Title: Reorienting Health Systems: Putting the PUBLIC back into Public Health
1Reorienting Health SystemsPutting the PUBLIC
back into Public Health
-
- National Collaborating Centres
- Baddeck
- August 23,2007
- Carolyn Bennett M.P.
-
2 Public Health Fantasy
3The Em PHA sis is on the wrong syl
LAB le
4Goal of Medicare Tommy Douglas
- Sharing risk
- getting people the health care they need when
they need it. - Keeping people well not just patching them up
once they get sick
5Fleeing the Medical Model,Embracing the Medicine
Wheel
6Blame Hippocrates?
7Affirm Hygeia
HYGEIA Goddess of Health
8 Reorienting Health Systems from Health Care to
Health
9 Health CARE Magnetic North Pole
10 We need a strong opposing force for HEALTH
11 We need
Empowered Citizens
12 Health Care
Health CARE
Empowered Citizens
HEALTH
13 Empowered Citizens
HEALTH
14Rx Civil society insisting on healthy public
policy
- Health literacy
- Civic efficacy
- Enlightened leadership
- Change in attitude
- respect for Bottom up solutions
- Democracy BETWEEN elections
15Citizens have to get it
- More health less health care
- Service contract ??????
- Or longer warranty ????
16The Tyranny of the Acute
- 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.
17Health is Politics
- If you want to move healthy public policies
forward, you have to have political dynamite - Dr. Halfan Mahler
18- 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
19CYNICISM
Meaningful citizen engagement must cynicism
not
20Political Will to do the right thing
- Dramatically improves with an educated public
health literacy - Illiteracy for Afghan women - blind
- Cant see whats going on
- Citizens pulling healthy public policy. Civic
efficacy
21Values... Versus public opinion
- Public opinion ?
- sometimes very shortsighted
- Whats in in for me ?
- What we see in polling data
- Need to drill down to values
- Deliberative dialogue
- Empowerment
- taking the time to educate and listen
- speaking plain language
- 2 way accountability
22Health literacy Civic Efficacy
- Ottawa Charter.
- Deconstructing the Deconstruction ????
-
- Or
- Get citizens the ammunition they need to help us
.
23Health Literacy Quizversion 1
- Is surveillance ?
- Pattern of disease
- cameras in school corridors
- Is Accessibility
- Getting the businessman to work from the suburbs
- Ramps and closed captioning
- Chronic Disease management
- What or who is being managed ?
- Isnt this about the health care providers too ?
- Why are we blaming the patients ?
- How many specialty clinics should one human have
to attend ? - Primary Care provider, setting
- Have you ever heard a real person say these words
?
24 What we have here is a failure to
communicate Cool Hand Luke 1967
25The solutions are complex
- For every complex human problem, there is a
neat simple solution, its just that its wrong - HL Mencken
- Tax cuts
- More cops
- More prisons
- another MRI machine being used 9-5
26Complex 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 !!!!
27Health Literacy Quizversion 2
Empowerment
Pulling Healthy Public Policy
Putting the Public back into Public Health
28Public Health 101
291.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 ?
302. Would you prefer
- A) Clean air
- B) Enough puffers and respirators
- for all
313. 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
324.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
335.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
346. 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
357. 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
367.Governments should boast about
- how much they spent on the sickness care system
- the health of their citizens, leaving no-one
behind
37teachable moments
- 2003
- Canada 44 died of SARS
- France14,000 died in the heat wave
- 2005..Katrina, Kasheshewan
38Beyond borders. SARS as a teachable moment
- Beyond silos
- Departments
- Disciplines
- Beyond jurisdictional squabbling
- Germs dont respect borders
- Neither do the social contagions
- Nor the humanitarian imperatives
39Social Determinants of Health vsChoose
Health(modifiable risks)
40The Causes of the Causes
41Evolution of the Healthy Canadians Tree
42(No Transcript)
43Progress
- First MoS Public Health 2003-2006
- Public Health Agency of Canada
- Chief Public Health Officer
- Public Health Network for Canada
- Health Goals
- National Collaborating Centres
- Knowledge Networks for the SDOH Commission
44CommuniquéFMM September 2004
- 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.
