University of Saskatchewan, College of Nursing

1
Public Health in Canada
University of Saskatchewan, College of
Nursing Dr. Gregory Taylor Director
General Office of Public Health Practice January
22, 2008
2
Outline

• Context
• Public Health Agency of Canada
• Public Health Network
• Initiatives and Priorities
• Immunization
• Opportunities

3
Public health is a joint effort

• Organized efforts of society to keep people
  healthy

• Collaborative efforts by governments are needed
• But front line workers are the true heroes

4
And has yielded great success

• Department of Health created in response to
  Spanish Flu
• Food Guide
• Family allowance, EI
• Eradication of polio
• Hospital insurance
• Medical Care Act
• Oral contraceptives
• Seatbelts
• Understanding of social determinants
• Tobacco Control

5
And the world and Canada is changing

• Emerging and reemerging diseases
• SARS The Wake Up Call
• Globalization
• Environment
• Terrorism
• Urbanization
• Advances in technology
• Evolving culture and values
• Widening income gap in Canada
• Aging population

bringing new challenges
6
And we learned from SARS

• Health professionals rose to the challenge
• Nature is inventive and unpredictable
• Next crisis is a plane ride away
• Wake-up call for public health
• Underlying chronic disease mortality
• Majority of those who died from SARS in Canada
  had underlying chronic disease
• Naylor report outlined key areas for improvement
  of public health system
• Leadership
• Capacity
• Communications and cooperation

7
Impacts of SARS beyond public health

• Economic costs of SARS
• 519 M in lost tourism 2003 and 722 M between
  2003-06
• Fear and social perceptions of risk
• A few deaths from SARS shut down a city
• Same number die from chronic disease every hour
• Perspective is important - Influenza in Canada
• Average of 4,000 deaths a year
• Best pandemic projections 11,000 to 58,000
  deaths
• So more deaths occur between pandemics than
  during

Canadian Tourism Commission
8
Creation of the Public Health Agency

• Public Health Agency and Chief Public Health
  Officer created in 2004
• MissionTo promote and protect the health of
  Canadians through leadership, partnership,
  innovation and action in public health.
• Vision Healthy Canadians and communities in a
  healthier world.

9
To fulfill key public health functions

• Population Health Assessment
• Surveillance
• Health Promotion
• Prevention of Disease and Injury
• Health Protection
• Emergency Preparedness and Response

10
How we are organized program branches

• Infectious Disease and Emergency Preparedness
  Branch
• Centre for Communicable Diseases and Infection
  Control
• Centre for Emergency Preparedness and Response
• Centre for Immunization and Respiratory
  Infectious Disease
• Centre for Food-borne, Environmental and Zoonotic
  Infectious Disease
• National Microbiology Laboratory (Winnipeg)
• Laboratory for Foodborne Zoonoses
• Policy Integration, Planning and International
  Directorate
• Health Promotion and Chronic Disease Prevention
  Branch
• Centre for Chronic Disease Prevention and Control
• Centre for Health Promotion
• Transfer Payment Services and Accountability
  Division
• Strategic Initiatives and Innovations Directorate
  
• WHO Collaborating Centre on Chronic Disease
  Policy
• Office of Public Health Practice
• Workforce Development Division
• Surveillance Policy and Public Health Law and
  Ethics Division

11
The Pan-Canadian Public Health Network

• A F/P/T network to
• Share knowledge and best practices
• Facilitate communications
• Develop public health strategies for Canada
• Enhance surge capacity
• Led by Council of senior public health
  representatives from all jurisdictionsin Canada
• PHN Council co-chaired by the CPHO of Canada and
  BCs CMOH

12
Working together to resolve Pan-Canadian issues

• FPT Expert Groups
• Communicable Disease Control
• Emergency Preparedness and Response
• Canadian Public Health Laboratory
• Surveillance and Information
• Non-Communicable Disease and Injury Prevention
  and Control
• Health Promotion
• Liaison Committees
• Health and Environment
• Substance Use and Abuse
• Tobacco Control
• HIV/AIDS
• Task Groups (time limited)
• Public Health Human Resources
• Antivirals for Prophylaxis
• Roles and Responsibilities in Pandemic
  Preparedness

13
Building public health capacity is key

• Skilled workforce is a key to success
• Key challenges for Canada
• Not enough public health professionals
• Uneven distribution (rural and remote areas)
• No common measure to quantify the gap
• Little surge capacity in case of an outbreak
• Not enough training opportunities
• Aging public health workforce

14
Support for public health professionals

• On-line continuing education
• Canadian Public Health Service (NEW!)
• Canadian Field Epidemiology Program
• Scholarships
• Public Health Research Chairs
• PHAC development programs

15
Core competencies in public health
Public Health Human Resources Task Group
identified 36 Core Competencies organized under
7 categories

• Public Health Sciences
• Assessment and Analysis
• Policy and Program Planning, Implementation
  Evaluation
• Partnerships, Collaboration and Advocacy
• Diversity and Inclusiveness
• Communication
• Leadership

16
Role of nurses is key

• Expanded, pro-active role can reduce wait times
  (CNA)
• PHAC support to nurses
• Supported First Annual CHNAC Conference 2007
• Grants to CHNAC and CASN to support public health
  nursing
• Workshops to support implementation of the
  Canadian Community Health Nursing Standards
  (Saskatoon Feb 28th)
• Pan-Canadian public nurse leaders meetings

