public health & public safety: what are the gaps & how do we fill them ? einstein meets...
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Public Health &Public Health &Public Safety:Public Safety:
What are the gaps &What are the gaps &How do we fill them ?How do we fill them ?Einstein meets DarwinEinstein meets Darwin
Queen`s UniversityQueen`s UniversitySeptember 12, 2008September 12, 2008
Carolyn Bennett M.D.,M.P.Carolyn Bennett M.D.,M.P.
Einstein
``insanity is doing the same thing over and over again and expecting different results…..``
Darwin
``It is not the strongest of the species that survives,
not the most intelligent,
but the one most responsive to change.``
Patient as PartnerPatient as Partner
Doctor MultidisciplinaryDoctor Multidisciplinary
Hospital CommunityHospital Community
Women’s health movementWomen’s health movement
= Social determinants of health= Social determinants of health
PovertyPovertyEnvironmentEnvironmentViolenceViolenceEquityEquityEducationEducationShelterShelter
Ongoing health DilemmasOngoing health Dilemmas
The The urgenturgent at the expense at the expense
of the of the importantimportant..
The politics of FEAR……The politics of FEAR……
SILOSSILOS
Jurisdictional nonsenseJurisdictional nonsense
Germs don`t respect bordersGerms don`t respect borders
Ongoing global health DilemmasOngoing global health Dilemmas
POLITICS……POLITICS……
TransparencyTransparency
CapacityCapacity
Global HealthGlobal Health
International Development International Development
Humanitarian CrisesHumanitarian Crises
Pandemic PreparednessPandemic Preparedness
HIV HIV / AIDS/ AIDS
Ebola, building capacity….Ebola, building capacity….– not included in 0.7 targetnot included in 0.7 target
Minister of HandwashingMinister of Handwashing
ChronologyChronologyTurn of century …. urbanizationTurn of century …. urbanization1918 Spanish flu1918 Spanish fluDepressionDepressionTommy Douglas – goal of medicareTommy Douglas – goal of medicare‘‘tyranny of the acute’tyranny of the acute’Lalonde ReportLalonde ReportOttawa CharterOttawa CharterSARSSARSTsunamiTsunamiKatrinaKatrinaoverdue for pandemicoverdue for pandemic
SARS Canada Spring 2003SARS Canada Spring 200344 deaths44 deaths
Median age 75 years - >83% were >60 yearsMedian age 75 years - >83% were >60 years
Underlying chronic disease a problemUnderlying chronic disease a problem
Requires close contact during active illnessRequires close contact during active illness
Health workers at greatest riskHealth workers at greatest risk
Antibiotics and anti-virals not effectiveAntibiotics and anti-virals not effective
Economic problems and disruption far from Economic problems and disruption far from problemproblem
Good Luck and Good managementGood Luck and Good management
BC Regional model more effectiveBC Regional model more effective
Governance – top down ?Governance – top down ?
WHOWHO
EU CDCEU CDC
CDCCDC
PHACPHAC– INSP INSP – BCCDCBCCDC– ??? Ontario Public Health Agency??? Ontario Public Health Agency– Local public healthLocal public health
Governance – top down ?Governance – top down ?WHO WHO
EU CDC EU CDC
CDC CDC
PHAC PHAC–INSP INSP –BCCDC BCCDC–??? Ontario Public Health Agency ??? Ontario Public Health Agency–Local public health Local public health
Lessons learned from SARSLessons learned from SARS
Failure of Communication and ScienceFailure of Communication and Science
Naylor’s 4 C’s – November 2003Naylor’s 4 C’s – November 2003– CollaborationCollaboration– CooperationCooperation– Communication Communication – Clarity – who does what, whenClarity – who does what, when
Germs don’t respect borders !!!!!Germs don’t respect borders !!!!!
The Mushroom Syndrome: The Mushroom Syndrome: SARS and Family MedicineSARS and Family Medicine
Ontario College of Family PhysiciansOntario College of Family Physicians
SARS briefingSARS briefing
Scarborough clinicScarborough clinic
Sharing informationSharing information
Data Data
Pandemic InfluenzaPandemic Influenza
Inevitable ?Inevitable ?
Preparation is good for our health….Preparation is good for our health….– like Y2Klike Y2K
Warning signs ?Warning signs ?– Fujian strain of fluFujian strain of flu– SARSSARS– H5N1 – birdH5N1 – bird– WNVWNV
Tamiflu debacleTamiflu debacle
Central command & control ?????
Ontario
Quebec
Aborig.
Sask.
Newf.
RCMP
Yukon
N.B. Vets
PEI
Nunavut
Military
N.W.T.
B.C.
