Transcript Document

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-Dr. David Butler-Jones, MD
-MHSc, LLD(h), FRCPC, FACPM, CCFP
-Chief Public Health Officer of Canada
Working together to address
public health challenges
1st annual Applied Health Sciences
Research Day
January 9, 2009
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“To Prevent Disease,
to Relieve Suffering,
and to Heal the Sick,
-This Is Our Work”
Sir William Osler
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Public Health Is:
• A set of programs and services
• A way of thinking about problems and solutions
• A whole-of-society approach – across sectors,
governments, states, jurisdictions
• Beyond just the health sector, but with
leadership from public health
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Role of Public Health?
• Not just about longer life…


About maximizing healthy years
Supporting through life course, when people are well,
when they’re not, until the end.
• Public health has a fundamental role:



in understanding impacts of physical and social
environments on our health
to advise other sectors, and provide leadership in
what we can all do to promote healthy aging
to engage partners across society to build healthy
enabling environments
“The health of the public is
the foundation upon which
rests the happiness of the
people and the welfare of
the state.”
Disraeli
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Report on the State of Public Health
• Seniors’ vulnerability crosses
diseases and risk
• We are only as healthy as the
least healthy among us
• Poverty about more than just
lack of money
• Resources for the basics. Influence. Connections.

These are the differences between good health, and
great health.
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Our health – Infant mortality
Infant mortality rate,
select OECD countries,
1980-2004
Canada
Source: Public Health Agency of Canada
using Health Canada’s Data Analysis and
Information System (DAIS), Organisation
for Economic Co-operation and
Development (OECD) Health Data, 2007.
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Our health – Infant mortality
The Challenge
Infant mortality rate
by neighbourhood
income, urban
Canada, 1971-2001
Q – population divided into fifths
based on the percentage of the
population in their neighbourhood
below the low-income cut-offs.
Source: Wilkins et al. (2007),
Statistics Canada.
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Our health – Life expectancy
Life expectancy at birth,
select OECD countries,
1980-2004
Canada
Source: Public Health Agency of
Canada using Health Canada’s Data
Analysis and Information System
(DAIS), Organisation for Economic Cooperation and Development (OECD)
Health Data, 2007.
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Our health – Life expectancy
The Challenge
Life expectancy at birth
by sex, Registered Indian
and general population,
Canada, 1980-2001
All Females
All Males
Female - Registered Indian
Male – Registered Indian
Source: Indian and Northern Affairs
Canada, Basic Departmental Data,
2004.
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Life expectancy continues to climb but…
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Life expectancy at birth,
Canada 1931-2005
Female
Male
80
75
70
65
60
Source: Statistics Canada
55
50
1920
1930
1940
1950
1960
1970
1980
1990
2000
2010
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It’s not just how long we live,
but how well we live
Self-Rated Health Somewhat or Much Worse Than a Year Ago
Self-rated health somewhat or much worse than a year ago
25%
20%
Percentage
15%
10%
5%
0%
12-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75+
Age Group
Source: Public Health Agency 2008 using Statistics Canada, Canadian Community Health Survey, 2007.
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What makes – and keeps – us healthy?
Factors that influence our health
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Challenges – Health Care Sustainability
Balance:
o Prevention
o Promotion
o Protection
o Treatment
“I’ve got it too
Omar… a strange
feeling like we’ve
just been going in
circles”
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So what can we do?
• Socio-economic determinants interact to
influence health

An improvement in any of these determinants can
improve health behaviours and outcomes.
• Factors that influence our health can be
positively impacted by the different sectors of
society working together to address health and
social inequalities through interventions.
• Some examples of interventions follow
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Income interventions
National Public Pensions for Seniors


CPP, QPP, GIS, Spouse’s & Widowed Spouse’s Allowance,
P/T supps
95% of seniors receive their income from OAS, GIS or SPA
Quebec’s Family Policy (1997)

Quebec has experienced steady decline in poverty rate, now
below nat’l average
Saskatchewan’s Initiative (1997)
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Financial independence for low-income families
Fewer families dependent on social assistance, increase in
disposable income among families working for minimum
wage
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Food security interventions
Breakfast for Learning
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Funding, nutrition education and other resources to
community based student nutrition programs across the
country
Improvements in performance, behaviour and attentiveness
Food Banks
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Over last 18 years, reliance on food banks has increased
91%
As of March 2007 there were:
673 food banks and 2,867 affiliated agencies
across Canada
o 2 million meals served and 720,000 individuals
provided with groceries
o
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Environment and housing interventions
• Vancouver Agreement

