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Improving Population Health:
An Election Wish List
Article for OHPE
by Connie Clement, Executive Director, Ontario Prevention Clearinghouse,
27 September 2007
 Introduction
Invest
in reducing health inequities
Invest
in health promotion resources and infrastructure
Invest
in civil society and community well-being
Invest
in public health
Invest
in the health promoting and prevention capacity of health care
Increase
government fiscal and planning capacity to improve population
health
Conclusion
Introduction
As election promises escalate and voting day
draws near, OHPE readers will reflect on how we each use our vote
and what we're asking of the elected provincial government. No
party has a platform that puts population health front and centre;
in fact, some concerns common to OHPE readers are not highly evident.
By most estimates, just less than 2% of health
spending --federally, provincially and in the territories--goes
to prevention and heath promotion. Social-safety-net spending--critical
to a healthy population and healthy individuals--has not recovered
from the provincial downloading to municipalities and deep cut-backs
in the 1990s.
It's an unusual opportunity to get to write
to several thousand respected colleagues to promote a wish list
to improve population health. What you're about to read is challenging,
yet doable; reasoned, though not exhaustive. I hope you'll join
me in calling upon the government elected to take the following
actions.
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Invest in reducing health inequities
The negative impact of social service cuts is
still widespread. The greatest impacts on health can be generated
by increased social spending and liberalized social policies.
My vote for best return on investment goes squarely to advancing
early child development and learning. Returns occur immediately
and continue for a lifetime.
Thus, I call on the incoming government to implement
the recommendations of its recent Early Learning Panel (an initiative
of this government's Best Start strategy). This will need to include
investments in early learning; continuing the Best Start and Healthy
Babies, Healthy Children programs; and ensuring that the Ontario
Child Benefit keeps families well above the poverty line.
At the same time, to help children, we must
improve the capacity and conditions of families and the "villages"
in which they live. Of the election challenges that I've read,
the Registered Nurses Association of Ontario (RNAO) defines the
strongest actions, including raising the minimum wage to $10 per
hour, reviewing and enforcing the Employment Standards Act, raising
social assistance rates by 35% and indexing them to inflation,
and raising Ontario Disability Support Plan rates by 20% and indexing
them to inflation
To this, as the Association of Ontario Health
Centres promotes, we should add uploading health and social service
back to the province.
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Invest in health promotion resources and infrastructure
The new government should rapidly follow
through on redesigning the Ontario Health Promotion Resource System
to maximize partnership, develop coherent and coordinated functions
and service delivery from their partners in nongovernmental organizations,
and reduce fragmentation. To revitalize this system will require
transformation investment and long-term changes in government-civil
society partnership. Collaboratively we need to create a clear
and inspiring health promotion vision, and then identify common
interests and establish goals. Government, and others, must invest
long-term to fund--at a level equivalent to those for medical
treatment and care--the processes and products necessary to support
capacity development; knowledge synthesis, translation and exchange;
advocacy; program and policy implementation; best practices identification;
and evaluation and applied research.
A start would be to double the budget
of the Ministry of Health Promotion! Another major step would
be to invest in a prevention system to complement our health care
system. A proposal for such a system submitted to government by
the Ontario Chronic Disease Prevention Alliance offers a starting
point.
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Invest in civil society and community
well-being
In the past two decades, we have seen government
partnerships with the populace undermined, especially under the
Harris-led Conservative government during the 1990s. It is critical
that the government elected in October fund nonprofit organizations
such that community members have the capacity to engage with government.
Further, that funding must ensure that all people in Ontario have
that capacity including new Canadians, First Nations and others
who are marginalized. Ontario would benefit from more good old-fashioned
community development and a revitalized healthy communities movement!
At the same time,
I call upon government to revisit its funding mechanisms to nonprofit
organizations. Across Canada non-profits are crippled by short-term,
project funding that is not indexed to inflation and that does
not adequately support core management and administration. The
Ministry of Health Promotion, as an example, does not link its
grants to inflation, resulting in less real-dollar spending annually
for its non-profit partners. Despite this limitation, many of
the recipient organizations achieve geographic service reach and
client number increases!
