1. 1 Reducing Health Disparities: Rethinking Public Policy Senator Wilbert J. Keon, Chair Senate Subcommittee on Population Health Study of the Senate Subcommittee on Population Health Annual Conference, Canadian Public Health Association, 1-4 June 2008

2. 2 Mandate Examine and report on the impact of the multiple factors and conditions that contribute to the health of Canada’s population - known collectively as the determinants of health.

3. 3 Four Reports on Population Health Policy International Perspectives Maternal Health and Early Childhood Education in Cuba Federal, Provincial and Territorial Perspectives Issues and Options Download the reports from: http://www.senate-senat.ca/health-sante.asp

4. 4 What We Learned The major cause of death and disability in Canada is health disparities The vast majorities of health disparities are neither natural nor inevitable but are the consequences of public policies Rethinking public policy can improve health outcomes

5. 5 Life Expectancy (LE) and Health-Adjusted Life Expectancy (HALE), Canada, 2001 Males at birthFemales at birth

6. 6 Differences in Life Expectancy: Men 79.2 77.4 76.2 78.2 77.7 76.6 76.9 75.0 74.9 79.5 79.4 68.6 66.0 67.2 68.8 77.0 60 65 70 75 80 85 Iceland Canada U.K. Turkey British Columbia Ontario Quebec Nunavut Quebec Montréal Saguenay Gatineau Lac Saint-Louis René-Cassin Maisonneuve Des Faubourgs OECD (2003–2004)Canada (2002)Quebec CMAs (2000–2002) Montréal (1994–1998) Life Expectancy at Birth for Men

7. 7 MALEFEMALE YearRegistered Indians All Canadians GapRegistered Indians All CanadiansGap 198060.971.710.868.078.910.9 198563.973.19.271.079.98.9 199066.974.47.574.080.86.8 199568.075.17.175.781.15.4 200070.276.76.575.281.96.7 200170.477.06.675.582.16.6 Sources: Population Projections of Registered Indians, 2000-2001, INAC, 2003 Population Projections for Canada, Provinces and Territories, 2000-2026, Statistics Canada 2001, Medium Assumption, pages 25-26. Projected Life Expectancy at Birth by Gender, Registered Indians and Canadian Population, Canada, 1980-2001

8. 8 What We Learned, cont’d The vast majorities of health disparities are neither natural nor inevitable but are the consequences of public policies Rethinking public policy can improve health outcomes There is no single right way to reduce health disparities

9. 9 What We Learned, cont’d Some countries lead the way – England and Sweden – and in Canada, some provinces are more advanced – Quebec and Newfoundland Potential tools to move the population health agenda forward include health goals/targets and health impact assessments Intersectoral action is key: all relevant departments, various levels of governments, NGOs and communities must work together

10. 10 What We Learned, cont’d There is a need to focus on some population groups, like children, low-income Canadians and Aboriginal peoples Some health determinants are critical, particularly early childhood education and income There is enough evidence to take action now The health sector cannot act alone What is missing is the political will

11. 11 What We Learned, cont’d There is a need to focus on some population groups, like children, low-income Canadians and Aboriginal peoples Some health determinants are critical, particularly early childhood education and income There is enough evidence to take action now The health sector cannot act alone What is missing is the political will

12. 12 What We Concluded The Subcommittee believes it is unacceptable for a privileged country like Canada to continue to tolerate disparities in health. Our challenge is to find ways to improve the health of all Canadians to equal that of those who experience the best health. (Issues and Options, p. 9)

13. 13 The Federal Role Direct responsibility and mandate for First Nations and Inuit health Shared responsibility for numerous health determinants – income support, social housing, education, environment, economic development, etc. The right and the obligation to take a leadership role Federal funding goal: to achieve the most health for every precious dollar spent

14. 14 What is Missing We need an ambitious vision – “What kind of Canada do we want?” We must build a business case for population health There must be dedicated leaders / champions from a range of sectors There is a need to rethink public policy

15. 15 What Must Be Done? Articulate a vision, build a business case Starting from current policies and programs, prioritize initial steps towards that vision Implement a series of parallel processes Action must occur from the bottom up and from the top down Work horizontally and cooperatively: “whole- of-government approach”

16. 16 If We Do It Right… Shifting public policy can accomplish the following: Health disparities will be reduced; many more people will live longer lives and enjoy a better quality of life; Savings will be made in the long term and a wide range of public services such as health care, social services and supports, etc. Healthier people will be better employed and improve productivity.

17. 17 Sir Michael Marmot World Health Organization Commission on the Social Determinants of Health The graded nature of the link between position in the hierarchy and death—the social gradient in mortality—is the challenge to understanding. The gradient is a broader issue than that of poverty and health. We have no difficulty in contemplating how dirty water, poor sanitary facilities, and inadequate nutrition and shelter could cause the diseases of poverty.

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19. 19 Newfoundland Community Accounts: Well-Being Index

20. 20 Health Status and Well-Being Frail Old Middle Old Young Old Parenting Maternal Health Early Human Development Pre-adolescence Work Life Life Cycle Stages and Policies for Population Health / Well-Being Socioeconomic Determinants of Health - 50% Post- Secondary Education Social Environment Physical Environment Early Child Development Education Employment and Working Conditions CultureGender Biology and Genetics Personal Health Practices Income and Social Status Social Support Networks 15%10% Health Care System 25% Pre-conception Pregnancy Early Years Youth Primary and Secondary Education Healthy Aging Employment and Workplace

21. 21 We Need Your Input Fax: (613) 947-2104 Email: SOC-AFF-SOC@sen.parl.gc.caSOC-AFF-SOC@sen.parl.gc.ca Mailing Address: Subcommittee on Population Health The Senate of Canada Ottawa, Ontario Canada, K1A 0A4 Deadline for Briefs: June 30, 2008