Tripartite agreement to battle crime, drugs, and
HIV infection
• Healthy Cities
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Public health criteria used for community design
and land use
Age-friendly cities
• Habitat for Humanity

Providing safe and affordable housing and
promoting ownership
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“I [eventually] had a
psychiatric diagnosis.
Found out medication
wasn’t going to get me
un-depressed – I was
depressed by the
situation I found
myself in unemployed and
homeless. … Some of
the people I don’t
know how they
survive, and some of
the people, well, they
just haven’t survived.”
A Day in the Life Project
Participant
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Education and literacy interventions
• Pathways to Education

Breaks cycle of poverty by increasing chances of youth
completing secondary, possibly post-secondary school
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Provides academic, social, financial and advocacy supports
to at-risk and economically disadvantaged youth
• Toronto’s Regent Park results include:
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Over 90% of high school students enrolled
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Decrease in dropout (56% to 10%) and absenteeism rates
(decreased by 50%)
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Quadrupled the number of youth attending college or
university
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Teen pregnancy rates fell 75%
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Social support interventions
• Montreal’s Santropol Roulant
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Meaningful youth employment by preparing and
delivering meals to seniors in isolated or vulnerable
situations
• Nova Scotia’s Eskasoni Primary Care Project
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Mi’kmaq community decided to manage their health
care with the collaborative efforts of a Tripartite
Steering Committee
New community health centre built, involved
community members
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Health behaviours interventions
• ActNow BC
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Champions healthy eating, physical activity, smoking
cessation and healthy choices during pregnancy
across B.C.
• Canada Prenatal Nutrition Program

Compared to similar high risk populations, CPNP
participants had:
o higher birth weights
o higher breastfeeding rates
o improved access to services
o better information on nutrition/parenting
o felt less stressed/isolated during pregnancy
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Access to health care interventions
Toronto’s Mobile Health Unit

Free primary care from female providers with experience in
cultural and gender sensitivities
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Lower absenteeism caused by health issues and off-site
medical appointments
TeleHomeCare, Prince Edward Island
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Health region has seen:
o
73% reduction in days of hospitalizatio
o
15% fewer emergency room visits
o
46% fewer hospital admissions
o
20% drop in doctor’s office appointments among clients
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There is a loftier ambition than
merely to stand high in the world.
It is to stoop down and lift
mankind a little higher.
-- Henry Van Dyke
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Addressing inequalities:
Priority areas for action
o
Social investment
o
Community capacity
o
Inter-sectoral action
o
Knowledge infrastructure
o
Leadership
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Moving forward
• Foster collective will and leadership
• Reduce child poverty, health inequalities, build
resilience, enabling families and communities
• Strengthen communities
• PHAC Action:
Help communities reduce health inequalities
o Forge/Strengthen Partnerships
o Partner with International Community
o Build an Effective Canadian Public Health System
o Increase internal focus and capacity
o
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Even when
we’re on the
right track,
if we’re not
moving,
We’ll get run
over.
Mark Twain
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Vital partnerships with academia …
• Content
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Information
Priority areas
• Communication
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Knowledge
Capacity
• Connection
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Leadership
Sharing
Partners
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How Do We Get The Science We Need?
• Intramural science and
technology – ranging from
fundamental research through
surveillance to technology
development
• Funding of research by others
directly or in partnership or
through CIHR
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National Linkages
NCCs, CIHR, Universities, Networks
• nosocomial
infections
• antimicrobial
resistance
• vaccine
development
Biomedical
• disease
pathogenisis
Clinical
Public
Health
Agency of
Canada
• enhanced surveillance
for immunization
Population
• Canada Health
Measures survey
Health
Services
• research on
surveillance
• disease etiology
• diagnostics
• public health
workforce
• evaluation of
community- based
interventions
• burden of illness
• cost effectiveness
• mathematical modelling
• social network analysis
International Linkages
WHO, CDC, GHSAG, Universities
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Interdisciplinary Needs:
Policy
Disease and Injury Prevention
Health Promotion
Health Protection
Health Surveillance
Knowledge
Technology
Population Health Assessment
Emergency Preparedness & Response
Science
Public Health Action
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A commitment to change
• Health is influenced by the type of society we choose
• No one is immune to health problems and health
inequalities – everyone is affected
• Many policies and programs already contributing to a
reduction in inequalities in health
• Canada has the ability to build on these experiences
• All Canadians have a role to play