Manitoba
Correct.Alberta
Learning from our SARS SistersLearning from our SARS Sisters
Hong Kong Hong Kong – Public Health AgencyPublic Health Agency
HanoiHanoi– VSFVSF
BangkokBangkok– Xray systemXray system
Soup lady should dish out facts
Winnipeg Free Press, Mon Oct 3 2005(sorry, no URL; subscription site)
Public Health Minister Carolyn Bennett says what bothers her about a flu pandemic is delivering chicken soup to victims.
……..At last month's annual meeting of the Canadian Public Health Association, she told Canadian Press that mutual support among citizens is one of the most important elements of the response to a pandemic.
Then she added: "The part that bugs me most is the bottom-up part. Does every Canadian know who their three neighbours are...and would we be able to get them the chicken soup and not get infected?"
Florence … Dec. 2004Florence … Dec. 2004
Lady with the LampLady with the LampMeticulous recordsMeticulous recordsStatisticianStatisticianClusters of diseaseClusters of disease
““To understand God’s thoughts we must study To understand God’s thoughts we must study statistics, for these are the measure of His statistics, for these are the measure of His purpose.” purpose.” Florence NightengaleFlorence Nightengale
Paris heat waveParis heat wave
CNN…. August 25, 2003CNN…. August 25, 2003
France heat wave death toll set at 14,802 France heat wave death toll set at 14,802 PARIS (AP) — The death toll in France PARIS (AP) — The death toll in France from August's blistering heat wave has from August's blistering heat wave has reached nearly 15,000, according to a reached nearly 15,000, according to a government-commissioned report government-commissioned report released Thursday, surpassing a prior tally released Thursday, surpassing a prior tally by more than 3,000. by more than 3,000.
2003 Paris Heat Wave2003 Paris Heat Wave
Nearly 15,000 people in France, most Nearly 15,000 people in France, most of them elderly, died from heat-related of them elderly, died from heat-related deaths during the heat wave that hit all deaths during the heat wave that hit all of Europe. of Europe.
French authorities say about half the French authorities say about half the people who died as a result of the heat people who died as a result of the heat wave died in their homes, not in wave died in their homes, not in hospitals or nursing homes hospitals or nursing homes
2003 Paris Heat Wave2003 Paris Heat Wave
Critics suggest many seniors were Critics suggest many seniors were abandoned by their families heading to abandoned by their families heading to vacation spots for the traditional August vacation spots for the traditional August holiday. holiday.
The French government cut more than The French government cut more than $150 million in elder funding earlier that $150 million in elder funding earlier that year year
VictimsVictims
The Poor: who either had no working air The Poor: who either had no working air conditioning or could not afford to turn it on. conditioning or could not afford to turn it on.
The Elderly: who were hesitant to open The Elderly: who were hesitant to open windows and doors at night for fear of crime. windows and doors at night for fear of crime.
African Americans: many blacks lived in African Americans: many blacks lived in areas of sub-standard housing and less areas of sub-standard housing and less cohesive neighborhoods.cohesive neighborhoods.
SurvivorsSurvivors
Hispanics: had an unusually low death Hispanics: had an unusually low death rate due to heat. Hispanics at the time rate due to heat. Hispanics at the time lived in places with higher population lived in places with higher population density, and more social cohesion. density, and more social cohesion.
Elderly women: who may have been more Elderly women: who may have been more socially engaged, were less vulnerable socially engaged, were less vulnerable than elderly menthan elderly men
Israel – Israel – January 2005January 2005
Surge capacitySurge capacity
Real time facts.. beds, icuReal time facts.. beds, icu
Communication with health care personnelCommunication with health care personnel
Training, training, trainingTraining, training, training
Blame Hippocrates?Blame Hippocrates?
Affirm Hygeia
HYGEIA: Goddess of Health
Fleeing the Medical Model,Fleeing the Medical Model,Embracing the Medicine WheelEmbracing the Medicine Wheel
WHO Commission on Social WHO Commission on Social Determinants of HealthDeterminants of Health
The Commission on Social Determinants of The Commission on Social Determinants of Health (CSDH) supports countries and global Health (CSDH) supports countries and global health partners to address the social factors health partners to address the social factors leading to ill health and focus on health leading to ill health and focus on health inequities. It draws the attention of society to the inequities. It draws the attention of society to the social determinants of health that are known to social determinants of health that are known to be among the worst causes of poor health and be among the worst causes of poor health and inequalities between and within countries. The inequalities between and within countries. The determinants include unemployment, unsafe determinants include unemployment, unsafe workplaces, urban slums, globalization and lack workplaces, urban slums, globalization and lack of access to health systems. of access to health systems.
The Causes of the CausesThe Causes of the Causes
VersusVersus
The CausesThe Causes
social determinantssocial determinantsvs.vs.
