Pandemic Preparedness vs' Chronic Disease Management Surely we need both

1
Pandemic Preparednessvs.Chronic Disease
Management Surely we need both

• Schulich School of Business
• York University
• January 31,2007
• Carolyn Bennett M.D.,M.P.

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Ongoing health CARE Dilemmas

• The urgent at the expense
• of the important.
• The politics of FEAR

3
Context of the tensions

• tyranny of the acute
• burden of chronic disease management
• Pandemic Preparedness
• social determinants of health

4
Public health 101

• Every nation that permits people to remain under
  the fetters of preventable disease and permits
  social conditions to exist that make it
  impossible for them to be properly fed, clothed
  and housed so as to maintain a high degree of
  resistance and physical fitness and, who
  endorses a wage that does not afford sufficient
  revenue for the home, a revenue that will make
  possible the development of a sound mind and
  body, is trampling on a primary principle of
  democracy.
• Dr. Charles Hastings, Medical officer of health
  for Toronto, 1907

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Chronolgy

• Turn of century . urbanization
• 1918 Spanish flu
• Depression
• Tommy Douglas goal of medicare
• tyranny of the acute
• Lalonde Report
• Ottawa Charter
• SARSgtgtgtgtoverdue for pandemic

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SARS Canada Spring 2003

• 43 deaths
• Median age 75 years - gt83 were gt60 years
• Underlying chronic disease a problem
• Requires close contact during active illness
• Health workers at greatest risk
• Antibiotics and anti-virals not effective
• Economic problems and Disruption far from problem
• Good Luck and Good management

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Lessons learned from SARS

• Naylors 4 Cs November 2003
• Collaboration
• Cooperation
• Communication
• Clarity who does what, when
• Germs dont respect borders !!!!!

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Minister of State (Public Health)

• Dec 2003 not just infectious disease
• Set up Public Health Agency of Canada
• Appoint Chief Public Health Officer for Canada
• Public Health Network
• Minister of Handwashing !
• Health vs. Health CARE

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SARS briefing

• Scarborough clinic
• Sharing information
• Data

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Pandemic Influenza

• Inevitable ?
• Preparation is good for our health.
• like Y2K
• Warning signs ?
• Fujian strain of flu
• SARS
• H5N1 bird
• WNV
• Tamiflu debacle

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Florence Dec. 2004

• Lady with the Lamp
• Meticulous records
• Statistician
• Clusters of disease
• To understand Gods thoughts we must study
  statistics, for these are the measure of His
  purpose. Florence Nightengale

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Israel January 2005

• Surge capacity
• Real time facts.. beds, icu
• Communication with health care personnel
• Training, training, training

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Blame Hippocrates?
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Affirm Hygeia
HYGEIA Goddess of Health
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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.

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Central command control ?????
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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

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Health vs. Health CARE

• more health less health care
• Service contract ?????
• best possible repair chop in a sickness care
  system
• longer warranty ?????
• Keeping as many Canadians well for as long as
  possible

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Gridlock Matrix

• Horizontal
• Whole of Government vs. Silos
• Silos within silos.eg Ministry of Health
• Vertical
• Across jurisdictions
• Across all sectors

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• For every complex human problem, there is a
  neat simple solution. Its just that its wrong.
  
• H. L. Mencken

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Glouberman and Zimmerman

• Complicated and Complex Systems What Would
  Successful Reform of Medicare Look Like? (2002)
• - Submission to the Romanow Commission

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social determinantsvs.choose health
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Evolution of the Healthy Canadians Tree
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Evolution of the Healthy Canadians Tree
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WHO Commission on Social Determinants of Health

• The worst thing for physicians is to patch
  people up and then send them straight back into
  the conditions that made them sick in the first
  place.
• -Sir Michael Marmot
• Launch WHO Commission , Santiago, Chile. March
  2005

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WHO Commission on Social Determinants of Health

• The Commission on Social Determinants of Health
  (CSDH) supports countries and global health
  partners to address the social factors leading to
  ill health and focus on health inequities. It
  draws the attention of society to the social
  determinants of health that are known to be among
  the worst causes of poor health and inequalities
  between and within countries. The determinants
  include unemployment, unsafe workplaces, urban
  slums, globalization and lack of access to health
  systems.

