Title: From HEALTH CARE to systems for HEALTH: Family Practice Nurses are key
1From HEALTH CARE to systems for
HEALTHFamily Practice Nurses are key
-
- Ontario Family Practice Nurses Conference
- Carolyn Bennett M.D.,M.P.
- Ottawa
-
2(No Transcript)
3Whats a Doc Like Me Doing in a Place Like
Parliament Hill? the evolution of an MD/MP
- Fight for Womens College Hospital
- 1995 candidate provincial election
- Doctor on Call
- 1997 M.P.
4- Empowered patients
- Effective advocates
- Engaged citizens
5Womens health movement
- Social determinants of health
- Poverty
- Environment
- Violence
- Equity
- Education
- Shelter
6Womens College Hospital
- Patient as Partner
- Doctor Multidisciplinary
- Hospital Community
7Same job !!
- Ask people whats wrong listen
- Opening a chart and helping people through a
system - Very few issues of public policy that havent
been through our office
8Patient as PartnerCitizens and Elected
Representative
- Patient knows body best
- I knew the system besttogether we could navigate
a path - Citizens know whats working and whats not
- My role as an MP bottom up
9Sir Michael MarmotChair, 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
10Health OR Health CARE
- Health is a state of complete physical, mental
and social well-being and not merely the absence
of disease or infirmity. (WHO 1948) - Health Care - The prevention, treatment, and
management of illness and the preservation of
mental and physical well-being through the
services offered by the medical and allied health
professions.
11Reorienting health systems
- FROM
- a health CARE system
- TO
- a true system for HEALTH
12Canadian Institute for Advanced Research
- 25 health attributable to health care system
- 15 biology and genetics
- 10 physical environment
- 50 social and economic environments
13Humbling reality
- The health of our population cannot be the sole
responsibility of the Ministry of Health and the
health care sector.
14Canadian legacy
- Tommy Douglas Father of Medicare
- Lalonde Report 1974
- Ottawa Charter 1986
- SARS, Naylor Report 2003
- WHO Commission SDOH 2005
- Health Goals for Canada 2005
15Goal of Medicare Tommy Douglas
- 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
16Lalonde Report (1974)
- The Government of Canada, in cooperation with
others, will pursue two broad objectives - 1. To reduce mental and physical health hazards
for those parts of the Canadian population whose
risks are high, and - 2. To improve the accessibility of good mental
and physical health care for those whose present
access is unsatisfactory.
17In pursuit of these two objectives, five
strategies are proposed
- 1. A Health Promotion Strategy
- 2. A Regulatory Strategy
- 3. A Research Strategy
- 4. A Health Care Efficiency Strategy
- 5. A Goal-Setting Strategy
18Ottawa Charter for Health Promotion (1986)
- The participants in this Conference pledge
- 1. to move into the arena of healthy public
policy, and to advocate a clear political
commitment to health and equity in all sectors
19Ottawa Charter for Health Promotion (1986)
- 2. to counteract the pressures towards harmful
products, resource depletion, unhealthy living
conditions and environments, and bad nutrition
and to focus attention on public health issues
such as pollution, occupational hazards, housing
and settlements
20Ottawa Charter for Health Promotion (1986)
- 3. to respond to the health gap within and
between societies, and to tackle the inequities
in health produced by the rules and practices of
these societies
21Ottawa Charter for Health Promotion (1986)
- 4. to acknowledge people as the main health
resource to support and enable them to keep
themselves, their families and friends healthy
through financial and other means, and to accept
the community as the essential voice in matters
of its health, living conditions and well-being
22Ottawa Charter for Health Promotion (1986)
- 5. to reorient health services and their
resources towards the promotion of health and to
share power with other sectors, other disciplines
and, most importantly, with people themselves
23Ottawa Charter for Health Promotion (1986)
- 6. to recognize health and its maintenance as a
major social investment and challenge and to
address the overall ecological issue of our ways
of living.
24 Fantasy
25The Em PHA sis is on the wrong syl
LAB le
26Fleeing the Medical Model,Embracing the Medicine
Wheel
27Blame Hippocrates?
28Affirm Hygeia
HYGEIA Goddess of Health
29Learnings..
- Cuba
- Chile President Lagos
- Vietnam. VSF
- Thailand the Xray system..
30From Health CARE to Systems for HEALTH
31 Health CARE Magnetic North Pole
32 We need a strong opposing force for HEALTH
33 We need
Empowered Citizens
34 Health Care
Health CARE
Empowered Citizens
HEALTH
35 Empowered Citizens
HEALTH
36Romanow Report
- Discussion paper 8
- Zimmerman Glouberman
- Complex Adaptive Systems
- HIV/Aids Brazil vs Africa
37Complexity Theory
- Simple
- Complicated
- Complex
38The solutions are complex
- For every complex human problem, there is a
neat simple solution, its just that its wrong - HL Mencken
39Complex doesnt fit into a 7 second sound
bite..or on a bumper sticker
- We must fiercely defend the complex solutions for
the complex problems .. - BUTwe need simpler messages
-
40Citizens have to get it
- More health less health care
- Service contract ??????
- Or longer warranty ????
41The 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.
42Health is Politics
- If you want to move healthy public policies
forward, you have to have political dynamite - Dr. Halfan Mahler
43- HOWEVER
- Public policy usually follows public opinion.
