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Opportunities and Challenges in health promotion with a new Liberal Government

For the last issue of 2015 we asked organizations and individuals to reflect on the impact the new Liberal Government could have on the health of Canadians.

We invited health promoters and health organizations to send us their thoughts on the following questions: What will the change in government mean to health promotion and public health in Canada?  What are the challenges and opportunities that lie ahead?


Contents

Possible Impact of New Liberal Government on the Health of Canadians
Irving Rootman, Adjunct Professor, School of Public Health and Social Policy, University of Victoria

Parachute
Scott Watson, Manager of Government Relations

Bridge for Health
Kathleen Lane and Paola Ardiles

Helping Canadian Communities Help Syrian refugees
Canadian Paediatric Society

What will the change in government mean to health promotion and public health in Canada?
Dennis Raphael, York University

A New Era in Healthcare?
Anne Rucchetto

Making Healthy Platform Promises a Reality
Manuel Arango, Director, Health Policy and Advocacy, Heart and Stroke Foundation

Letter on the Future of Health Promotion with the New Federal Government
Tanya Beattie, BScH, MPA, Health Promoter, Chair, Health Promotion Ontario
Janette Leroux, MSc, PhD (candidate), School of Kinesiology and Health Studies, Queen’s University
Ketan Shankardass, MHSc, PhD, Assistant Professor, Wilfrid Laurier University, Scientist
Centre for Research on Inner City Health


Possible Impact of New Liberal Government on the Health of Canadians
Irving Rootman, Adjunct Professor, School of Public Health and Social Policy, University of Victoria

In my view, the recent change in government could mean a great deal to health promotion and public health and to the health of Canadians. On the positive side, we need to remember that a Liberal Government led by the father of the new Prime Minister was responsible for putting health promotion on the map, not only in Canada, but internationally. So perhaps one of the opportunities that we could take advantage of is to remind this government of its history and role in health promotion in Canada and elsewhere and the fact that both health promotion and public health have languished in the last few years as a result of the policies and actions of the Conservative Government. One way of doing so might be to correspond with or meet with the new Minister of Health who may be positively inclined toward both health promotion and public health as a result of her previous contacts with people in these fields.

Another opportunity may be to take advantage of the current entry of Syrian refugees to highlight the need for restoring and enhancing literacy programs that were cut by the previous government. This might also include re-establishing the Canadian Council on Learning  (which the last Liberal Government established) that among other things, sponsored programs and research on health literacy that included funding the Canadian Expert Panel on Health Literacy whose recommendations have not been implemented because of the policies of the Conservative Government. Given the fact that education is a key determinant of health, these actions could have a significant impact not only on the health and job prospects of new immigrants to Canada but also on recent immigrants that have been deprived of opportunities to learn English or French. Restoring the Canadian Council on Learning could also impact the heath of other Canadians through the development of new and improved educational opportunities for the entire population.

No doubt there are many other opportunities to influence the new government to take appropriate action to improve the health of Canadians though health promotion and public health that will be suggested by other contributors to this issue of OPHE. Hopefully, some of the ideas that are suggested will be implemented in spite of challenges such as finding funding.

Parachute
Scott Watson, Manager of Government Relations

Whenever there is a change in the governing party there is always a renewed sense of optimism and opportunity. While the change of minister, staffers and some bureaucrats may be the end of relationships, the new government holds the potential of new relationships and new opportunities. That said, there are challenges to face.

One of the challenges is the unpredictability of the early weeks of a new government. In the time that has passed since the Liberal Government was elected we have seen speculation on priorities, dates, budgets, and staff. Organizations are anxious to connect with ministers and their staff but both need time to get organized and briefed on their portfolios. The public release of the ministerial mandate letters allowed those organizations to identify priority areas and look at how their activities align.

For injury prevention, the good news was in the health and sport ministerial mandate letters indicating a priority in the area of concussions education and awareness. The Minister of Indigenous and Northern Affairs has indicated a priority on social determinants of health including working with her peers at justice, environment, health and fisheries. Both are positive early indications of what the Liberal Government's activities will be and Parachute is looking forward to working with the new federal government as we ensure Canadians live long lives to the fullest.

Health promotion and public health will also likely benefit from the focus on collaboration and consensus that the new government is focusing on. Committee participation, network engagement and having stakeholder support are critical in this new parliament. Specific to injury prevention, Parachute welcomes the opportunity to expand our network and work with multiple levels of government and multiple stakeholders on projects.

