Public health renewal building a system to meet the needs of nova scotians
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Public Health Renewal: Building a System to meet the Needs of Nova Scotians. Dr. Robert Strang, Chief Public Health Officer Public Health Association of Nova Scotia Nov. 13 th , 2007. Public Health.

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Public Health Renewal: Building a System to meet the Needs of Nova Scotians

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Public Health Renewal: Building a System to meet the Needs of Nova Scotians

Dr. Robert Strang, Chief Public Health Officer

Public Health Association of Nova Scotia

Nov. 13th, 2007

Public Health

  • Science and art of promoting health, preventing disease, prolonging life and improving quality of life through the organized efforts of society.

Public Health in England (Acheson Report), 1988

Public Health – Contributes to:

  • Improved levels of health status of the population and decreased health disparities

  • Decreased burden on the personal health services system and thereby contribute to its sustainability

  • Improved preparedness and response capacity for health emergencies

F/P/T Improving Public Health System Infrastructure Report, 2005

Public Health System Core Functions

  • 5 core functions:

    • Population health assessment

    • Health surveillance

    • Disease and injury prevention

    • Health promotion

    • Health protection

F/P/T Advisory Committee on Population Health (ACPH)

How we do our work: Using a Population Health Approach

  • Focus on the health of populations

  • Address the determinants of health and their interactions

  • Base decisions on evidence

  • Increase upstream investment

  • Apply multiple strategies

  • Collaborate across sectors and levels

  • Employ mechanisms for public involvement

Historical Perspective

  • Learning from SARS (November 03)

  • Public Health Review Process

    • Terms of Reference of Review approved (CEOs, SLT)

    • Expert External Review Team

    • Provincial Advisory Committee

    • Engagement of local and provincial levels

    • External Consultant – Dr. Brent Moloughney

  • Public Health Review

    • Oct 04 Consultant hired and review begun

    • Sept 05 final report completed

    • Jan 06 Cabinet approval

    • Feb 06 Dept of HPP established

    • April 06 Report released

    • Spring-Winter 06 establishing the new Dept

    • April 07 Major budget increase

    • Aug 07 CPHO appointed

  • Review’s major findings

    • Improve structure & capacity provincially

    • Improve structure & capacity locally

    • Improve integration between system levels

    • Improve integration with rest of health system

    • Address infrastructure- people- information- organization

    Review’s major findings

    • 21 Actions for system renewal

    • Significant work required

      • Deterioration over a decade; fix will take a decade

    • Actions for Renewal are all inter-dependent

      • Cannot pick and choose

    • Most “actions” are projects unto themselves

    • Many important decisions within the actions

      • Will require system thinking and involvement of all players

    • System renewal must occur while system remains operational

    • Comprehensive in nature

    • Provide the path for renewal

    What’s happened to date?

    • New Department announced in Feb 2006 (#4)

    • Chief Public Health Officer appointed (#2)

    • Provincial organization re-organized and implemented and major recruitment underway (#3)

    • Interdepartmental activity and commitment to environmental health secretariat (#6)

    • Liaison with Atlantic Provinces and academic partners on opportunities for collaboration (#7, 8, 9, 17)

    • PANORAMA:CDC component of information system development (#10)

    • Public health laboratory project (#13)

    • Ongoing Pandemic planning in partnership with DOH (#15)

    • Multi-year budget for system renewal completed (#16)

    • Ongoing liaison with Public Health Agency of Canada (PHAC) (#19)

    • Project team for implementation under recruitment (#21)

    HPP Vision

    Helping Nova Scotians to be healthier and safer

    HPP Mission

    We will lead the collaborative effort to prevent illness and injury, promote and protect health and reduce disparities in health status

    HPP Strategic Goals

    Improve the health of the population.

    Support capacity building within government, communities, families and individuals.

    Create supportive social and physical environments.

    Develop and influence policy that supports improved health.

    Create and sustain a sufficient, competent and healthy workforce in HPP and throughout the public health system.

    Guiding Principles

    • Foundation. We are grounded in the principles of community development and committed to a population health approach to our work.

    • Partnership. We will work in a collaborative, transparent and responsive way.

    • Integration. We will work within and across disciplines, sectors and organizations.

    • Evidence Informed. We will make decisions based upon the best available information.

    • Accountability. We will be responsible for our individual and collective actions.


    We believe in creating a culture that inspires all of us to achieve our best. We believe in being responsive and decisive.


    We believe in openness, honesty, trust, respect and acknowledging the contributions made by all.


    We believe in the importance of teamwork and open communication.


    We believe in achieving our goals through a spirit of creativity and exploration.


    We believe in continuous learning, self –improvement, personal wellness and professional development.

    Practice what we preach

    Doing the right thing

    The whole is greater than

    the sum of its parts

    Thinking outside the box

    Life-long learning

    HPP Values

    New Departmental Structure

    Key Public Health Issues and Why Are These Important To Nova Scotians

    • Environmental Sustainability → future generations

    • Chronic Disease and Injury Prevention → sustainability of health care system economic impact

    • Mental Health & Addictions → under-recognized; societal impact; underlying factor for other key issues

    • Early Childhood Development → primordial prevention

    • (Re) Emerging Infectious Diseases → credibility and risk management

    • Shared theme of health disparities → equity

    How To Address These Issues More Effectively

    • Provide leadership

    • Enhance partnerships

    • System’s thinking

    • Longer term thinking

    • Build capacity

    • Create supportive environments

    • Strong public health system

    Requirements for a Strong PH System

    • systems approach

    • commitment to all PH functions

    • information & evidence

    • integrated settings based approach

    • leadership & catalyst for change

    • collaboration

    • community development

    Key Public Health Partners

    • Prov. Govt departments

    • Academia

    • NGOs

    • PHAC/Health Canada/Environment Canada/ CFIA

    • FNIHB/ First Nations communities

    Key Partners & PH System

    • Need shared dialogue to develop common understanding of

      • PH functions & PH system

      • system level roles & responsibilities

      • leadership

      • decision making

      • accountability

      • communication

      • integration with rest of health system

    Short Term Goals (where to next)

    • Establish presence of CPHO

    • Build teams at provincial, local and systems level

    • Engage partners at local, provincial and national level

    • High gear business planning for 08-09

    • Maintain momentum

    Discussion Points

    • How to strengthen links between PH system and PHANS?

    • Role of PHANS in PH renewal?

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