Health, Not Health Care - Changing the Conversation

The 2010 annual report of the Chief Medical Officer of Health says that Ontario needs a new conversation about health with an overarching strategy geared towards health promotion and chronic disease and injury prevention.

Healthy Public Policy

Public health officials agree that social, economic and physical conditions affect the health of the population. Recognizing and working on these factors, called the social determinants of health, can help people live healthier lives and become sick less often.

The four most important social determinants of health are:

• Income and Social Status
• Education and Literacy
• Employment/Working Conditions
• Healthy Child Development.

Healthy public policy is what results when the conversation changes from health care to health. According to Dr. King's report, healthy public policy must inform everything we do. Real public health will only truly be practiced when we apply a health lens to every policy that is implemented, every program that is carried out and every service that is delivered.

Chronic Diseases

The health risk behaviours of smoking, unhealthy eating, poor physical activity and excessive alcohol use are responsible for 40 to 60 per cent of Ontario's health burden.

In Ontario:

• Exercising and rates for eating vegetables and fruits are higher than in 2000/01 but lower than in 2005
• Overall smoking rates have remained essentially the same since 2005
• Obesity rates grew to 17 per cent in 2007/08 from 16 per cent in 2000/01
• Drinking high amounts of alcohol that increases the risk of cancer has risen to 20 per cent in 2007/08 from 17 per cent in 2000/01.

Heart disease is the leading cause of death in this province, followed by cancers, stroke and chronic obstructive lung disease. Chronic diseases often lead to other chronic conditions. In 2003, 70 per cent of chronically ill Ontarians over the age of 45 had multiple conditions.

Modern health care systems do very well when it comes to treating chronic conditions, but preventing them remains a challenge.

To do a better job of changing these behaviours and preventing chronic diseases, Ontario needs to look beyond the health care system. All sectors need to work together to develop healthy public policy.

Recommendations

The Chief Medical Officer of Health makes a number of recommendations for government to keep people healthy and prevent sickness and injury.

• Use a health lens - Start applying a health lens to every program and policy in Ontario - at the provincial, regional and municipal levels - so we can be clear on the health benefits or potential impacts of everything we do.
• Set goals and targets. - Set clear goals and targets for every single health benefit we want to achieve and every single health problem we want to prevent.
• Set health indicators - Settle on a finite set of indicators which, studied properly, will paint a picture of how healthy we are, where geography, gender, culture and economic status are causing health inequities in Ontario, and how we might try to address these inequities.
• Enable more collaboration across governments, sectors, communities - Tear down the impediments to collaboration between the municipal sector, health sector, education, social services, environment, transportation - some of the key sectors/ministries that need to work together to improve health.
• Harness the full potential of our health system - Bring greater collaboration among public health, primary care and acute care. Use every patient interaction as an opportunity to inform patients about health promotion and disease prevention.
• Catch people doing the right thing - Recognize and reward the health achievements of both the health and non-health sectors.