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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.
3
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
4
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
5
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
is
Re
né
-Ca
ssin
Ma
iso
nn
eu
ve
De
s F
au
bo
urg
s
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
10
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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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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