J.F. Mustard Founding President of the Canadian Institute for Advanced

just days before he died.<br><br> before he died. Meeting of Executive Committee, Meeting of Executive Committee, Section on International Child Section on International Child Health AAP Health AAP 37 YEARS of FRIENDSHIP 37 YEARS of FRIENDSHIP " " We first met the Hillmans in Kenya in We first met the Hillmans in Kenya in 1969. 1969.<br><br> " " We had much in common. We had much in common. " " In 1982 the Hillmans sent us a letter In 1982 the Hillmans sent us a letter asking if we would take on the project of asking if we would take on the project of rehabilitation of the rehabilitation of the Kasangati Kasangati Health Health Centre.<br><br> Centre. Lao pediatric curriculum Lao pediatric curriculum " " We asked Don and Liz to help develop the We asked Don and Liz to help develop the curriculum with which we started the Lao curriculum with which we started the Lao pediatric residency program. pediatric residency program.<br><br> " " We also worked together as consultants to We also worked together as consultants to the World Bank the World Bank 4 4 a project to evaluate a project to evaluate medical education in Laos. medical education in Laos. Donald A.<br><br> Hillman, O.C., Donald A. Hillman, O.C., M.D.C.M.,PhD M.D.C.M.,PhD " " McGill University Medical School McGill University Medical School " " Post graduate training Hospital for Sick Post graduate training Hospital for Sick Children in Toronto Children in Toronto " " Fellowship in Pediatric Endocrinology, Fellowship in Pediatric Endocrinology, Massachusetts General Hospital, Boston Massachusetts General Hospital, Boston " " PhD Investigative Medicine, McGill PhD Investigative Medicine, McGill Donald A. Hillman 9s career Donald A.<br><br> Hillman 9s career " " McGill University McGill University Paediatric Paediatric faculty faculty " " Memorial University of Newfoundland Memorial University of Newfoundland - - Professor of Professor of Paediatrics Paediatrics and Physician in and Physician in Chief at the Chief at the Janeway Janeway Child Health Centre. Child Health Centre. " " Since 1989 Since 1989 3 3 Professor at McMaster Professor at McMaster University and at the University of Ottawa University and at the University of Ottawa Countries where he made a Countries where he made a difference for children difference for children " " Canada, England, Kenya, Tanzania, Canada, England, Kenya, Tanzania, " " Zambia, South Africa, Laos, China, Kuwait, Zambia, South Africa, Laos, China, Kuwait, " " Singapore, Malaysia, Bhutan, India, Singapore, Malaysia, Bhutan, India, " " Guyana, the Philippines, and Pakistan Guyana, the Philippines, and Pakistan " " PLUS his students are working in scores of PLUS his students are working in scores of additional countries!<br><br> additional countries! Introduction Introduction " " Hunter and gatherer civilizations Hunter and gatherer civilizations " " Agricultural revolution 10,000 years ago Agricultural revolution 10,000 years ago " " Extra food led to towns and cities, laws, Extra food led to towns and cities, laws, technological innovations, rulers and technological innovations, rulers and institutions to govern societies. institutions to govern societies.<br><br> " " There were pressures on humans to be There were pressures on humans to be better able to communicate, establish laws better able to communicate, establish laws and record transactions. and record transactions. Sailing ships led to exploration and Sailing ships led to exploration and trading trading " " The introduction of pathogens from The introduction of pathogens from Europe decimated populations in the Europe decimated populations in the Americas.<br><br> Americas. " " In spite of increased prosperity, improved In spite of increased prosperity, improved health and well being, there have been health and well being, there have been continuing conflicts among nations, continuing conflicts among nations, religions, and cultures. religions, and cultures.<br><br> To Prevent Continuing Conflict To Prevent Continuing Conflict " " cThe ability of human beings to communicate cThe ability of human beings to communicate with and understand each other, plan for the with and understand each other, plan for the future, and control their behavior in the diverse future, and control their behavior in the diverse regions of our planet will be an important factor regions of our planet will be an important factor in the continuing evolution of civilizations and in the continuing evolution of civilizations and our attempts to reduce the risk of conflicts, our attempts to reduce the risk of conflicts, violence, and destructive behaviors. d violence, and destructive behaviors. d " " (Above underlined by Don Hillman) (Above underlined by Don Hillman) " " cThe inequities in health, development, cThe inequities in health, development, income, literacy, and the social instability income, literacy, and the social instability and violence in different parts of the world and violence in different parts of the world are a serious problem for our continuing are a serious problem for our continuing experiments in civilizations. d experiments in civilizations. d " " ( ( Underlined by Don Hillman) Underlined by Don Hillman) Child Development is Key Child Development is Key " " cChild development and experience cChild development and experience - - based based brain development in the very early years brain development in the very early years of life sets biological pathways that affect of life sets biological pathways that affect cognition, cognition, behavior(violence behavior(violence ), capacity to ), capacity to learn, memory, and physical and mental learn, memory, and physical and mental health throughout the life cycle. d health throughout the life cycle. d " " (Underlined by Don Hillman) (Underlined by Don Hillman) Literacy performance Literacy performance " " In the US populations with the lowest In the US populations with the lowest literacy performance had the poorest literacy performance had the poorest physical and mental health. physical and mental health. " " The development of the brain in the early The development of the brain in the early years affects both literacy competence years affects both literacy competence and health.