Bridge for Health
Kathleen Lane and Paola Ardiles

Over the past several years, there has been much talk of the social determinants of health, yet even with compelling evidence to make the case for “upstream action,” there has been little impact on public policy. Health was not an issue during the last federal election, although many of the contentious issues that did come up, such as climate change, democratic reform, economic development, and freedom from violence and discrimination, can be considered important social and ecological determinants of health.

Many public health advocates were disappointed with the perceived “narrow” view of our new government’s ministerial mandate on health. It seems as though the Minister of Health’s mandate has a more “traditional” focus, with priorities targeted at reducing the consumption of unhealthy food and tobacco, and improving access to home and palliative care.

However, taking action on the determinants of health requires on-going and sustainable efforts on behalf of other sectors to address the “causes of the causes.” It is encouraging to see that Prime Minister Trudeau has already taken steps towards inter-sectoral action on the determinants of health. Although they are not framed as such, the majority of ministerial mandate letters outline priorities for improving the health and wellbeing of Canadians. For example, Trudeau has asked his ministers to:

  • Address gaps in services for Indigenous Peoples and those with mental illness throughout the criminal justice system.
  • Ensure workplaces are free from harassment and sexual violence.
  • Combat climate change by making our resource sectors world leaders in the use and development of clean energy and sustainable technology.
  • Support employment by improving the quality and impact of our programs to promote innovation, scientific research and entrepreneurship.
  • Make post-secondary education more affordable for students from low- and middle-income families.

Given the new political climate, how can we use our collaboration and community engagement skills to create processes to enable people to increase control over, and to improve, their health? How can we reclaim our roles as advocates? How can we effectively use our research and knowledge translation skills to present evidence in a language that resonates with other sectors and community partners, so that it can be used to create fair policies that will benefit all Canadians? As is usually the case, the biggest challenges are also the biggest opportunities. It is now time to re-engage and use our core competencies to enable, mediate and advocate, as was outlined 30 years ago with the creation of the Ottawa Charter for Health Promotion.

www.bridgeforhealth.org

Helping Canadian communities help Syrian refugees
Canadian Paediatric Society

The federal government has committed to bringing 25,000 Syrian refugees (http://www.cic.gc.ca/english/refugees/welcome/index.asp?utm_source=cic-h...) to Canada over the coming weeks and months. Many of these will be children and youth, who will have a range of physical, emotional and mental health needs.

Caring for Kids New to Canada (http://www.kidsnewtocanada.ca/) is a comprehensive resource for people who work with immigrant and refugee children, youth and families. Developed by the Canadian Paediatric Society (http://www.cps.ca/) with input from a range of experts and organizations, the site has evidence-based information on medical conditions, mental health, child development, and much more. It also has a range of tools, checklists and links to local resources.

Among the many health issues covered on the site are:

The site also features resources to help families navigate the health system, and to make connections with local agencies:

The Future
Dennis Raphael, York University

What will the change in government mean to health promotion and public health in Canada?

To date no federal or provincial/territorial government in Canada has explicitly placed the issues of health equity and the social determinants of health on their public policy agenda.  Nor has any governing party or opposition party raised these issues in a significant way.  There are inklings of a concern with these issues amongst new government ministers as Carolyn Bennett is well known as an advocate on these issues yet she achieved little while Minister of State for  Public Health under the previous Liberal Government.

The new Minister of Health Jane Philpott is said to be aware of these issues but the basic issue is this: Historically, the Liberals campaign on the left but govern from the right.  And it should not be lost on us that the new Minister of Finance William Morneau – the key minister whose portfolio has the most to do with achieving health equity and making the distribution of the social determinants of health more equitable – is a Bay Street veteran and former chair of the business-friendly C.D. Howe Institute. And we should not forget that the main shredding of the Canadian welfare state occurred during the 1990s under the Liberal watch. Currently, Liberal Premier Kathleen Wynne of Ontario is hell-bent on privatizing what used to be public institutions.

What are the challenges and opportunities that lie ahead?

The business-friendly Canadian economic and political system is not oriented to address issues of health equity and the social determinants of health.  The Liberal Party has historically been a pro-business party with any significant efforts such as the institution of Medicare and public pensions coming during a period of minority government with the NDP holding the balance of power.  

