Dr. David Butler-Jones, MD MHSc, LLD(h), FRCPC, FACPM, CCFP Chief Public Health Officer of Canada

1. Dr. David Butler-Jones, MD • MHSc, LLD(h), FRCPC, FACPM, CCFP • Chief Public Health Officer of Canada

2. Working together to address public health challenges 1st annual Applied Health Sciences Research DayJanuary 9, 2009

3. “To Prevent Disease, to Relieve Suffering, and to Heal the Sick,-This Is Our Work”Sir William Osler

4. Public Health Is: • A set of programs and services • A way of thinking about problems and solutions • A whole-of-society approach – across sectors, governments, states, jurisdictions • Beyond just the health sector, but with leadership from public health

5. Role of Public Health? • Not just about longer life… • About maximizing healthy years • Supporting through life course, when people are well, when they’re not, until the end. • Public health has a fundamental role: • in understanding impacts of physical and social environments on our health • to advise other sectors, and provide leadership in what we can all do to promote healthy aging • to engage partners across society to build healthy enabling environments

6. “The health of the public is the foundation upon which rests the happiness of the people and the welfare of the state.” Disraeli

7. Report on the State of Public Health • Seniors’ vulnerability crosses diseases and risk • We are only as healthy as the least healthy among us • Poverty about more than just lack of money • Resources for the basics. Influence. Connections. • These are the differences between good health, and great health.

8. Our health – Infant mortality Infant mortality rate, select OECD countries, 1980-2004 Canada Source: Public Health Agency of Canada using Health Canada’s Data Analysis and Information System (DAIS), Organisation for Economic Co-operation and Development (OECD) Health Data, 2007.

9. Our health – Infant mortalityThe Challenge Infant mortality rate by neighbourhood income, urban Canada, 1971-2001 Q – population divided into fifths based on the percentage of the population in their neighbourhood below the low-income cut-offs. Source: Wilkins et al. (2007), Statistics Canada.

10. Our health – Life expectancy Life expectancy at birth, select OECD countries, 1980-2004 Canada Source: Public Health Agency of Canada using Health Canada’s Data Analysis and Information System (DAIS), Organisation for Economic Co-operation and Development (OECD) Health Data, 2007.

11. Our health – Life expectancyThe Challenge Life expectancy at birth by sex, Registered Indian and general population, Canada, 1980-2001 All Females All Males Female - Registered Indian Male – Registered Indian Source: Indian and Northern Affairs Canada, Basic Departmental Data, 2004.

12. Life expectancy continues to climb but… Life expectancy at birth, Canada 1931-2005 Source: Statistics Canada

13. It’s not just how long we live, but how well we live Self-rated health somewhat or much worse than a year ago

14. What makes – and keeps – us healthy?Factors that influence our health

15. Challenges – Health Care Sustainability Balance: • Prevention • Promotion • Protection • Treatment “I’ve got it too Omar… a strange feeling like we’ve just been going in circles”

16. So what can we do? • Socio-economic determinants interact to influence health • An improvement in any of these determinants can improve health behaviours and outcomes. • Factors that influence our health can be positively impacted by the different sectors of society working together to address health and social inequalities through interventions. • Some examples of interventions follow

17. Income interventions National Public Pensions for Seniors • CPP, QPP, GIS, Spouse’s & Widowed Spouse’s Allowance, P/T supps • 95% of seniors receive their income from OAS, GIS or SPA Quebec’s Family Policy (1997) • Quebec has experienced steady decline in poverty rate, now below nat’l average Saskatchewan’s Initiative (1997) • Financial independence for low-income families • Fewer families dependent on social assistance, increase in disposable income among families working for minimum wage

18. Food security interventions Breakfast for Learning • Funding, nutrition education and other resources to community based student nutrition programs across the country • Improvements in performance, behaviour and attentiveness Food Banks • Over last 18 years, reliance on food banks has increased 91% • As of March 2007 there were: • 673 food banks and 2,867 affiliated agencies across Canada • 2 million meals served and 720,000 individuals provided with groceries

