CONSULTATIONS ON PUBLIC HEALTH GOALS FOR CANADA

Meeting Summary

WELCOME AND OVERVIEW

Federal Minister of State Carolyn Bennett (Public Health) opened the meeting outlining the context for the day’s discussions and the role of public health goals in improving the health status of Canadians. She acknowledged the decades of work that have led to this point, the support at all levels and sectors of government across the country, and the commitment, time and expertise being given by the stakeholders in attendance. She stressed the importance of strengthening the public health system and focussing on more health, and less health care. This requires a commitment to promotion and prevention that has already been expressed in Newfoundland.

GUEST REMARKS

Acting Minister of Health and Community Services Loyola Sullivan acknowledged that public health is a process that requires time to evolve and improve, and that it speaks to the health system in its broadest form. In Atlantic Canada they are proud to be a host partner with the national Collaborating Centre on Excellence in Social Determinants of Health. In response to the recommendations outlined in Investing in Health: A Report on Public Health Capacity in Newfoundland and Labrador, capacity is being strengthened in terms of training, resources, and support and infrastructure. In the current budget, $6 million was committed towards strengthening public health, which included $2.4 million towards a wellness strategy. This strategy will complement ongoing work and focus on healthy eating, reducing obesity, reducing smoking, reducing injury rates, and increasing physical activity.

OBJECTIVES

• Review proposed theme areas.
• Review, consider and discuss sub-theme areas.
• Recommend goal statements for theme areas.

THEMES

Discussions took place in small groups around the proposed theme areas and the sub-themes as they appear in the consultation workbook. Each table was assigned one theme area and asked to focus its discussions on this one area, by reworking or developing new sub-themes, drafting goal statements and including any other comments or input. Each theme as it appears in the consultation workbook and the suggestions (or sub-themes) around how they can addressed appear in the text boxes and are followed by a summary of each of the small group discussions as reported back in plenary.

Theme

The theme must reflect that opportunities be accessible to all.

Goal statements

• Provide expertise and resources at the community level to build capacity and action initiatives that support healthy development and learning.
• Provide support, training and resources that encourage active participation in decision-making mechanisms or structures that support healthy development and learning, e.g., provide support and/or programs that help individuals to become effective members of a committee.
• Apply the anti-smoking campaign / support successes to the marketing and sales of unhealthy food choices.

Sub-themes

Change sub-theme “Quality education opportunities for children, youth and young adults” to “Quality and affordable education opportunities for children, youth and young adults.” Affordable education is essential. Whereas a high school diploma was once the base for accessing opportunities and ensuring a standard of living, this is no longer the case. It is much more difficult to make a living without some post-secondary education or training, and the associated costs make it burdensome to many after graduation, and outright inaccessible to others.

Add the sub-theme “Quality employment opportunities that match credentials.”

Principles and other considerations

Opportunities must be universally accessible. For this to happen, barriers need to be identified and addressed including:

• food security and poverty
• affordable day care (especially as it relates to women participating in the workforce)
• special populations, e.g., children living in low socio-economic circumstances, Aboriginal communities etc.

Other issues to consider include:

• The critical role of building capacity at the community level.
• Student debt load.
• Employment opportunities (including that opportunities match education credentials, especially for young adults).

Goal statements for specific sub-themes

Goal statements for sub-theme “Consider the workplace as a health promoting environment”

• Support volunteerism especially in small, rural communities. Support clusters of organizations and volunteers across geographic communities and across various theme areas and target groups, while respecting autonomy and the need for separate agendas.
• Increase the capacity of the voluntary, non-profit sector. Reconsider the availability of core funding for key community organizations.
• Introduce province-wide healthy workplace guidelines and regulations that address issues of physical and mental health.

Goal statement for sub-theme “Meaningful work and adequate working conditions.”

• Increase the ability to do the required job. For this to be done access needs to be increased for training and education opportunities for people in current jobs which have changed over time.

Goal statement for sub-theme “A strong, sustainable economy.”

• Develop creative strategies to make the economy sustainable, which will prevent out-migration and support population growth. For example, job creation using our supply of qualified human resources and increased child care supports and allowances (this will address the issue of people not having children because they cannot afford to).

