York University
Faculty of Health Convocation Address

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

Thursday, June 14
Toronto

Thank you Chancellor (The Hon. Peter Cory), President Marsden and Dean Skinner.

I have come to believe life is a journey not a destination, and congratulations to all of you who have just passed another station.

Around the turn of the last century, one of this country’s – and perhaps the world’s --  greatest physicians said: “to prevent disease, to relieve suffering, and to heal the sick: this is our work.”

I don’t think Sir William Osler’s ordering was unintentional.  There’s an inherent logic to it.

While healing is core to our art, it is in the prevention of disease and injury, and in compassionate caring, where I believe we do our best and most important work --   though sometimes we lose the balance.

Let me give you just one simple example.

If not for the polio vaccine, no one would be worrying about hip and knee replacements because all the orthopaedic surgeons we could train would be consumed with trying to deal with the after-effects of polio.

And if not for our increasing weight as a society – what some have referred to as the obesity epidemic – 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 smallpox.

I must confess it is not in public health where I started my career.

In fact, it was one of the last things I would have considered as a medical student.

I have always had a passion for clinical medicine, for the mystery and challenge of diagnosis, for the care and support of others.  And it is only after I became too busy on public health issues following the SARS outbreak that I finally gave up part-time clinical practice.

Working in health in whatever capacity is, I believe, a tremendous privilege.
We are involved with humanity at its greatest and weakest moments … in profound life experiences.  In birth, in death, in the midst of suffering … we are invited into others’ experiences of great joy and of profound sorrow.

It has now been my privilege for more decades than I want to acknowledge, to journey not only with individuals, but also with whole communities.

That is one of the things about public health that I have enjoyed most and which presents us with our most interesting challenges. Given what we know about health, and its underlying determinants.... what more do we really need to know, in order to work towards the health and well-being of individuals and communities?  We continue to better articulate the pathways and the subtleties. The basics, though, we have known for a very long time.

Public Health documents of a century ago speak to many of the same issues and debates we face today.

And some 150 years ago Benjamin Disraeli, Prime Minister of Britain said: "the health of the public is the foundation upon which rests the happiness of the people and the welfare of the state".

Equally true today, though for awhile we seemed to have forgotten it.

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 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 be 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 disasters, infectious disease outbreaks, or the burden of chronic disease and injury.

Now then, there are surprises on the journey.

We all remember Christopher Columbus. He was looking for India, and didn’t actually find it. He found the Americas. He assumed the inhabitants were Indians, and he named them so. And within 200 years of arrival, 90% of the population was wiped out, mostly by imported infectious diseases.
 
So in searching for India, he found the wrong place, named the wrong people, and it had unexpected and disastrous results.

But in the end, he’s still one of the most famous and celebrated names in history.  Go figure.

But never discount the positive things that can be brought about by serendipity.

Penicillin was discovered quite by accident – an invasion of mould into Petri dishes.

Modern vaccination as we know it came about after it was noticed that people once exposed to cowpox didn’t contract smallpox.

And not too long ago most of the genes we knew to be involved in breast cancer had been discovered by people working on something other than breast cancer.
 
What we intend and what we achieve don’t always start out on the same path.

Likewise, it’s those opportunities that appear when we least expect, that are often the grandest and most satisfying.
 
Much of what I have done (for better or worse) was not planned in terms of what I thought I would end up doing.

It is said that chance favours those who are prepared.

It is a delicate balance of thinking ahead, doing the good work, being flexible enough to respond to urgent needs, while not losing sight of the longer term goals.

Matsuo Basho, the 17th century Japanese poet, said “Do not seek to follow in the footsteps of the men and women of old, seek what they sought.”

So where does that bring us?

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 the causes of the causes. To engage across sectors and perspectives to bring what is needed to deal with the current threats and prevent future problems.

Most of us, I think, would prefer not having heart disease at a young age to recovering from bypass surgery.

It is about purpose and balance.  Knowing what it is we aspire to and directing our energy in that direction.

Public Health depends on the understanding and experience of almost any discipline and field of endeavour you can think of.  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 has the opportunity to be healthy and prosper.

It must not be about a competition between, prevention, treatment and care, but rather the balance that delivers the best outcomes.

And 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 and whatever we do?

What is the endeavour of which we are a part?

And for whom do we do it?

As soon as it becomes just about us, our needs or interests, I believe we lose 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.

Dorothy Soelle, a German Theologian, speaks of how in Western society we often limit what we do only to hose things likely to guarantee success, or winning, or profit.  However there are many things we do, not because we are likely to succeed, but because it is the right thing to do.

I often 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 our patient who must live with the consequences and whose decision we respect. The art is knowing the difference of when each applies.                                 

Whatever area of health (or other sector) you work in much is expected of you.

Your hard work in getting to this point offers great promise.

And the rewards are there when we recognize them for what they are.

Each of you, if you are open to them, will be part of miraculous events, sometimes in the midst of what are otherwise tragedies. They will change you.

I can't remember what wise woman said it, but I remember when I was growing up (though I'm not sure I have yet) an idea that “if we are not part of the solution we are part of the problem".

We each have our role to play, and while individually it may seem daunting, together and with others it's quite remarkable what we can do and where our careers can take us.

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

Your talents are very much needed, and warmly welcomed. I congratulate you all, and wish you the very best on your journey.