17
Addressing other public health priorities

• Major public health challenges
• Infectious disease (pandemic influenza HIV/AIDS)
• Chronic disease (Diabetes)
• Obesity
• Mental health
• Immunization
• Global public health (WHO)
• Health determinants and disparities
• Aboriginal people, children, seniors
• Environment
• Integrated information and knowledge functions
• Surveillance and regulations
• Science, research and knowledge translation
• Accountability, managing for results

18
Health inequalities in Canada

• Despite a robust economy and overall improvements
  in health, inequalities persist.
• Socio-economic Status
• Lower socio-economic status is associated with
  reduced life expectancy, higher infant mortality,
  low birth weight, increased incidence of
  cardio-vascular disease, infectious disease,
  injury and suicide
• Aboriginal Identity
• Aboriginal peoples have shorter life spans,
  higher death from suicide, accident and injury,
  and higher diabetes rates.
• Gender
• Women live longer but suffer more from chronic
  disease. Income related health gaps are larger
  for men.
• Geographic Location
• - People living in Canadas northern remote
  communities have the worst disability-free life
  expectancy and lowest life expectancy in the
  country.

19
Socio-economic gradients in health

• Everyone benefits from addressing social
  determinants
• Health status improves in a stepwise manner for
  each increment in the following
• Income social status
• Education
• Employment working conditions
• This remains true across various measures of
  health and across many countries
• All of these variables are interconnected and
  generally thought of as proxies for power,
  control

20
(No Transcript)
21
Canadas Reference Group on Social Determinants

• Supports Canadas contributions to WHO Commission
  on Social Determinants
• PHAC and National Collaborating Centre for
  Determinants of Health are members
• Mobilizes national action on social determinants
• International sharing of knowledge, best
  practices

22
Health and social policy in Canada

• Many key levers for addressing social
  determinants of health are at provincial level
• i.e. universal education, health care service
  delivery, welfare payments
• Federal level fulfills a variety of roles
• National leadership and support to provinces
• Taxes and transfers
• Employment insurance
• Regulation, standards, policy frameworks
• Information, surveillance
• Prevention/promotion programming

23
State of Evidence

• Excellent knowledge of
• What determines health at a population level
• Key health inequalities in Canada
• Good improving knowledge of
• Range of policies and mechanisms needed to
  address social determinants and inequalities
• Potential Health sector roles
• Further knowledge development needs
• Effectiveness of interventions to address social
  determinants inequalities
• Best mix of policy approaches for use in Canada

24
An emerging public health issue obesity

• 26 of Canadian children (age 2-17) and 59 of
  adults are obese or overweight (2005)
• Obesity in children almost most tripled between
  1978 (3) and 2004 (8)
• Increased health risks in adulthood
• Reports of rising Type 2 diabetes, childhood
  hypoerlipidemia, hypertension
• Is obesity the new tobacco?

25
Obesity Trends Among Canadian Adults HPS, 1985
26
Obesity Trends Among Canadian Adults HPS, 1990
27
Obesity Trends Among Canadian Adults NPHS, 1994
28
Obesity Trends Among Canadian Adults NPHS, 1998
29
Obesity Trends Among Canadian Adults CCHS, 2000
30
Obesity Trends Among Canadian Adults CCHS, 2003
31
Increasing profile of public health

• Chief Public Health Officer for Canada
  independent voice on public health issues
• Legislated to issue Report annually on the state
  of public health in Canada
• Bringing public health perspective to broader
  social policy
• Increasing awareness about importance of public
  health

to shift focus to prevention
32
National Immunization Strategy

• Launched in 2003 to strengthen collaboration with
  P/Ts and stakeholders to improve effectiveness of
  immunization programs
• Key results include
• Better harmonization of immunization programs
• Improved vaccine supply management
• Improved vaccine safety monitoring
• Coordinated public education campaigns
• Identified important research priorities

Immunization saves more lives and prevents more
suffering everyday than any other medical
intervention.

• 2004 - support to P/Ts in introducing programs
  for 4 vaccines
• HPV Vaccine Trust (2007)

33
HPV vaccine

• HPV one of the most common sexually transmitted
  infections in Canada (75 of sexually active
  Canadians will have at least one type of HPV
  infection in their lifetime).
• GardasilTM HPV Vaccine protects against four HPV
  types which cause the vast majority of cervical
  cancers or anogenital warts.
• Based on the evidence, the National Advisory
  Committee on Immunization advised the use of
  Gardasil in 2007 for girls between 9 and 13
• Four provinces (Ontario, PEI, NL and NS) launched
  school-based programs in 2007
• The F/P/T Canadian Immunization Committee (CIC)
  will soon provide programmatic recommendations on
  the HPV vaccine

34
Public Health Opportunities

• Investments in public health recognized as a
  public good
• Opportunities to reduce inequalities in health
• Balance of promotion, prevention, protection and
  treatment
• Collaborative, coordinated, multi-sectoral
  leadership at all levels
• community, regional, provincial, national, and
  international levels

35
You are public health
Public health practitioners on the front line
36
Contact information

• www.phac-aspc.gc.ca
• gregory_taylor_at_phac-aspc.gc.ca
• [phone]