Sub-themes

Change sub-theme “An adequate level of income” to “An adequate level of income and sustainable economy.”

Add the following sub-themes:

• Find a way to integrate the agendas of health and other departments to ensure the decisions made within one department do not undermine those made in another.
• Develop healthy public policies at the federal, provincial and municipal levels.
• Make decisions that are not based solely on funding and costs, but also take into account long-term effects on population health status. Deficit reductions at the federal and provincial levels have resulted in fewer teachers and nurses etc. As well, public policies have assisted in the creation of the current obesity epidemic.
• Create support for volunteerism and non-profit organizations, including by developing and supporting community leadership. Many public health issues are identified by volunteer and community groups. The declining level of volunteerism is negatively affecting communities’ capacity.
• Ensure the basic infrastructure necessary to sustain healthy communities. This can include providing professional staff to get things started, supporting community leaders (e.g., those who work with women’s groups, autism groups). Support communities to organize and get initiatives off the ground.
• Use gender and culture as a lens for decision-making.

Additional comments

[Note: One group worked on both Theme 2 and Theme 3 and the following challenges and opportunities apply to both themes.]

Challenges include:

• Downloading to communities.
• Not providing adequate resources and assistance to help communities build capacity.
• Reduction in volunteerism.
• Lack of sustainable economies in small, rural towns.
• Clientele from organizations such as John Howard Society return to the community without adequate supports.

Opportunities include:

• Community design can promote healthy life styles, e.g., ability to walk to work and school.
• Provide basic, appropriate water and sewage systems.
• Provide support and incentives around beatifying homes and properties.
• Coordinate issues to decrease the number of organizations that rely on volunteers.
• Address cost problems in the health care system, not just the acute issue.
• Develop affordable housing options that are not dependent on government.
• Use the Internet to allow citizens and community groups to participate in policy dialogue and share information across the country, e.g., www.voluntarygateway.ca.
• Ensure that the public health goals reflect that their advancement requires a strong non-profit, voluntary sector with well-trained staff and volunteers.
• Identify health communities and assess if their strengths can be shared with other communities.
• Encourage local economies to build more self-reliant and environmentally sound communities, e.g., local farming means food is not transported over long distances.
• Develop healthy public policies with input from vulnerable populations.
• Support initiatives such as wellness coalitions and family resource centres.
• Examine sustainable economies and environments to ensure end products are viewed with respect to what is required to create them.
• Legislate mandatory recycling.
  

Goal statements

• Introduce financial support programs to assist with home purchase, e.g. Registered Home Ownership Savings Plans (RHOSP), and access to suitable rental properties.
• Design must include:
  • structures – services, voluntary organizations, opportunities for involvement, with a design that is central, includes social settings, aesthetics, and is within walking distance
  • people – trained, skilled, expertise, leaders and opportunities to influence.
• Encourage local food production (growing / processing) to decrease reliance on transportation and to promote job growth.
• Focus on resurgence of skills. Communities need to re-skill themselves to become self-reliant, e.g., through farming and fishing.

Sub-themes

Add the following sub-themes:

• Ensure full-loop thinking for all economic businesses that includes cradle to grave analysis of products. For example:
  • Tobacco is a crop that is grown and turned into a product that is deadly.
  • Natural resources are being depleted to make products that cannot be recycled. This includes the bottles for bottled water, when the local tap water is perfectly safe to drink.
  • Video lottery terminals are addictive. The resulting revenue impoverishes those who are addicted to them and there are not enough resources to help them.
  • A vast amount of gas and fossil fuels are burned to transport food.
• Refocus people’s view of health and health care. Basic services is not about having a doctor in every community, it is really about healthy people in healthy communities.

The term vulnerable needs to be addressed as it is a stigmatising label, “at-risk” may be a better term. This idea also should be broadly defined and include women, people with low literacy, the elderly, individuals at risk, injection drug users, gay people, people who are incarcerated etc. It should be acknowledged that everyone is “vulnerable” at some point.