45Health Goals for Canada
-
- As a nation, we aspire to a Canada in which
every person is as healthy as they can be
physically, mentally, emotionally and
spiritually. -
46Next step
- Indicatorsfor each goal ?
- Canadian Index of Wellbeing
- Atkinson Foundation .very interesting
47Changing the way we do things..
- Measurement
- Process
- Structure
48Changing the way we do things..Managing for
results..
- Whole of Government results.
- Health outcomes NY State. Hb A1C reportable
- Health system performance readmission rates
- The Causes (modifiable risks)
- The Causes of the Causes (SDOH)
- Transparent, comparable and understandable
- Newfoundland and Labrador Community Accounts
- Measuring Quality of Life The Use of Societal
Outcomes for Parliamentarians - 2001, Library of Parliament, Canada
- GIS invaluable..
- http//www.statcan.ca/english/freepub/82-221-XIE/
2007001/maps/maps.htmdt
49The mobilization of shameIrwin Cotler
Management 101 If its measured it gets
noticed, if its noticed it gets done
50Process .
- Article 54 in PQ
- HIA. All MCs , budget, TB guidelines
- Gender Based Analysis
- Disability lens
- Triple bottom line. NWT
- UKChildrens Commissioner.
- impact on children of all policies
- Bias-free framework Mary Anne Burke, Margrit
Eichler Global Forum for Health Research
51Structure Gridlock
horizontal departments
vertical - jurisdiction
52Structure
- Silo- busting - Horizontality
- Ministries or Ministers
- ACTNOW B.C.
- Seniors, Children, Women
- Multicultural/Settlement
- UK Minister of Joined-Up Government
- Cabinet committees
- Paul Martins Aboriginal Affairs Kelowna
- Manitoba Cabinet Committee on Children
- Parliament
- Status of Women
- Persons with Disabilities.
53Structure
- Jurisdictional squabble
- SARS . Naylor report..
- Collaboration
- Cooperation
- Communication
- Clarity of who does, what, when
54Population Health Keeping Canadians healthy.
- Citizen centered federalism
- bottom up
- Strong common purpose.
- Local wisdom, local knowledge to get it done
- Aligning all levels of government and all
government departments to what is determined in
communities.
55InternationalWHO NGO Advisory Group Health
Promotion
- Clear they need to be included
- Clear they know its politics
- strengths
- Respond to needs in community
- Identify policy gaps
- Advocacy and consensus building
- Resource mobilization
56Mahler
- All I learned was from developing countries.
- Learned the word Empowerment
- Community Empowerment
- Family Empowerment
- Individual Empowerment
- NB dynamic centre is the family
57Ministries of Diseases Dr. Harry Jeene
- Mirroring the way Northern countries are
structured, developing countries also fund health
as a set of diseases.
58Health Promotion in partnership Dr. Harry
Deene
- There is not much profit to be made in Health
Promotion, certainly not for the Pharma, fast
food and entertainment industries, - Neither for the donors who require quick wins,
direct attributions and an increasing preference
for commodities. - There is even little in it for the formal health
care providers, including those in primary health
care - 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.
59Dr. Harry Deene
- We have missed our Alma Alta
- 2000 targets
- We are missing our 2015 MDG targets
- (and where are health promotion, chronic
conditions, mental health and trauma in these
MDG's'anyway ?) - Civil Society will have to exercise much more
pressure to get health promotion on the agenda,
North and South.
60Putting the poli back into Politics ( policy
!)
- The art of making the necessary possible
- Deciding what is necessary is political..
- We need great people to run for public office.
- We need great people to want to be civil
servants. - They need to be believers in bottom up
61No time for pessimists
62Sir 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.
63Research.Learning Culture
- Evidence-informed practice
- Practice-informed evidence
- Courage to fund what works
- Courage to stop funding what doesnt
- Complex adaptive systems
64We need enlightened leadership too !!
HEALTH
65Dr. 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. -
66Reorienting Health Systems
Healthy Public Policy
Empowered Citizens
Enlightened Leadership
67Dr. Elizabeth Blackwell
-
- We are not tinkers, who merely 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.