Events Organized by Elected Officials and Citizens

Capital Health, NS Response

Public Health Services-Capital Health, Nova Scotia
Comments on Public Health Themes and Goals
From consultations with professionals

***Goals should be focused on the determinants of health, not on lifestyle behaviour. Also should be population based not individual based. Lifestyle behaviour changes will be an indicator of the goal’s success

1. Opportunities for healthy development and learning throughout life

Awareness

Invest in health promotion advertising on TV
Encourage and promote Breastfeeding – increased brain development / make more a cultural norm (other cultures are more accepting)
Better urban community planning – where will they access school, recreation etc.
System hard to navigate within the social systems, need advocates & coordinators in the healthcare system
Anticipatory guidance for parents with raising children (with their role as parents) – ongoing / variety of ways and places / provide child care / make it the norm to want to learn this

Community / Programming

Programs to support parents teaching children at an early age
Community services – protecting children (safety)
Gap in service for children “in between” special needs and those who have concerns in various determinants of health
Need resources in community to focus on healthy development (staff/finances for support and tools, etc/and time)
Gap noted for age 3 – 5, need to focus on Early Childhood Development
Shifting the perceived focus that children need to be in formalized programs to ‘develop healthy’, but instead go back to basics and families need to play together
Increase resources and accessibility to green spaces
Programs for seniors
Federal expert to coordinate and develop standard (on ECD, adults, seniors) education in schools messages, tools
Legislation for recreational activities within child care
More child care centres. Possible government funded or subsidized with care programs. Government could subsidize child care workers. Easier access to education to be a child care worker
Ensure daycare environments accepting of breast milk being brought to site
Have an office of child development within Provincial / Federal government
Community Supports for Children and Parents
- Free child care universal
- Breastfeeding as a cultural norm
- More affordable post secondary education

Education

Stronger infant mental health programs (focusing on attachment)
Breastfeeding (support for, promotion of and link to healthy development)
Need different access points to job education opportunities (apprenticeships – opportunities at high school level, company support (employer) to participate in providing training
Alternatives to traditional education to support various learning styles of population
Community/parental education re: effects of determinants of health and focus importance on early childhood development
Need to know best practice for providing opportunities for healthy development
Esteem building for parents and skills based (in house or home)
Community planning and development to support integration
Education system needs to support teachers to be best they can be, i.e.: less focus on seniority so that teachers can teach what the are good at, and new teacher can find employment (i.e. hire health specific teacher)
Respect for child care workers / standardized education
Increase initiation and duration rate of breastfeeding, make it more a cultural norm
Children spend so much time in school – lower number of children per class to create a better learning environment
Educate early in school about healthy lifestyle
Public school system falling short – special needs or gifts – needs to be more supportive of families with special needs
Expand early intervention / infant stimulation to meet social and income needs besides developmental
Parenting classes – to learn parenting skills – what to expect
Provide opportunity for teachers to teach classes where they have expertise (eg. Not putting science teacher teaching gym)
Community supports for parent to inform their role as parents
Tools to help so parents can parent more effectively

Support / Financial

Adequate support for health education in public school system
Support for informal child care services
Monetary support for parents in general (tax cuts, subsidy) to enable more flexibility in their choices
Increased focus and support for ECDI (Early Childhood Development Initiative) – support pay equity for child care workers
Schools need more support in house to deliver more e.g. elementary school focus on health, focus on health throughout (P-12) school
Funding for programming
Increasing parental leave to 1.5 years or having more flexible variants to return to work (to return at 50% or more/less instead of full time or nothing)
Allowing both parents a one year leave (or more)
- Early childhood support for children and parents
Compensate child care workers adequately and appropriately
Money
Easy links to local services, community supports
Increase funding to Family Resource Centres

