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A Vision of Health & Health Care  in Northern Ontario  March 31, 2010 Hon. Carolyn Bennett, M.D., M.P.
Geography is no excuse for inequality… Allan Rock Minister of Health 1998
Rural Health in Rural Hands Strategic Directions for Rural, Remote, Northern and Aboriginal Communities 2002  <ul><li>Buil...
Canadian legacy:  HEALTH trumps health CARE <ul><li>Tommy Douglas… Father of Medicare </li></ul><ul><li>Lalonde Report 197...
Goal of Medicare…  <ul><li>Sharing risk </li></ul><ul><ul><li>getting people the health care they need when they need it <...
The Tyranny of the Acute <ul><li>As long as citizens think of the  sickness  care system whenever they hear the word  ‘hea...
Canadian Institute for    Advanced Research <ul><ul><li>25% health attributable to health care system </li></ul></ul><ul><...
Fleeing the Medical Model, Embracing the Medicine Wheel
Humbling reality <ul><li>The health of our population cannot be the sole responsibility of the Ministry of Health and the ...
Process …. <ul><li>‘ Health in all Policies” - Finland </li></ul><ul><li>Article 54 in PQ </li></ul><ul><li>Health Impact ...
Real Strategies –  What, by when, and how <ul><li>Poverty reduction </li></ul><ul><li>Housing </li></ul><ul><li>Transporta...
Sustainability of Health Care System  <ul><li>Our cherished health care system will only be sustainable if we redouble our...
Health as % GDP <ul><li>In 2007  </li></ul><ul><ul><li>US 16.2 %  </li></ul></ul><ul><ul><li>Canada 10.6 % </li></ul></ul>...
 
Boom, Bust and Echo <ul><li>“ Over the next 2 decades, as 9.8 million baby boomers turn 50, we will witness a significant ...
Boom, Bust and Echo <ul><li>“ Governments should view  small-town hospitals  not as a burden on the health care budget but...
Boom, Bust and Echo <ul><li>“… .  bring their new wealth with them.  </li></ul><ul><li>… . already happening in the Okanag...
`Hospital` vs Health Care Centre <ul><li>Form follows function </li></ul><ul><li>Needs assessment </li></ul><ul><li>Popula...
What services  ? <ul><li>Volume ? </li></ul><ul><li>Triage/Transfer </li></ul><ul><li>Telehealth </li></ul><ul><li>Back-up...
What Health Human Resources ? <ul><li>Interdisciplinary </li></ul><ul><li>Recruitment </li></ul><ul><li>Retention </li></u...
The Grey Tsunami ? R.O.M.P. Collingwood April 24, 2008 Dr. Carolyn Bennett  M.P. The Grey  Tsunami ?
Age-Friendly  Rural And Remote Communities:  A Guide <ul><li>Outdoor Spaces and Buildings </li></ul><ul><li>Transportation...
Age-Friendly  Rural And Remote Communities:  A Guide <ul><li>Community Support & Health Services </li></ul><ul><ul><li>Car...
Age-Friendly Rural And Remote Communities
 
 
<ul><li>The Issue:   </li></ul><ul><li>21% of Canadians are rural </li></ul><ul><li>9.4% of Canadian physicians are rural ...
<ul><li>Rural Canadians do not have fair access to health care:   </li></ul><ul><li>Half the number of doctors serving peo...
<ul><li>Why the doctor shortage is twice as severe in rural Canada:   </li></ul><ul><li>Medical Schools and residency trai...
<ul><li>For every rural community we should aim for </li></ul><ul><li>Clean water and sanitary waste disposal </li></ul><u...
<ul><li>For Canadian medical schools we should aim for </li></ul><ul><li>A representative proportion of rural/urban studen...
<ul><li>Ministerial Advisory Council on Rural Health </li></ul><ul><li>Rural Access to Scholarships </li></ul><ul><li>Rura...
<ul><li>Strategies must be developed to improve: </li></ul><ul><li>Return-of-service programs </li></ul><ul><li>Financial ...
Health Care or a Real System for Health <ul><li>Patchwork quilt of non- systems </li></ul><ul><li>Focus on sickness…and th...
Re-orienting Health Systems from Health  Care  to Health
Rx:  Civil society insisting on healthy public policy <ul><li>Health literacy </li></ul><ul><li>Civic efficacy </li></ul><...
Citizens have to ‘get it’ <ul><li>More health …less health care </li></ul><ul><li>Service contract ?????? </li></ul><ul><l...
“ Health is Politics”   <ul><li>“  If you want to move healthy public policies forward, you have to have  political dynami...