Goal statements

• Build inventories for research. This will require human resources and funding.
• Provide affordable and accessible supports for vulnerable populations.
• Provide education for professionals and communities to understand, identify and support vulnerable populations.
• Work collaboratively with professionals and stakeholders. There is not enough communication between the institutions and the community. Communities need to know what resources are available, and they in turn will share this information with others.
• Incorporate diversity into public health policy to better meet the needs of individuals and communities.
• Create stronger links between economic and social sectors.

Sub-themes

Add the following sub-themes:

• Safe, stable, affordable housing. This is an important starting point.
• Harm reduction approach model.
• Early childhood intervention. Provide safe, secure, early interventions. Start with children and include adults. Focus on physical activity and healthy eating.
• Promoting awareness, understanding and tolerance around the issues. This relates to the idea of vulnerable populations and being sensitive to the different issues different people face.
• Collaborative / interdisciplinary approach between primary health care and public health. For example, there should be linkages between the primary health care initiative and public health.
• Apply evidence-based practice. Information must not only be collected, it also needs to be analysed and used.
• Capacity building and inclusion of community.
• Meeting basic human needs through equitable access.
• Accessibility to determinants of health. This goes beyond medical services and includes housing etc.

Other considerations

• More key stakeholders need to be involved, e.g., occupational health professionals, community representation etc.
• Basic needs have to be met.
• Be aware of culture, language, discrimination and stigma.

Goal statements

• Make existing facilities accessible for community use, including schools, public pools, community recreation facilities, Lions’ Clubs etc.
• Conduct a federal, provincial and municipal public policy review and analysis to determine impact on health, identify gaps, and recommend amendments as appropriate. This includes all current legislation.
• Deliver health information and knowledge in a user-friendly format across the lifespan.
• Develop a health education program in schools that encompasses physical activity and healthy eating knowledge and practices. This should be part of the curriculum.
• Communicate to the general population how to and where to access resources about maintaining a healthy lifestyle. Although much information exists it is not easily accessible.
• Financially resource the development of community initiatives to support communities’ volunteer structures. With volunteer burn-out an increasing problem, financial resources to support them are required.
• As part of this initiative, consult with the community to develop principles to guide the implementation of health goals and objectives to ensure outcomes are inclusive of all residents of Canada.
• Develop a mechanism to support youth to make informed decisions about the choices in their lives. Youth themselves could be supported to facilitate such an educational mechanism. For example, the Teen Tobacco Team helps guide anti-smoking campaigns targeted towards youth.
• Set minimum standards in various areas, e.g., courses in the areas of physical education, health, and nutrition should be part of the mandatory annual curriculum, and ensure minimal offerings to all geographic locations.

Other considerations

• Instil the value of volunteerism in young people.
• The population of Newfoundland and Labrador is aging at a faster rate than any other province in Canada. Half of the population will soon be over 50. This must be recognized in the discussion of supports to enhance health.
• Much of what is encompassed in the theme of “supports” is learned from life experience, not through a formal education process. A mechanism should be in place to support this informal structure.

Goal statements

• Develop funding models that support public health, that are sensitive to geography, have broad partnerships, recognize the diversity of the population, and are multidisciplinary.
• Ensure the public is aware of the health care options available to them in their community and support them to be participants in their own health choices, not spectators.
• Develop an accountability framework that supports public health. Include the concepts of partnerships and integration and ensure that work is reported on through both public and financial avenues.
• Integrate health boards to provide increased opportunities for groups to work together.

Sub-theme

Add the following sub-theme:

• Invest resources in the front-line.

Other considerations

• Linkages to the broader health systems cannot exist or persist in the absence of investment.

“Talking to people who are passionate about this issues is the best possible contagious disease you can have.”

– Minister Carolyn Bennett

 

GENERAL DISCUSSION

Following is a summary of general discussion items raised in plenary before and after the small group discussions, organized by broad topic areas.

Front-line staff

Because public health goals are high-level, there will be difficulty in ensuring that they can realistically filter down to the front-line staff. This will require both commitment to supporting the front-line staff and funding.

Newfoundland and Labrador is in the process of focusing and integrating its health system, and is challenged by some of the poorest health status in the country. The provincial government has committed to support and funding for public health, including penetration to the front-line level. Establishing goals is a necessary first step in this process.