Access

Health literacy (all age groups – access)
Accessible and affordable child care services and pre-school for those children (work based day care)
After graduation – people limited by cost and requirements for post secondary education, need affordable post secondary education
Equal access and more services for early intervention “progress” centres
No access to parents/children for home visiting and informal assessment; and recognize importance of independent assessment on front line
Access needed for all same services, universal services
Marketing about ‘necessary toys’ (gadgets for brain development), need to limit since not all population has access to them
Food security within the school system: breakfast programs and healthier food choices in vending machines and cafeterias
Universal – free, quality childcare (as opposed to subsidized)
More affordable university education to ensure access for all
Access to information to make the right choices
Our resources don’t meet the need of special populations
Every child regardless of income, should have the same opportunity starting out in life – create an environment (a start for life long learning) day care, preschool
All families / children having equal access to PHS and community services (adoptive, internal and external)
Same opportunity for all – daycare, schools
Breakfast programs for all children
Equal standardized opportunities for all children within the school system
Access to information to make the right choices
All families / children have equal access to PHS and community services

Overall

Need a coordinated approach for Canada to deliver health promotion initiatives
Needed all Public Health in Canada doing immunizations; will result in contact with all families on ongoing basis; ongoing assessment/education on developmental milestones and health promotion message (standard approaches)
Medical lobby in Nova Scotia (immunizations)
All children should have the same star in life and opportunity
Make the right choices the easy choice – the norm
Mandatory immunization for children entering school
Equal opportunity for all children
- Within school – education, small classrooms, nutrition, physical activity
- Within community – sports, programs, arts
- Expand early intervention programs

2. Supportive communities and healthy working environments

Community/Social

Increased public awareness
Need for a broad standardized community assessment tool
To identify, lobby, advocate for standards of living that promote health among all populations, including working poor, disabled people, silent minorities, etc
Social networks are important – not all feel this is a gap – this varies and will be individually determined – need to be flexible
Communities would need to identify their own supports, Community Development
Encouraging participation in community programs for children and parents to be involved: sports, girl guides, 4H etc, increasing access for all these programs
Social interaction through volunteer programs
National child care policy
Develop national standards / child care guidelines
Incentives to make at home moms valued by society and themselves, i.e. Meet & greet / opportunity to volunteer in the community
Family support – whatever that means, i.e. One parent, mom or dad
Commitment to development of supportive community
Involve community – have them tell you what the needs are
Capacity building
Promote cultural diversity

Programs

Need more incentives for people on social assistance to further their education and better their lives (beyond their GED)
Trying to privatize parts of health care system, not good
Guidance to create and support programs in smaller communities
Support and expansion of apprenticeship programs
Violence prevention
Dental care part of health care for all ages
Support for families and children

Business/Financial

Minimum wage too low
Tax incentives for businesses who provide a living wage and benefits (for working poor)
Incentives to employers who hire people with disabilities
What is job security now? –less full time jobs – less benefits – less flexibility for workers – all bottom line and efficiency not healthy work environment
Social assistance provides more than minimum wage
Work environments: air quality legislation enforced
Affordable education at university level (supports in place for low income families)
To have a healthy, productive workplace
Promote health of staff in work place
Supportive working environment
Recognize mental health issues / stress leave
When short staffed – sufficient staff for work load
Flex hours / compressed work week
Re civic activities – time off work to participate
Tax breaks for employers who offer these incentives to have a healthier workplace
Work-place choice, i.e. Working from home
Incentives to participate as volunteers, i.e. time off
Policy to more fairly redistribute tax benefits to support lower income people

Education

Programs to make education mandatory: GED skills training, parenting programs for those on social assistance
Aptitude tests for social assistance to encourage people to discover their abilities
Needs to be an alternative to current public education system delivery (support for individual learning styles – to work to fulfill potential)
Financial aid and time off to further education
Access to education: childcare for returning students in school regardless of whether or not they live at home
Working poor – financial aid for education
Address issue of youth working in unsafe environments
Skill development / support participation

Gender

Gender divide in the workplace – even right to issues that are valued (e.g. women are about healthy child development). Need to teach children on level playing field in public system
Pay equity for occupations/genders (job classification systems)
Promote adult women and young women’s value to the workforce
Pay equity

Overall

PH should be same nation wide
We want to be a reflection of what we represent, i.e. child care at work, personal example, workplace example, time off for exercise, cost share exercise program

