INVESTMENT FOR HEALTH: A Canadian Perspective

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INVESTMENT FOR HEALTH A Canadian Perspective
Hon. Dr. Carolyn Bennett, M.P. Canada October
3, 2007

• 10th European Health Forum Gastein

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1st and last Minister of State Public Health

• M.P. for Toronto
• Sworn in December 2003
• Wake of SARS

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SARS -2003 Conference Board of Canada

• 1.5 billion reduction in real GDP in Canada
• 950 million reduction in City of Toronto
• (Chinese restaurants empty in Montreal ..
  Not a single case of SARS)

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Arguments for Action on Health Determinants

• Economic considerations
• Pay now, or pay later
• Social responsibility
• Health is a fundamental human need and,
  therefore, a basic human right.
• Moral obligation
• doing the right thing
• The mobilization of shame
  Irwin Cotler

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Canada should be good at this..

• Tommy Douglasfather of medicare
• voted 1 Canadian
• getting people the health care they need when
  they need it.
• Keeping people well not just patching them up
  once they get sick
• Lalonde report 1974
• Ottawa Charter 1986
• Cdn Institute Advanced Research
• 25 health attributable to health care system
• 15 biology and genetics
• 10 physical environment
• 50 social and economic environments

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The Tyranny of the Acute

• BUT..
• As long as citizens think of the sickness care
  system whenever they hear the word health we
  are not going to be able to reorient health
  systems.

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Health is Politics

• If you want to move healthy public policies
  forward, you have to have political dynamite
• Dr. Halfan Mahler

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• HOWEVER
• Public policy usually follows public opinion.
• BECAUSE.
• Doing the right thing is very difficult is the
  people arent onside
• Father knows best not great politics

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Political Will to do the right thing

• Dramatically improves with an educated public
  health literacy
• economic arguments helpful but must be
  understandable
• Citizens pulling healthy public policy. Civic
  efficacy

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teachable moments

• 2003
• Canada 44 died of SARS
• France14,000 died in the heat wave
• 2004
• Katrina

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The solutions are complex

• For every complex human problem, there is a neat
  simple solution, its just that its wrong
• HL Mencken

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Complex doesnt fit into a 7 second sound
bite..or on a bumper sticker

• We must fiercely defend the complex solutions for
  the complex problems ..
• BUTwe need simpler messages
• PLAIN LANGUAGE
• Myth busting data
• Paint the picture.
• beautiful GIS maps !!!!

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Health Literacy Quiz

Empowerment
Pulling Healthy Public Policy
Putting the Public back into Public Health
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Public Health 101
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1.Do you think we should have a

• A) strong fence at the top of the cliff
• B) state of the art fleet of ambulances and
  paramedics waiting at the bottom ?

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2. Would you prefer

• A) Clean air
• B) Enough puffers and respirators
• for all

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3. Would you prefer that wait-times were reduced
by

• A) a falls program to reduce preventable hip
  fractures
• B) private orthopaedic hospitals and more
  surgeons

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4.Should we invest in

• A) early learning, child care, literacy,the
  early identification of learning disabilities and
  bullying programmes
• B) increase the budget for young offenders
  incarceration

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5.Should we

• A) assume that the 'grey tsunami' will bankrupt
  our health care system
• B) include our aging population in the planning
  of strategies to keep them well

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6. Is the best approach to food security

• A) food banks and vouchers
• B) Income security, affordable housing, community
  gardens and community kitchens and a national
  food policy

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7. Pick the one that is NOT correct

• Pandemic Preparedness should focus on
• Tamiflu for all
• Working with the vets to keep avian flu a disease
  of birds
• Making sure people wash their hands especially
  the doctors and nurses
• Research on vaccines
• Community care plans for our most vulnerable

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7.Governments should boast about

• how much they spent on the sickness care system
• the health of their citizens, leaving no-one
  behind

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Barriers

• LANGUAGE
• TRUSTED DATA
• STRUCTURE
• PROCESS

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LANGUAGE

• Healthy public policy v.s. Sickness Care
• Repair shop v.s. population health
• determinants of health
• Health disparities
• Non-medical determinants of health
• Health inequalities
• Deprivation
• Social exclusion
• Health in all policies..Finland
• Investments for health

