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

to the

19th IUHPE World Conference on Health Promotion and Health Education

“Another Step Forward?”

Vancouver
June 15, 2007

Thank you, bonjour, buenas tardes. 

It’s been quite an inspiration for me to participate in this conference with all of you. 

And it has been a privilege to be the honorary co-host. I emphasize the honorary, as you all know the tremendous work of Marcia and the Canadian Consortium and all of the many volunteers who have made this happen.  This conference has covered tremendous ground and reflected an excitement and an interest that is much needed as we move forward.  So I want to thank all the organizers who have brought us together and made this possible. 

Now Disraeli said: “the health of the public is the foundation upon which rests the happiness of the people and the welfare of the state.” 

And then a hundred years later the Ottawa Charter was seminal achievement in public health that testifies the power of unifying thought, purpose and action.

What stands out clearly to me is that the principles laid out in the Charter are as relevant today as they were in 1986.  But the world we share has changed dramatically in the past two decades, making effective public health measures more critical than ever before. 

Now, Jean-Jacques Rousseau in the 1700's was able to say, without any challenge, that “half of children die before their 8th year.  This is nature’s law, why try to prevent it?”

Well for the last 200 years, we have been trying to prevent it, but climate change, urbanization, industrialization of agriculture, the liberalization of trade policies…  these issues are altering landscapes, lifestyles and health outcomes around the world. 

Children in war torn countries can now expect to live no longer than they could in the 1700's. 

It’s an even greater tragedy that, if that wasn’t enough, in Sub-Saharan Africa, as Mary pointed out, life expectancy has fallen to the level of the bronze age. 

So when we say health promotion is coming of age, what is it that we are actually saying?

To me, to come of age means to recognize one’s role, one’s purpose, and more importantly to act to fulfill it. 

As we find in the Ottawa Charter, health is created in the context of everyday life where people live, work and play. And health promotion in that same document is described as the process of enabling people to increase control over and improve their health.

Notice how it doesn’t say, a person, or, a population. It says people.  For me this is very significant as it is both about individuals and communities. 

There was a time not so long ago when it felt like we in public health were so busy shooting at ourselves that no one else had to. 

While the debates are important, I think we as a society sometimes get too caught up in the either/or thinking. 

Is it nature or nurture that determines outcomes?

Are populations or individual approaches more important?

Do we work in community kitchens and buying cooperatives, or lobby for change in national food policy?

Is it about the social determinants or individual choices?

Do we work with the public or the private sector?

To me the answer to all of them is yes.  It is not about either/or, it is the balance of complementary approaches that is most likely to be successful. 

If I can quote from President Kennedy: “The problems of the world cannot possibly solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men [and women] who can dream of things that never were.”

And he also said, “few will have the greatness to bend history itself, but each of us can work to change a small portion of events and then total of all those acts will be written in the history of this generation”.

If I’ve learned anything over my career to this point, the first is that what little wisdom we may have is rarely unique to us or to our time.  And secondly it is that it is all connected.

It is no coincidence that the areas hardest hit by the Tsunami and hurricane Katrina were also the poorest.  It should also no surprise that healthy resilient communities have fewer problems, and when they do face them, they recover faster. 

This is true whether we talk about natural or man-made disaster, infectious disease outbreaks or the burden of chronic disease and injury, or mental health problems.

Let me give you just one simple example: if not for polio vaccine, no one in this part of the world would be worried about hip and knee replacements because all the orthopedic surgeons we could train would be consumed with trying to deal with the after-effects of polio.  And if not for our increasing weights as a society -- which some have referred to as the obesity pandemic -- we quite likely could eliminate those long hip and knee waiting lists.  Finally, if not for poverty in war torn regions of the world, we would have already wiped out polio as we have done for small pox.

Public health is by definition the organized efforts of society to improve health and well-being and to reduce inequalities in health. 

It is not simply a set of programs and services, but a way of thinking about problems.  It is not only about solving the current problems, but works to understand and address, as Sir Michael would say, “the causes of the causes.”  

