The Politics of Health & Health The Politics of Health & Health CareCare

Health literacy + Civic efficacy = Political Health literacy + Civic efficacy = Political WillWill

Honourable Dr. Carolyn Bennett, Honourable Dr. Carolyn Bennett, MPMP

Canadian Federation Medical Canadian Federation Medical StudentsStudents

February 2, 2014February 2, 2014

February 6, 2011February 6, 2011

“Politics in Canada has always been the art of making the necessary possible.

Therefore deciding what’s necessary IS

political

Peter C. Newman

►Empowered Empowered patientspatients

►Effective Effective advocatesadvocates

►Engaged citizensEngaged citizens

►Patient as PartnerPatient as Partner►Doctor MultidisciplinaryDoctor Multidisciplinary►Hospital CommunityHospital Community►Social Determinants of HealthSocial Determinants of Health

Poverty, violence, environment, shelter, Poverty, violence, environment, shelter, equity, educationequity, education

Sir Michael MarmotSir Michael MarmotChair, WHO Commission on Social Determinants of Chair, WHO Commission on Social Determinants of

HealthHealth

““The worst thing for a physician is to The worst thing for a physician is to help someone get well and then send help someone get well and then send them straight back into the situation them straight back into the situation that made them sick in the first place”that made them sick in the first place”

WHY do this ?

Ongoing health CARE DilemmasOngoing health CARE Dilemmas

The The urgenturgent at the expense at the expense

of the of the importantimportant..

The politics of FEAR……The politics of FEAR……

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

PublicPublic policy usually follows policy usually follows

public public opinion….opinion….

BECAUSE…….BECAUSE…….

Doing the right thing is very difficult Doing the right thing is very difficult is the is the publicpublic isn’t onside… isn’t onside…

““Father knows best” not great politicsFather knows best” not great politics

Political Will Political Will to do the right thingto do the right thing

dramatically improves withdramatically improves with

►Health LiteracyHealth Literacy ‘‘tyranny of the acute’tyranny of the acute’

►Civic efficacy Civic efficacy Citizens pulling healthy public policyCitizens pulling healthy public policy

AttitudeAttitude 2+2=52+2=5

Knowledgeable Stakeholders Knowledgeable Stakeholders

+ + Committed Politicians Committed Politicians

==Better Public PolicyBetter Public Policy

Goal of Goal of Medicare… Medicare…

►Sharing riskSharing risk getting people the health care they need getting people the health care they need

when they need itwhen they need it

►Keeping people well not just Keeping people well not just patching them up once they get sickpatching them up once they get sick

““Reorienting health systems”Reorienting health systems”

FROMFROMa health a health CARECARE system system

TOTOa true system for a true system for HEALTHHEALTH

Ottawa charter 1986Ottawa charter 1986

The Em The Em PHAPHA sis sis

is on the wrong is on the wrong

syl syl LABLAB le le

Minister of HandwashingMinister of Handwashing

Minister of State (Public Minister of State (Public Health)Health)

► Sworn in December 2003Sworn in December 2003

►20032003 Canada… 44 died of SARSCanada… 44 died of SARS France…14,000 died in the heat waveFrance…14,000 died in the heat wave

►2000 WHO Report2000 WHO Report France #1France #1 Canada #30Canada #30

Beyond borders…. Beyond borders…. SARS as a teachable momentSARS as a teachable moment

► Beyond silos Beyond silos DepartmentsDepartments DisciplinesDisciplines

► Beyond jurisdictional squabblingBeyond jurisdictional squabbling

► Germs don’t respect bordersGerms don’t respect borders

► Neither do the social contagionsNeither do the social contagions► Nor the humanitarian imperativesNor the humanitarian imperatives

Lessons learned from SARSLessons learned from SARS

► Jurisdictional squabbleJurisdictional squabble

Germs don’t respect bordersGerms don’t respect borders

Naylor report..Naylor report..►CollaborationCollaboration►CooperationCooperation►CommunicationCommunication►Clarity of who does, what, whenClarity of who does, what, when

Sustainability =Sustainability =Prevention + QualityPrevention + Quality

►PREVENTIONPREVENTION Decrease the demand sideDecrease the demand side

►QUALITYQUALITY Increase the cost effectiveness on the Increase the cost effectiveness on the

supply sidesupply side

““Many attribute the quality problems Many attribute the quality problems to a lack of money. Evidence and to a lack of money. Evidence and analysis have convincingly refuted analysis have convincingly refuted this claim. In health care, this claim. In health care, good good quality often costs considerably less quality often costs considerably less than poor qualitythan poor quality.”.”