3. Sustainable, diverse and safe environments

Awareness

Public Health Canada commercials
Media marketing for breastfeeding (positive)
Positive Public Health messages (media) on variety of topics (playing, etc. as input as formalized
Parental education regarding recreation
More cohesive and vocal Public Health System - All provinces & territories do the same within Public Health (i.e. immunization). Share resources, etc.
Goals – set standards, role model, lobby, advocate for sustainable, diverse and safe environment
Be present at tables where discussions are made about environment
Strong social marketing campaign for Public Health- who we are and what we do
Standards and presence on product safety boards
Division of Health Canada – Food Inspection Agency – Federal level. Increase communications
Recycle, reuse, reduce. Continue with this trend. Make it the social norm via marketing
Global change of thinking – protect the earth, one world, etc.
Personal health practices
Increase rail travel
Decrease clear cutting
e.g. Bedford Highway – Protective Legislation, Community plans more voice
Doing well – pesticides – HRM Bylaw – leaders educated to be advocates
PH Goal – We are a global society and we all impact on each other
Example to rest of population on a healthy workplace
Green policies within government act as a lead by example / role model
E.g. moderate temp control
Includes healthy workplace in all levels
All workplaces scent / tobacco free

Community

Focus on more informal recreation opportunities
Networking, peer supports
Community development – social skills – give back to community – instil in elementary students – sustainability – barter system
‘Citizenship’ as focus. Recognition of leadership in communities
Social inclusion – opportunity for marginalized – due to finances (e.g. cadets) – how do ‘we’ fix
Youth activity – supports in community

Education

Recognize different learning needs of schools/environments
Environmental hazards – biological / physical / chemical threat / product
Contaminates – air / water / food / soil
Climate change / Global Warning

Planning / Programming

Traffic taming initiatives – urban planning
Urban planning – signage
Focus on small community development. All have green space, (school, store) to promote equal access
Bike lanes, paths and patrolled – safe areas
Support sustainable agricultural development
Canadian urban planning to increase physical activity
Health inspectors should return to Public Health
Responsibility of business
Consider the human cost when making business decisions
Protecting natural features and resources
Liveable communities – communities built for people
Forestry practices – i.e. clear cutting, make companies responsible
Short term vs. long term planning
Buy local, invest in local agriculture
Selling resources – manage natural resources better, (i.e. water, oil)
Kyoto – follow up
Natural and built environments – opportunities
Indoor air quality
Creating healthy environments – homes / schools / workplaces / communities
Don’t have transportation infrastructure to reduce gas emissions
Dedicated green space – bicycle/walking trails / playgrounds
Developed and natural percentage of green space left
Bike lanes on roads
Bus safety – side walks – garbage cans
We don’t have infrastructure to support sidewalks due to low transportation budget, safe pathways to school / ? liability
Overlap with different departments – health / transportation / community services to find solutions / new approaches
Modern construction – “can’t open windows”
No disaster planning
Lower debt – devolution of Health and Education Regional
Measure GPI – well being & societal of areas before det. Actions
Public Housing – located in various areas to avoid poverty congestion
Water – no supports - $10,000 Septic
Public Policy – that includes sustainable diverse and safe environments throughout all policy development (Social Public Policy)
Urban & rural development consider public policy
International infrastructure
Agriculture policy – water testing not free
Need long term attention / planning
Measure the health of our nation as our bench mark
Need GHI – Gross Happiness Index to measure development, well being, safety, etc. Use to measure success in this theme.
Incentives to individuals and industry
Links / integration public partners
Private industry more safety, incentives

Access

Subsidies, rebates and tax breaks for companies that use sustainable business practices within the environment
Safe housing
Need to increase Public Health inspection of environment as opposed to reaction to situation
Safety and security for residents
Need to put Public Health back in Public Health Services, eg limited Health Inspectors for restaurants, stores
Vulnerable people – don’t have supports to make changes
Promote model communities – inequity