Funding

When funding is based on population and does not account for other factors such as geography and cultural differences, challenges arise. It is difficult to deliver public health services to more remote and varied communities, resulting in a disadvantage to these areas. A funding formula should be developed that addresses these disparities.

Current funding structures and timelines can compromise a project’s success. Project funding (versus core funding) results in tight timelines resulting in communities being forced to act quickly and not having sufficient time to properly plan projects. As well, different funding envelopes that target specific populations make it difficult to carry out population health based initiatives.

Infectious versus chronic diseases

There is always a great sense of urgency around issues of infectious disease, such as SARS. However, it is the chronic, non-communicable diseases that pose the greatest public health threat and these are not addressed with the same immediacy.

Other partners

The important public health work that is carried out by those who work in the area of animal health has been done as part of an assumed role. This network should be formally acknowledged and supported, as should other public health partners such as pharmacists etc.

Vulnerable populations

Mental Health Week is taking place during the first week of May, with the theme of “practice mind and body fitness.” There is much information around what needs to be done to keep physically healthy, but there is a lack of information around mental health. It is anticipated that depression will soon be one of the most prevalent illnesses facing our society and that one in five people will experience a mental illness in their lifetime. Other considerations around mental illness include stigmatisation, and the effects of maternal depression on children. Prevention for mental health is an important issue that merits serious consideration.

Ten percent of the population has a learning disability, yet there is a lack of awareness and understanding as well as a lack of support. This issue should be reflected in the public health goals. Other issues such as food security and poverty also need to be addressed in the process.

Approach

The public health goals setting exercise should align with what is going on in the communities and involve all stakeholders and partners and all government departments.

ADJOURNMENT

Minister Bennett thanked the participants for their valuable input and enthusiasm. She stressed her commitment to assured listening, and her hope that this meeting marked the beginning of a relationship with the participants remaining an influential part of the process. She also encouraged further involvement with their broader networks in the process by filling out workbooks and visiting the Web site (www.healthycanadians.ca).

Consultations on Public Health Goals for Canada
St. John’s, Newfoundland, April 27, 2005

List of Participants

Dr. David Allison, Regional Medical Officer of Health
Ada Benoit, Conne River Health and Social Services
Mike Bugden, YMCA-YWCA of St. Johns
Geoff Chaulk, Canadian Mental Health Association Newfoundland and Labrador
Ellen Coady, Department of Education
Claudette Coombs, NLTA
Mary Ennis, Coalition of Persons with Disabilities
Lynn Green, Learning Disabilities Association of Newfoundland and Labrador
Joyce Hancock, Newfoundland Advisory Council of Women
Annette Johns, Newfoundland and Labrador Association of Social Workers
Mark Jones, Department of Education
Anne Kearney, ARNNL, Centre for Nursing Studies
Cynthia King, Newfoundland and Labrador Housing Corporation
Daphne LeDrew, Canadian Living Foundation - Breakfast for Learning, Kids Eat Smart
Rosemary Lester, Seniors’ Resource Centre
Fay Matthews, Health and Community Services Eastern
Dr. Jane McGillivray, Medical Officer of Health
Gary Milley, Newfoundland and Labrador Parks/Recreation Association
Cindy Murphy, John Howard Society of Newfoundland and Labrador Inc
Richard Neron, Aids Committee of Newfoundland
Mr. John Peddle, Newfoundland and Labrador Health Boards Association
Penelope M. Rowe, Community Services Council Newfoundland and Labrador
Jitin Sekhri, Francophone Federation of Newfoundland
George Skinner, Pharmacists' Association of Newfoundland and Labrador
Kim Silver, Health Canada
Dr. Faith Stratton, Chief Medical Officer of Health
Eleanor Swanson, Dept of Health and Community Services (Wellness Strategy)
Paul Thumey, Newfoundland and Labrador Lung Association
Gail Turner, LIHC Labrador
Lynn Vivian-Book, Dept. of Health and Community Services (Programs)
Dr. Minnie Wasmeier, Regional Medical Officer of Health
Dr. Hugh Whitney, Department of Agriculture
Saira David, PHAC