Fyke Report 2001 Fyke Report 2001 (Saskatchewan)(Saskatchewan)

Focus on QUALITY saves $$ and lives

PREVENTIONPREVENTION

► Our cherished health care system will Our cherished health care system will only be sustainable if we redouble our only be sustainable if we redouble our efforts to efforts to keep Canadians well keep Canadians well as was as was articulated in the original commitment to articulated in the original commitment to medicare.medicare.

► For Canadians to be as healthy as they For Canadians to be as healthy as they can be, and in order to close the can be, and in order to close the unacceptable gap in health status for our unacceptable gap in health status for our most vulnerable Canadians we must work most vulnerable Canadians we must work across across all government departments, all all government departments, all jurisdictions and in all sectorsjurisdictions and in all sectors. .

The Tyranny of the AcuteThe Tyranny of the Acute

As long as citizens think of the As long as citizens think of the sicknesssickness care system whenever they care system whenever they hear the word hear the word ‘health’‘health’ we are not we are not going to be able to reorient health going to be able to reorient health systems.systems.

Fleeing the Medical Model,Fleeing the Medical Model,Embracing the Medicine WheelEmbracing the Medicine Wheel

Blame Hippocrates?Blame Hippocrates?

Affirm Hygeia

HYGEIA: Goddess of Health

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.

Teachable MomentsTeachable Moments

Kasheshewan Reserve . . . Dr. HillKasheshewan Reserve . . . Dr. Hill Hurricane Katrina Hurricane Katrina

The 2003 heat wave in FranceThe 2003 heat wave in France

The 1995 Chicago heat waveThe 1995 Chicago heat wave►Heat Wave: A Social Autopsy of Disaster in Heat Wave: A Social Autopsy of Disaster in

Chicago Chicago by Eric Klinenberg by Eric Klinenberg

The Tyranny of the AcuteThe Tyranny of the Acute

As long as citizens think of the As long as citizens think of the sicknesssickness care system whenever they care system whenever they hear the word hear the word ‘health’‘health’ we are not we are not going to be able to reorient health going to be able to reorient health systems.systems.

Citizens have to ‘get it’Citizens have to ‘get it’

►More More healthhealth …less …less health carehealth care

►Service contract ??????Service contract ??????►Or longer warranty ????Or longer warranty ????

The Grey Tsunami ?The Grey Tsunami ?

R.O.M.P.R.O.M.P.

CollingwoodCollingwood

April 24, 2008April 24, 2008

Dr. Carolyn Bennett M.P.Dr. Carolyn Bennett M.P.

The Grey The Grey Tsunami ?Tsunami ?

FantasyFantasy

Health Literacy QuizHealth Literacy Quiz

►

Empowerment Pulling Healthy Public Policy

Putting the Public back into Public Health

Public Health 101 Public Health 101

1.Do you think we should 1.Do you think we should have a:have a:

A) strong fence at the top of the cliffA) strong fence at the top of the cliff

B) state of the art fleet of ambulances B) state of the art fleet of ambulances and paramedics waiting at the and paramedics waiting at the bottom ? bottom ?

2. Would you prefer:2. Would you prefer:

A) Clean airA) Clean air

B) Enough puffers and respirators B) Enough puffers and respirators

for all for all

3. Would you prefer that wait-3. Would you prefer that wait-times were reduced by:times were reduced by:

A) a falls program to reduce preventable A) a falls program to reduce preventable hip fractureship fractures

B) private orthopaedic hospitals and B) private orthopaedic hospitals and more surgeonsmore surgeons

4.Governments should boast 4.Governments should boast about:about:

A)A) how much they spent on the sickness how much they spent on the sickness care system care system

B)B) the health of their citizens, leaving the health of their citizens, leaving no-one behindno-one behind

Social Determinants of HealthSocial Determinants of Health

vs vs

Choose HealthChoose Health(modifiable risks)(modifiable risks)

The Causes of the The Causes of the CausesCauses

VersusVersus

The CausesThe Causes

2005

Health Goals for CanadaHealth Goals for Canada As a nation, we aspire to a Canada in which every As a nation, we aspire to a Canada in which every

person is as healthy as they can be – person is as healthy as they can be – physically, physically, mentally, mentally, emotionally and emotionally and spiritually.spiritually.

