FromHEALTH CAREtosystems forHEALTH:Family Practice Nurses are key …… Ontario Family Practice Nurses Conference Carolyn Bennett M.D.,M.P. Ottawa
What’s a Doc Like Me Doing in a Place Like Parliament Hill? –the evolution of an MD/MP • Fight for Women’s College Hospital • 1995 – candidate provincial election • “Doctor on Call” • 1997 M.P.
Empowered patients • Effective advocates • Engaged citizens
Women’s health movement = Social determinants of health • Poverty • Environment • Violence • Equity • Education • Shelter
Women’s College Hospital • Patient as Partner • Doctor Multidisciplinary • Hospital Community
Same job !! • Ask people what’s wrong & listen • Opening a chart and helping people through a system • Very few issues of public policy that haven’t been through our office
Patient as PartnerCitizens and Elected Representative • Patient knows body best • I knew the system best…together we could navigate a path • Citizens know ‘what’s working and what’s not’ • My role as an MP … “bottom up”
Sir 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”
Health OR Health CARE • Healthis 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.
“Reorienting health systems” FROM a health CARE system TO a true system for HEALTH
Canadian Institute for Advanced Research • 25% health attributable to health care system • 15% biology and genetics • 10% physical environment • 50% social and economic environments
Humbling reality • The health of our population cannot be the sole responsibility of the Ministry of Health and the health care sector.
Canadian 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
Goal 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
Lalonde 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.
In 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
Ottawa 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;
Ottawa 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;
Ottawa 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;
Ottawa 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;
Ottawa 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;
Ottawa 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.
Affirm Hygeia HYGEIA: Goddess of Health
Learnings….. • Cuba • Chile … President Lagos • Vietnam…. VSF • Thailand… the Xray system..
From Health CARE to Systems for HEALTH
Health CARE Magnetic North Pole
We need Empowered Citizens
Health CARE Health Care Empowered Citizens HEALTH
Empowered Citizens HEALTH
Romanow Report • Discussion paper # 8 • Zimmerman & Glouberman • Complex Adaptive Systems • HIV/Aids Brazil vs Africa
Complexity Theory • Simple • Complicated • Complex
The solutions are complex For every complex human problem, there is a neat simple solution, it’s just that it’s wrong… HL Mencken
Complex doesn’t fit into a 7 second sound bite…..or on a bumper sticker We must fiercely defend the complex solutions for the complex problems .. BUT……we need simpler messages
Citizens have to ‘get it’ • More health …less health care • Service contract ?????? • Or longer warranty ????
The 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.
“Health is Politics” “ If you want to move healthy public policies forward, you have to have political dynamite ” Dr. Halfan Mahler
HOWEVER…… Public policy usually follows public opinion…. BECAUSE……. Doing the right thing is very difficult is the people aren’t onside… • “Father knows best” not great politics
Political Will to do the right thing • Dramatically improves with an educated public…… health literacy • Citizens pulling healthy public policy…. Civic efficacy
Health Literacy Quizversion 1 • ‘surveillance’ • ‘Accessibility’ • Chronic Disease management • Primary Care … provider, setting
“What we have here is a failure to communicate” Cool Hand Luke 1967
Health Literacy Quizversion 2 Empowerment Pulling Healthy Public Policy Putting the Public back into Public Health
1.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 ?
2. Would you prefer: A) Clean air B) Enough puffers and respirators for all