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From HEALTH CARE to systems for HEALTH: Family Practice Nurses are key

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From HEALTH CARE to systems for HEALTH: Family Practice Nurses are key Ontario Family Practice Nurses Conference Carolyn Bennett M.D.,M.P. – PowerPoint PPT presentation

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Title: From HEALTH CARE to systems for HEALTH: Family Practice Nurses are key


1
From HEALTH CARE to systems for
HEALTH Family Practice Nurses are key
  • Ontario Family Practice Nurses Conference
  • Carolyn Bennett M.D.,M.P.
  • Ottawa

2
(No Transcript)
3
Whats a Doc Like Me Doing in a Place Like
Parliament Hill? the evolution of an MD/MP
  • Fight for Womens College Hospital
  • 1995 candidate provincial election
  • Doctor on Call
  • 1997 M.P.

4
  • Empowered patients
  • Effective advocates
  • Engaged citizens

5
Womens health movement
  • Social determinants of health
  • Poverty
  • Environment
  • Violence
  • Equity
  • Education
  • Shelter

6
Womens College Hospital
  • Patient as Partner
  • Doctor Multidisciplinary
  • Hospital Community

7
Same job !!
  • Ask people whats wrong listen
  • Opening a chart and helping people through a
    system
  • Very few issues of public policy that havent
    been through our office

8
Patient as Partner Citizens and Elected
Representative
  • Patient knows body best
  • I knew the system besttogether we could navigate
    a path
  • Citizens know whats working and whats not
  • My role as an MP bottom up

9
Sir Michael Marmot Chair, WHO Commission on
Social Determinants of Health
  • The worst thing for a physician is to help
    someone get well and then send them straight back
    into the situation that made them sick in the
    first place

10
Health OR Health CARE
  • Health is a state of complete physical, mental
    and social well-being and not merely the absence
    of disease or infirmity. (WHO 1948)
  •  Health Care - The prevention, treatment, and
    management of illness and the preservation of
    mental and physical well-being through the
    services offered by the medical and allied health
    professions.

11
Reorienting health systems
  • FROM
  • a health CARE system
  • TO
  • a true system for HEALTH

12
Canadian Institute for Advanced Research
  • 25 health attributable to health care system
  • 15 biology and genetics
  • 10 physical environment
  • 50 social and economic environments

13
Humbling reality
  • The health of our population cannot be the sole
    responsibility of the Ministry of Health and the
    health care sector.

14
Canadian legacy
  • Tommy Douglas Father of Medicare
  • Lalonde Report 1974
  • Ottawa Charter 1986
  • SARS, Naylor Report 2003
  • WHO Commission SDOH 2005
  • Health Goals for Canada 2005

15
Goal 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

16
Lalonde Report (1974)
  • The Government of Canada, in cooperation with
    others, will pursue two broad objectives
  • 1. To reduce mental and physical health hazards
    for those parts of the Canadian population whose
    risks are high, and
  • 2. To improve the accessibility of good mental
    and physical health care for those whose present
    access is unsatisfactory.

17
In pursuit of these two objectives, five
strategies are proposed
  • 1. A Health Promotion Strategy
  • 2. A Regulatory Strategy
  • 3. A Research Strategy
  • 4. A Health Care Efficiency Strategy
  • 5. A Goal-Setting Strategy

18
Ottawa Charter for Health Promotion (1986)
  • The participants in this Conference pledge
  • 1. to move into the arena of healthy public
    policy, and to advocate a clear political
    commitment to health and equity in all sectors

19
Ottawa Charter for Health Promotion (1986)
  • 2. to counteract the pressures towards harmful
    products, resource depletion, unhealthy living
    conditions and environments, and bad nutrition
    and to focus attention on public health issues
    such as pollution, occupational hazards, housing
    and settlements

20
Ottawa Charter for Health Promotion (1986)
  • 3. to respond to the health gap within and
    between societies, and to tackle the inequities
    in health produced by the rules and practices of
    these societies

21
Ottawa Charter for Health Promotion (1986)
  • 4. to acknowledge people as the main health
    resource to support and enable them to keep
    themselves, their families and friends healthy
    through financial and other means, and to accept
    the community as the essential voice in matters
    of its health, living conditions and well-being

22
Ottawa Charter for Health Promotion (1986)
  • 5. to reorient health services and their
    resources towards the promotion of health and to
    share power with other sectors, other disciplines
    and, most importantly, with people themselves

23
Ottawa Charter for Health Promotion (1986)
  • 6. to recognize health and its maintenance as a
    major social investment and challenge and to
    address the overall ecological issue of our ways
    of living.

24
Fantasy

25
The Em PHA sis is on the wrong syl
LAB le

26
Fleeing the Medical Model, Embracing the Medicine
Wheel
27
Blame Hippocrates?
28
Affirm Hygeia
HYGEIA Goddess of Health
29
Learnings..
  • Cuba
  • Chile President Lagos
  • Vietnam. VSF
  • Thailand the Xray system..