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Social Determinants of Health vsChoose
Health(modifiable risks)
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The Causes of the Causes

• Versus
• The Causes

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(No Transcript)
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TRUSTED DATA

Management 101 If its
measured it gets noticed, if its
noticed it gets done
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Canadian reality

• Health expenditures represent over 50 of all
  provincial budgets
• ????? Incentive to other ministries to help get
  that down

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Public Health as total health

• CIHI
• "National Health Expenditure Trends, 1975-2006
• Table A.3.1.2 - Part 2
• 2000 5.3
• 2003 5.8
• 2004 5.5
• 2005 5.5
• 2006 5.8

• OECD Health Data 2007
• Canada
• 2000 5.7 in
• 2003 6.3
• 2004 6.1
• 2005 6.1
• 2006 6.4

SARS
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OECD .. PH as

• Finland France
  United States
• 2000 3.5
  3.0 4.0
• 2001 3.6
  2.9 3.9
• 2002 3.6
  3.1 4.0
• 2003 3.8 Heat wave 2.1
  3.7
• 2004 3.8
  2.0 Katrina 3.5
• 2005 3.9
  2.1 3.5

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Meaningful data.

• of total health care expenditures for public
  health
• But after a crisis in public health the health
  care spending rises..

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Data . questioned

• 2000 Ontario Medical Association report on SMOG
• 600 million health care costs
• 560 million loss in productivity
• 1998 Tobacco strategy 100 million strategy
• Concerns re accountability ???
• Short term arguments
• Post op pneumonia, premature babies
• Results
• 1997 30 smokers
• 2006 19 smokers

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Meaningful data

• 70 of young offenders - learning disability
• families spending more that 50 of income on
  housing, 30 CMHC
• Health outcomes of suburbs
• Litre for a litre
• Public transportation greater physical
  activity.. Ontario College of Family Physicians
• Scotland health outcomes by postal code..
  Investments made accordingly

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Structure

• Silos, ministerial accountability
• Parliament.. Committees also vertical
• Cabinet committees silo-busting
• Aboriginal affairs Kelowna accord
• Health, education, housing, economic development,
  accountability

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Process

• Attitudes. Who decides ? John Lavin, McMaster
• 83 public servants admitted needed more
  information about health consequences of policy
  alternatives that their depts face
• Finance officials consistently lower awareness
  and less convinced that health determinants
  should be considered in all major govt
  initiatives.
• Focus of health promoters.
• content NOT process
• Need to build in support across political parties
  so that the work continues after govt changes

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Process

• Health Impact Analysis predictive
• dash board
• Sweden, Quebec, England
• Report cardsafter the fact
• Auditor General
• Commissioners
• Parliament
• Measuring Quality of Life The Use of Societal
  Outcomes for Parliamentarians 2001, Library of
  Parliament, Canada
• Project funding vs core funding

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Learning Culture

• Evidence-informed practice
• Practice-informed evidence
• Courage to fund what works
• Courage to stop funding what doesnt
• Complex adaptive systems
• measure,adapt and measure again

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Research

• Applied. When the bough breaks
• Gina Browns study of single moms
• Sharing
• Domestic violence clearing house
• Knowledge translation

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No time for pessimists
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Sir Michael Marmot

• Evidence is not enough. There has to be the
  desire, the political will for change. Given that
  will - a big given but I am an optimist - the
  evidence of what works will be a great help.

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research
practice
policy
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Engaged citizens
research
practice
policy
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Engaged citizens
research
KT
practice
policy
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Engaged citizens
research
KT
practice
policy
Political will
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Engaged citizens
research
Applied research
KT
practice
policy
Political will
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Engaged citizens
Economic Evidence
Applied research
KT
practice
policy
Political will
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Dr. John Hastings M.O.H. Toronto on the
occasion of his Presidency of the APHA,1918

• Every nation that permits people to remain under
  the fetters of preventable disease and permits
  social conditions to exist that make it
  impossible for them to be properly fed, clothed
  and housed so as to maintain a high degree of
  resistance and physical fitness and, who
  endorses a wage that does not afford sufficient
  revenue for the home, a revenue that will make
  possible the development of a sound mind and
  body, is trampling on a primary principle of
  democracy.