1. 1 Municipal Government and Public Health: How Cities are Addressing the Social Determinants of Health & Health Inequalities Thematic Session, Suite 303 WTCC 8:30am to 10:00am, Wednesday June 4, 2008 CPHA Conference, Halifax NS

2. 2 The Session Brian Ward, Moderator, PHAC Dr. Cory Neudorf, Chief Medical Officer, Saskatoon Health Region Councillor Sheila Fougere, Halifax Regional Municipality Discussion, Statements, Questions & Responses

3. 3 Social Determinants of Health & Municipal Government The health of Canadians is determined largely by the conditions in which they live. Different conditions lead to differences in social status. Different social status leads to different health status. Municipal leaders significantly shape the conditions of people’s lives, and of their health.

4. 4 Estimated Impact of Factors Determining the Health Status of the Population 50% 25% 15% 10% Source: Estimation by the Canadian Institute for Advanced Research, The Standing Senate Committee on Social Affairs, Science and Technology, The Health of Canadians – The Federal Role, Volume One: The Story So Far, March 2001. Social and Economic Environment Health Care System Biology and Genetic Endowment Physical Environment

5. 5 Positive Determinant when: –Universal infrastructure: i.e. water, waste, transportation systems, community planning, recreational & cultural opportunities, –Protective policies: i.e. pollutants, tobacco, health and safety standards & inspection, –Basic needs met: i.e. adequate & affordable housing, Negative Determinant when: –Excluded populations, poor quality/ageing infrastructure, private interests over-ride public interests

6. 6 Social & Economic Environment “Roy Romanow’s Advice” Don’t be poor Get a good start in life Graduate from high school Get a job Pick your community Live in quality housing

7. 7 The Municipal Determinants of Good Health “Pick Your Community” Accessible, Affordable, Safe Housing Access to safe water & sanitation Efficient waste management Safe working & living environments Health & environmentally planned land use Food security Public transportation Child care Recreational & Cultural programs and facilities Public Health promotion & programming Health and Crisis Leadership and Management Immigrant & Settlement Services

8. 8 Some municipal initiatives of note I Social Support Networks –City of Regina’s Urban Aboriginal Community Grant Program –Halifax Regional Municipality Immigration Action Plan Healthy Child Development –Toronto’s Early Child Development Initiative –Edmonton’s Child Friendly Strategy

9. 9 Some municipal initiatives of note II Social Environments: –Vancouver's Four Pillars Drug Strategy & Wellness Walkway –Toronto’s injury prevention initiative –Safer Calgary initiative Food Security –Ottawa’s Food Security Group –Nourrir Montréal

10. 10 Some municipal initiatives of note III Environmental Health: –Many Smoking By-laws (national leadership) –Calgary’s Reduced Vehicle Idling initiative Affordable Housing –Toronto's Streets to Home program –Region of Waterloo’s Affordable Housing Strategy –London’s Convert to Rent Program –Ottawa’s deferred property tax program

11. 11 Municipal Health Leadership “Health for All” Pesticide bylaws: Hudson Quebec 1991 –Now: 135 municipalities with pesticide control by-laws improving the health of 42% of Canadians (October 2007) Supreme Court affirmed the right of Municipalities to protect residents health through bylaws, endorsing the precautionary principle

12. 12 Some background on Municipal Government 3,700 municipal governments in Canada The 10 largest urban economies accounted for 47% of the GDP; Toronto’s GDP is larger than that of 8 provinces and 29 American states Municipal employees: over 350,000 Public transit: 1.63 billion passengers yearly Annual Public housing investment: $2.1 Billion

13. 13 Background (continued) Two types: –Single/lower tier –cities towns, townships with full responsibilities for municipal services –Upper tier – regional or metropolitan municipalities with wider area and possible several lower tier municipalities within them Created by provincial legislation therefore great variety across Canada

14. 14 Total Government Revenue as % of GDP 1989 - 2005

15. 15 Tax Revenue Distribution

16. 16 Revenues

17. 17 Property Tax Horizontal equity: regressive –Among categories i.e. business vs. rental vs. homeowner Vertical equity: regressive –Share of household income represented by the tax goes down as income goes up Often inefficient: –suburban expansion, hollow cores, elderly & fixed income Highly visible –Differentiated visibility and responsible leadership

18. 18 How others tax for revenue Income PropertySales/Other Service Canada0.0%91.5% 2.0% 6.5 Australia0.0100 0.0 0.0 Mexico0.189.5 2.4 7.9 U.S.A5.272.622.0 0.0 France0.053.211.035.9 Japan44.633.021.3 1.0 Germany75.817.7 6.4 0.3 Italy21.613.623.041.8 OECD 2004

19. 19 Expenditures

20. 20 Expenditures

21. 21 Municipal Government and the Social/Economic Physical Determinants

22. 22 The roles and contributions of Municipal Government on SDH Leaders on the determinants of health in areas of municipal mandates. Partners on the determinants of health where municipal government has the experience, contact and relationships Brokers & instigators where the solution requires a multitude of players. Guarantors that the local voice is heard.

23. 23 Where Public Health and Municipal Government meet Inclusive Communities: barrier-free design, programming & planning Environmental Health: the bio-dome Active Living: city/town as health club & outdoors places Food Security & Nutrition: the garden & the market Affordable Healthy Housing: Community Safety: Child Health & Development:

24. 24 What Public Health & Municipal Government can do together 1. Integrated & intersectoral leadership 2. Community participation and empowerment 3. Evidence based strategies for learning

25. 25 And Finally…. Conference Objectives: To provide a forum to critically reflect on our progress, and To consider Canada’s future role in the reduction of health inequalities in response to the anticipated report of the WHO Commission on Social Determinants of Health.