30
From Health CARE to Systems for HEALTH
31
Health CARE Magnetic North Pole
32
We need a strong opposing force for HEALTH
33
We need
Empowered Citizens
34
Health Care
Health CARE
Empowered Citizens
HEALTH
35
Empowered Citizens
HEALTH
36
Romanow Report
  • Discussion paper 8
  • Zimmerman Glouberman
  • Complex Adaptive Systems
  • HIV/Aids Brazil vs Africa

37
Complexity Theory
  • Simple
  • Complicated
  • Complex

38
The solutions are complex
  • For every complex human problem, there is a
    neat simple solution, its just that its wrong
  • HL Mencken

39
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

40
Citizens have to get it
  • More health less health care
  • Service contract ??????
  • Or longer warranty ????

41
The 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.

42
Health is Politics
  • If you want to move healthy public policies
    forward, you have to have political dynamite
  • Dr. Halfan Mahler

43
  • 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

44
Political Will to do the right thing
  • Dramatically improves with an educated public
    health literacy
  • Citizens pulling healthy public policy. Civic
    efficacy

45
Health Literacy Quiz version 1
  • surveillance
  • Accessibility
  • Chronic Disease management
  • Primary Care provider, setting

46
What we have here is a failure to
communicate Cool Hand Luke 1967
47
Health Literacy Quiz version 2

Empowerment
Pulling Healthy Public Policy
Putting the Public back into Public Health
48
Public Health 101
49
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 ?

50
2. Would you prefer
  • A) Clean air
  • B) Enough puffers and respirators
  • for all

51
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

52
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

53
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

54
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

55
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

56
8.Governments should boast about
  • how much they spent on the sickness care system
  • the health of their citizens, leaving no-one
    behind

57
teachable moments
  • 2003
  • Canada 44 died of SARS
  • France14,000 died in the heat wave
  • 2005..Katrina, Kasheshewan

58
Beyond 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

59
Social Determinants of Health vs Choose
Health (modifiable risks)
60
The Causes of the Causes
  • Versus
  • The Causes

61
Evolution of the Healthy Canadians Tree
62
(No Transcript)
63
Communiqué FMM 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.

64
Progress
  • 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

65
Health 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.

66
Changing the way we do things..
  • Measurement
  • Process
  • Structure
  • People
  • Research

67
Better Data
  • E-Rx
  • Dx and Rx
  • Birth defects, injuries, diseases etc
  • Incentives for reporting

68
The mobilization of shame Irwin Cotler

Management 101 If its measured it gets
noticed, if its noticed it gets done
69
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
70
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.
GIS User

All of the Infrastructures services, including
the Public Health Map Generator, are available at
no cost to all public health professionals in
Canada.
71
Scotland Honourable Andy Kerr
  • Health outcomes down to postal code
  • Letter from Family Doctor
  • Interventions
  • Already paying off

72
Process .Health in all Policies
  • Article 54 in PQ
  • HIA. All MCs , budget, TB guidelines
  • Citizen Engagement

73
Structure Gridlock
horizontal departments
vertical - jurisdiction
74
Structure
  • Silo- busting - Horizontality
  • Ministries or Ministers
  • Cabinet committees
  • Parliament
  • Officers of Parliament - Commissioners

75
Structure
  • Jurisdictional squabble
  • SARS . Naylor report..
  • Collaboration
  • Cooperation
  • Communication
  • Clarity of who does, what, when

76
People
  • Need to attract generalists
  • Interdisciplinary care
  • Scope of Practice replaced by
  • Core Competencies
  • Self-care

77
HHR Training
  • Interdisciplinary
  • Social Responsibility
  • Cultural Sensitivity
  • Social Determinants of Health
  • PUBLIC HEALTH

78
Family Practice role in Public Health Getting
credit !!!
  • Health promotion
  • Disease and injury prevention
  • Health literacy
  • Link community, hospitals
  • Mental Health
  • Addictions
  • Chronic Disease Mgt.
  • Self care

79
Research.Learning Culture
  • Evidence-informed practice
  • Practice-informed evidence
  • Courage to fund what works
  • Courage to stop funding what doesnt
  • Complex adaptive systems

80
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.

81
No time for pessimists
82

Research
Practice
Policy
83

Research
KT
Practice
Policy
84
Research
KT
Practice
Policy
Political will
85
Research
Applied research
KT
Practice
Policy
Political will
86
Engaged citizens
Research
Applied research
KT
Practice
Policy
Political will
87
Health Care
Empowered Citizens
Systems for HEALTH
Systems for HEALTH
88
M.D.
  • 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. Dr. Elizabeth Blackwell first woman
    physician Wanless Report UK
    2003 commissisoned by Gordon Brown
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