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WHO Commission on Social Determinants of Health

• Canada no health goals
• Embarrassing gap in health status for our
  aboriginal peoples
• Indicators. Suicidethe most poignant
• Persuade the Commission to come to Canada

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Health Goals for Canada

• Canada is a country where

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Health Goals for Canada

• Overarching Goal
• As a nation, we aspire to a Canada in which every
  person is as healthy as they can be
• physically
• mentally
• emotionally
• and spiritually.

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Health Goals for Canada

• Basic Needs(Social and Physical Environments)
• Our children reach their full potential, growing
  up happy, healthy, confident and secure.
• The air we breathe, the water we drink, the food
  we eat, and the places we live, work and play are
  safe and healthy - now and for generations to
  come.

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Health Goals for Canada

• Belonging and Engagement
• Each and every person has dignity, a sense of
  belonging, and contributes to supportive
  families, friendships and diverse communities.
• We keep learning throughout our lives through
  formal and informal education, relationships with
  others, and the land.
• We participate in and influence the decisions
  that affect our personal and collective health
  and well-being.
• We work to make the world a healthy place for all
  people, through leadership, collaboration and
  knowledge.

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Health Goals for Canada

• Healthy Living
• Every person receives the support and information
  they need to make healthy choices.

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Health Goals for Canada

• A System for Health
• We work to prevent and are prepared to respond to
  threats to our health and safety through
  coordinated efforts across the country and around
  the world. (pandemic prep)
• A strong system for health and social well-being
  responds to disparities in health status and
  offers timely, appropriate care.(chronic disease)

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Geoinformatics Technologies (GIS)

• Dr. Cory Neudorf , MOH, Saskatoon

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GIS Map Generator -PHAC

• powerful graphical and
• analytical dimension to public health
• Brings together the fundamental
  epidemiological triad of
• person, time, and the often-neglected
  place.
• 1.The spread of
  diseases over time
• 2.Spatial patterns of outbreaks
• 3.Population groups at risk
• 4.Availability and access to
  health care

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Reportable diseases

• Infectious
• Contagious.social contagion
• Diabetes NY PH A1C
• Mental health problems

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Health Reform ??

• Doing things differently.
• Investments that incent change
• Stop rewarding bad behaviour
• Prevention
• Chronic Disease management
• Whole of government responsibility
• Across jurisdictions
• Accountability for results
• Not boasting about how much is spent

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Chronic Disease Management

• Case manager
• CHF. Sault Ste Marie
• Asthma . Edmonton
• Diabetes Tridec
• Bone and Joint. Dr. Cy Frank, Alta

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Cuba

• GPs Annual report
• patients stopped smoking
• Sedentary
• BP out of control
• Lipids out of control
• Obese
• Rating
• well
• sick
• Disabled

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Patient empowerment

• Our bodies, ourselves
• Change in diabetes mgt.
• Back education unit
• Childbirth
• HIV/AIDS
• Breast cancer
• menopause

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Medical Education

• Undergrad
• Interdisciplinary
• Social determinants
• Social responsibility
• Multicultural
• CME

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Pressure Points

• Public Health Agency of Canada
• Public Health Network
• Patient Safety Institute- Targeting Safer
  Healthcare for Canadians
• AMI, CLI, MedRec, RRT, SSI,VAP
• 3/6 infections
• Canadian Council on Health Services Accreditation
• National Collaborating Centre on Infectious
  Disease
• CIHR Institute of Infection and Immunity

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Breakdown of Costs

• In 2005, Canada spent 142 billion on health
  care, or 10.4 of GDP. Of this amount, 98.8
  billion (or 69.6) were spent by the public
  sector, while 43.2 billion (30.4) were provided
  by the private sector.

data are from Health Care in Canada, 2006 by the
Canadian Institute of Health Information (CIHI).
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Breakdown of Costs cont.

