Toronto - Beaches Roundtable Report
April 14th, 2004
In Toronto - Beaches, the Minister of State met approximately nine local
public health stakeholders.
1. Regarding a Mandate for a Public Health Agency of Canada:
Collaboration and Transparency
- The Agency must focus on the roles of public health within various
jurisdictions. Principles of collaboration and information sharing
are key factors to achieving a strong Public Health Agency of Canada.
These principles of collaboration and information sharing must be built
into the ground rules in meaningful way. For example, within the housing
sector, all levels of government participated and all levels had valuable
input.
- Utilization of a federal policy lens which reflects implications
of policy making on public health in government, for example, the creation
of a Ministry responsible for homelessness hinders integration.
- To use the federal public health role as a national platform for
priority setting within public health, and then to act on it through
education, integration, and information sharing mechanisms such as
data systems and communication systems.
- Enhancement of inter-Ministerial and intra-Ministerial communication.
For example, the Minister of Sport, Minister of Health and Minister
of Education should communicate regularly.
- The Agency must address specific issues that relate to geographic
disparity. For example, specific public health issues and challenges
arise in urban environments, which may be different from rural environments,
which may be different from remote environments, etc.
- Continuation with Health Canada's focus on health promotion
and the social determinants of health, including education.
- The Agency must be responsive to multiple health needs, including
various linguistic groups and various cultural minority groups.
Citizen / Stakeholder Engagement
- Utilization of previous citizen engagement processes proved to be
effective, for example, stakeholder consultations through the Office
of Consumer Affairs and Public Involvement.
Privacy Legislation
- The Agency must recognize that concerns exist with privacy legislation
(federal and provincial) with respect to sharing information in a timely
way in an emergency situation. For example, with the creation of an
electronic health record, patient information may be shared efficiently.
Creative ways of sharing information in a timely way must be considered.
2. Regarding Operational Strategies for a Public Health Agency of Canada:
- An Agency should consider:
- Time and money should not go to building the Agency, but rather
to the substantive issues that prompted its creation.
- Focus on a chronic disease prevention strategy. Prevention
work can be achieved through the utilization of existing social
organizations and the Agency should mandate them to look at various
health concerns, for example, cardiovascular disease and diabetes.
- Consideration of Canada's international role and exploration
ways of utilizing Canada's wealth of resources and knowledge
within an international public health community.
- Exploration of and utilization of domestic best practices
such as the Vancouver Tripartite Agreement, and international
best practices, such as the Austrian System with respect to decreasing
wait times for most procedures (except open heart surgeries wait
of 6 months), in order to reduce duplication.
- Communication
- During the SARS experience, there was a lack of communication
with the community with respect to information dissemination
or guidelines on what to do. One-on-one communication strategies
with community workers, who can do prevention work, education
work and delivery of health care services, must be developed.
3. Investments:
Participants urged an Agency to focus on the following priority
investments:
- Communications / I.T
- Information sharing and key messages must be delivered in
a clear and consistent way from the federal government all the
way to community organizations.
- Data systems, communication systems and other mechanisms must
be put in place to share public health information in a timely
way.
- Increased technical human resources working with data management
would be beneficial, since a lack of information management professionals
and technical expertise exists.
- Utilization of existing strengths with respect to data management
and technical expertise without duplication or replication.
- Funding Environment
- Infrastructure money is needed for the development of core
funding for agencies that deliver programs. Currently, agencies
use the strength of voluntary sector. Agencies are facing years
and years of project based funding, with no core funding. With
that type of funding environment, a lack of accountability exists,
since there is no funding for human resources or information
technology. Programs and services delivered by community agencies
cannot function without core funding for human resources, computers,
and other operational expenses.
- Utilization of resources that already exist in many communities
to avoid putting more dollars into training public health professionals.
For example, naturopathic doctors may be useful in health promotion
advocating for proper nutrition, diet, stress management, etc.
4. Public Health Issues:
Participants also raised concerns about specific public health
issues, including:
- Poverty
- Poverty, homelessness and inadequate housing are key determinants
of health that need to be considered. All government departments
at all levels must look through a social and economic inclusion
lens to assess their impact on public health.
- Recognition that specific issues relating to poverty impact
public health differently than other populations. For example,
due to the combination of funding cuts to community organizations
and of limited resources of the poor, some mothers can only choose
one health promotion program over another, for example, a Healthy
Babies program over a Nutrition services program, from those
which may otherwise be accessible to other classes in communities.
- There needs to be less of a focus on researching issues of
poverty, homelessness and inadequate housing impacts on public
health, and more focus on governments funding solutions, creating
legislation, and beginning to build massive infrastructure that
is needed.
- There needs to be a comprehensive approach in a communication
mechanism to disseminate information regarding less fortunate
communities. For example, $58 million was given to Toronto organizations
dealing with homelessness this year; however, Toronto is losing
300 shelters this year, as well.
- To address poverty, homelessness and inadequate housing issues,
existing resources must be used and more resources must be provided
in all areas of public health including clinical resources, information
technology resources, educational resources, communication and
information dissemination mechanisms and voluntary sector resources.
- Recognition that public health work is currently happening
through existing social organizations, community organizations,
the voluntary sector and local public health units and determine
how the PHAC will interact with local public health units.
- Mental Health
- Any new frontiers of public health must include mental health
and the effects of stress on health. Existing organization can
aide in the work of surveillance, data collection and dissemination.
This work need not be duplicated.
- Must work with the mental health community and the voluntary
sector to determine their role in maintaining a comprehensive
public health system.
- Children and Youth Health
- Income, transportation and early childhood development. These
determinants are important when dealing with child and youth
health and issues must be addressed collaboratively by municipalities,
local community organizations, and other key sectors involved
in public health issues.
- Best practices from across Canada and internationally on how
to deal with renting space (i.e., Saskatoon in Motion project)
should be examined and utilized. For example, there is a province
wide coalition that deals with trying to keep gymnasiums in schools
open in the evenings and on the weekends. These empty spaces
must be better utilized to address issues of decreased levels
of activity in children, decreased organized clubs, such as boy
scouts, girl guides, and decreased levels of feeling safe and
secure.
- Recognition that the current public health system is reactive,
rather than proactive. For example, health system dollars are
spent on acute care, whereas funding should go to children and
youth learning about nutrition and physical activity, etc.
- Recognition that volunteer groups are becoming full time fundraisers
and the voluntary sector is losing volunteers for lack of interest
in this type of work.
- Health professionals are required from different cultural
groups to help various communities and their children and youth.
Some community schools have 27 different languages.
- A common approach between health and education must be taken.
Goals need to be specific, measurable, attainable, realistic
and timely, in order for the community to know when a real difference
has been made.
- Children and youth need access to public health nurses in schools
to deal with issues regarding bullying, stress, depression, etc.
As well, guidance councillors in schools are needed to develop
clear guidelines in councillor roles in order to be able to deliver
an effective full service education plan.
5. Chief Public Health Officer:
- CPHO also needs to instill confidence among Canadians by providing
leadership during emergencies.
- CPHO needs to be a proactive advocate for public health needs, for
example, nutrition, physical activity, and not reactive, for example,
the health care system.
- CPHO must ensure access to public health nurses.