4. Vulnerable populations

Access

Accessible to the services and resources
Equitable access to program services that support healthy lifestyles
Transportation and childcare to these programs and services is key
Access to childcare: government run childcare agencies partially funded for marginalized populations
Barrier: isolation of groups e.g. reserve
Reserve vs. non reserve – seen as trap
Contributing to society in the way they can, given limitations – ‘meaningful’ life
Need to be able to identify those who need extra support
Geography – especially northern Canada. Places that depend on ferry services etc.
Accessibility to services and resources for vulnerable populations through financial commitment from government and other levels along with community commitment and empowerment, e.g. volunteers and peer supports
Sometimes difficult population to reach because of geography, culture
Community PH staff at community level
Offices in community we serve
Affordable Housing
Meaningful Employment – adequate wage – valued
Safety
Day Cares – affordable, available – sustainable
Opportunities for personal growth and development – formal education – stimulation, contribution, meaningful participation
Community institutions – not accessible
Public Education system – same for everyone (Crisis)
Access to opportunities that support healthy lifestyles (nothing is free)
Access to information of supports that are there (power-information)
Immigration policies – mid east legislation
Free Child Care Centre – support families
Equity - in opportunity (School / Day Care / Pre-School – Provincial system

Awareness

Some recognition by public systems of need to support vulnerable population
Peer support should be highlighted for various cultures. Research by professionals to be more aware of cultural impacts
More data and evidence on the importance of programs: Resources allocated to programs that are proven effective by research (i.e. peer support)
Attitude toward the vulnerable population by the larger Canadian population. Increase the understanding of this situation (including people of influence)
Do they have a voice – vulnerable and marginalized
Education needed regarding cultural diversity i.e. health issues needed at school
Need to be able to identify culture but balance health
Dignity for those who cannot work as traditionally accepted
Each individual group has different needs
Understanding big picture before acting
Public perception – how the public views the importance of reaching this population
Voice for vulnerable
Private vs. Advocate of / Public tiers
Voice

Community Resources

Community commitment – volunteers play a huge role in helping their community
Comprehensive tool to assess community
Support for peer supports
Affordable child care. Those on income assistance with children, cannot afford to work, it encourages people to stay on assistance
Vulnerable populations need focus but not in one lump – creative solutions – targeting needs/assets
Support for employment/housing/role recovery
Capacity building
Skills assessment/training – job coaches
Respite Services – Community supported
Lack of Resources – i.e. for Mental Health System that support vulnerable populations
“Charity” model
Collaboration
Participation – of vulnerable groups – Autonomy

Coordination/Financial Investments

Central, accountable umbrella body to coordinate various groups
- Transportation
- Living wage
- Jobs with benefits
- Supports for employment – job coaches
Financial commitment from government level and other levels/resources
Need for system navigators to coordinate individuals and groups through or between systems
Outreach programs need to increase in multitude (we need more of them)
Enforcing occupational health and safety in the private industry. Safety needs to be monitoring by Occupational and Safety offices
Whose mandate is it to keep this at the forefront? Do we need to organize them (coalition)
Canada is trying to deal with this issue when companies and business in global – reduced sovereignty
Who is in charge – government or business?
Efforts not coordinated for vulnerable populations
Feeling the need to incorporate populations (vulnerable) into a more diverse to give more choice/ exposure to ‘outside world’
Break the cycle in aboriginal/low income
Fragmented health community services system (public systems) i.e. NS health promotion, public health services, community services
To create streamlined framework (not a matrix mess) for coordination of services (internal within Public Health, external offices of government etc.)
Money
Employment legislation
Ideologies – individualism / neo-liberalism
Decrease gap between rich and poor

Overall

Missing Theme – Youth / Seniors
Don’t support “gifts” we penalize weakness, don’t value as contributing members of society

