Toronto - Beaches Roundtable Report

April 14th, 2004

In Toronto - Beaches, the Minister of State met approximately nine local public health stakeholders.

1. Regarding a Mandate for a Public Health Agency of Canada:

Collaboration and Transparency

• The Agency must focus on the roles of public health within various jurisdictions. Principles of collaboration and information sharing are key factors to achieving a strong Public Health Agency of Canada. These principles of collaboration and information sharing must be built into the ground rules in meaningful way. For example, within the housing sector, all levels of government participated and all levels had valuable input.
• Utilization of a federal policy lens which reflects implications of policy making on public health in government, for example, the creation of a Ministry responsible for homelessness hinders integration.
• To use the federal public health role as a national platform for priority setting within public health, and then to act on it through education, integration, and information sharing mechanisms such as data systems and communication systems.
• Enhancement of inter-Ministerial and intra-Ministerial communication. For example, the Minister of Sport, Minister of Health and Minister of Education should communicate regularly.
• The Agency must address specific issues that relate to geographic disparity. For example, specific public health issues and challenges arise in urban environments, which may be different from rural environments, which may be different from remote environments, etc.
• Continuation with Health Canada's focus on health promotion and the social determinants of health, including education.
• The Agency must be responsive to multiple health needs, including various linguistic groups and various cultural minority groups.

Citizen / Stakeholder Engagement

• Utilization of previous citizen engagement processes proved to be effective, for example, stakeholder consultations through the Office of Consumer Affairs and Public Involvement.

Privacy Legislation

• The Agency must recognize that concerns exist with privacy legislation (federal and provincial) with respect to sharing information in a timely way in an emergency situation. For example, with the creation of an electronic health record, patient information may be shared efficiently. Creative ways of sharing information in a timely way must be considered.

2. Regarding Operational Strategies for a Public Health Agency of Canada:

• An Agency should consider:
  • Time and money should not go to building the Agency, but rather to the substantive issues that prompted its creation.
  • Focus on a chronic disease prevention strategy. Prevention work can be achieved through the utilization of existing social organizations and the Agency should mandate them to look at various health concerns, for example, cardiovascular disease and diabetes.
  • Consideration of Canada's international role and exploration ways of utilizing Canada's wealth of resources and knowledge within an international public health community.
  • Exploration of and utilization of domestic best practices such as the Vancouver Tripartite Agreement, and international best practices, such as the Austrian System with respect to decreasing wait times for most procedures (except open heart surgeries wait of 6 months), in order to reduce duplication.
• Communication
  • During the SARS experience, there was a lack of communication with the community with respect to information dissemination or guidelines on what to do. One-on-one communication strategies with community workers, who can do prevention work, education work and delivery of health care services, must be developed.

3. Investments:

Participants urged an Agency to focus on the following priority investments:

• Communications / I.T
  • Information sharing and key messages must be delivered in a clear and consistent way from the federal government all the way to community organizations.
  • Data systems, communication systems and other mechanisms must be put in place to share public health information in a timely way.
  • Increased technical human resources working with data management would be beneficial, since a lack of information management professionals and technical expertise exists.
  • Utilization of existing strengths with respect to data management and technical expertise without duplication or replication.
• Funding Environment
  • Infrastructure money is needed for the development of core funding for agencies that deliver programs. Currently, agencies use the strength of voluntary sector. Agencies are facing years and years of project based funding, with no core funding. With that type of funding environment, a lack of accountability exists, since there is no funding for human resources or information technology. Programs and services delivered by community agencies cannot function without core funding for human resources, computers, and other operational expenses.
  • Utilization of resources that already exist in many communities to avoid putting more dollars into training public health professionals. For example, naturopathic doctors may be useful in health promotion advocating for proper nutrition, diet, stress management, etc.

4. Public Health Issues:

Participants also raised concerns about specific public health issues, including:

• Poverty
  • Poverty, homelessness and inadequate housing are key determinants of health that need to be considered. All government departments at all levels must look through a social and economic inclusion lens to assess their impact on public health.
  • Recognition that specific issues relating to poverty impact public health differently than other populations. For example, due to the combination of funding cuts to community organizations and of limited resources of the poor, some mothers can only choose one health promotion program over another, for example, a Healthy Babies program over a Nutrition services program, from those which may otherwise be accessible to other classes in communities.
  • There needs to be less of a focus on researching issues of poverty, homelessness and inadequate housing impacts on public health, and more focus on governments funding solutions, creating legislation, and beginning to build massive infrastructure that is needed.
  • There needs to be a comprehensive approach in a communication mechanism to disseminate information regarding less fortunate communities. For example, $58 million was given to Toronto organizations dealing with homelessness this year; however, Toronto is losing 300 shelters this year, as well.
  • To address poverty, homelessness and inadequate housing issues, existing resources must be used and more resources must be provided in all areas of public health including clinical resources, information technology resources, educational resources, communication and information dissemination mechanisms and voluntary sector resources.
  • Recognition that public health work is currently happening through existing social organizations, community organizations, the voluntary sector and local public health units and determine how the PHAC will interact with local public health units.
• Mental Health
  • Any new frontiers of public health must include mental health and the effects of stress on health. Existing organization can aide in the work of surveillance, data collection and dissemination. This work need not be duplicated.
  • Must work with the mental health community and the voluntary sector to determine their role in maintaining a comprehensive public health system.
• Children and Youth Health
  • Income, transportation and early childhood development. These determinants are important when dealing with child and youth health and issues must be addressed collaboratively by municipalities, local community organizations, and other key sectors involved in public health issues.
  • Best practices from across Canada and internationally on how to deal with renting space (i.e., Saskatoon in Motion project) should be examined and utilized. For example, there is a province wide coalition that deals with trying to keep gymnasiums in schools open in the evenings and on the weekends. These empty spaces must be better utilized to address issues of decreased levels of activity in children, decreased organized clubs, such as boy scouts, girl guides, and decreased levels of feeling safe and secure.
  • Recognition that the current public health system is reactive, rather than proactive. For example, health system dollars are spent on acute care, whereas funding should go to children and youth learning about nutrition and physical activity, etc.
  • Recognition that volunteer groups are becoming full time fundraisers and the voluntary sector is losing volunteers for lack of interest in this type of work.
  • Health professionals are required from different cultural groups to help various communities and their children and youth. Some community schools have 27 different languages.
  • A common approach between health and education must be taken. Goals need to be specific, measurable, attainable, realistic and timely, in order for the community to know when a real difference has been made.
  • Children and youth need access to public health nurses in schools to deal with issues regarding bullying, stress, depression, etc. As well, guidance councillors in schools are needed to develop clear guidelines in councillor roles in order to be able to deliver an effective full service education plan.

5. Chief Public Health Officer:

• CPHO also needs to instill confidence among Canadians by providing leadership during emergencies.
• CPHO needs to be a proactive advocate for public health needs, for example, nutrition, physical activity, and not reactive, for example, the health care system.
• CPHO must ensure access to public health nurses.