Federal – Provincial Federal – Provincial Federal Government needs to Federal Government needs to lead by examplelead by example

55thth biggest system – biggest system –

aboriginal, military, veterans, Corrections, RCMP, PSaboriginal, military, veterans, Corrections, RCMP, PS

PREVENTIONPREVENTION► Public Health NetworkPublic Health Network

PHAC + Chief Public Health Officer for CanadaPHAC + Chief Public Health Officer for Canada 13 Juridictions 13 Juridictions

QUALITYQUALITY► Health Council CanadaHealth Council Canada

was overseeing 2004 Accord – should oversee Fed was overseeing 2004 Accord – should oversee Fed responsibilitiesresponsibilities

6 provinces have Quality Councils ? All 13 ?6 provinces have Quality Councils ? All 13 ?

Scotland – Honourable Andy Scotland – Honourable Andy KerrKerr

►Health outcomes down to postal codeHealth outcomes down to postal code►Letter from Family DoctorLetter from Family Doctor► InterventionsInterventions►Already paying offAlready paying off

The GoalThe Goal► Most appropriate careMost appropriate care

►In the most appropriate placeIn the most appropriate place

►By the most appropriate person – By the most appropriate person –

paid and unpaidpaid and unpaid

Sir Michael MarmotSir Michael Marmot

““Evidence is not enough. There has to Evidence is not enough. There has to be the desire, be the desire, the political will for the political will for changechange. Given that will - a big given . Given that will - a big given but I am an optimist - the evidence of but I am an optimist - the evidence of what works will be a great help.”what works will be a great help.”

No time for pessimists

ResearchResearch

► Evidence-informed practiceEvidence-informed practice► Practice-informed evidencePractice-informed evidence

► Courage to fund what worksCourage to fund what works► Courage to stop funding what doesn`tCourage to stop funding what doesn`t

► Complex adaptive systems…Complex adaptive systems…

Research

Practice Policy

Research

Practice Policy

KT

Research

Practice Policy

KT

Political will

Research

Practice Policy

KT

Political will

Appliedresearch

Research

Practice Policy

ENGAGED CITIZENS

KT

Political will

Appliedresearch

Empowered PatientsEmpowered PatientsEffective AdvocatesEffective AdvocatesEngaged Citizens Engaged Citizens

► Use the system wiselyUse the system wisely

Keeping our families wellKeeping our families well Clinical guidelinesClinical guidelines Self Care ManualsSelf Care Manuals

► Fight for more HEALTH so we`ll need less Fight for more HEALTH so we`ll need less health carehealth care

► Democracy between electionsDemocracy between elections

““We are not tinkers, who patch and We are not tinkers, who patch and

mend what is broken. We must be mend what is broken. We must be watchmen, guardians of the life and watchmen, guardians of the life and health of our generation, so that health of our generation, so that stronger and more able generations stronger and more able generations may come after.”may come after.”

Dr. Elizabeth BlackwellDr. Elizabeth Blackwellfirst woman physician North first woman physician North

AmericaAmerica

M.D. M.D. / / M.P.M.P.

“ “ The system is my patient now”The system is my patient now”

``Ask what`s wrong, listen, ``Ask what`s wrong, listen, together make a plan.`` together make a plan.``

““A A politicianpolitician thinks of the next thinks of the next election, a election, a statesmanstatesman thinks thinks of the next generation”of the next generation”

James Freeman ClarkeJames Freeman Clarke

Work to elect more statesmen …. Work to elect more statesmen ….

Work to elect more doctors !!!!Work to elect more doctors !!!!