5. Supports for personal choices, skills and capacities that enhance health

Awareness

Public Health needs a higher profile – better marketing of our messages
Personal choice gets too much press and weight. Reduce victim-planning approach. Great focus on other determinants of health in press/promotion. Need to raise awareness.
Stronger consultative process with Nova Scotia H.P.
Ph – be in limelight with “hot topics” e.g. VLTs, need to build a profile within communities, provinces, national level, etc.
PH staff - need to be visible - lobbying in government groups
Include healthy PH policy in any new development e.g. New mall
Some issues not short term enough - politicians not interested in longer term issues (related to votes). Need to educate them and build our profile.
Appreciate diversity in workplace
Communities need to be involved to bring about changes, need community involvement not ‘top down’ approach.
Change the approach to our messages - encourage education of population that all groups have value
Making breastfeeding cultural norm - we should have expectation that women will breastfeed will be supported - increase initiation and duration rate, ability to return to work & breastfeed.

Barriers

Children isolated
Video games high accessibility, decrease physical activity
Understanding the determinant of health by providers stop victim blaming
Television advertisement of unhealthy choices, i.e. tobacco and beer ads, fast food shouldn’t be played. Omit from media, lead to misconceptions on healthy choices
Marginalize population – they don’t believe they can advocate for themselves – that they are valued in society
Low self esteem
Respect lacking between children and adults
Lack of supports in the schools
Regulating the advertising to children (fast food, junk food, violence, tobacco, alcohol) as in the timing of programs

Community Resources

Role models in early life, peers, community, media, etc.
Supports for after school programs
Hands on training / diversity
Supports for parents to promote healthy, secure attachment (Social Marketing)
Support to help children develop values, morals, spirituality, sense of community (non denominational)
Supports for personal choices
Develop ways for groups to build capacity – ongoing
Rec. Centres should not have unhealthy foods available - “double message”
Daycare - universally available to all wage earners

Access

Nutrition, access to affordable healthy food choices (Food security)
Remove some of the barriers to making healthy choices, e.g. subsidizing fruits, vegetables and meats so they are affordable
Need input from youth
Access to accurate health information (i.e. on web)
The first necessity is equity. You cannot enact choices without this
Need real socially equitable policies, eg. example: all have the same, all have home care and car, not stressed, families are home with children
Choices become more limited as you become more vulnerable
Easier access to activities and sports
Legislation regarding healthy choices
Support for breastfeeding, make it the cultural/national norm
Get rid of VLTs , become a tobacco free nation
Connect with food security (i.e., milk more expensive than pop)

Education

Social program – skills training to support healthy decision making
Parenting support, programs, education
Alcohol. “How do you make choices”?
Education in elementary years, i.e. tobacco
Support for basic life education in the classroom
When people apply for social assistance, mandatory prenatal education, life skills, etc.
Promoting secure infant attachment enabling and educating parents to make this happen
Public Health needs to determine whom to target with social marketing campaigns (evidence based)
Liaison with school – for healthy food choices
Teach basic cooking in schools
Parenting education, remove stigma, make a ‘social’ norm.
Education needs to be high tech – to entice & keep up with ‘techie’ population.
More education – drug use (abuse) for youth
Employers to support their staff with issues such as stress, need to create healthy workplaces.
Schools need to do better job re helping children and youth deal with stress in healthy ways (not turn to drugs) - helps kids copy with stress later in life
Increase physical activity - phys Ed not mandatory, lack of trained [physical education teacher. Need to put priority in health curriculum throughout education system (P-12)
Breastfeeding - Canada’s Food Guide - teach in schools
In NS Healthy Sexuality book - breasts have dual function

Financial Support

Budget increase – recreation
Support at home parenting for dual income families. Tax breaks for stay at home mothers and fathers
Break the chain – cultural, i.e. social assistance
More money for best practice programs
Stop supporting private health care; private schools, need to encompass whole population not just the elite. Need Equity.
Rich become richer; poor become poorer
Sustainable
Provide support to organizations who actively build capacity within their community
Working with minimum wage earners
Cross sectors - industry, agriculture, large grocery chain, work together to reduce cost of healthy foods
Apprenticeships for youth - build confidence - incentives for business to do this

Overall

Recommendation: really need to act on reducing inequities to make this happen
Canada needs to place priority on equity
Make the healthy choices the easy ones / the normal ones, including
Be proactive NOT reactive

