The Politics of Health & Health Care Health literacy + Civic efficacy = Political Will Honourable Dr. Carolyn Bennett, MP Canadian Federation Medical Students February 2, 2014 February 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 patients ► Effective advocates ► Engaged citizens

► Patient as Partner ► Doctor Multidisciplinary ► Hospital Community ► Social Determinants of Health  Poverty, violence, environment, shelter, equity, education

Sir Michael Marmot Chair, WHO Commission on Social Determinants of Health “The worst thing for a physician is to help someone get well and then send them straight back into the situation that made them sick in the first place”

WHY do this ?

Ongoing health CARE Dilemmas Ongoing health CARE Dilemmas The urgent at the expense The urgent at the expense of the important. 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

Public policy usually follows public opinion…. public opinion….BECAUSE……. Doing the right thing is very difficult is the public isn’t onside…  “Father knows best” not great politics

Political Will to do the right thing dramatically improves with ► Health Literacy  ‘tyranny of the acute’ ► Civic efficacy  Citizens pulling healthy public policy

Attitude 2+2=5 Knowledgeable Stakeholders + Committed Politicians = Better Public Policy

Goal of Medicare… Goal of Medicare… ► Sharing risk  getting people the health care they need when they need it ► Keeping people well not just patching them up once they get sick

“Reorienting health systems” FROM a health CARE system TO a true system for HEALTH Ottawa charter 1986

The Em PHA sis is on the wrong syl LAB le

Minister of Handwashing

Minister of State (Public Health) ► Sworn in December 2003 ► 2003  Canada… 44 died of SARS  France…14,000 died in the heat wave ► 2000 WHO Report  France #1  Canada #30

Beyond borders…. SARS as a teachable moment ► Beyond silos  Departments  Disciplines ► Beyond jurisdictional squabbling ► Germs don’t respect borders ► Neither do the social contagions ► Nor the humanitarian imperatives

Lessons learned from SARS ► Jurisdictional squabble  Germs don’t respect borders  Naylor report.. ► Collaboration ► Cooperation ► Communication ► Clarity of who does, what, when

Sustainability = Prevention + Quality ► PREVENTION  Decrease the demand side ► QUALITY  Increase the cost effectiveness on the supply side

“Many attribute the quality problems to a lack of money. Evidence and analysis have convincingly refuted this claim. In health care, good quality often costs considerably less than poor quality.” Fyke Report 2001 (Saskatchewan) Focus on QUALITY saves $$ and lives

PREVENTION ► Our cherished health care system will only be sustainable if we redouble our efforts to keep Canadians well as was articulated in the original commitment to medicare. ► For Canadians to be as healthy as they can be, and in order to close the unacceptable gap in health status for our most vulnerable Canadians we must work across all government departments, all jurisdictions and in all sectors.

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

Fleeing the Medical Model, Embracing the Medicine Wheel

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 Moments Kasheshewan Reserve... Dr. Hill Hurricane Katrina The 2003 heat wave in France The 1995 Chicago heat wave ► Heat Wave: A Social Autopsy of Disaster in Chicago by Eric Klinenberg

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

Citizens have to ‘get it’ ► More health …less health care ► Service contract ?????? ► Or longer warranty ????

The Grey Tsunami ? R.O.M.P.Collingwood April 24, 2008 Dr. Carolyn Bennett M.P. The Grey Tsunami ?

Fantasy Fantasy

Health Literacy Quiz ► Empowerment Pulling Healthy Public Policy Putting the Public back into Public Health

Public Health 101

1.Do you think we should have a: A) strong fence at the top of the cliff B) state of the art fleet of ambulances and paramedics waiting at the bottom ?

2. Would you prefer: A) Clean air A) Clean air B) Enough puffers and respirators B) Enough puffers and respirators for all

3. Would you prefer that wait-times were reduced by: A) a falls program to reduce preventable hip fractures B) private orthopaedic hospitals and more surgeons

4.Governments should boast about: A) how much they spent on the sickness care system B) the health of their citizens, leaving no-one behind

Social Determinants of Health vs Choose Health (modifiable risks)

The Causes of the Causes Versus The Causes

2005

Health Goals for Canada As a nation, we aspire to a Canada in which every person is as healthy as they can be – As a nation, we aspire to a Canada in which every person is as healthy as they can be –physically,mentally, emotionally and spiritually.

Federal – Provincial Federal Government needs to lead by example Federal Government needs to lead by example 5 th biggest system – 5 th biggest system – aboriginal, military, veterans, Corrections, RCMP, PS aboriginal, military, veterans, Corrections, RCMP, PSPREVENTION ► Public Health Network  PHAC + Chief Public Health Officer for Canada  13 Juridictions QUALITY QUALITY ► Health Council Canada  was overseeing 2004 Accord – should oversee Fed responsibilities  6 provinces have Quality Councils ? All 13 ?

Scotland – Honourable Andy Kerr ► Health outcomes down to postal code ► Letter from Family Doctor ► Interventions ► Already paying off

The Goal ► Most appropriate care ► In the most appropriate place ► By the most appropriate person – paid and unpaid paid and unpaid

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

No time for pessimists

Research Research ► Evidence-informed practice ► Practice-informed evidence ► Courage to fund what works ► Courage to stop funding what doesn`t ► Complex adaptive systems…

Research PracticePolicy

Research PracticePolicy KT

Research PracticePolicy KT Political will

Research PracticePolicy KT Political will Applied research

Research PracticePolicy ENGAGED CITIZENS KT Political will Applied research

Empowered Patients Effective Advocates Engaged Citizens Empowered Patients Effective Advocates Engaged Citizens ► Use the system wisely  Keeping our families well  Clinical guidelines  Self Care Manuals ► Fight for more HEALTH so we`ll need less health care ► Democracy between elections

“We are not tinkers, who patch and mend what is broken. We must be watchmen, guardians of the life and health of our generation, so that stronger and more able generations may come after.” Dr. Elizabeth Blackwell first woman physician North America

M.D. / M.P. “ The system is my patient now” “ The system is my patient now” ``Ask what`s wrong, listen, together make a plan.`` ``Ask what`s wrong, listen, together make a plan.``

“A politician thinks of the next election, a statesman thinks of the next generation” “A politician thinks of the next election, a statesman thinks of the next generation” James Freeman Clarke James Freeman Clarke Work to elect more statesmen …. Work to elect more doctors !!!!