1. The Politics of Health & Health Care Health literacy + Civic efficacy = Political Will Honourable Dr. Carolyn Bennett, MP Canadian Federation Medical Students February 6, 2001 February 6, 2011

2. “Politics in Canada has always been the art of making the necessary possible. Therefore deciding what’ necessary IS political Peter C. Newman

3. ► Empowered patients ► Effective advocates ► Engaged citizens

4. ► Patient as Partner ► Doctor Multidisciplinary ► Hospital Community ► Social Determinants of Health  Poverty, violence, environment, shelter, equity, education

5. 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”

7. Ongoing health CARE Dilemmas Ongoing health CARE Dilemmas The urgent at the expense The urgent at the expense of the important. The politics of FEAR…… The politics of FEAR……

8. Canadian Institute for Advanced Research   25% health attributable to health care system   15% biology and genetics   10% physical environment   50% social and economic environments HEALTH VS HEALTH CARE

9. Public policy usually follows public opinion…. public opinion….BECAUSE……. Doing the right thing is very difficult is the public isn’t onside…  “Father knows best” not great politics

10. Political Will to do the right thing dramatically improves with ► Health Literacy  ‘tyranny of the acute’ ► Civic efficacy  Citizens pulling healthy public policy

11. Attitude 2+2=5 Knowledgeable Stakeholders + Committed Politicians = Better Public Policy

12. Chronology Chronology ► Turn of century …. urbanization ► 1918 Spanish flu ► Depression ► Tommy Douglas – goal of medicare ► ‘tyranny of the acute’ ► Lalonde Report 1974 ► Ottawa Charter 1986 ► Failed attempt at Health Goals… 1992 ? ► SARS 2003 ► Health Goals for Canada 2005 ► WHO Commission for SDOH 2005-2008

13. Goal of Medicare… Goal of Medicare… ► 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

14. Lalonde Report 1974 ► Followed by  Series of reports on `risk factors` by long range health planning directorate  Series of targeted population reports ► Nutrition, Physical Fitness, Children etc.  Fraser & Wigle - first thinking on potential years of life lost formula.....economic costs of dying prematurely from preventable diseases  Maureen Law as DM... Health Goals process  Killed before Health Ministers Meeting ► Dx: HEALTH IMPERIALISM

15. “Reorienting health systems” FROM a health CARE system TO a true system for HEALTH Ottawa charter 1986

16. The Em PHA sis is on the wrong syl LAB le

17. Minister of Handwashing

18. Minister of State (Public Health) ► Sworn in December 2003 ► 2003  Canada… 44 died of SARS  France…14,000 died in the heat wave ► 2000 WHO Report  France #1  Canada #30

19. Beyond borders…. SARS as a teachable moment ► Beyond silos  Departments  Disciplines ► Beyond jurisdictional squabbling ► Germs don’t respect borders ► Neither do the social contagions ► Nor the humanitarian imperatives

20. Fleeing the Medical Model, Embracing the Medicine Wheel

21. Blame Hippocrates?

22. Affirm Hygeia HYGEIA: Goddess of Health

23. Oath of Hygeia, an oath of health care providers I swear by Hygieia, the goddess of health making her my witness that I will fulfill according to my ability and judgment this oath and covenant: I affirm that the ultimate goal of all health providers is to promote health, prevent disease and injury whenever possible.

24. Teachable Moments Kasheshewan Reserve... Dr. Hill Hurricane Katrina The 2003 heat wave in France The 1995 Chicago heat wave ► Heat Wave: A Social Autopsy of Disaster in Chicago by Eric Klinenberg

26. Victims ► The Poor: who either had no working air conditioning or could not afford to turn it on. ► The Elderly: who were hesitant to open windows and doors at night for fear of crime. ► African Americans: many blacks lived in areas of sub-standard housing and less cohesive neighborhoods.

27. Survivors ► Hispanics: had an unusually low death rate due to heat. Hispanics at the time lived in places with higher population density, and more social cohesion. ► Elderly women: who may have been more socially engaged, were less vulnerable than elderly men

28. 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. 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.

29. Citizens have to ‘get it’ ► More health …less health care ► Service contract ?????? ► Or longer warranty ????

30. The Grey Tsunami ? R.O.M.P.Collingwood April 24, 2008 Dr. Carolyn Bennett M.P. The Grey Tsunami ?

31. Fantasy Fantasy

32. Health Literacy Quiz ► Empowerment Pulling Healthy Public Policy Putting the Public back into Public Health

33. Public Health 101

34. 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 ?

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

36. 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

37. 4.Governments should boast about: A) how much they spent on the sickness care system B) the health of their citizens, leaving no-one behind

38. Social Determinants of Health vs Choose Health (modifiable risks)

39. The Causes of the Causes Versus The Causes

40. Evolution of the Healthy Canadians Tree

41. 2005

42. 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.

43. Progress ► First MoS Public Health 2003-2006 ► Public Health Agency of Canada ► Chief Public Health Officer ► Public Health Network for Canada ► Health Goals for Canada ► National Collaborating Centres ► Knowledge Networks for the SDOH Commission ► Minister Aglukkaq…Nunavut Public Health Strategy

44. Health Goals for Canada As a nation, we aspire to a Canada in which every person is as healthy as they can be – As a nation, we aspire to a Canada in which every person is as healthy as they can be –physically,mentally, emotionally and spiritually.

45. Health Goals ► Choose indicators ► Include stakeholder in choosing meaningful and realistic but bold targets ► Develop real strategies….  what, by when and how

46. “The mobilization of shame” Irwin Cotler Management 101 “If it’s measured it gets noticed, if it’s noticed it gets done”

47. 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…

48. 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.

49. Scotland – Honourable Andy Kerr ► Health outcomes down to postal code ► Letter from Family Doctor ► Interventions ► Already paying off

50. Research Research ► Evidence-informed practice ► Practice-informed evidence ► Courage to fund what works ► Courage to stop funding what doesn`t ► Complex adaptive systems…

51. 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.”

52. No time for pessimists

53. Research PracticePolicy

54. Research PracticePolicy KT

55. Research PracticePolicy KT Political will

56. Research PracticePolicy KT Political will Applied research

57. Research PracticePolicy ENGAGED CITIZENS KT Political will Applied research

58. “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 in North America

59. “A politician thinks of the next election, a statesman thinks of the next generation” “A politician thinks of the next election, a statesman thinks of the next generation” James Freeman Clarke James Freeman Clarke Work to elect more statesmen …. Work to elect more doctors !!!!