<ul><li>HOWEVER…… </li></ul><ul><li>Public policy usually follows public  opinion…. </li></ul><ul><li>BECAUSE……. </li></ul...
CYNICISM
Political Will  to do the right thing <ul><li>Dramatically improves with an educated public……  health literacy </li></ul><...
Values... Versus public opinion <ul><li>Public opinion ?  </li></ul><ul><ul><li>sometimes very shortsighted </li></ul></ul...
Values... Versus public opinion <ul><li>Public opinion ?  </li></ul><ul><ul><li>sometimes very shortsighted </li></ul></ul...
Health Literacy Quiz version 1 <ul><li>Is ‘surveillance’  ? </li></ul><ul><ul><ul><li>Pattern of disease </li></ul></ul></...
“ What we have here is a failure to communicate” Cool Hand Luke 1967
The solutions are complex <ul><li>For every complex human problem, there is a neat simple solution, it’s just that it’s wr...
Health Literacy Quiz version 2 Empowerment Pulling  Healthy Public Policy Putting the Public back into Public Health
Public Health 101
1.Do you think we should have a: <ul><li>A) strong fence at the top of the cliff </li></ul><ul><li>B) state of the art fle...
2. Would you prefer: <ul><li>A) Clean air </li></ul><ul><li>B) Enough puffers and respirators  </li></ul><ul><li>for all  ...
3. Would you prefer that wait-times were reduced by: <ul><li>A) a falls program to reduce preventable hip fractures </li><...
4. Should we invest in: <ul><li>A) early learning, child care, literacy,the early identification of learning disabilities ...
5. Should we: <ul><li>A) assume that the 'grey tsunami' will bankrupt our health care system  </li></ul><ul><li>B) include...
6. Is the best approach to food security: <ul><li>A) food banks and vouchers </li></ul><ul><li>B) Income security,affordab...
7. Governments should boast about: <ul><li>how much they spent on the sickness care system  </li></ul><ul><li>the health o...
teachable moments <ul><li>2003 </li></ul><ul><ul><li>Canada… 44 died of SARS </li></ul></ul><ul><ul><li>France…14,000 died...
Beyond borders….  SARS as a teachable moment <ul><li>Beyond silos  </li></ul><ul><ul><li>Departments </li></ul></ul><ul><u...
Social Determinants of Health    vs Choose Health (modifiable risks)
The Causes of the Causes Versus The Causes
Evolution of the Healthy Canadians Tree
 
Progress <ul><li>First MoS Public Health 2003-2006 </li></ul><ul><li>Public Health Agency of Canada </li></ul><ul><li>Chie...
Communiqué FMM September 2004 <ul><li>“ In addition, governments commit to accelerate work on a pan-Canadian  Public Healt...
Health Goals for Canada <ul><li>As a nation, we aspire to a Canada in which every person is as healthy as they can be –  <...
Next step <ul><li>Indicators…for each goal ? </li></ul><ul><li>Canadian Index of Wellbeing   </li></ul><ul><li>  Atkinson ...
Changing the way we do things.. Managing for results….. <ul><li>Whole of Government – results. </li></ul><ul><ul><li>Healt...
With the Public Health Map Generator, you can produce high quality, detailed maps of  your own  health data, in combinatio...
GIS User ******* The Public Health Map Generator is a secure, web-based mapping application, accessible only to clients re...
“ The mobilization of shame” Irwin Cotler Management 101 “ If it’s measured it gets noticed, if it’s noticed it gets done”
Scotland – Honourable Andy Kerr <ul><li>Health outcomes down to postal code </li></ul><ul><li>Letter from Family Doctor </...
Process …. <ul><li>Article 54 in PQ </li></ul><ul><li>HIA…. All MC’s , budget, TB guidelines </li></ul><ul><li>Gender Base...
Structure  Gridlock  horizontal – departments vertical - jurisdiction
Structure <ul><li>Silo- busting - Horizontality </li></ul><ul><ul><li>Ministries or Ministers  </li></ul></ul><ul><ul><ul>...
Population Health:  Keeping Canadians healthy…. <ul><li>‘ Citizen centered’ federalism… </li></ul><ul><ul><li>bottom up </...
International WHO NGO Advisory Group  Health Promotion <ul><li>Clear they need to be included </li></ul><ul><li>Clear they...
Mahler <ul><li>All I learned was from developing countries.  </li></ul><ul><li>Learned the word Empowerment  </li></ul><ul...
Research….Learning Culture <ul><li>Evidence-informed practice </li></ul><ul><li>Practice-informed evidence </li></ul><ul><...