‘choose health’‘choose health’
Evolution of the Healthy Canadians TreeEvolution of the Healthy Canadians Tree
Evolution of the Healthy Canadians TreeEvolution of the Healthy Canadians Tree
““Reorienting health systems”Reorienting health systems”
FROMFROM
a health a health CARECARE system system
TOTO
a true system for a true system for HEALTHHEALTH
Public Health 101 Public Health 101
1.Do you think we should have 1.Do you think we should have a:a:
A) strong fence at the top of the cliffA) strong fence at the top of the cliff
B) state of the art fleet of ambulances and B) state of the art fleet of ambulances and paramedics waiting at the bottom ? paramedics waiting at the bottom ?
2. Would you prefer:2. Would you prefer:
A) Clean airA) Clean air
B) Enough puffers and respirators B) Enough puffers and respirators
for all for all
3. Would you prefer that wait-times 3. Would you prefer that wait-times were reduced by:were reduced by:
A) a falls program to reduce preventable hip A) a falls program to reduce preventable hip fracturesfractures
B) private orthopaedic hospitals and more B) private orthopaedic hospitals and more surgeonssurgeons
4.Should we invest in:4.Should we invest in:
A) early learning, child care, literacy,the A) early learning, child care, literacy,the early identification of learning disabilities early identification of learning disabilities and bullying programmesand bullying programmes
B) increase the budget for young offenders’ B) increase the budget for young offenders’ incarcerationincarceration
5.Should we:5.Should we:
A) assume that the 'grey tsunami' will A) assume that the 'grey tsunami' will bankrupt our health care system bankrupt our health care system
B) include our aging population in the B) include our aging population in the planning of strategies to keep them wellplanning of strategies to keep them well
6. Is the best approach to food 6. Is the best approach to food security:security:
A) food banks and vouchersA) food banks and vouchers
B) Income security,affordable housing, B) Income security,affordable housing, community gardens and community community gardens and community kitchens and a national food policykitchens and a national food policy
7. Pick the one that is NOT correct7. Pick the one that is NOT correct
Pandemic Preparedness should focus onPandemic Preparedness should focus on
A)A) Tamiflu for allTamiflu for all
B)B) Working with the vets to keep avian flu a Working with the vets to keep avian flu a disease of birdsdisease of birds
C)C) Making sure people wash their hands Making sure people wash their hands especially the doctors and nursesespecially the doctors and nurses
D)D) Research on vaccinesResearch on vaccines
E)E) Community care plans for our most vulnerableCommunity care plans for our most vulnerable
8.Governments should boast about:8.Governments should boast about:
A)A) how much they spent on the sickness how much they spent on the sickness care system care system
B)B) the health of their citizens, leaving no-the health of their citizens, leaving no-one behindone behind
Romanow ReportRomanow Report
Discussion paper # 8 Discussion paper # 8 – Zimmerman & GloubermanZimmerman & Glouberman– Complex Adaptive SystemsComplex Adaptive Systems– HIV/Aids Brazil vs AfricaHIV/Aids Brazil vs Africa
GloubermanGlouberman and and ZimmermanZimmerman
Complicated and Complex Systems: What Complicated and Complex Systems: What Would Successful Reform of Medicare Would Successful Reform of Medicare Look Like?Look Like? (2002) (2002)
- Submission to the Romanow Commission- Submission to the Romanow Commission
Bottom upBottom up
Strong common purposeStrong common purpose
Local wisdom, local knowledge to get it Local wisdom, local knowledge to get it donedone
Complexity TheoryComplexity Theory
Simple : following a recipeSimple : following a recipe
Complicated : putting a rocket on the Complicated : putting a rocket on the moonmoon
Complex : raising a childComplex : raising a child
The solutions are complexThe solutions are complex
For every complex human problem, there For every complex human problem, there is a neat simple solution, it’s just that it’s is a neat simple solution, it’s just that it’s wrong… wrong…
HL MenckenHL Mencken
Health Goals for CanadaHealth Goals for Canada
Overarching Goal
As a nation, we aspire to a Canada in which every person is as healthy as they can be –
- physically- mentally - emotionally- and spiritually.
Health Goals for CanadaHealth Goals for Canada
Basic Needs(Social and Physical Environments)
Our children reach their full potential, growing up happy, healthy, confident and secure.
The air we breathe, the water we drink, the food we eat, and the places we live, work and play are safe and healthy - now and for generations to come.
Health Goals for CanadaHealth Goals for CanadaBelonging and Engagement
Each and every person has dignity, a sense of belonging, and contributes to supportive families, friendships and diverse communities.
We keep learning throughout our lives through formal and informal education, relationships with others, and the land.
We participate in and influence the decisions that affect our personal and collective health and well-being.
We work to make the world a healthy place for all people, through leadership, collaboration and knowledge.
Health Goals for CanadaHealth Goals for Canada
Healthy Living
Every person receives the support and information they need to make healthy choices.