<br><br> and health. 50 percent of the US and Canadian 50 percent of the US and Canadian populations show poor literacy capability populations show poor literacy capability " " 50% do not have literacy and understanding 50% do not have literacy and understanding capability which is adequate for today 9s capability which is adequate for today 9s knowledge based societies. knowledge based societies.<br><br> " " cCan we in developed countries take the steps cCan we in developed countries take the steps to improve the competence and quality of our to improve the competence and quality of our populations and demonstrate what can be populations and demonstrate what can be done? d done? d " " (underlined by Don Hillman) (underlined by Don Hillman) Brain development in children Brain development in children " " cExperience affects the formation of the cExperience affects the formation of the synapses among neurons to establish synapses among neurons to establish pathways for the different hierarchies of pathways for the different hierarchies of the brain that govern or control our the brain that govern or control our intellectual, emotional, psychological and intellectual, emotional, psychological and physical responses to stimuli d. physical responses to stimuli d. " " ( ( Underlined by Don Hillman) Underlined by Don Hillman) Epigenetic effect Epigenetic effect " " Conditions in early life can permanently Conditions in early life can permanently alter gene expression.<br><br> alter gene expression. " " E.g. Adverse maternal E.g.<br><br> Adverse maternal behaviour behaviour can lead can lead to poor protein synthesis from DNA to poor protein synthesis from DNA because of epigenetic effects on the gene because of epigenetic effects on the gene promoter functions. promoter functions. Importance of touch Importance of touch " " cTouch is a critical factor influencing the cTouch is a critical factor influencing the development of the LHPA pathway, which, development of the LHPA pathway, which, if it is dysfunctional, can influence if it is dysfunctional, can influence behaviour behaviour , including antisocial , including antisocial behaviour behaviour , , in later life. d in later life. d " " ( ( Underlined by Don Hillman) Underlined by Don Hillman) Early Child and Brain Development Early Child and Brain Development and and Behaviour Behaviour " " ADHD is a product of interaction between ADHD is a product of interaction between the environment and genetic vulnerability.<br><br> the environment and genetic vulnerability. " " Brain pathways involved in ADHD are also Brain pathways involved in ADHD are also involved in other forms of involved in other forms of behaviour behaviour . .<br><br> Thus, there is often co morbidity with Thus, there is often co morbidity with ADHD. ADHD. Some countries show high performance and fairly Some countries show high performance and fairly flat socioeconomic gradients flat socioeconomic gradients " " cAll the countries with fairly flat gradients and cAll the countries with fairly flat gradients and high performance in literacy have quality, high performance in literacy have quality, universal programs for early child development. d universal programs for early child development. d " " cTelevision viewing in childhood and cTelevision viewing in childhood and adolescence is associated with poor educational adolescence is associated with poor educational achievement by 26 years of age. d achievement by 26 years of age. d " " ( ( Underlined by Don Hillman) Underlined by Don Hillman) " " Review of Romanian orphanages Review of Romanian orphanages " " Children adopted into middle class British Children adopted into middle class British homes compared with non deprived UK homes compared with non deprived UK children.<br><br> Substantial deficits in children. Substantial deficits in development persisted for many of the development persisted for many of the children adopted. They concluded there children adopted.<br><br> They concluded there was some form of early biological was some form of early biological programming or neural damage of the programming or neural damage of the vulnerable children stemming from the vulnerable children stemming from the institutional deprivation. institutional deprivation. 40% of children under 5 years are 40% of children under 5 years are stunted in developing countries stunted in developing countries " " Growth restriction in the very early years Growth restriction in the very early years has long term functional consequences.<br><br> has long term functional consequences. " " Recent study in Peru found that Recent study in Peru found that malnutrition in early childhood associated malnutrition in early childhood associated with diarrhea was associated with poor with diarrhea was associated with poor cognitive function at age 9 years. cognitive function at age 9 years.