Research Practice Policy
Research Practice Policy KT
Research Practice Policy KT Political will
Research Practice Policy KT Political   will Applied research
Research Practice Policy ENGAGED CITIZENS KT Political   will Applied research
Health  in Cuba 2009
Infant mortality 20 x 1000 new born American Region 4,7 x1000 newborn Cuba
Dispensarizacion <ul><li>`the constant assessment of population and risk` </li></ul><ul><li>``We don`t expect people to ge...
Pride in their results <ul><li>Family doctors annual report </li></ul><ul><ul><li>Smokers,obese,sedentary,lipids,BP </li><...
Integration of Health Professional Education & Community <ul><li>health professional must be a professor and give tutorial...
POLICLINICO UNIVERSITARIO PLAZA DE LA  REVOLUCIÓN
Actividades con la comunidad <ul><li>Círculos de abuelos. </li></ul><ul><li>Círculos de gestantes (clases de psicoprofilax...
Polyclinics <ul><li>“ The family is the centre of our attention” </li></ul><ul><li>Risk rated –  potable H 2 O, violence <...
No time for pessimists
<ul><li>“ We are not tinkers, who patch and mend what is broken. We must be watchmen, guardians of the life and health of ...
Sir Michael Marmot <ul><li>“ Evidence is not enough. There has to be the desire, the political will for change. Given that...
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Transcript of "Bennett (Keynote Health & Health Care Northern Ontario 2010)"

  1. 1. A Vision of Health & Health Care in Northern Ontario March 31, 2010 Hon. Carolyn Bennett, M.D., M.P.
  2. 2. Geography is no excuse for inequality… Allan Rock Minister of Health 1998
  3. 3. Rural Health in Rural Hands Strategic Directions for Rural, Remote, Northern and Aboriginal Communities 2002 <ul><li>Building Healthy Communities </li></ul><ul><li>Infrastructure for Community Capacity-building </li></ul><ul><li>Intersectoral Collaboration </li></ul><ul><li>Rural Health Research </li></ul><ul><li>Health Information Technology </li></ul><ul><li>Health Human Resources </li></ul><ul><li>Aboriginal Health </li></ul>
  4. 4. Canadian legacy: HEALTH trumps health CARE <ul><li>Tommy Douglas… Father of Medicare </li></ul><ul><li>Lalonde Report 1974 </li></ul><ul><li>Ottawa Charter 1986 </li></ul><ul><li>SARS, Naylor Report 2003 </li></ul><ul><li>WHO Commission SDOH 2005 </li></ul><ul><li>Health Goals for Canada 2005 </li></ul>
  5. 5. Goal of Medicare… <ul><li>Sharing risk </li></ul><ul><ul><li>getting people the health care they need when they need it </li></ul></ul><ul><li>Keeping people well not just patching them up once they get sick </li></ul>
  6. 6. The Tyranny of the Acute <ul><li>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. </li></ul>
  7. 7. Canadian Institute for Advanced Research <ul><ul><li>25% health attributable to health care system </li></ul></ul><ul><ul><li>15% biology and genetics </li></ul></ul><ul><ul><li>10% physical environment </li></ul></ul><ul><ul><li>50% social and economic environments </li></ul></ul>
  8. 8. Fleeing the Medical Model, Embracing the Medicine Wheel
  9. 9. Humbling reality <ul><li>The health of our population cannot be the sole responsibility of the Ministry of Health and the health care sector </li></ul><ul><li>For Canadians to be as healthy as they can be, and in order to close the unacceptable gap in health status for our most vulnerable Canadians we must work across all government departments, all jurisdictions and in all sectors . </li></ul>
  10. 10. Process …. <ul><li>‘ Health in all Policies” - Finland </li></ul><ul><li>Article 54 in PQ </li></ul><ul><li>Health Impact Analysis </li></ul><ul><ul><li>All MC’s , budget, TB guidelines </li></ul></ul><ul><li>Better data…. Disease registries </li></ul>
  11. 11. Real Strategies – What, by when, and how <ul><li>Poverty reduction </li></ul><ul><li>Housing </li></ul><ul><li>Transportation </li></ul><ul><li>Injury Prevention </li></ul><ul><li>Healthy Ageing – Dementia </li></ul><ul><li>Mental Health </li></ul><ul><li>others ??????????? </li></ul>
  12. 12. Sustainability of Health Care System <ul><li>Our cherished health care system will only be sustainable if we redouble our efforts to keep Canadians well </li></ul><ul><li>We must develop integrated systems for health that are accountable for results </li></ul>
