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Reducing Health Disparities: Rethinking Public Policy

Senator Wilbert J. Keon, ChairSenate Subcommittee on Population Health

Study of the Senate Subcommitteeon Population Health

Annual Conference, Canadian Public Health Association, 1-4 June 2008

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Mandate

Examine and report on the impact of the multiple factors and conditions that contribute to the health of Canada’s population - known collectively as the determinants of health.

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Four Reports on Population Health Policy

International Perspectives Maternal Health and Early

Childhood Education in Cuba Federal, Provincial and Territorial

Perspectives Issues and Options

Download the reports from: http://www.senate-senat.ca/health-sante.asp

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What We Learned

The major cause of death and disability in Canada is health disparities

The vast majorities of health disparities are neither natural nor inevitable but are the consequences of public policies

Rethinking public policy can improve health outcomes

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Life Expectancy (LE) and Health-Adjusted Life Expectancy (HALE), Canada, 2001

50

55

60

65

70

75

80

85

90

bottom middle top bottom middle top

HALE LE

Males at birth Females at birth

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Differences inLife Expectancy: Men

79.2

77.476.2

78.277.7

76.6 76.9

75.0 74.9

79.5 79.4

68.6

66.067.2

68.8

77.0

60

65

70

75

80

85Ic

ela

nd

Ca

na

da

U.K

.

Tu

rke

y

Brit

ish

Co

lum

bia

On

tario

Qu

eb

ec

Nu

na

vut

Qu

eb

ec

Mo

ntr

éa

l

Sa

gu

en

ay

Ga

tine

au

La

c S

ain

t-L

ou

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Ma

iso

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eu

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OECD (2003–2004) Canada (2002) Quebec CMAs (2000–2002)

Montréal (1994–1998)

Life

Exp

ect

an

cy a

t B

irth

fo

r M

en

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MALE FEMALEYear Registered

Indians All Canadians

Gap Registered Indians

All Canadians Gap

1980 60.9 71.7 10.8 68.0 78.9 10.9

1985 63.9 73.1 9.2 71.0 79.9 8.9

1990 66.9 74.4 7.5 74.0 80.8 6.8

1995 68.0 75.1 7.1 75.7 81.1 5.4

2000 70.2 76.7 6.5 75.2 81.9 6.7

2001 70.4 77.0 6.6 75.5 82.1 6.6

Sources: Population Projections of Registered Indians, 2000-2001, INAC, 2003

Population Projections for Canada, Provinces and Territories, 2000-2026, Statistics Canada 2001, Medium Assumption, pages 25-26.

Projected Life Expectancy at Birth by Gender, Registered Indians and Canadian Population, Canada, 1980-2001

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What We Learned, cont’d

The vast majorities of health disparities are neither natural nor inevitable but are the consequences of public policies

Rethinking public policy can improve health outcomes

There is no single right way to reduce health disparities

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What We Learned, cont’d Some countries lead the way – England and

Sweden – and in Canada, some provinces are more advanced – Quebec and Newfoundland

Potential tools to move the population health agenda forward include health goals/targets and health impact assessments

Intersectoral action is key: all relevant departments, various levels of governments, NGOs and communities must work together

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What We Learned, cont’d There is a need to focus on some

population groups, like children, low-income Canadians and Aboriginal peoples

Some health determinants are critical, particularly early childhood education and income

There is enough evidence to take action now

The health sector cannot act alone What is missing is the political will

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What We Learned, cont’d There is a need to focus on some

population groups, like children, low-income Canadians and Aboriginal peoples

Some health determinants are critical, particularly early childhood education and income

There is enough evidence to take action now

The health sector cannot act alone What is missing is the political will

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What We Concluded

The Subcommittee believes it is unacceptable for a privileged country like Canada to continue to tolerate disparities in health. Our challenge is to find ways to improve the health of all Canadians to equal that of those who experience the best health. (Issues and Options, p. 9)

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The Federal Role Direct responsibility and mandate for

First Nations and Inuit health Shared responsibility for numerous

health determinants – income support, social housing, education, environment, economic development, etc.

The right and the obligation to take a leadership role

Federal funding goal: to achieve the most health for every precious dollar spent

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What is Missing

We need an ambitious vision – “What kind of Canada do we want?”

We must build a business case for population health

There must be dedicated leaders / champions from a range of sectors

There is a need to rethink public policy

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What Must Be Done? Articulate a vision, build a business case Starting from current policies and

programs, prioritize initial steps towards that vision

Implement a series of parallel processes Action must occur from the bottom up

and from the top down Work horizontally and cooperatively:

“whole-of-government approach”

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If We Do It Right…

Shifting public policy can accomplish the following:

• Health disparities will be reduced; many more people will live longer lives and enjoy a better quality of life;

• Savings will be made in the long term and a wide range of public services such as health care, social services and supports, etc.

• Healthier people will be better employed and improve productivity.

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Sir Michael Marmot

World Health Organization Commission on the Social Determinants of Health

The graded nature of the link between position in the hierarchy and death—the social gradient in mortality—is the challenge to understanding. The gradient is a broader issue than that of poverty and health. We have no difficulty in contemplating how dirty water, poor sanitary facilities,

and inadequate nutrition and shelter could cause the diseases of poverty.

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Newfoundland Community Accounts: Well-Being Index

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Health Statusand

Well-Being

Frail Old

Middle Old

Young Old

Parenting

Maternal Health

Early Human Development

Pre-adolescence

WorkLife

Life Cycle Stages and Policies for Population Health / Well-Being

Socioeconomic Determinants of Health - 50%

Post-SecondaryEducation

Social Environment

Physical Environment

Early Child

DevelopmentEducation

Employment and Working Conditions

Culture GenderBiology

and Genetics

Personal Health

Practices

Income and Social Status

Social Support

Networks

15% 10%

Health Care

System

25%

Pre-conception

Pregnancy

Early Years

YouthPrimary and SecondaryEducation

Healthy Aging

Employment and Workplace

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We Need Your Input Fax: (613) 947-2104 Email: SOC-AFF-

SOC@sen.parl.gc.ca Mailing Address:

Subcommittee on Population HealthThe Senate of CanadaOttawa, Ontario Canada, K1A 0A4

Deadline for Briefs: June 30, 2008