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Canadian Experiences inPublic Health Advocacy:

Canadian Public Health Association

The authoritative non-governmental voice for public health in Canada since 1910

Presentation toIncreasing Policy Influence and Engagement of National Public

Health Associations in Africa; Progress and Challenges

13th World Congress on Public HealthApril 23, 2012

James Chauvin, Director of Policyjchauvin@cpha.ca

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Presentation

• Canadian Public Health Association• CPHA’s Policy Platform• Two case studies:

- Chrysotile Asbestos- Insite (supervised injection facility)

• Social Determinants of Health• Implications for CPHA

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CPHA: What is it?

• Founded in 1910• Act of Parliament 1912• Represents public health in Canada with links to

the international public health community• Only Canadian NGO solely focused on public

health• Only national voice for PH in Canada until 2003

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CPHA: Who are we?

• National in scope, international in reach• Voluntary individual membership• Charitable status• Primarily an advocacy organization• CPHA members believe in universal and

equitable access to the basic conditions which are necessary to achieve health for all Canadians

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Some days, policy advocacy feels like this….

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And some days you may need some of this….

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And then there are the days when it all goes like this….

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CPHA’s Policy Advocacy History

• 101 years advocating for healthy public policy & practice

• 50 years advocating on tobacco use/control

• 30 years advocating for health equity/SDH

• 1990s: focus on health systems reform

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CPHA’s Policy Advocacy History• 2003: SARS – outcomes:

– Public Health Agency of Canada (PHAC) established– Position of Chief Public Health Officer of Canada created– Public health system response capacity

reviewed/strengthened– Greater awareness about importance to invest in “public

health”

• 2009: pH1N1 – outcomes:– PH system responded to major national emergency– Important role of PHAC in working in coordinated fashion

with provinces/territories– Mixed PH messages to public and front-line health

practitioners– Resources for front-line health units and practitioners– High stress on and very limited front-line public health

“surge capacity”

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CPHA Priority Policy Foci• Health Equity/Poverty/Social Determinants of

Health (including housing, transport, indigenous health, etc)

• Public Health Leadership• Public Health Infrastructure (including human

resources)• Chronic Disease Prevention• Environmental Health* does not exclude infectious disease prevention, health promotion,

mental health, nutrition, etc.

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What did CPHA do in 2010/11?• Position statements on Chrysotile Asbestos, Tobacco

Use in Canada and PH Approach to Alcohol• Opposed federal government decisions on gun

control, long-form census, mandatory prison sentences

• Application for intervener status before Supreme Court (Insite appeal)

• Analysis of CPHA’s Documents and Statements over 30 years and Recommendations for Future Action

• Response to the 2010 and 2011 Federal Budgets• Presentation to several Parliamentary committees• NCD Prevention, SDH/health equity

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CPHA Policy/advocacy 2012+

• Position Papers on Ecosystem Health and Illegal Psychoactive Substances

• Endorsement of Low-Risk Cannabis Guidelines

• The place of Public Health within a renewed Federal/Provincial/Territorial Health Fund Transfer Agreement

• The SDH/Health Equity as they affect particularly vulnerable populations (youth, indigenous people)

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Mining and Export of Chrysotile Asbestos

Photo: Sonumadhavan

photo by Alexey Plovarov

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CPHA’s Position

1. Ban mining, use and export of asbestos2. Cease funding of Chrysotile Institute3. Establish national surveillance system and registry for

asbestos-related diseases and workers exposed to asbestos4. Just/adequate transition assistance income support and

training for asbestos industry workers and financial assistance to their communities

5. Complete removal and replacement of asbestos-containing insulation in indigenous community housing

6. Fair compensation provided to people suffering from asbestos-related diseases

7. All public and commercial buildings have asbestos-containing materials identified and managed to observe strict OH&S standards

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Quo vadis?

