Backgrounder - Health Services and Population Health

Toward a Healthy Future: Second Report on the Health of Canadians summarizes the most current information we have on the health of Canadians and the factors that influence or "determine" health. It suggests several priority areas for action in the new millennium. One of these is renewing and reorienting the health sector to increase accountability and effectively improve the health of all Canadians. This backgrounder discusses two important aspects of reorienting the health sector: trends in health services and the role of a population health strategy.

Canadians value their health-care system and want to maintain high-quality care. But health services are among many factors that influence health. Toward a Healthy Future shows that factors in the socioeconomic and physical environment, as well as healthy child development, personal health practices and biology have a major impact on health. These factors operate independently of whether we spend more money on health care.

Highlights: Health Services Trends

• Disease and injury prevention activities in areas such as immunization, seatbelt use and mammography, as well as health promotion efforts in areas such as early child development are showing positive results. These activities must continue if progress is to be maintained.
• The annual growth rate of Canada's insured health-care expenditures fell from 11.1% between 1975 and 1991 to 2.5% between 1991 and 1996. Despite these spending slow downs, Canadians did not report a significant increase in unmet health-care needs in 1996-97, and most measures of population health (such as life expectancy) continued to improve.
• At the same time, little information on the quality of care or the impact of restructuring was available. However, there is some evidence to suggest that the public's assessment of the overall quality of the health-care system, although still largely favourable, has declined to some extent since the beginning of the decade.
• While overall access to universally insured care remains largely unrelated to income, low- and moderate-income Canadians are less likely than high-income Canadians to have insurance for health services such as eye care, dentistry, mental health counseling and prescription drugs, and they tend to report lower rates of use of such services.
• There has been a substantial decline in the average length of stay in hospital. Shifting care into the community and the home raises concerns about the increased financial, physical and emotional burdens placed on families, especially women. The demand for home care has increased in several jurisdictions and there is a concern about equitable access to these services.
• Expenditures on medications and the use of prescription drugs have increased dramatically since 1975. In 1996-97, 30% of Canadians aged 12 and over and 46% of Canadians aged 75 and over used three or more medications.

A Population Health Approach

A population health approach focuses on the conditions that underlie health, and then uses what is learned to suggest policies and actions that will improve the well-being of all Canadians. A population health approach uses both short- and long-term strategies to:

• improve the underlying and interrelated conditions in the environment that enable all Canadians to be healthy; and
• reduce inequities in the underlying conditions that put some Canadians at a disadvantage for attaining and maintaining optimal health.

How can the health sector, whose traditional role is treating the sick, influence the root causes of health and help to reduce inequities in health status? The answer lies in a collaborative effort to renew and reorient the health sector so that it can:

• take action to meet the emerging challenges in health promotion, injury and disease prevention and health protection, as well as in treatment services;
• increase the accountability of health services through improved reporting on the quality of health services, and improving access to all needed services;
• increase our understanding of how the basic determinants of health influence collective and personal well-being;
• evaluate and identify policy and program strategies that work; and
• influence sectors outside of health that can significantly affect health status.

The Need for Dialogue and Collaboration

Obviously, the health sector has a key direct role in improving health. But, since many of the determinants of health are outside the traditional system, building alliances with other sectors is a primary strategy for improving the health of the population. Other health-determining sectors that need to be involved include finance, justice, housing, education, recreation, the physical environment, employment, transportation and social services.

The ideal outcome of these collaborations will be healthy public policies in a variety of sectors, as well as in the health sector itself. The health sector cannot do it all, nor can it impose its agenda on other sectors. It can, however, initiate dialogue and partnerships with others, and act as a collaborator for change. All sectors stand to benefit from improvements in health and the conditions that influence health. Healthy, well-educated, productive citizens who nurture their young people and live in a civic, egalitarian, sustainable society feel in control of their destiny. They are better prepared to address the local, provincial/territorial, national and global challenges of the new millennium.

Improving health is everyone's business. Collaboration in the pursuit of the public's health needs to occur at all levels -- families, neighbourhoods, communities, provinces and territories, regions and in the country as a whole. Partners need to include voluntary, professional, business, consumer and labour organizations, private industry, governments and representatives of communities of faith, various cultures, population groups and disadvantaged groups. Together, we can give no greater gift to the next generation than a healthy future.

For More Information

Toward a Healthy Future: Second Report on the Health of Canadians was developed by the Federal, Provincial and Territorial Advisory Committee on Population Health in collaboration with Health Canada, Statistics Canada, the Canadian Institute for Health Information and the Centre for Health Promotion, University of Toronto. The full text can be found on the Health Canada Web site: http://www.hc-sc.gc.ca. Printed copies of the Report are available from Provincial and Territorial Ministries of Health or from:

Publications
Health Canada
Tunney's Pasture (AL 0900C2)
Ottawa, ON K1A 0K9
Telephone: (613) 954-5995
Fax: (613) 941-5366
E-mail: Info@www.hc-sc.gc.ca

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