Rural Health Forum -  State of Healthcare in Rural Ontario:  Setting the Stage November 5, 2009 Hon. Carolyn Bennett, M.D....
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…  Tommy Douglas <ul><li>Sharing risk </li></ul><ul><ul><li>getting people the health care they need when ...
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><...
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...
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
 
 
 
 
 
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...
SOCIETY OF RURAL PHYSICIANS –  NATIONAL RURAL HEALTH STRATEGY
SOCIETY OF RURAL PHYSICIANS –  NATIONAL RURAL HEALTH STRATEGY
SOCIETY OF RURAL PHYSICIANS –  NATIONAL RURAL HEALTH STRATEGY
SOCIETY OF RURAL PHYSICIANS –  NATIONAL RURAL HEALTH STRATEGY
Reorienting Health Systems from Health  Care  to Health
  Health CARE Magnetic North Pole
We need a strong opposing force for HEALTH
We need  Empowered Citizens
Empowered  Citizens   HEALTH Health Care Health CARE
Rx:  Civil society insisting on healthy public policy <ul><li>Health literacy </li></ul><ul><li>Civic efficacy </li></ul><...
Health Care or a Real System for Health <ul><li>Patchwork quilt of non- systems </li></ul><ul><li>Focus on sickness…and th...
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 Meaningful citizen engagement must  cynicism not
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...
Complex doesn’t fit  into a 7 second sound bite….. or on a bumper sticker <ul><li>We must fiercely defend the complex solu...
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 a...
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. Pick the one that is NOT correct <ul><li>Pandemic Preparedness should focus on </li></ul><ul><li>Tamiflu for all </li><...
8.Governments should boast about: <ul><li>how much they spent on the sickness care system  </li></ul><ul><li>the health of...
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 – ph...
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”
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...
Ministries of Diseases     Dr. Harry Jeene <ul><li>Mirroring the way Northern countries are structured, developing countri...
Health Promotion in partnership Dr. Harry Deene <ul><li>There is not much profit to be made in Health Promotion, certainly...
Dr. Harry Deene <ul><li>We have missed our Alma Alta </li></ul><ul><li>2000 targets  </li></ul><ul><li>We are missing our ...
The Policy Makers <ul><li>As most decision makers are male, female health issues are particularly hard to get on the agend...
<ul><li>“ The art of making the necessary possible” </li></ul><ul><li>Deciding what is necessary is political….. </li></ul...
No time for pessimists
Sir Michael Marmot <ul><li>“ Evidence is not enough. There has to be the desire, the political will for change. Given that...
Research….Learning Culture <ul><li>Evidence-informed practice </li></ul><ul><li>Practice-informed evidence </li></ul><ul><...
HEALTH We need enlightened leadership too !!
Dr. John Hastings  M.O.H. Toronto…  on the occasion of his Presidency of the APHA , 1918   <ul><li>Every nation that permi...
Reorienting Health Systems: + = Empowered Citizens Enlightened Leadership Healthy Public Policy
<ul><li>“ The care of the public health is the first duty of a statesman.&quot;  </li></ul><ul><li>Benjamin Disraeli </li>...
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Dr. Carolyn Bennett