  13. 13. Health as % GDP <ul><li>In 2007 </li></ul><ul><ul><li>US 16.2 % </li></ul></ul><ul><ul><li>Canada 10.6 % </li></ul></ul><ul><li>$7,421 per American and $5,170 per Canadian . </li></ul><ul><li>The projection for 2018 in the US is a staggering 20.3% of GDP. </li></ul>
  14. 15. Boom, Bust and Echo <ul><li>“ Over the next 2 decades, as 9.8 million baby boomers turn 50, we will witness a significant exodus from big-city Canada to small-town Canada. </li></ul><ul><li>The participants in this exodus are going to need the same hospitals that provincial governments want to close in the mid-1990’s” </li></ul>
  15. 16. Boom, Bust and Echo <ul><li>“ Governments should view small-town hospitals not as a burden on the health care budget but as a powerful tool for the economic development of rural regions . </li></ul><ul><li>In the years to come, the reassuring presence of a good local hospital will act as a magnet for relatively prosperous new retirees, whose arrival will create new demand for good and services.” </li></ul>
  16. 17. Boom, Bust and Echo <ul><li>“… . bring their new wealth with them. </li></ul><ul><li>… . already happening in the Okanagan and other parts of the B.C. interior </li></ul><ul><li>… ..one scenario where increased population does lead to increased prosperity….. A Region that loses its local hospital may be losing its best chance for economic rebirth. ” </li></ul>
  17. 18. `Hospital` vs Health Care Centre <ul><li>Form follows function </li></ul><ul><li>Needs assessment </li></ul><ul><li>Population served </li></ul><ul><li>Evidence-based </li></ul><ul><li>Outcomes - Quality </li></ul>
  18. 19. What services ? <ul><li>Volume ? </li></ul><ul><li>Triage/Transfer </li></ul><ul><li>Telehealth </li></ul><ul><li>Back-up </li></ul>
  19. 20. What Health Human Resources ? <ul><li>Interdisciplinary </li></ul><ul><li>Recruitment </li></ul><ul><li>Retention </li></ul><ul><li>CME </li></ul><ul><li>Relief/locums </li></ul>
  20. 21. The Grey Tsunami ? R.O.M.P. Collingwood April 24, 2008 Dr. Carolyn Bennett M.P. The Grey Tsunami ?
  21. 22. Age-Friendly Rural And Remote Communities: A Guide <ul><li>Outdoor Spaces and Buildings </li></ul><ul><li>Transportation </li></ul><ul><li>Housing </li></ul><ul><li>Respect and Social Inclusion </li></ul><ul><li>Social Participation </li></ul><ul><li>Communication and Information </li></ul><ul><li>Civic Participation and Employment Opportunities </li></ul><ul><li>Community Support & Health Services </li></ul>
  22. 23. Age-Friendly Rural And Remote Communities: A Guide <ul><li>Community Support & Health Services </li></ul><ul><ul><li>Caring and Responsible Professionals </li></ul></ul><ul><ul><li>Home Health and Support Services </li></ul></ul><ul><ul><li>Diversity of Health Services and Facilities </li></ul></ul><ul><ul><li>Availability of Equipment and Aids </li></ul></ul><ul><ul><li>Caregiver Support (including respite) </li></ul></ul><ul><ul><li>Information </li></ul></ul>
  23. 24. Age-Friendly Rural And Remote Communities
  24. 27. <ul><li>The Issue: </li></ul><ul><li>21% of Canadians are rural </li></ul><ul><li>9.4% of Canadian physicians are rural </li></ul><ul><li>Rural Canadians have more illness </li></ul><ul><li>Rural Canadians have shorter life expectancy </li></ul>SOCIETY OF RURAL PHYSICIANS OF CANADA NATIONAL RURAL HEALTH STRATEGY: SUMMARY
  25. 28. <ul><li>Rural Canadians do not have fair access to health care: </li></ul><ul><li>Half the number of doctors serving people who are sicker </li></ul><ul><li>Lack of specialists: 3% of Canadian specialists are rural </li></ul><ul><li>Pregnant women have to move away from home to deliver, increasing cost and causing poor medical outcomes </li></ul>SOCIETY OF RURAL PHYSICIANS OF CANADA NATIONAL RURAL HEALTH STRATEGY: SUMMARY
  26. 29. <ul><li>Why the doctor shortage is twice as severe in rural Canada: </li></ul><ul><li>Medical Schools and residency training programs </li></ul><ul><li>90% of medical students come from wealthy urban families </li></ul><ul><li>medical schools promote specialist care and research </li></ul><ul><li>Medical schools require urban living for 7-8 years </li></ul><ul><li>Medical schools teach skills for urban practice </li></ul><ul><li>Working Conditions and remuneration </li></ul><ul><li>Maintaining licensure requires attendance at urban courses </li></ul><ul><li>Urban hospitals do not support rural physicians </li></ul><ul><li>Attrition rate is high </li></ul>SOCIETY OF RURAL PHYSICIANS OF CANADA NATIONAL RURAL HEALTH STRATEGY: SUMMARY
