and Montreal (Canada), and contrasted disparities across demographic and socioeconomic characteristics. Population wide surveys using the Early Development Instrument (EDI) were conducted among 4-6 years-old children in both Montreal and Melbourne in 2012, measuring five domains of ECD: 1-Physical Health/Well-Being (PHYS); 2-Social Competence (SOC); 3-Emotional Maturity (EMOT); 4-Language/Cognitive Development (COGN); and 5-Communication Skills/General Knowledge (COMM). Descriptive analyses of summary EDI indicators and domain indicators (including median scores and interquartile ranges) were compared between metropolitan areas, using their respective 95% confident intervals (CIs). Analyses were performed using Stata software (v14). The proportion of children developmentally vulnerable in at least one domain of ECD was 26.8% (95% CIs: 26.2, 27.3) in Montreal vs. 19.2% (95% CIs: 18.8, 19.5) in Melbourne. The Melbourne advantage was greatest for EMOT and COGN (11.5% vs. 6.9%; 13.0% vs. 5.8%). In both Montreal and Melbourne, boys, immigrants, children not speaking the language of the majority at home, and those living in the most deprived areas were at greater risk of being developmentally vulnerable. Relative risks as a function of home language and area-level deprivation subgroups were smaller in Montreal than in Melbourne. This study shows that Melbourne's children globally experience better ECD outcomes than Montreal's children, but that inequity gaps are greater in Melbourne for language and area-level deprivation subgroups. Further research is warranted to identify the environmental factors, policies, and programs that account for these observed differences.
人们普遍认为儿童早期发展（ECD）对于改善人口健康和缩小健康不平等差距至关重要。各个部门和司法管辖区的环境特征和公共政策都被认为会影响 ECD。国际比较为更好地了解这些生态决定因素对 ECD 的影响提供了宝贵的机会。本研究比较了澳大利亚墨尔本（澳大利亚）和加拿大蒙特利尔（加拿大）的 ECD 结果，并对比了人口统计学和社会经济特征的差异。2012 年，在蒙特利尔和墨尔本对 4-6 岁儿童进行了全人群调查，使用早期发展工具（EDI）测量了 ECD 的五个领域：1-身体健康/健康（PHYS）；2-社会能力（SOC）；3-情感成熟度（EMOT）；4-语言/认知发展（COGN）；5-沟通技巧/一般知识（COMM）。使用 Stata 软件（v14）比较了大都市地区之间的 EDI 综合指标和领域指标（包括中位数和四分位距）的描述性分析，并使用各自的 95%置信区间（CI）。蒙特利尔至少有一个 ECD 领域发育脆弱的儿童比例为 26.8%（95%CI：26.2，27.3），而墨尔本为 19.2%（95%CI：18.8，19.5）。墨尔本在 EMOT 和 COGN 方面的优势最大（11.5%比 6.9%；13.0%比 5.8%）。在蒙特利尔和墨尔本，男孩、移民、在家不讲多数人语言的儿童以及生活在最贫困地区的儿童面临更大的发育脆弱风险。家庭语言和地区贫困程度亚组的相对风险在蒙特利尔比在墨尔本小。本研究表明，墨尔本的儿童在全球范围内经历的 ECD 结果优于蒙特利尔的儿童，但在语言和地区贫困程度亚组中，墨尔本的不平等差距更大。需要进一步研究以确定造成这些差异的环境因素、政策和计划。