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Dr. Carolyn Bennett

  1. 1. Rural Health Forum - State of Healthcare in Rural Ontario: Setting the Stage November 5, 2009 Hon. Carolyn Bennett, M.D., M.P.
  2. 2. 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>
  3. 3. 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>
  4. 4. Goal of Medicare… Tommy Douglas <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>
  5. 5. 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>
  6. 6. 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>
  7. 7. 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>
  8. 8. 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>
  9. 9. 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>
  10. 10. 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>
  11. 11. Age-Friendly Rural And Remote Communities
  12. 17. 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. 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>
  13. 18. 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 . 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>
  14. 19. 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>
  15. 20. SOCIETY OF RURAL PHYSICIANS – NATIONAL RURAL HEALTH STRATEGY
  16. 21. SOCIETY OF RURAL PHYSICIANS – NATIONAL RURAL HEALTH STRATEGY
  17. 22. SOCIETY OF RURAL PHYSICIANS – NATIONAL RURAL HEALTH STRATEGY
  18. 23. SOCIETY OF RURAL PHYSICIANS – NATIONAL RURAL HEALTH STRATEGY
  19. 24. Reorienting Health Systems from Health Care to Health
  20. 25. Health CARE Magnetic North Pole
  21. 26. We need a strong opposing force for HEALTH
  22. 27. We need Empowered Citizens
  23. 28. Empowered Citizens HEALTH Health Care Health CARE
  24. 29. 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>
  25. 30. 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>
  26. 31. 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>
  27. 32. “ 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>
  28. 33. <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>
  29. 34. CYNICISM Meaningful citizen engagement must cynicism not
  30. 35. Political Will to do the right thing <ul><li>Dramatically improves with an educated public…… health literacy </li></ul><ul><ul><ul><li>Illiteracy for Afghan women - ‘blind’ </li></ul></ul></ul><ul><ul><ul><li>Can’t see what’s going on </li></ul></ul></ul><ul><li>Citizens pulling healthy public policy…. Civic efficacy </li></ul>
  31. 36. 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>
  32. 37. 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>
  33. 38. 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>
  34. 39. “ What we have here is a failure to communicate” Cool Hand Luke 1967
  35. 40. 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>
  36. 41. Complex doesn’t fit into a 7 second sound bite….. or on a bumper sticker <ul><li>We must fiercely defend the complex solutions for the complex problems .. </li></ul><ul><li>BUT……we need simpler messages </li></ul><ul><li> PLAIN LANGUAGE </li></ul><ul><li> Myth busting data </li></ul><ul><li> Paint the picture…. </li></ul><ul><li> beautiful GIS maps !!!! </li></ul>
  37. 42. Health Literacy Quiz version 2 Empowerment Pulling Healthy Public Policy Putting the Public back into Public Health
  38. 43. Public Health 101
  39. 44. 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>
  40. 45. 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>
  41. 46. 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>
  42. 47. 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>
  43. 48. 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>
  44. 49. 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>
  45. 50. 7. Pick the one that is NOT correct <ul><li>Pandemic Preparedness should focus on </li></ul><ul><li>Tamiflu for all </li></ul><ul><li>Working with the vets to keep avian flu a disease of birds </li></ul><ul><li>Making sure people wash their hands especially the doctors and nurses </li></ul><ul><li>Research on vaccines </li></ul><ul><li>Community care plans for our most vulnerable </li></ul>
  46. 51. 8.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>
  47. 52. 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>
  48. 53. 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>
  49. 54. Social Determinants of Health vs Choose Health (modifiable risks)
  50. 55. The Causes of the Causes Versus The Causes
  51. 56. Evolution of the Healthy Canadians Tree
  52. 58. 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>
  53. 59. 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>
  54. 60. 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 – physically, mentally, emotionally and spiritually. </li></ul>
  55. 61. 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>
  56. 62. 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>
  57. 63. 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…
  58. 64. 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.
  59. 65. “ The mobilization of shame” Irwin Cotler Management 101 “ If it’s measured it gets noticed, if it’s noticed it gets done”
  60. 66. 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>
  61. 67. Structure Gridlock horizontal – departments vertical - jurisdiction
  62. 68. 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>
  63. 69. 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>
  64. 70. 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>
  65. 71. 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>
  66. 72. Ministries of Diseases Dr. Harry Jeene <ul><li>Mirroring the way Northern countries are structured, developing countries also fund health as a set of diseases. </li></ul>
  67. 73. Health Promotion in partnership Dr. Harry Deene <ul><li>There is not much profit to be made in Health Promotion, certainly not for the Pharma, fast food and entertainment industries, </li></ul><ul><li>Neither for the donors who require quick wins, direct attributions and an increasing preference for commodities. </li></ul><ul><li>There is even little in it for the formal health care providers, including those in primary health care </li></ul><ul><li>Major shifts in thinking are required, and these can only be driven by communities working as full and equal partners with the formal health system, especially at the Primary Care level. </li></ul>
  68. 74. Dr. Harry Deene <ul><li>We have missed our Alma Alta </li></ul><ul><li>2000 targets </li></ul><ul><li>We are missing our 2015 MDG targets </li></ul><ul><ul><li>(and where are health promotion, chronic conditions, mental health and trauma in these MDG's'anyway ?) </li></ul></ul><ul><li>Civil Society will have to exercise much more pressure to get health promotion on the agenda, North and South. </li></ul>
  69. 75. The Policy Makers <ul><li>As most decision makers are male, female health issues are particularly hard to get on the agenda </li></ul><ul><li>(Some female health ministers, not enough female finance ministers) </li></ul><ul><ul><ul><ul><ul><li>Dr. Harry Jeene </li></ul></ul></ul></ul></ul>
  70. 76. <ul><li>“ The art of making the necessary possible” </li></ul><ul><li>Deciding what is necessary is political….. </li></ul><ul><li>We need great people to run for public office. </li></ul><ul><li>We need great people to want to be civil servants. </li></ul><ul><li>They need to be believers in ‘bottom up’ </li></ul>Putting the ‘poli’ back into Politics (& policy !)
  71. 77. No time for pessimists
  72. 78. 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>
  73. 79. 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. 80. HEALTH We need enlightened leadership too !!
  75. 81. Dr. John Hastings M.O.H. Toronto… on the occasion of his Presidency of the APHA , 1918 <ul><li>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. </li></ul>
  76. 82. Reorienting Health Systems: + = Empowered Citizens Enlightened Leadership Healthy Public Policy
  77. 83. <ul><li>“ The care of the public health is the first duty of a statesman.&quot; </li></ul><ul><li>Benjamin Disraeli </li></ul><ul><li>Aspiring to become a statesman should be the first duty of every politician …… </li></ul>

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