  27. 30. <ul><li>For every rural community we should aim for </li></ul><ul><li>Clean water and sanitary waste disposal </li></ul><ul><li>Appropriate public health and social services </li></ul><ul><li>Modern and well-supported health care facilities </li></ul><ul><li>For every rural Canadian we should aim for </li></ul><ul><li>Access to a well-trained rural family physician with primary support team </li></ul><ul><li>Access to emergency and other general hospital services within a reasonable time and distance </li></ul><ul><li>Access to specialized diagnosis and treatment within an integrated system with outcomes comparable to patients who live in cities </li></ul>SOCIETY OF RURAL PHYSICIANS OF CANADA GOALS FOR A PAN-CANADIAN RURAL HEALTH STRATEGY
  28. 31. <ul><li>For Canadian medical schools we should aim for </li></ul><ul><li>A representative proportion of rural/urban students </li></ul><ul><li>Rural learning experiences for all students and residents to increase interest and understanding of rural practice </li></ul><ul><li>Rural streams for interested students and residents </li></ul><ul><li>Procedural and other advanced training for rural physicians to enhance provision of local services </li></ul><ul><li>For Canadian health research we should aim for </li></ul><ul><li>Development and support of a rural health research network </li></ul><ul><li>Development and support of community-based rural health research involving rural physicians and other health care providers </li></ul>SOCIETY OF RURAL PHYSICIANS OF CANADA GOALS FOR A PAN-CANADIAN RURAL HEALTH STRATEGY
  29. 32. <ul><li>Ministerial Advisory Council on Rural Health </li></ul><ul><li>Rural Access to Scholarships </li></ul><ul><li>Rural Access Development Program </li></ul><ul><li>Rural Medicine Skill Enhancement Program </li></ul><ul><li>National Rural Medical Round Table </li></ul><ul><li>Extension of Medical School to Rural Communities </li></ul><ul><li>Enhanced Training of Residents in Rural Residency Programs </li></ul><ul><li>Strengthen Rural Health Research </li></ul><ul><li>Facilitated Implementation of Broad Band Telehealth </li></ul>SOCIETY OF RURAL PHYSICIANS OF CANADA SOLUTIONS…
  30. 33. <ul><li>Strategies must be developed to improve: </li></ul><ul><li>Return-of-service programs </li></ul><ul><li>Financial incentives for rural practice </li></ul><ul><li>Stable group practices with appropriate facilities and health care teams </li></ul><ul><li>Community involvement and support </li></ul><ul><li>Functional referral networks </li></ul>SOCIETY OF RURAL PHYSICIANS OF CANADA SOLUTIONS…
  31. 34. Health Care or a Real System for Health <ul><li>Patchwork quilt of non- systems </li></ul><ul><li>Focus on sickness…and the repair shops </li></ul>
  32. 35. Re-orienting Health Systems from Health Care to Health
  33. 36. Rx: Civil society insisting on healthy public policy <ul><li>Health literacy </li></ul><ul><li>Civic efficacy </li></ul><ul><li>Enlightened leadership </li></ul><ul><ul><li>Change in attitude… </li></ul></ul><ul><ul><li>respect for Bottom up solutions </li></ul></ul><ul><ul><li>“ Democracy BETWEEN elections” </li></ul></ul>
  34. 37. Citizens have to ‘get it’ <ul><li>More health …less health care </li></ul><ul><li>Service contract ?????? </li></ul><ul><li>Or longer warranty ???? </li></ul>
  35. 38. “ Health is Politics” <ul><li>“ If you want to move healthy public policies forward, you have to have political dynamite ” </li></ul><ul><li>Dr. Halfan Mahler </li></ul>
  36. 39. <ul><li>HOWEVER…… </li></ul><ul><li>Public policy usually follows public opinion…. </li></ul><ul><li>BECAUSE……. </li></ul><ul><li>Doing the right thing is very difficult is the people aren’t onside… </li></ul><ul><ul><li>“ Father knows best” not great politics </li></ul></ul>
  37. 40. CYNICISM
  38. 41. Political Will to do the right thing <ul><li>Dramatically improves with an educated public…… health literacy </li></ul><ul><li>Citizens pulling healthy public policy…. Civic efficacy </li></ul>