19. Environment and housing interventions • Vancouver Agreement • Tripartite agreement to battle crime, drugs, and HIV infection • Healthy Cities • Public health criteria used for community design and land use • Age-friendly cities • Habitat for Humanity • Providing safe and affordable housing and promoting ownership

20. “I [eventually] had a psychiatric diagnosis. Found out medication wasn’t going to get me un-depressed – I was depressed by the situation I found myself in - unemployed and homeless. … Some of the people I don’t know how they survive, and some of the people, well, they just haven’t survived.” A Day in the Life Project Participant

21. Education and literacy interventions • Pathways to Education • Breaks cycle of poverty by increasing chances of youth completing secondary, possibly post-secondary school • Provides academic, social, financial and advocacy supports to at-risk and economically disadvantaged youth • Toronto’s Regent Park results include: • Over 90% of high school students enrolled • Decrease in dropout (56% to 10%) and absenteeism rates (decreased by 50%) • Quadrupled the number of youth attending college or university • Teen pregnancy rates fell 75%

22. Social support interventions • Montreal’s Santropol Roulant • Meaningful youth employment by preparing and delivering meals to seniors in isolated or vulnerable situations • Nova Scotia’s Eskasoni Primary Care Project • Mi’kmaq community decided to manage their health care with the collaborative efforts of a Tripartite Steering Committee • New community health centre built, involved community members

23. Health behaviours interventions • ActNow BC • Champions healthy eating, physical activity, smoking cessation and healthy choices during pregnancy across B.C. • Canada Prenatal Nutrition Program • Compared to similar high risk populations, CPNP participants had: • higher birth weights • higher breastfeeding rates • improved access to services • better information on nutrition/parenting • felt less stressed/isolated during pregnancy

24. Access to health care interventions Toronto’s Mobile Health Unit • Free primary care from female providers with experience in cultural and gender sensitivities • Lower absenteeism caused by health issues and off-site medical appointments TeleHomeCare, Prince Edward Island • Health region has seen: • 73% reduction in days of hospitalizatio • 15% fewer emergency room visits • 46% fewer hospital admissions • 20% drop in doctor’s office appointments among clients

25. There is a loftier ambition than merely to stand high in the world. It is to stoop down and lift mankind a little higher. -- Henry Van Dyke

26. Addressing inequalities:Priority areas for action • Social investment • Community capacity • Inter-sectoral action • Knowledge infrastructure • Leadership

27. Moving forward • Foster collective will and leadership • Reduce child poverty, health inequalities, build resilience, enabling families and communities • Strengthen communities • PHAC Action: • Help communities reduce health inequalities • Forge/Strengthen Partnerships • Partner with International Community • Build an Effective Canadian Public Health System • Increase internal focus and capacity

28. Even when we’re on the right track, if we’re not moving, We’ll get run over. Mark Twain

29. Vital partnerships with academia … • Content • Information • Priority areas • Communication • Knowledge • Capacity • Connection • Leadership • Sharing • Partners

30. How Do We Get The Science We Need? • Intramural science and technology – ranging from fundamental research through surveillance to technology development • Funding of research by others directly or in partnership or through CIHR

31. National Linkages NCCs, CIHR, Universities, Networks • nosocomial infections • disease etiology • diagnostics • antimicrobial resistance • vaccine development • disease pathogenisis Biomedical Clinical Public Health Agency of Canada • public health workforce • evaluation of community- based interventions • burden of illness • cost effectiveness • enhanced surveillance for immunization • Canada Health Measures survey • research on surveillance • mathematical modelling • social network analysis Health Services Population International Linkages WHO, CDC, GHSAG, Universities

32. Interdisciplinary Needs: Policy Disease and Injury Prevention Health Promotion Health Protection Health Surveillance Population Health Assessment Emergency Preparedness & Response Knowledge Technology Science Public Health Action

33. A commitment to change • Health is influenced by the type of society we choose • No one is immune to health problems and health inequalities – everyone is affected • Many policies and programs already contributing to a reduction in inequalities in health • Canada has the ability to build on these experiences • All Canadians have a role to play