Health Goals for CanadaHealth Goals for Canada
A System for Health
We work to prevent and are prepared to respond to threats to our health and safety through coordinated efforts across the country and around the world.
A strong system for health and social well-being responds to disparities in health status and offers timely, appropriate care
Next stepsNext steps
Choose indicatorsChoose indicators
Work with stakeholders to determine Work with stakeholders to determine meaningful targetsmeaningful targets
Empower `bottom up`Empower `bottom up`– Strong common purpose, local wisdom, local Strong common purpose, local wisdom, local
knowledge to get the job done….knowledge to get the job done….
GISGIS
If a picture is worth a thousand words, If a picture is worth a thousand words,
A map is worth a thousand pictures….A map is worth a thousand pictures….
Maps at CDC or HHS shouldn’t stop at Maps at CDC or HHS shouldn’t stop at the 49the 49thth Parallel !!!! Parallel !!!!
powerful graphical and
analytical dimension to public health 1.
Brings together the fundamental epidemiological triad of person, time, and the often-neglected place.
• • 1.The spread of diseases over time
2.Spatial patterns of outbreaks 3.Population groups at risk
4.Availability and access to health care 5.Program intervention planning and assessment
GIS Map Generator -PHACGIS Map Generator -PHAC
With the Public Health Map Generator, you can produce high quality, detailed maps of your own health data, in combination with extensive geography from our spatial data warehouse…
GIS User
*******
The Public Health Map Generator is a secure, web-based mapping application, accessible only to clients registered with the GIS Infrastructure at the Public Health Agency of Canada. All of the Infrastructure’s
services, including the Public Health Map Generator, are available at no cost to all public health professionals in Canada.
Scotland – Honourable Andy Scotland – Honourable Andy KerrKerr
Health outcomes down to postal codeHealth outcomes down to postal code
Letter from Family DoctorLetter from Family Doctor
InterventionsInterventions
Already paying offAlready paying off
ResearchResearch
Evidence-informed practiceEvidence-informed practicePractice-informed evidencePractice-informed evidence
Courage to fund what worksCourage to fund what worksCourage to stop funding what doesn`tCourage to stop funding what doesn`t
Complex adaptive systems…Complex adaptive systems…
Research
Practice Policy
Research
Practice Policy
KT
Research
Practice Policy
KT
Political will
Research
Practice Policy
KT
Political will
Appliedresearch
Research
Practice Policy
ENGAGED CITIZENS
KT
Political will
Appliedresearch
Putting the Public back intoPutting the Public back intoPublic HealthPublic Health
Civic Literacy ….. individualCivic Literacy ….. individual
Civil Society…. Community ActionCivil Society…. Community Action
ProgressProgress
First MoS Public Health 2003-2006First MoS Public Health 2003-2006
Public Health Agency of CanadaPublic Health Agency of Canada
Chief Public Health OfficerChief Public Health Officer
Public Health Network for CanadaPublic Health Network for Canada
Health GoalsHealth Goals
National Collaborating CentresNational Collaborating Centres
Knowledge Networks for the SDOH CommissionKnowledge Networks for the SDOH Commission
A beginning……A beginning……
Global Health Security Action GroupGlobal Health Security Action Group
Canada-Asia Regional Emerging Infectious Canada-Asia Regional Emerging Infectious Disease Initiative $15MDisease Initiative $15M
Global Public Health Intelligence NetworkGlobal Public Health Intelligence Network
International Health Regulations 2005International Health Regulations 2005– Still dependent on country`s capacity Still dependent on country`s capacity
((? willingness) ? willingness) to identify, verify and manage an to identify, verify and manage an outbreak.outbreak.
Global Pandemic Influenza Global Pandemic Influenza Readiness Conference, Readiness Conference,
Ottawa 2005Ottawa 2005
Animal-human healthAnimal-human health– WHO, IOE, FAOWHO, IOE, FAO
Capacity and SurveillanceCapacity and Surveillance
Risk CommunicationRisk Communication
ResearchResearch– access to vaccines and antiviralsaccess to vaccines and antivirals
Beyond borders…. Beyond borders…. SARS as a teachable momentSARS as a teachable moment
Beyond silos Beyond silos – DepartmentsDepartments– DisciplinesDisciplines
Beyond jurisdictional squabblingBeyond jurisdictional squabbling
Germs don’t respect bordersGerms don’t respect borders
Neither do the social contagionsNeither do the social contagionsNor the humanitarian imperativesNor the humanitarian imperatives
““We are not tinkers, who patch and mend what We are not tinkers, who patch and mend what is broken. We must be watchmen, guardians is broken. We must be watchmen, guardians of the life and health of our generation, so of the life and health of our generation, so that stronger and more able generations may that stronger and more able generations may come after.”come after.”
Dr. Elizabeth Blackwell Dr. Elizabeth Blackwell first woman physician in North Americafirst woman physician in North America