• Investigate the use of federal funds provided to the Chrysotile Institute

• Continue to communicate CPHA’s position and concerns to GoC and media

• Advocate for Cdn technical assistance to build OH&S policies and practice in export recipient countries

• Continue engaging Cdn PH community on the issue

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Safe Injection Drug Facility: Insite

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What is Insite?

• PHS Community Services Society – non-profit community NGO

• Provides housing and support to hard to reach, house and treat people in Vancouver’s downtown east side

• Health & social services facility authorized and funded by British Columbia gov’t

• Houses Canada’s only safe injection facility

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Population of DTES

• Injection drug use = 15 years average• 51% inject heroin; 32% cocaine• 87% infected with HCV; 17% HIV• 18% aboriginal• 20% homeless, majority living in poor housing• 80% have been incarcerated• 38% involved in sex trade• 59% reported a non-fatal overdose• 21% using methadone

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The Issue

• People using illegal injection drugs within confines of safe injection facility liable to prosecution for possessing a controlled substance [CDSA, s. 4(1)]

• Insite staff liable to prosecution for trafficking [CDSA, s 5(1)]

• Users and staff afforded exemption from prosecution by federal Minister of Health under CDSA s. 56 (September 2003, for 3 yrs)

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Judicial Issues

• Federal constitutional power to legislate re criminal law cannot interfere with provincial power re health care – interjurisdictional immunity/paramountcy

• CDSA sections 4(1) and 5(1) unconstitutional – deprive people addicted to one or more controlled substances access to health care – violates S7 of Charter of Rights and Freedoms

• Unfettered discretion of Minister of Health unconstitutional

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Judicial Interventions

• Supreme Court of British Columbia (2008). Plaintiff: PHS Community Services et al/Defendant: Attorney General of Canada

• Court of Appeal for British Columbia (2010). Plaintiff: Attorney General of Canada et al/Defendant: PHS Community Services et al.

• Supreme Court of Canada (May 2011). Appellant: Attorney General of Canada et al/Respondent: PHS Community Services et al

• Several interveners, including CPHA

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CPHA’s Position

• Addiction is an illness, not a lifestyle choice• Insite reduces risk to overdose and infection,

promotes counselling/treatment• Drugs do not cause HIV or HCV• Risk morbidity/mortality associated with injecting

reduced with presence of qualified health professional

• Insite did not increase drug-related loitering, drug dealing, drug-related crime, drug use nor promote “drug use acceptable” messaging

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CPHA’s Legal Arguments

• CDSA s. 4(1) is unconstitutional as applied to health care services delivered at Insite – deprives individuals of their life, liberty and security interests

• s. 4(1) fails to protect the public from harms associated with drug use

• s. 4(1) provision “overboard, arbitrary and grossly disproportionate, violating s. 7 of Charter

• “discouraging the use of safe-injection services harms individual and public health and safety”

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Supreme Court Decision (30/09/11)

• Unanimous, written by Chief Justice• The delivery of health care services is not

immune from federal interference• CDSA constitutionally valid and applicable to

Insite under fed/prov division of powers• However, application of CDSA ss. 4(1) & 5(1)

deprives Insite clients of Charter rights (s. 7)• Covers staff (possession/trafficking) and clients• Minister of Health compelled to provide

exemption

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Where do we go from here?

• Insite can operate – Minister obliged to provide exemption

• Future safe-injection drug sites• Application of Charter 7 to other harm

reduction situations

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Frontline Health: Beyond Health Care

• Building the case for investments in public health and in particular the SDH

• Develop position statement on a whole-of-government approach to health equity/SDH

• Creating awareness/understanding among media, politicians and press

• Knowledge exchange/transfer within Cdn PH community (experiential)

• Telling the story about HE/SDH in Canada

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Implications for CPHA

• Raises visibility of CPHA• Impact/influence on policy and practice• Reinforced/expanded advocacy activities• Puts us in the federal government’s sites

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“The world we have created is a product of our thinking; it cannot be changed

without changing our thinking.”

Albert Einstein