  39. 42. Values... Versus public opinion <ul><li>Public opinion ? </li></ul><ul><ul><li>sometimes very shortsighted </li></ul></ul><ul><ul><li>What’s in in for me ? </li></ul></ul><ul><ul><li>What we see in polling data </li></ul></ul><ul><li>Need to drill down to values… </li></ul><ul><ul><li>Deliberative dialogue </li></ul></ul><ul><li>Empowerment </li></ul><ul><ul><li>taking the time to educate and listen </li></ul></ul><ul><ul><li>speaking plain language </li></ul></ul><ul><ul><li>2 –way accountability </li></ul></ul>
  40. 43. Values... Versus public opinion <ul><li>Public opinion ? </li></ul><ul><ul><li>sometimes very shortsighted </li></ul></ul><ul><ul><li>What’s in in for me ? </li></ul></ul><ul><ul><li>What we see in polling data </li></ul></ul><ul><li>Need to drill down to values… </li></ul><ul><ul><li>Deliberative dialogue </li></ul></ul><ul><li>Empowerment </li></ul><ul><ul><li>taking the time to educate and listen </li></ul></ul><ul><ul><li>speaking plain language </li></ul></ul><ul><ul><li>2 –way accountability </li></ul></ul>
  41. 44. Health Literacy Quiz version 1 <ul><li>Is ‘surveillance’ ? </li></ul><ul><ul><ul><li>Pattern of disease </li></ul></ul></ul><ul><ul><ul><li>cameras in school corridors </li></ul></ul></ul><ul><li>Is ‘Accessibility’ </li></ul><ul><ul><ul><li>Getting the businessman to work from the suburbs </li></ul></ul></ul><ul><ul><ul><li>Ramps and closed captioning </li></ul></ul></ul><ul><li>Chronic Disease management </li></ul><ul><ul><ul><li>What or who is being managed ? </li></ul></ul></ul><ul><ul><ul><li>Isn`t this about the health care providers too ? </li></ul></ul></ul><ul><ul><ul><li>Why are we blaming the patients ? </li></ul></ul></ul><ul><ul><ul><li>How many specialty clinics should one human have to attend ? </li></ul></ul></ul><ul><li>Primary Care … provider, setting </li></ul><ul><ul><ul><li>Have you ever heard a real person say these words ? </li></ul></ul></ul>
  42. 45. “ What we have here is a failure to communicate” Cool Hand Luke 1967
  43. 46. The solutions are complex <ul><li>For every complex human problem, there is a neat simple solution, it’s just that it’s wrong… </li></ul><ul><li>HL Mencken </li></ul><ul><li>Tax cuts </li></ul><ul><li>More cops </li></ul><ul><li>More prisons </li></ul><ul><li>another MRI machine being used 9-5 </li></ul>
  44. 47. Health Literacy Quiz version 2 Empowerment Pulling Healthy Public Policy Putting the Public back into Public Health
  45. 48. Public Health 101
  46. 49. 1.Do you think we should have a: <ul><li>A) strong fence at the top of the cliff </li></ul><ul><li>B) state of the art fleet of ambulances and paramedics waiting at the bottom ? </li></ul>
  47. 50. 2. Would you prefer: <ul><li>A) Clean air </li></ul><ul><li>B) Enough puffers and respirators </li></ul><ul><li>for all </li></ul>
  48. 51. 3. Would you prefer that wait-times were reduced by: <ul><li>A) a falls program to reduce preventable hip fractures </li></ul><ul><li>B) private orthopaedic hospitals and more surgeons </li></ul>
  49. 52. 4. Should we invest in: <ul><li>A) early learning, child care, literacy,the early identification of learning disabilities and bullying programmes </li></ul><ul><li>B) increase the budget for young offenders’ incarceration </li></ul>
  50. 53. 5. Should we: <ul><li>A) assume that the 'grey tsunami' will bankrupt our health care system </li></ul><ul><li>B) include our aging population in the planning of strategies to keep them well </li></ul>
  51. 54. 6. Is the best approach to food security: <ul><li>A) food banks and vouchers </li></ul><ul><li>B) Income security,affordable housing, community gardens and community kitchens and a national food policy </li></ul>
  52. 55. 7. Governments should boast about: <ul><li>how much they spent on the sickness care system </li></ul><ul><li>the health of their citizens, leaving no-one behind </li></ul>
  53. 56. teachable moments <ul><li>2003 </li></ul><ul><ul><li>Canada… 44 died of SARS </li></ul></ul><ul><ul><li>France…14,000 died in the heat wave </li></ul></ul><ul><li>2005.. Katrina, Kasheshewan </li></ul>
