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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

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.

Canada

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Our health – Infant mortalityThe 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

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.

Life expectancy at birth, select OECD countries, 1980-2004

Canada

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Our health – Life expectancyThe Challenge

Source: Indian and Northern Affairs Canada, Basic Departmental Data, 2004.

Life expectancy at birth by sex, Registered Indian and general population, Canada, 1980-2001

All Females

All Males

Female - Registered Indian

Male – Registered Indian

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Life expectancy continues to climb but…

50

55

60

65

70

75

80

85

1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

FemaleMale

Life expectancy at birth, Canada 1931-2005

Source: Statistics Canada

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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

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What makes – and keeps – us healthy?Factors that influence our health

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Challenges – Health Care Sustainability

Balance:

oPrevention

oPromotion

oProtection

oTreatment

“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) 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 Funding, nutrition education and other resources to

community based student nutrition programs across the country

Improvements in performance, behaviour and attentiveness

Food Banks Over last 18 years, reliance on food banks has increased

91% As of March 2007 there were:

o 673 food banks and 2,867 affiliated agencies across Canada

o 2 million meals served and 720,000 individuals provided with groceries

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Environment and housing interventions

• Vancouver Agreement Tripartite agreement to battle crime, drugs, and

HIV infection

• Healthy Cities 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

Provides academic, social, financial and advocacy supports to at-risk and economically disadvantaged youth

• Toronto’s Regent Park results include: Over 90% of high school students enrolled

Decrease in dropout (56% to 10%) and absenteeism rates (decreased by 50%)

Quadrupled the number of youth attending college or university

Teen pregnancy rates fell 75%

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Social support interventions

•Montreal’s Santropol Roulant Meaningful youth employment by preparing and

delivering meals to seniors in isolated or vulnerable situations

• Nova Scotia’s Eskasoni Primary Care Project 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 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 weightso higher breastfeeding rateso improved access to serviceso better information on nutrition/parentingo 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

Lower absenteeism caused by health issues and off-site medical appointments

TeleHomeCare, Prince Edward Island 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: o Help communities reduce health inequalitieso Forge/Strengthen Partnershipso Partner with International Communityo Build an Effective Canadian Public Health Systemo Increase internal focus and capacity

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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

Information Priority areas

• Communication Knowledge Capacity

• Connection 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

• public health workforce

• evaluation of community- based interventions

• burden of illness

• cost effectiveness

• enhanced surveillance for immunization

• Canada Health Measures survey

• research on surveillance

• mathematical modelling

• social network analysis

Biomedical Clinical

Population

• antimicrobial resistance

• vaccine development

• disease pathogenisis

• nosocomial infections

• disease etiology

• diagnostics

Health

Services

Public Health

Agency of Canada

International Linkages

WHO, CDC, GHSAG, Universities

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Disease and Injury Prevention Health Promotion Health Protection

Health Surveillance Population Health Assessment

Emergency Preparedness & Response

Interdisciplinary Needs:

Knowledge

Science

Technology

Policy

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