Public Health- All Hands on Deck

Public Health: All Hands on Deck Elinor Wilson, RN, PhD Chief Executive Officer Canadian Public Health Association Who is Involved in Creating Health?           Individuals Families Neighbourhoods Schools Workplaces Communities Provinces and Territories Regions Country as a whole International Orgs Society Government Non Profit Sector Private Sector    Non Governmental Organizations (NGO)  Organizations that are located outside the political state as well as organizations distinguishable from the private sector (Lohmann, 1992) In Canada, the preferred term is “nonprofit and voluntary sector” referring to „service delivery‟ organizations in areas such as health, education, social services, community development and housing, as well as those that serve „expressive‟ functions in arts, labour and professional associations.  Non Profit Sector  Includes almost every type of: – Voluntary association – Charity – Church – Trade and professional association – Advocacy organization  Approximately 170,000 in Canada Voluntary Sector   Includes charities and non profits Organizations whose work depends on: – Serving a public benefit; – Volunteers, at least for their governance; – Financial support from individuals; and – Limited direct influence by governments. Significance of the Civil Society Internationally   Major economic role In a Johns Hopkins Study of 22 countries: – Non-profits accounted for 19 million full-timeequivalent employees - average 5% of workforce – Volunteers contribute equivalent of 10 million additional full time jobs – Non-profits employed 6 times as many people compared to the largest private company in each country – If the sector were a country, it would be the eighth largest economy in the world International Growth of the Non Profit Sector      France: Growth from 10,000 new organizations per year in 1960s to over 50,000 in last few decades Hungary: 23,000 new associations from 1989-1993 Russia: at least 100,000 new organizations in 7-8 years India: 1,000,000 registered Brazil: 200,000-300,000 registered International Growth of the Non Profit Sector    20 year erosion of state capacity to address social welfare, health & environmental issues Global communications revolution that has facilitated the growth of NGOs Recognition internationally that the deliberation of health issues and determinants occurs where the public health community has little access and is not prepared Role of Civil Society      Civil society can play the role of critic, catalyst and advocate Mobilizes people Raises public awareness Guarantees that the interests of those that may be under represented are not being neglected (e.g. poor, uneducated, illiterate, unorganized, weak) Civil society may need to be a watchdog, a whistleblower or the vanguard to warrant that government and--to a lesser extent--the private sector respect their borders The Canadian Public Health Association     Began in 1908 Partnerships is main method of work International links Strengthening Public Health Infrastructure - an essential part of CPHA‟s core business  Public health has been described as the science and art of promoting health, preventing disease, prolonging life and improving quality of life through the organized efforts of society. Dr. John Last “Dictionary of Epidemiology” The Future of Public Health: Reports and Commissions         Campbell (2004, 2005) Walker (February 2004) Naylor (October 2003) Romanow ( November 2002) Kirby (October 2002) Mazankowski (January 2002) Clair (January 2001) Fyke (April 2001) Lessons learned – a few highlights      Define core functions Modernize legislation Develop system performance measures National public health leadership Properly funding the system Summary of Recommendations: What‟s Needed… Core Infrastructure Elements Core Public Health functions  Legislative organization and governance structures  Accountability mechanisms/performance targets  Earmarked budget allocations and grants system for Public Health  Federal Response     Public Health Agency of Canada Chief Public Health Officer of Canada Public Health Network Increased Funding in Federal budgets The Future        Public health goals for Canada Public health FPT Network Pan-Canadian Public Health Strategy PHAC legislation Public health as a web of interconnections and collaboration Mutual aid, data sharing, etc. Expertise, resources, solutions – Right issues, right place, right time Canadian Coalition for Public Health in the 21st Century  Formed as SARS underway CPHA the secretariat Now, 40 national organizations – – – – Professional Academic Disease / condition Advocacy    Multi-sectoral, multi-disciplinary CCPH21 - Messages  National Public Health Leadership – Public Health Goals – Public Health Legislation – Overarching framework, and internal alignment   Adequate financing for public health at all levels Strengthened public health human resources CDPAC Foundation      Canadian Heart Health Initiative Canadian Diabetes Strategy Canadian Strategy for Cancer Control Risk Factor plans – e.g. tobacco WHO Country-wide integrated NonCommunicable Disease Intervention (CINDI) CDPAC Mission Fostering a countrywide movement towards an integrated, population health approach for the prevention of chronic diseases through collaborative leadership, advocacy and capacity building. December 2002 Description of CDPAC Role  Voice of influence for system change to reduce chronic diseases and improve health The synergistic and dynamic network of intersectoral partners at all levels to share information, plan and act together.  