Can we expect this leopard to change its spots? The main task for health promoters is to continue to educate the public so that any government of any stripe will be forced to address these issues. The efforts of Ryan Meili of Upstream to build a social movement to force government action on these issues are probably more important than ever. He deserves our support.
 
A New Era in Healthcare?
Anne Rucchetto

The Liberal Party’s majority victory in our recent federal election signals a shift in attitudes on the part of Canadians. Amidst increasing controversy, it seems the conscience of the Canadian public could no longer support the Conservative Party’s antics—perhaps not even the “old stock” Canadians, as Harper himself put it.

With Justin Trudeau as our new Prime Minister, backed by a fairly diverse representation of cabinet ministers, it seems plausible that Canadians might be able to breath a collective sigh of relief in respect to the country’s fate.

The Liberals have pledged to invest $3 billion dollars into our Healthcare system. This sounds promising, but we have yet to see how this affects public health. A vast body of growing research has proven that health outcomes have much more to do with precipitating social issues than individual choices, or even monetary investments in healthcare. Rather, it is things such as access to healthy food, job security, living wages, education, social support, and strong communities that predict positive health outcomes. The state of our health is ultimately a reflection of the state of our lives more broadly. This is why researchers speculate that marginalized groups such as racialized people, low-income earners, and those deprived of higher education consistently show higher rates of morbidity and mortality, compared to their more privileged counterparts.

It is the job of healthcare professionals and health promoters to draw attention to the enormous role that inequality plays in determining the nation’s health. It seemed that the Harper Government wilfully enforced widespread inequality through policing activism, criminalising poverty with ‘The War on Drugs’, and pushing through Bill C-51—one of the most overtly oppressive pieces of legislation in Canadian history. The Liberal party has, at least, expressed a commitment to the well being of all Canadians. Collaborating with these good intentions could bring about real positive change. This will ultimately depend on healthcare professionals’ and health promoters’ willingness to publicly confront the social ills that contribute to collective illness.

Making healthy platform promises a reality
Manuel Arango, Director, Health Policy and Advocacy, Heart and Stroke Foundation

Leading up to the federal election, the Heart and Stroke Foundation worked hard to make health an important part of the pre-election discussion and commitments. We ran a Healthy Candidates campaign which encouraged all candidates to “Go Healthy” by publicly committing to invest more to promote and support better health in Canada – and we celebrated every candidate who signed up. We also encouraged all voters to get involved by personally challenging their candidates. The results were terrific engagement across the country: 425 candidates signed on and over 4571 Canadians participated in the campaign.
We also publicly applauded the health commitments all parties made in their platforms leading up to the election.

Now the Heart and Stroke Foundation is looking forward to working with the new Liberal Government to improve the heart health of Canadians, including the important health issues outlined in its platform:

  • Introducing new restrictions on the commercial marketing of unhealthy foods and beverages to children, similar to those now in place in Quebec.
  • Bringing in tougher regulations to eliminate trans fats, similar to those in the U.S. and to reduce salt in processed foods
  • Improving food labels to give more information on added sugars
  • Introducing plain packaging requirements for tobacco products, similar to those in Australia and the United Kingdom.
  • Ensuring that northern families have access to affordable, healthy food, we will increase investments in the Nutrition North program by $40 million over four years.
  • Developing a pan-Canadian collaboration on health innovation and will provide access to necessary prescription medication and will reduce the costs Canadians pay for drugs.
  • Making the Employment Insurance Compassionate Care Benefit more flexible and easier to access.

In addition to working with the government on these commitments, the Heart and Stroke Foundation will also be encouraging the government to adopt a tax on sugary drinks.  

Letter on the Future of Health Promotion with the new Federal Government

Tanya Beattie, BScH, MPA, Health Promoter, Chair, Health Promotion Ontario
Janette Leroux, MSc, PhD (candidate), School of Kinesiology and Health Studies, Queen’s University
Ketan Shankardass, MHSc, PhD, Assistant Professor, Wilfrid Laurier University, Scientist
Centre for Research on Inner City Health

“Positive, Ambitious, Hopeful” – we too would use these words to describe the work and values of health promoters in Ontario as the new Federal Government begins its tenure. Health Promoters work across sectors to prevent illness, and we see how people’s living and working conditions profoundly impact their health and quality of life. Health promoters work alongside the most vulnerable Canadians – those who are at risk of being at risk. We deal with the need to encourage healthier choices while recognizing that our living conditions and policies structure our choices – that is, there are social determinants of health that are fundamentally important for well-being. As members of Health Promotion Ontario, we aim to connect with each other to support our collective efforts to promote health. As an organization, we are growing in our capacity to support the strong professional development of health promoters across the province [1].