<br><br> Successful early childhood Successful early childhood intervention programs intervention programs " " Perry Preschool Perry Preschool program(Ypsilanti program(Ypsilanti study) study) " " -- -- children performed much better in children performed much better in literacy tests, fewer became criminals. literacy tests, fewer became criminals. " " -- -- Abccedarian Abccedarian project project 4 4 20 year 20 year followup followup on cognitive performance .<br><br> Children who on cognitive performance . Children who received preschool plus a three year received preschool plus a three year school program performed best. school program performed best.<br><br> cReadiness to Learn d measures in cReadiness to Learn d measures in Canada Canada " " Physical health and well being Physical health and well being " " Social competence Social competence " " Emotional maturity Emotional maturity " " Language and cognitive development Language and cognitive development " " Communication skills and general knowledge Communication skills and general knowledge " " In Canada the largest number of vulnerable In Canada the largest number of vulnerable children were in the middle class children were in the middle class Equity and Development Equity and Development " " Equity includes equal opportunity and avoidance Equity includes equal opportunity and avoidance of deprivation. of deprivation. " " cIt may not be possible to avoid significant cIt may not be possible to avoid significant negative influences in societies that could lead negative influences in societies that could lead to disruption of our civilizations, excessive to disruption of our civilizations, excessive violence and loss of life, chaos, and a return to violence and loss of life, chaos, and a return to less democratic governance. d less democratic governance. d " " (underlined by Don Hillman) (underlined by Don Hillman) Improvement of early child development in Improvement of early child development in less developed countries less developed countries " " cThe challenges are more difficult than in cThe challenges are more difficult than in developed countries.<br><br> developed countries. " " More than 20% of the 140 million children in More than 20% of the 140 million children in Africa are at very high risk for poor Africa are at very high risk for poor development. development.<br><br> " " In twelve African countries, as a consequence of In twelve African countries, as a consequence of AIDS and war and civil strife, orphans comprise AIDS and war and civil strife, orphans comprise 20% of children under age 15 years. d 20% of children under age 15 years. d " " (underlined by Don Hillman) (underlined by Don Hillman) WORLD COGNITIVE WATCH WORLD COGNITIVE WATCH " " Assess cognitive impairments (causes and Assess cognitive impairments (causes and interventions) annually in each country. interventions) annually in each country. " " Establish global benchmarks for Establish global benchmarks for improvement.<br><br> improvement. " " Intervention/prevention programs by Intervention/prevention programs by Ministries of Health, UN agencies, and Ministries of Health, UN agencies, and NGOs NGOs Final quote underlined by Don Final quote underlined by Don " " cWe have the knowledge to improve the health, cWe have the knowledge to improve the health, well well - - being and competence of populations within being and competence of populations within and across countries and set in place economics and across countries and set in place economics based on sustainable development. Surely the based on sustainable development.<br><br> Surely the task of developed countries is to demonstrate task of developed countries is to demonstrate how to apply this knowledge and improve the how to apply this knowledge and improve the health,well health,well - - being and competence of our being and competence of our populations and to identify the causes of the populations and to identify the causes of the gaps between what we know and what we can gaps between what we know and what we can to and take steps to close this gap. d to and take steps to close this gap. d Don Hillman 9s legacy to the children Don Hillman 9s legacy to the children of the world of the world " " He developed high quality pediatric He developed high quality pediatric training programs in many places and in training programs in many places and in many countries. many countries. " " He taught many students, residents, and He taught many students, residents, and fellows.<br><br> fellows. " " He set an example of how to do things for He set an example of how to do things for altruistic reasons and how to be altruistic reasons and how to be humble. humble.<br><br> Dr. Hillman believed in continuity Dr. Hillman believed in continuity and and followup followup " " The Hillmans stayed in touch with their The Hillmans stayed in touch with their students.<br><br> students. " " They stayed with their child health They stayed with their child health projects over decades. projects over decades.<br><br> " " Recently, they have been planning to Recently, they have been planning to return to East Africa to review the long return to East Africa to review the long term impacts of their projects there. term impacts of their projects there. <br><br>

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