  54. 57. Beyond borders…. SARS as a teachable moment <ul><li>Beyond silos </li></ul><ul><ul><li>Departments </li></ul></ul><ul><ul><li>Disciplines </li></ul></ul><ul><li>Beyond jurisdictional squabbling </li></ul><ul><li>Germs don’t respect borders </li></ul><ul><li>Neither do the social contagions </li></ul><ul><li>Nor the humanitarian imperatives </li></ul>
  55. 58. Social Determinants of Health vs Choose Health (modifiable risks)
  56. 59. The Causes of the Causes Versus The Causes
  57. 60. Evolution of the Healthy Canadians Tree
  58. 62. Progress <ul><li>First MoS Public Health 2003-2006 </li></ul><ul><li>Public Health Agency of Canada </li></ul><ul><li>Chief Public Health Officer </li></ul><ul><li>Public Health Network for Canada </li></ul><ul><li>Health Goals </li></ul><ul><li>National Collaborating Centres </li></ul><ul><li>Knowledge Networks for the SDOH Commission </li></ul>
  59. 63. Communiqué FMM September 2004 <ul><li>“ In addition, governments commit to accelerate work on a pan-Canadian Public Health Strategy . For the first time, governments will set goals and targets for improving the health status of Canadians through a collaborative process with experts. The Strategy will include efforts to address common risk factors, such as physical inactivity, and integrated disease strategies. First Ministers commit to working across sectors through initiatives such as Healthy Schools.” </li></ul>
  60. 64. Health Goals for Canada <ul><li>As a nation, we aspire to a Canada in which every person is as healthy as they can be – </li></ul><ul><li>physically, </li></ul><ul><li>mentally, </li></ul><ul><li>emotionally and </li></ul><ul><li>spiritually. </li></ul>
  61. 65. Next step <ul><li>Indicators…for each goal ? </li></ul><ul><li>Canadian Index of Wellbeing </li></ul><ul><li> Atkinson Foundation ….very interesting </li></ul>
  62. 66. Changing the way we do things.. Managing for results….. <ul><li>Whole of Government – results. </li></ul><ul><ul><li>Health outcomes – NY State…. Hb A1C reportable </li></ul></ul><ul><ul><li>Health system performance – readmission rates </li></ul></ul><ul><ul><li>The Causes (modifiable risks) </li></ul></ul><ul><ul><li>The Causes of the Causes (SDOH) </li></ul></ul><ul><li>Transparent, comparable and understandable </li></ul><ul><ul><li>Newfoundland and Labrador Community Accounts </li></ul></ul><ul><ul><li>“ Measuring Quality of Life: The Use of Societal Outcomes for Parliamentarians” </li></ul></ul><ul><ul><ul><li>2001, Library of Parliament, Canada </li></ul></ul></ul><ul><li>GIS …invaluable….. </li></ul><ul><li>http://www.statcan.ca/english/freepub/82-221-XIE/2007001/maps/maps.htm#dt </li></ul>
  63. 67. With the Public Health Map Generator, you can produce high quality, detailed maps of your own health data, in combination with extensive geography from our spatial data warehouse…
  64. 68. GIS User ******* The Public Health Map Generator is a secure, web-based mapping application, accessible only to clients registered with the GIS Infrastructure at the Public Health Agency of Canada. All of the Infrastructure’s services, including the Public Health Map Generator, are available at no cost to all public health professionals in Canada.
  65. 69. “ The mobilization of shame” Irwin Cotler Management 101 “ If it’s measured it gets noticed, if it’s noticed it gets done”
  66. 70. Scotland – Honourable Andy Kerr <ul><li>Health outcomes down to postal code </li></ul><ul><li>Letter from Family Doctor </li></ul><ul><li>Interventions </li></ul><ul><li>Already paying off </li></ul>
  67. 71. Process …. <ul><li>Article 54 in PQ </li></ul><ul><li>HIA…. All MC’s , budget, TB guidelines </li></ul><ul><li>Gender Based Analysis </li></ul><ul><li>Disability lens </li></ul><ul><li>Triple bottom line…. NWT </li></ul><ul><li>UK…Children’s Commissioner. </li></ul><ul><ul><li>impact on children of all policies </li></ul></ul><ul><li>Bias-free framework :Mary Anne Burke, Margrit Eisler; Global Forum for Health Research </li></ul>
  68. 72. Structure Gridlock horizontal – departments vertical - jurisdiction