As health promoters, we want to offer some constructive advice as to how the new Federal Government can act to strengthen health and well-being by intervening upstream of our health behaviours and our need for medical care. To begin with, they must coordinate the effort of the Minister of Health with a range of other ministries that impact on the social determinants of health. While the new Minister of Health has a mandate that is largely focused on more traditional objectives of strengthening the health care system and encouraging healthier lifestyles [2], it is hopeful that the Minister of Indigenous and Northern Affairs has indicated that the social determinants of health will also be a key concern of the federal cabinet.

We were greatly encouraged when the Liberal Party recently endorsed Policy Resolution 153 (2014 Liberal Party Canada Convention, Montreal Canada) to fund “a national model for health promotion.” Below, we highlight some key areas that the new Federal Government can work to promote population health and equity:

  • We are encouraged by the statement in the Minister of Health’s mandate that “when Canadians are in good physical and mental health, they are able to work better, be more productive, and contribute more fully to our economy while living healthier, happier lives” [2]. To seriously pursue this objective means fostering healthier public policies across ministries through intersectoral action, so we encourage the new Federal Government to consider adopting a framework for Health in all Policies (HiAP) [3]. The Liberal Party has recently endorsed many policy resolutions that reflect a HiAP approach, including Policy Resolution 100 (2014 Liberal Party Canada Convention, Montreal, Canada) to create a Basic Annual Income (BAI) for a “fair economy.”
  • We are also encouraged by the new Federal Government’s commitment to act on the findings of the Truth and Reconciliation Commission (TRC) [4], and for launching a public inquiry into missing and murdered Indigenous women. The TRC highlighted how the Federal Government’s residential school system was “part of a coherent policy to eliminate Aboriginal people as a distinct peoples and to assimilate them into the Canadian mainstream against their will.” Evidence suggests there are many ways that this system and other abuses of the rights of Indigenous Canadians has affected the ability of generations of Indigenous Canadians to live healthy, well lives. We encourage the new Federal Government to strengthen the human rights of Indigenous Peoples in this country – and their control over the social determinants of their health – by becoming signatories of the UN Declaration on the Rights of Indigenous Peoples (UNDRIP) [5]. For example, as the new Federal Government has indicated its intention to pursue the development of oil pipelines [6], they must do more than the previous Federal Government to pursue their development objectives while honouring UNDRIP, which necessitates a duty to “consult and cooperate in good faith” to obtain “free, prior and informed consent” of Indigenous Peoples.

 The new Federal Government has a historic opportunity to transform the way that Canadians experience illness and wellness. In these early days, there are promising signs that the social determinants of health are on the agenda. As we approach the 30th anniversary of the Ottawa Charter for Health Promotion and its call for Health for All [7], we hope that intersectoral action and human rights become central themes of policy-making for this government. As health promoters, we are counting on it.

The opinions expressed in this article are those of the authors and do not necessarily reflect the views of Health Promotion Ontario and its members.

1. Pan-Canadian Network for Health Promotion Competencies. Available at: http://www.healthpromotercanada.com/
2. Office of the Prime Minister of Canada (2015) Minister of Health Mandate Letter.  Available at: http://pm.gc.ca/eng/minister-health-mandate-letter [Accessed December 1, 2015]
3. WHO, 2013. Health in all policies: Helsinki Statement. Framework for country action. Available at: http://apps.who.int/iris/bitstream/10665/112636/1/9789241506908_eng.pdf [Accessed December 3, 2015].
4. Truth and Reconciliation Commission of Canada, 2015. Honouring the truth, reconciling for the future : summary of the final report of the Truth and Reconciliation Commission of Canada. Available at: http://www.trc.ca [Accessed December 14, 2015]
5. United Nations, 2008. United Nations Declaration on the Rights of Indigenous People. Available at: http://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf [Accessed: December 3rd, 2015].
6. David Ljunggren (2015, November 5). Liberals back Keystone XL pipeline, Stephane Dion says. The Globe and Mail. Retrieved from: http://www.theglobeandmail.com/news/national/liberals-back-keystone-xl-p...
7. WHO, 2015. The Ottawa Charter for  Health Promotion. Retrieved from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/