• The 142 billion were distributed among the
  following categories of expenditures
• Hospitals 30
• Physicians 13
• Retail Drugs 17
• Other Professionals 11
• Other Institutions 9
• Public Health 5
• Capital 4
• Administration 4
• Other 6

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Breakdown of Costs cont.

• The proportion of health care spending devoted to
  "acute care" in 2005 amounted to 43, if both
  hospitals' and physicians' services are included.
  
• Emergency preparedness, prevention, the control
  of chronic diseases, food and water safety, early
  childhood development and other population health
  strategies are all included in the category of
  public spending.

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Public Health Agency of Canada Management
Committee

• Dr. David Butler-Jones Chief Public Health
  Officer
• Nicole Cléroux Executive Assistant to the Chief
  Public Health Officer Ottawa
• Sheila Ryan Monette A/Executive Director,
  Corporate Secretariat
• Dr. Frank Plummer Chief Science Advisor

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Health Promotion and Chronic Disease

• Dr. Sylvie Stachenko A/Deputy Chief Public Health
  Officer, Health Promotion and Chronic Disease
  Prevention Branch (HPCDP)
• Claude Rocan Director General, Centre for Health
  Promotion (CHP)
• Dr. Gregory TaylorA/Director General, Centre for
  Chronic Disease Prevention and Control (CCDPC)

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Public Health Practice and Regional Operations

• Dr. David Mowat  A/Deputy Chief Public Health
  Officer, Public Health Practice and Regional
  Operations Branch (PHPRO)
• Maura Ricketts A/Director General, Office of
  Public Health Practice (OPHP)
• Gary Ledoux A/Director General, Regions
• Beth Sherwood A/Regional Director, Atlantic
  Region
• Jean-Louis Caya Regional Director, Québec Region
• Mauricette Howlett Regional Director,
  Ontario/Nunavut Region
• Larry Flynn A/Regional Director,
  Manitoba/Saskatchewan Region
• Don Onischak Regional Director, Alberta/NWT
• Sylvie Bérubé Regional Director, British
  Columbia/Yukon

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Strategic Policy, Communications Corporate
Services

• Jim Harlick Assistant Deputy Minister, Strategic
  Policy, Communications and Corporate Services
  Branch (SPCCSB)
• Élaine Chatigny Director General, Communications
• Luc Ladouceur A/Director General, Finance and
  Planning Directorate
• Chantal J. Morin Director General, Human
  Resources
• Susan Lamont-Baerg Director General, Information
  Management and Information Technology Directorate
• James Gilbert Director General, Strategic Policy
• Jane Allain Legal Services

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Infectious Disease and Emergency Preparedness

• Dr. Robert C. Clarke A/Deputy Chief Public Health
  Officer, Infectious Disease and Emergency
  Preparedness Branch (IDEP)
• Dr. Frank Plummer A/Director General, Centre for
  Infectious Disease Prevention and Control (CIDPC)
  
• Dr. Ron St. John Director General, Centre for
  Emergency Preparedness and Response (CEPR)
• Dr. Frank Plummer Scientific Director General,
  National Microbiology Laboratory (NML) Winnipeg
• Dr. Mohamed Karmali Director General, Laboratory
  for Foodborne Zoonoses (LFZ) Guelph
• Dr. Arlene King Director General, Pandemic
  Preparedness Secretariat

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Only 6 Provinces with Ministers dedicated to
Health Promotion

• Saskatchewan has a Minister of Healthy Living
  Services, Graham Addley
• Manitoba has a Minister of Healthy Living
  Services, Kerri Irvin-Ross
• Ontario has a Minister of Health Promotion, Jim
  Watson
• Nova Scotia has Minister of Health Promotion and
  Protection, Barry Barnet
• In New Brunswick, Premier Shawn Graham is the
  Minister responsible for Wellness, Culture and
  Sport
• Alberta has a Minister of Health and Wellness,
  Dave Hancock

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We are not tinkers who merely patch and mend
what is broken, we must be watchmen, guardians
of the life and health of our generation, so
that stronger more able generations may come
after. Elizabeth Blackwell, M.D.