-
- BECAUSE.
- Doing the right thing is very difficult is the
people arent onside - Father knows best not great politics
44Political Will to do the right thing
- Dramatically improves with an educated public
health literacy - Citizens pulling healthy public policy. Civic
efficacy
45Health Literacy Quizversion 1
- surveillance
- Accessibility
- Chronic Disease management
- Primary Care provider, setting
46 What we have here is a failure to
communicate Cool Hand Luke 1967
47Health Literacy Quizversion 2
Empowerment
Pulling Healthy Public Policy
Putting the Public back into Public Health
48Public Health 101
491.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 ?
502. Would you prefer
- A) Clean air
- B) Enough puffers and respirators
- for all
513. 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
524.Should we invest in
- A) early learning, child care, literacy,the
early identification of learning disabilities and
bullying programmes - B) increase the budget for young offenders
incarceration
535.Should we
- A) assume that the 'grey tsunami' will bankrupt
our health care system - B) include our aging population in the planning
of strategies to keep them well
546. Is the best approach to food security
- A) food banks and vouchers
- B) Income security,affordable housing, community
gardens and community kitchens and a national
food policy
557. Pick the one that is NOT correct
- Pandemic Preparedness should focus on
- Tamiflu for all
- Working with the vets to keep avian flu a disease
of birds - Making sure people wash their hands especially
the doctors and nurses - Research on vaccines
- Community care plans for our most vulnerable
568.Governments should boast about
- how much they spent on the sickness care system
- the health of their citizens, leaving no-one
behind
57teachable moments
- 2003
- Canada 44 died of SARS
- France14,000 died in the heat wave
- 2005..Katrina, Kasheshewan
58Beyond borders. SARS as a teachable moment
- Beyond silos
- Departments
- Disciplines
- Beyond jurisdictional squabbling
- Germs dont respect borders
- Neither do the social contagions
- Nor the humanitarian imperatives
59Social Determinants of Health vsChoose
Health(modifiable risks)
60The Causes of the Causes
61Evolution of the Healthy Canadians Tree
62(No Transcript)
63CommuniquéFMM September 2004
- In addition, governments commit to accelerate
work on a pan-Canadian Public Health Strategy.
For the first time, governments will set goals
and targets for improving the health status of
Canadians through a collaborative process with
experts.
64Progress
- First MoS Public Health 2003-2006
- Public Health Agency of Canada
- Chief Public Health Officer
- Public Health Network for Canada
- Health Goals
- National Collaborating Centres
- Knowledge Networks for the SDOH Commission
65Health Goals for Canada
-
- As a nation, we aspire to a Canada in which
every person is as healthy as they can be
physically, mentally, emotionally and
spiritually. -
66Changing the way we do things..
- Measurement
- Process
- Structure
- People
- Research
67Better Data
- E-Rx
- Dx and Rx
- Birth defects, injuries, diseases etc
- Incentives for reporting
68The mobilization of shameIrwin Cotler
Management 101 If its measured it gets
noticed, if its noticed it gets done
69With the Public Health Map Generator, you can
produce high quality, detailed maps of your own
health data, in combination with extensive
geography from our spatial data warehouse
70The Public Health Map Generator is a secure,
web-based mapping application, accessible only to
clients registered with the GIS Infrastructure at
the Public Health Agency of Canada.
GIS User
All of the Infrastructures services, including
the Public Health Map Generator, are available at
no cost to all public health professionals in
Canada.
71Scotland Honourable Andy Kerr
- Health outcomes down to postal code
- Letter from Family Doctor
- Interventions
- Already paying off
72Process .Health in all Policies
- Article 54 in PQ
- HIA. All MCs , budget, TB guidelines
- Citizen Engagement
73Structure Gridlock
horizontal departments
vertical - jurisdiction
74Structure
- Silo- busting - Horizontality
- Ministries or Ministers
- Cabinet committees
- Parliament
- Officers of Parliament - Commissioners
75Structure
- Jurisdictional squabble
- SARS . Naylor report..
- Collaboration
- Cooperation
- Communication
- Clarity of who does, what, when
76People
- Need to attract generalists
- Interdisciplinary care
- Scope of Practice replaced by
- Core Competencies
- Self-care
77HHR Training
- Interdisciplinary
- Social Responsibility
- Cultural Sensitivity
- Social Determinants of Health
- PUBLIC HEALTH
78Family Practice role in Public Health Getting
credit !!!
- Health promotion
- Disease and injury prevention
- Health literacy
- Link community, hospitals
- Mental Health
- Addictions
- Chronic Disease Mgt.
- Self care
79Research.Learning Culture
- Evidence-informed practice
- Practice-informed evidence
- Courage to fund what works
- Courage to stop funding what doesnt
- Complex adaptive systems
80Sir 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.
81No time for pessimists
82 Research
Practice
Policy
83 Research
KT
Practice
Policy
84Research
KT
Practice
Policy
Political will
85Research
Applied research
KT
Practice
Policy
Political will
86Engaged citizens
Research
Applied research
KT
Practice
Policy
Political will
87Health Care
Empowered Citizens
Systems for HEALTH
Systems for HEALTH
88M.D.
- 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 Wanless Report UK
2003commissisoned by Gordon Brown