To engage across sectors and perspectives to bring what is needed to deal with current threats and prevent future problems.  It depends on the understanding and experience of almost any discipline and field of science that you can think of.  In fact I have yet to find a sector or perspective that is not important to consider. 

It is a whole of society approach to addressing the determinants, creating supportive environments and working to ensure that every person -- every person --  has the opportunity to be healthy and prosper. 

It is also about the individuals in that society.  It must not be about a competition between promotion, prevention, treatment and care, but rather the balance that delivers the best outcomes. 

It’s not just about length of life, it must be about the quality of life gained and preserved.  And why do we do it?  Is it a job or a vocation, wherever we work or whatever we do?  What is the endeavor of which we are a part, and for whom do we do it?

Mind you as soon as it becomes just about us, our needs or interests, I believe we loose our effectiveness and are less likely to be invited along on the journey of others -- thus kept out of where we can be most effective. 

Now I sometimes speak of the art of public health. There are things and times when we must say, “you will not do this,” or “you will not put this in the water,” but most times it is bringing what we have to offer and accepting that it is the community or patient who must live with the consequences, and whose decisions we respect. 

The art is knowing the difference of when which applies.

Now I can’t remember what wise woman said it, but I do remember when I was growing up -- though I’m not sure I’ve actually grown up yet -- an idea that if we are not part of the solution we are a part of the problem.  We each have our role to play, and while individually it may seen daunting, together and with others it’s quite remarkable what we can do and where our careers can take us. 

It is important that we do bring to bear what we can.  One of my favorite illustrations of the import of this is the quote of Henry Van Dyke: “use what talents you possess for the woods will be very silent if the only birds that sang were those that sang best”. 

Health promotion thinking must be core to public health. Not only is it reflected in research and programs of health promotion, but should be reflected throughout other activities because it is not only what we do, but what we influence that is important. 

You have over the past few days heard some of the many different issues and approaches being taken around the world, we continue to have much to learn from each other.

In Canada, in the Public Health Agency health promotion approaches cross over all of our mandate, but it is also essential that there is an organizational home to keep the fires burning and to influence other activities. 

We have a constellation of events in Canada that will help us to move the agenda forward.  There is the establishment of the Public Health Agency with a strong focus on health promotion.  The position of Chief Public Health Officer, that I have the privilege to hold, and which not only has a role as a Deputy Minister within the federal public service, but a legislative mandate to speak as necessary, independent of government if necessary.  The work of the WHO Commission on Social Determinants of Health, and that we are pleased to support.  The Canadian Senate Sub-Committee that is working on population health. And Health Goals for Canada, which are high level and describe what we aspire to -- and some have the feeling that they don’t have much traction -- but what they do give us is a point where we can assess and refer back to as to whether we’re making progress.

The over arching goal is as follows: as a nation we aspire to a Canada in which every person is as healthy as can be physically, mentally, emotionally and spiritually. 

And we have practitioners and academics across the country and the National Collaborating Centers to assist in translating knowledge into practice.  And early next spring, my first report on the State of Public Health in Canada will be published with the theme of Health Inequalities, just to name a few. 

I don’t think international collaboration in public health has ever been stronger, and even work on planning for pandemics across sectors has led to new collaborations on other health issues.

So some progress is being made, though we know that there are formidable challenges that we face. 

Steven Leacock, who was a Canadian economist and humorist, would say that success is 10% inspiration and 90% perspiration. 

Dorothy Soelle, who is a German theologian, talks about how in our western society, and increasingly elsewhere I think, we are reluctant to take on or invest in things that do not have sufficient chance of profit or success.  However, she would say, and I would too, that some things we do, not because we necessarily will succeed - though surely we must - but we do then simply because it is the right thing to do.

So I want to thank you for allowing me to be part of this. I will take close with one final reminder from an American philosopher -- I call him a philosopher, others would call him a humorist. Mark Twain has a caution for all of us and that is that “even when we are on the right track, if we are not moving we will be run over.“

Merci, gracias, thank you very much.