Remarks for
Dr. David Butler-Jones,
Chief Public Health Officer of Canada

IFA 9th Global Conference on Ageing

Creating an Enabling Environment – A Public Health Perspective

September 6, 8:40 AM
Montréal
159, rue St-Antoine ouest
Room 517d

15 Minutes

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Introduction

I would like to welcome everyone to this morning's plenary on creating enabling environments. It's a great pleasure to take part in a panel with such international perspectives, in front of such a diverse, international crowd.

To give a bit of background for our international guests, I want to start by noting that in 2003 Canada experienced a kind of turning point in its public health story – the outbreak of Severe Acute Respiratory Syndrome … or SARS, as we know it.

I won't get into too much detail on the outbreak – suffice it to say, we were caught somewhat by surprise when we went from seeing cases in East Asia, to having cases appear on our own shores.

It highlighted a lot of strengths in our public health system, but also many weaknesses.

We weren't prepared. We didn't have the capacity for such a massive public health mobilization.  We didn't have the optimum collaboration and communication needed for a new, complex outbreak.  And while we had leaders, we lacked a specific public health leadership that could guide and coordinate at the national level.

So in 2004 the federal government created the Public Health Agency of Canada, and at the same time established the position of Chief Public Health Officer that I have the privilege to hold.

It's a unique role in Canada. On the one hand, I am a Deputy in the federal government and I manage the Agency, providing public health advice to our Minister and the government with policy, program and financial accountability. On the other hand, as Chief Public Health Officer I have a corresponding role to communicate with governments, stakeholders, and perhaps most importantly, directly with Canadians about public health issues.

The building of enabling environments is a cornerstone of public health in general.

The Public Health Agency has a fairly simple, straightforward corporate vision: healthier Canadians and communities in a healthier world.

Simple, but getting there is complex.

In all we do at the Agency, or the work of public health generally, whether protecting and promoting health, or preventing injury and illness … we engage partners from all over society to build healthy, enabling environments – together.  Public health is ultimately a team sport.

One catch phrase I find irritating is “we have to look after children because they are the future.” And while that may be true—their ideas and involvement are also key to our success in the present. Similarly, older persons are not just important to our past.  They are critical contributors to our successful present. 

Canada is not alone in the fact that its population is getting older and both living longer, and living longer in good health.

This is a good thing. It testifies in part to our collective achievements in medicine and public health.

CPHO's Report

Just a few months ago I released the first Chief Public Health Officer's Report on the State of Public Health in Canada.

It's a report I've wanted to write for a very long time, because it is my belief that any population is only as healthy as its least healthy members. We need to not only recognize the underlying factors that lead to health inequalities but also ways and evidence to address them. 

In general, in Canada we pride ourselves on being healthy. But we're not all benefiting in the same way from the policies and advancements that have, over the years, improved average health outcomes.

And so I focused this report on health inequalities in Canada. It's not a prescriptive report… the point is to raise awareness and provide examples of what we can do individually and collectively to improve health overall and reduce the gaps between the least and most healthy populations. 

If there is one lesson from SARS, it is that it is all connected.  Our vulnerabilities cross diseases and risks. 

Poverty is more than just a lack of money.  Having enough resources for the basics of life is core. But having influence over our situation, our futures, loving and being loved, is key to the difference between okay and great health. 

So it is less about doing things to people as it is about having the supportive environments that allow people the tools to take charge of their own futures.

Now, Lincoln once said it's the role of governments to do for people what they cannot do for themselves.

And without a doubt, governments at all levels in all jurisdictions have a role in building enabling environments.

But as with most public health activities, close collaboration across sectors, jurisdictions and levels, both domestically and internationally is absolutely necessary. It is, as always, a whole-of-society approach that goes far beyond just the health sector -  although it is as a sector important for us to engage, advocate, and support these efforts.

I want to quickly raise three examples that I think highlight how this can come together.

WHO, Age-Friendly communities

First, and I think Alex will talk about this in greater detail, there's the WHO's Age-Friendly Cities Initiative. I am proud of the role played by the Public Health Agency of Canada in partnering with the WHO on this.

And not just the WHO, but the International Federation on Ageing, and Canada's provinces and territories have all come together in support of Age-Friendly Communities.

It is about providing options for communities that can support health and well-being not just for the elders among us, but for all society.

Emergency Preparedness and Response ///  Listeria outbreak

I also want to take a moment to highlight the important work that's being done on seniors and emergency preparedness and response. The Public Health Agency has collaborated closely with domestic and international partners on this file.

It is about the addressing of the needs of vulnerable populations in an emergency. Whether its avoiding preventable deaths in a heat wave or a hurricane or an infectious disease outbreak, it requires planning, preparation and organization.

It is however also important to not see seniors as simply a vulnerable population. As full and functioning members of society, we need them to be feeding in to our emergency plans and preparations, and taking part in community response measures.

In Canada, we're just coming out of an outbreak of listeriosis –  an infection caused by bacteria that is commonly found in the environment – but which poses relatively low risk for most of us. It is the elderly, pregnant women, infants and the immune-compromised who are most vulnerable, and for whom the illness can often be fatal.  

While the public health system worked well to react and respond quickly, it's important we see every event as a teachable moment.

Nature is inventive. There are many things out there that can cause human health problems or emergencies. We will continue to have such challenges, but we must always, always, be mindful of the impact any one of these possibilities can have on any vulnerable population, and we must know in advance how we will respond.

 

Falls

The last example I want to highlight is falls prevention.

Clearly, it is a major public health issue in any country.

We've had a number of recent guides and reports on falls prevention -   from the recent WHO Global Report on Falls Prevention in older age to the Public Health Agency's 2005 report on fall injuries and death in Canadians 65 and over. The Agency has also recently been working with stakeholders to determine how we can enhance surveillance data on seniors' falls in Canada.

And there are many local programs and activities as well as experience around the world that we can learn from.

Ultimately, small interventions and education can make a big difference to quality of life.

Conclude

Beyond our daily work of plagues, pestilence and chronic disease and injury prevention, public health has a fundamental role in understanding how physical and social environments affect health.

There are so many trends shaping our environment today – from urbanization, to migration, to climate change -   trends that intersect with an ageing population.

And so public health has a vital and enduring role going forward. We should be a leader for other sectors, advising on what we can collectively do to help us all age in a healthy way as the world changes all around us.

Building supportive enabling environments is a long term endeavor. And with a multitude of social and economic components to it, it's not an easy one.

But we need to plan now, and build now, for an older future. 

Almost 3000 years ago, the Greek poet Hesiod advised the farmers of the land: “It will not always be summer: build your barns now.” 

Because in 20 to 30 years, when a quarter of us are over 65, we don't want to find ourselves with the choice of either city cores that aren't supportive of an older population … or suburban developments that have no footpaths, few parks, no benches, and that concentrate services in giant box malls accessible only by car. 

This congress and the work that follows is an important step along the road.

I'd like to close with two quotes from people I think of as two great North American philosophers - or humourists depending on your perspective.

Firstly, Stephen Leacock, an economist who taught at McGill:  “Success is 10% inspiration and 90% perspiration”.

And finally as Samuel Clemens, or Mark Twain, would say, “even when we're on the right track, if we're not moving, we'll get run over.”

Thank you, Merci.