6. An integrated, supportive health system

Emergency Planning

Strategies and plans needed for emergency situation (i.e. SARS) Disaster planning lacking in Public Health
Acute and tertiary settings need to interact with Public Health in Disaster planning. Also the media and communications need to be integrated

Integrated/Coordinated System

National strategy should be developed structurally; i.e. service delivery should be equal across provinces in order to properly coordinate. Provincial strategies should mimic national initiatives
Information system: health information technology system needs to pt put in place to connect Provinces and Provincial health systems
Standardization of information via epidemiologists within and across provinces to record statistics and pass on to the appropriate people
Resources are allocated poorly: should be reaching toward future goals and access to these resources should be standardized on a national level according to our goals. Duplication of services needs to be avoided and acute sacrifices need to be expected.
Decisions need to be made quickly so than actions can be implemented and time will not lost reaching and agreement
Aspects of system need to be better integrated – linked to mental health, eye care and oral health (outside systems)
We provide aid to other countries – immunize, dental care, etc. Why could we not do that here? (Link to vulnerable populations). Barrier ƒ professionals interest here, business, income
Integration of our messages and recommendations.
Lack of cooperation / coordination between departments, i.e. Schools / community services

Raise awareness

Public Health Care Workers need more knowledge of Health Surveillance, population health to a greater depth to guide their focus
Lack of understanding by the public of what Public health represents: communication should be stronger with the public
Need public awareness presentations/grass root strategies to promote Public Health – who we are and what we do – to individuals (media campaigns) and groups such as Community Health Boards
Communication is poor. Poor understanding of systems, how they work, link. No person in the ‘know’ – accountable for advocacy for services
Poor link, communication – acute care and public health not seen as continuum, seen as separate.

Access to care

Waiting lists – large issue. Not just waiting for individual but family and person – their mental health – stress and waiting on support people
Need to catch all populations, including the vulnerable population
Supportive; persistence? Call the media? Shouldn’t be necessary to call and hassle for care, treatment, wait lists etc. Should be fair, equitable access
Privatization, fear that it would water down public system. OK for those who can pay. Wouldn’t it lighten burden for others? Increase inequality or decrease? Address with health insurance
USA ƒ trying to get back to public system
Need to act upon Romanow recommendations
More public funding for medical care - (??? Private)
Walk-in clinic at hospital site
Wellness centres with in community / schools
Communication between all government departments
More multi-disciplinary centres for medical care, alternative, attractive methods of paying physicians - more funding for and utilisation of nurse practitioners, mid-wives, etc.
Finances
Demand for private care

Supports Needed

Support for families re establishing healthy lifestyle
Affordable recreation
Affordable daycare
Parenting classes - at specific ages
Affordable post-secondary education
Addressing diverse learning needs of students
Public school system - supporting healthy living, activity, etc.
Guidance related to post secondary education
Reconsider fund-raising strategies in school (i.e. fundraiser - sale of chocolate v/s good food in cafeteria / More funding for schools so fundraising is not necessary
Leave out contradictions when promoting healthy activities
Healthy public policy within every department (i.e. health promotion under everyone’s umbrella)
Co-ordination with all government departments (i.e. transportation)
Infrastructure to support healthy environments
Before development of housing areas - consider schools, roads, space, etc.
Public policy around mandatory immunization prior to school
PHS partnering with schools to get messages out re healthy living
Space needed for things like immunizations
Communicate to public re infectious diseases, health issues, etc. (ongoing - not just at times of crisis)
Get public involved
Healthy daycare nutrition
Equal opportunity to succeed in life (life span) (education, sports, culture, etc.) - all this is free!
Teaching life skills in school (continuum)
A health System Supporting Determinants of Health

General Comments on the Proposed GoalsGoal#3—should encompass seniors

Goal#4—should include healthy home life
Goal#6—should include offering choices and alternative health care providers
Potential #12 goals: Healthy Public Policy-health impact

Overall Comments

Too individually focused, need system goals—look at collaboration and legislation

Saskatoon Health Region