Public Health Renewal: Building a System to meet the Needs of Nova Scotians

1
Public Health Renewal Building a System to meet
the Needs of Nova Scotians

• Dr. Robert Strang, Chief Public Health Officer
• Public Health Association of Nova Scotia
• Nov. 13th, 2007

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Public Health

• Science and art of promoting health, preventing
  disease, prolonging life and improving quality of
  life through the organized efforts of society.

Public Health in England (Acheson Report), 1988
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Public Health Contributes to

• Improved levels of health status of the
  population and decreased health disparities
• Decreased burden on the personal health services
  system and thereby contribute to its
  sustainability
• Improved preparedness and response capacity for
  health emergencies

F/P/T Improving Public Health System
Infrastructure Report, 2005
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Public Health System Core Functions

• 5 core functions
• Population health assessment
• Health surveillance
• Disease and injury prevention
• Health promotion
• Health protection

F/P/T Advisory Committee on Population Health
(ACPH)
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How we do our work Using a Population Health
Approach

• Focus on the health of populations
• Address the determinants of health and their
  interactions
• Base decisions on evidence
• Increase upstream investment
• Apply multiple strategies
• Collaborate across sectors and levels
• Employ mechanisms for public involvement

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Historical Perspective

• Learning from SARS (November 03)
• Public Health Review Process
• Terms of Reference of Review approved (CEOs, SLT)
• Expert External Review Team
• Provincial Advisory Committee
• Engagement of local and provincial levels
• External Consultant Dr. Brent Moloughney
• Public Health Review
• Oct 04 Consultant hired and review begun
• Sept 05 final report completed
• Jan 06 Cabinet approval
• Feb 06 Dept of HPP established
• April 06 Report released
• Spring-Winter 06 establishing the new Dept
• April 07 Major budget increase
• Aug 07 CPHO appointed

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Reviews major findings

• Improve structure capacity provincially
• Improve structure capacity locally
• Improve integration between system levels
• Improve integration with rest of health system
• Address infrastructure - people -
  information - organization

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Reviews major findings

• 21 Actions for system renewal
• Significant work required
• Deterioration over a decade fix will take a
  decade
• Actions for Renewal are all inter-dependent
• Cannot pick and choose
• Most actions are projects unto themselves
• Many important decisions within the actions
• Will require system thinking and involvement of
  all players
• System renewal must occur while system remains
  operational
• Comprehensive in nature
• Provide the path for renewal

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Whats happened to date?

• New Department announced in Feb 2006 (4)
• Chief Public Health Officer appointed (2)
• Provincial organization re-organized and
  implemented and major recruitment underway (3)
• Interdepartmental activity and commitment to
  environmental health secretariat (6)
• Liaison with Atlantic Provinces and academic
  partners on opportunities for collaboration (7,
  8, 9, 17)
• PANORAMACDC component of information system
  development (10)
• Public health laboratory project (13)
• Ongoing Pandemic planning in partnership with DOH
  (15)
• Multi-year budget for system renewal completed
  (16)
• Ongoing liaison with Public Health Agency of
  Canada (PHAC) (19)
• Project team for implementation under recruitment
  (21)

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HPP Vision
Helping Nova Scotians to be healthier and safer
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HPP Mission
We will lead the collaborative effort to prevent
illness and injury, promote and protect health
and reduce disparities in health status
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HPP Strategic Goals

• Improve the health of the population.
• Support capacity building within government,
  communities, families and individuals.
• Create supportive social and physical
  environments.
• Develop and influence policy that supports
  improved health.
• Create and sustain a sufficient, competent and
  healthy workforce in HPP and throughout the
  public health system.

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Guiding Principles

• Foundation. We are grounded in the principles of
  community development and committed to a
  population health approach to our work.
• Partnership. We will work in a collaborative,
  transparent and responsive way.
• Integration. We will work within and across
  disciplines, sectors and organizations.
• Evidence Informed. We will make decisions based
  upon the best available information.
• Accountability. We will be responsible for our
  individual and collective actions.

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HPP Values

• LEADERSHIP
• We believe in creating a culture that inspires
  all of us to achieve our best. We believe in
  being responsive and decisive.
• INTEGRITY
• We believe in openness, honesty, trust, respect
  and acknowledging the contributions made by all.
• COLLABORATION
• We believe in the importance of teamwork and open
  communication.
• INNOVATION EXCELLENCE
• We believe in achieving our goals through a
  spirit of creativity and exploration.
• PEOPLE DEVELOPMENT
• We believe in continuous learning, self
  improvement, personal wellness and professional
  development.

• Practice what we preach
• Doing the right thing
• The whole is greater than
• the sum of its parts
• Thinking outside the box
• Life-long learning

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New Departmental Structure
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Key Public Health Issues and Why Are These
Important To Nova Scotians

• Environmental Sustainability ? future generations
  
• Chronic Disease and Injury Prevention ?
  sustainability of health care system economic
  impact
• Mental Health Addictions ?
  under-recognized societal impact
  underlying factor for other key issues
• Early Childhood Development ? primordial
  prevention
• (Re) Emerging Infectious Diseases ? credibility
  and risk management
• Shared theme of health disparities ? equity

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How To Address These Issues More Effectively

• Provide leadership
• Enhance partnerships
• Systems thinking
• Longer term thinking
• Build capacity
• Create supportive environments
• Strong public health system

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Requirements for a Strong PH System

• systems approach
• commitment to all PH functions
• information evidence
• integrated settings based approach
• leadership catalyst for change
• collaboration
• community development

19
Key Public Health Partners

• Prov. Govt departments
• Academia
• NGOs
• PHAC/Health Canada/Environment Canada/ CFIA
• FNIHB/ First Nations communities

20
Key Partners PH System

• Need shared dialogue to develop common
  understanding of
• PH functions PH system
• system level roles responsibilities
• leadership
• decision making
• accountability
• communication
• integration with rest of health system

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Short Term Goals (where to next)

• Establish presence of CPHO
• Build teams at provincial, local and systems
  level
• Engage partners at local, provincial and national
  level
• High gear business planning for 08-09
• Maintain momentum

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Discussion Points

• How to strengthen links between PH system and
  PHANS?
• Role of PHANS in PH renewal?