Current Structure Alliance members, active participants and subscribers National Stakeholders Provincial and Territorial Alliances Steering Committee Working Groups Secretariat Stakeholders: Engaged Communities of Practice Prevention Research Nutrition Tobacco Public Health Canadian Municipalities Professional Parks and Assoc. Recreation School Health Workplace Others CDPAC Functions     Collaborative Leadership – facilitating joint problem solving and decision making among key stakeholders. Enhancing Capacity – developing, fostering and supporting relationships and resources at all levels (community, organizational, inter-organizational and systems) Advocacy – influencing public opinion and societal attitudes to bring about changes in government, community or institutional policies Governance and Administration Act Now BC: The Business Case 100% 90% 80% 70% 60% Revenue Growth – 3% Education Growth – 3% Health Growth – 8% Balanced Budget Other spending reaches zero by 17/18 Total 100.0% Health 53.6% 71.3% Percent 50% 40% 30% 20% 10% 0% 41.6% 28.4% 27.0% Education 27.0% 27.0% 16.6% Other -0.6% -10% 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17 17/18 Year Act Now BC: The Approach      Partnership-based platform of programs and services led by Ministry of Health (the “coach”). All ministries contribute to goals and objectives. Programs are designed and delivered in cooperation with more than 70 partners from other levels of government, non-government organizations, industry associations, and the private sector. Programs are delivered in variety of venues where people live, work, learn and play (homes, workplaces, schools, communities). Focuses on changing social behaviours. Act Now BC: The Approach  World Health Organization identified effective prevention initiatives as: – integrated: combinations of preventive strategies – comprehensive: multiple partners in multiple settings: ie, workplaces, schools, municipalities – participatory: including people in decisions and actions – sustainable: include a capacity building element, and – awareness raising: provide access to education and information to achieve effective participation and empowerment  WHO looking at ActNow BC as model for Best Practices Strategic Communications Conceptual Framework Premier Committee on Social Development StrongStart BC Cabinet Committee Committee on Natural Resources & the Economy Children & Family Develop. Small Bus. & Revenue Aboriginal Relations & Reconciliation Advanced Education Education Transportation Community Services Forests & Range Agriculture & Lands Health Economic Development Public Safety & Solicitor General Employment & Income Assistance Labour & Citizen’s Services Attorney General .Environment Energy, Mines & Petroleum Res Tourism, Sports & Arts Finance Coordination and Stewardship All sectors, municipalities, Non-Governmental Organizations, Agencies, Businesses and Industry ActNow BC provides a unifying brand for the strategic cross governmental and cross-sectoral initiative for creating a healthy BC population. Facilitates “improved alignment of cross-ministry policy” WHO and Civil Society Linking for Better Change     Engaged with WHO to implement health programmes at country level; Made outreach to remote areas and populations possible; Advocated public health issues to a broader audience; and Addressed sensitive issues and worked in alliance with WHO to raise funds more effectively. People’s Heath Movement People’s Charter for Health        Health as a Human Right Determinants of health Social and political challenges Environmental challenges War, violence, conflict and natural disasters People centered health sector People‟s participation for a healthy world Global Peoples Health Charter: Significance  It endorses health as a social, economic and political issue and as a fundamental human right; It identifies inequality, poverty, exploitation, violence and injustice as the roots of preventable ill-health; It underlines the imperative that “health for all” means challenging powerful economic interests, opposing globalization as the current iniquitous development model; it thus drastically changes our political and economic priorities; It brings in a new perspective and the voices from the poor and the marginalized (the rarely heard) encouraging people to develop their own local solutions; and     It encourages people to hold accountable their own local authorities, national governments, international organizations and national and transnational corporations. NGO Contribution  International – World Health Federation, UICC, Diabetes, etc. – Ottawa Charter CPHA  Health Canada  WHO  NGO Contribution  National and Provincial – CDPAC – Provincial Healthy Living or Chronic Disease Alliances – Pan-Canadian Healthy Living Strategy  CDPAC Co-chair – CHHI – Foundation of Chronic Disease Work International Conferences & Declarations Why is Collaboration Appropriate? Collaboration is a social process particularly suited to situations characterized by: – Interdependence – Complexity – Uncertainty Successful Partnerships Early Ongoing Meaningful 1. 2. 3. Balancing the rights of individuals with the needs of the community Global Health Treaty    Should ensure a common high level of health protection and health rights for all citizens, wherever they live, love, work and play (and travel, buy or google) From those risks and threats to their health, safety and well-being which are beyond the control of individuals and communities Cannot be effectively tackled by nation states alone but need to be multiactor (e.g. health threats, unsafe products, unfair Ilona Kickbusch commercial practices). Global Health Treaty         Reform and strengthen global institutions and international law for health and bind a wide range of actors Introduce and ensure new sustainable financing mechanisms Control unsafe goods and products, ensure corporate accountability Address health dimensions of trans-boundary/collective human security issues Fight major diseases and defined global health emergencies including rapid response Create surveillance and information systems Harmonize aid to give priority support to PHC and PH health infrastructures Strengthen professional capacity and ensure human resources at a global level and address the brain drain. Ilona Kickbusch Role of CPHA     Organize National Global Health Summits Discuss mechanisms for a political process Intellectual leadership, set agendas, build alliances Work with decision makers and parliamentarians to create new types of public health forums Ilona Kickbush CPHA 2005 If you need a bridge, you do not give the money to drivers you need to go out and build a bridge. http://thetyee.ca/Views/2006/05/04/CanadaStoodUp/ “Good health is the bedrock on which social progress is built. A nation of healthy people can do those things that make life worthwhile, and as the level of health increases so does the potential for happiness.” Marc Lalonde, Minister of National Health and Welfare, 1974