  69. 73. Structure <ul><li>Silo- busting - Horizontality </li></ul><ul><ul><li>Ministries or Ministers </li></ul></ul><ul><ul><ul><li>ACTNOW B.C. </li></ul></ul></ul><ul><ul><ul><li>Seniors, Children, Women </li></ul></ul></ul><ul><ul><ul><li>Multicultural/Settlement </li></ul></ul></ul><ul><ul><ul><li>UK Minister of Joined-Up Government </li></ul></ul></ul><ul><ul><li>Cabinet committees </li></ul></ul><ul><ul><ul><li>Paul Martin’s Aboriginal Affairs – Kelowna </li></ul></ul></ul><ul><ul><ul><li>Manitoba – Cabinet Committee on Children </li></ul></ul></ul><ul><ul><li>Parliament… </li></ul></ul><ul><ul><ul><li>Status of Women </li></ul></ul></ul><ul><ul><ul><li>Persons with Disabilities…. </li></ul></ul></ul>
  70. 74. Population Health: Keeping Canadians healthy…. <ul><li>‘ Citizen centered’ federalism… </li></ul><ul><ul><li>bottom up </li></ul></ul><ul><li>Strong common purpose…. </li></ul><ul><li>Local wisdom, local knowledge to get it done </li></ul><ul><li>Aligning all levels of government and all government departments to what is determined in communities. </li></ul>
  71. 75. International WHO NGO Advisory Group Health Promotion <ul><li>Clear they need to be included </li></ul><ul><li>Clear they know it’s politics </li></ul><ul><li>strengths </li></ul><ul><ul><li>Respond to needs in community </li></ul></ul><ul><ul><li>Identify policy gaps </li></ul></ul><ul><ul><li>Advocacy and consensus building </li></ul></ul><ul><ul><li>Resource mobilization </li></ul></ul>
  72. 76. Mahler <ul><li>All I learned was from developing countries. </li></ul><ul><li>Learned the word Empowerment </li></ul><ul><li>Community Empowerment </li></ul><ul><li>Family Empowerment </li></ul><ul><li>Individual Empowerment </li></ul><ul><li>NB dynamic centre is the family </li></ul>
  73. 77. Research….Learning Culture <ul><li>Evidence-informed practice </li></ul><ul><li>Practice-informed evidence </li></ul><ul><li>Courage to fund what works </li></ul><ul><li>Courage to stop funding what doesn`t </li></ul><ul><li>Complex adaptive systems… </li></ul>
  74. 78. Research Practice Policy
  75. 79. Research Practice Policy KT
  76. 80. Research Practice Policy KT Political will
  77. 81. Research Practice Policy KT Political will Applied research
  78. 82. Research Practice Policy ENGAGED CITIZENS KT Political will Applied research
  79. 83. Health in Cuba 2009
  80. 84. Infant mortality 20 x 1000 new born American Region 4,7 x1000 newborn Cuba
  81. 85. Dispensarizacion <ul><li>`the constant assessment of population and risk` </li></ul><ul><li>``We don`t expect people to get sick and come to us`` </li></ul>
  82. 86. Pride in their results <ul><li>Family doctors annual report </li></ul><ul><ul><li>Smokers,obese,sedentary,lipids,BP </li></ul></ul><ul><li>Statisicians, Epidemiologists, Psychologists </li></ul><ul><li>Accountability to Govt and Legislature </li></ul><ul><ul><li>Weekly meeting with Minister </li></ul></ul>
  83. 87. Integration of Health Professional Education & Community <ul><li>health professional must be a professor and give tutorials to the students. </li></ul><ul><li>`Polyclinics` - Teaching University </li></ul><ul><li>` We don`t train basketball players on a soccer pitch and vice versa ` </li></ul>
  84. 88. POLICLINICO UNIVERSITARIO PLAZA DE LA REVOLUCIÓN
  85. 89. Actividades con la comunidad <ul><li>Círculos de abuelos. </li></ul><ul><li>Círculos de gestantes (clases de psicoprofilaxis). </li></ul><ul><li>Círculo de lactantes. </li></ul><ul><li>Círculo de adolescentes. </li></ul><ul><li>Círculos de interés de escolares </li></ul>
  86. 90. Polyclinics <ul><li>“ The family is the centre of our attention” </li></ul><ul><li>Risk rated – potable H 2 O, violence </li></ul><ul><ul><ul><li>Healthy </li></ul></ul></ul><ul><ul><ul><li>Sick </li></ul></ul></ul><ul><ul><ul><li>Disabled </li></ul></ul></ul><ul><li>The sick can be “admitted to their own homes” </li></ul><ul><li>Goal is to improve all health outcomes </li></ul><ul><li>‘ Psychoprophylaxis’ </li></ul><ul><li>Every child a ‘wanted child’ </li></ul>
  87. 91. No time for pessimists
  88. 92. <ul><li>“ We are not tinkers, who patch and mend what is broken. We must be watchmen, guardians of the life and health of our generation, so that stronger and more able generations may come after.” </li></ul><ul><li>Dr. Elizabeth Blackwell </li></ul>
  89. 93. Sir Michael Marmot <ul><li>“ 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.” </li></ul>
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