And, the limitations
on so-called advocacy must end. Ontario would not be smoke-free
today without the critical role that communities played in leading
the charge . Imagine what a robust civil society can do to contribute
to healthy public policies addressing a wider gamut of health
concerns.
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Invest in public health
I call on the government to develop an equivalent
wait-times strategy for public health, social services, education,
recreation, etc. We need the research, analysis and communications
to demonstrate to the public the astounding negative impact of
failing to promote healthy communities, enrich public health,
and prevent illness through early interventions. We need a government
willing to design and deliver on a 10-year Healthy Ontario Strategy,
not a 10-year health system plan developed by the Ministry of
Health and Long-Term Care.
I want a government that will rapidly and fully
implement the proposed public health program standards, and ensure
that all health units are resourced to meet these standards with
abundance, with adequate funding for provincial public health
coordination and watchdog functions. And, please ensure that the
Ontario Agency for Health Promotion and Protection is implemented
rapidly, with enhanced investments. The government must direct
the new Agency to step into the full breadth of public health
practice, not focus almost exclusively on infectious diseases.
Further, I'd like a new government that will
require all health units to define advocacy and interventions
to improve determinants of health as core public health work.
Such a requirement will help fulfill recommendations made by the
Ontario Public Health Association, the Association of Public health
Agencies, the Council of Medical Officers of Health and will deliver
on core expertise embedded in the draft public health competencies
being developed by the Public Health Agency of Canada.
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Invest in the health promoting
and prevention capacity of health care, especially primary care,
care-providing community services and self-management/self-care
strategies.
I'm excited about the potential of the forthcoming
10-year health system strategy. This strategy must ensure community
health centres throughout the province, including better funded
and more Aboriginal health access centres. Local Health Integration
Networks, which have regional authority for hospitals and community
health centres, must be accountable for working closely with public
health units and primary care practitioners (especially family
health teams).
We must end the gap and sometimes tension between
providers treating illnesses and helping people manage disease
and those of us promoting health. It fragments effectiveness and
wastes energy. I call on our next government to help close this
divide. I recommend that they invest in a strategy and infrastructure
to provide expert health promotion advice and knowledge synthesis/translation
for the health care sector, especially - but not exclusively -
primary care.
Specifically, they need to invest in health
promotion information an amount comparable to information investments
in health care. This includes creating the capacity to collect,
assess and disseminate health promotion resources, and information
as part of regional and provincial databases and portals (e.g.,
local health information network databases to support effective
referrals; healthyontario.ca; community information centres, community
care access centres) and to broker effective exchange of information
and linkages between Ontario and other key databases/portals (e.g.,
Canadian Health Network, healthycanadians.ca; the Public Health
Agency of Canada's health promotion and chronic disease Best Practices
Portal).
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Increase government fiscal
and planning capacity to improve population health.
Again, kudos to the RNAO for having the insight
to call on the government to increase its own fiscal capacity
through tax policies to increase revenues to enhance the health
of Ontarians through increased social spending. To this I add,
invest in prevention, health promotion and public/community health
specifically.
We're learning more and more about the importance
of whole- government approaches to improve population health.
Let's challenge the incoming government for leadership in population
health through the Minister of Health Promotion and transform
the existing inter-ministerial committee's mandate to help government
address health inequity. Let's ask that the new government to
implement health-impact assessment policy and procedures that
will apply to all new legislation before the end of this term
of office.
My final wish in this list is that the new Ontario
government contributes to pan-Canadian efforts to develop new
ways of monitoring population health progress. This includes setting
population health indicators as part of Ontario's 10-year health
system plan, breathing life into Canada's 2-year-old and languishing
public health goals, and contributing to the refinement and adoption
of the proposed Canadian Index of Wellbeing.
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Conclusion
The investment for this wish list may look large;
yet in context, it remains manageable and relatively small compared
to investments in health treatment and military spending. It's
a vital investment for health.
Please take the time to read the election
"asks" that are gathered on the OHPE site. Our colleagues
and partners at many of Ontario's nongovernmental organizations
have thoughtfully compiled advice to our political parties. My
wish list is just one take, written quickly - it is the slice
I make today as I write, not the perfect slice.
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