Health Disparities: Unacceptable for a Wealthy Country such as Canada - final report

Submitter Name: 
Brian Beaton

The Subcommittee on Population  Health of the Standing Senate Committee on Social Affairs, Science and Technology final report highlights the inadequacies and inequities of First Nation health systems and services that contribute to "third world health conditions".  

Canada is generally perceived as one of the greatest countries in the world in which to live. It has a vast and diverse geography rich in natural resources, clean air and a vast territory. When it comes to health however, we unfortunately have serious disparities. Some Canadians live their lives in excellent health with one of the highest life expectancies in the world; paradoxically others spend their life in poor health, with a life expectancy similar to some third world countries. The unfortunate Canadians, who suffer poor health throughout their lifetime, are frequently less productive adding to the burden on the health care delivery system and social safety net. We cannot correct this inequity through the health care delivery system itself, regardless of the expenditure we devote to it. ....

From Background of Subcomimittee

Press Release 

Ottawa, June 4, 2009 – Today, the Subcommittee on Population  Health of the Standing Senate Committee on Social Affairs, Science and Technology tabled its report,A Healthy, Productive Canada: A Determinant Of Health Approach”.

With the release of this final report, the subcommittee has come to the end of a long journey that began in February 2007, during the 1st session of the 39th Parliament, when the subcommittee received a mandate from the Senate “to examine and report on the impact of the multiple factors and conditions that contribute to the health of Canada’s population – referred to collectively as the determinants of health.” 

Over the past year, the subcommittee has published four in-depth reports examining various aspects of population health policy: Population Health Policy: International Perspectives, Maternal Health and Early Child Development in Cuba, Health Policy in Canada: Federal and Provincial/Territorial Perspectives and Population Health Policy: Issues and Options. These reports have clearly established that multiple factors and conditions – or “determinants” – contribute to or undermine the health of Canadians.

Senator Keon, Chair of the subcommittee stated that: “The federal role is to assist with the building of  healthy and vibrant communities. The need to provide funding in a flexible manner is imperative so as to allow and stimulate communities to be more creative in the development of programs oriented toward the development of healthy practices”.

Senator Pépin, Deputy Chair of the subcommittee, added that: “Even if well integrated, health care services alone, do not make a community healthy. Goverments at all level should support an overall, community-based approach to health and human development and assist with the integration of health and social services, wherever possible, and where it makes sense for the users”.

The subcommittee found that Canada is seriously falling behind countries such as the United Kingdom and Sweden and stated that it is unacceptable for a wealthy country such as Canada to continue to tolerate such disparities in health.  Furthermore the subcommittee stressed that disparities may widen even further with the current economic crisis, which is unprecedented in terms of its global reach and impact. The subcommittee maintains that a whole of government approach is required with intersectoral action embracing business, volunteers and community organizations. This will not be easy, but it can and must be done.  We cannot afford to do otherwise, says the report.

The report demonstrates clearly that to implement a population health information system with longitudinal capacity that can monitor, evaluate and report on well being throughout the human life course is required.  Community initiatives that integrate education, health and social services are required so we can reduce disparities, stem the prevalence of disease and increase productivity. We must not be intimidated by this task, which is doable and which will eventually lead to a nation with health equity, well-being and drastically improved productivity.  The challenge is for every Canadian, the benefits are to every Canadian.

The committee’s mandate, schedule of meetings, most recent reports and minutes of proceedings can be seen at: www.senate-senat.ca/social.asp.

Recommendations:

Recommendation 1 That the Prime Minister of Canada take the lead in announcing, developing and implementing a population health policy at the federal level;

That a Cabinet Committee on Population Health be established to coordinate the development and implementation of the federal population health policy;

That the Prime Minister of Canada chair the Cabinet Committee on Population Health;

That the Cabinet Committee on Population Health comprise the relevant departmental ministers including, but not limited to: Human Resources and Skills Development, Indian and Northern Affairs, Finance, Health, Environment, Justice, Agriculture and Agri-Food, Industry, Public Health Agency, and Status of Women.

Recommendation 2 That the Prime Minister of Canada convene a meeting with all First Ministers to establish an intergovernmental mechanism for collaboration on the development and implementation of a pan-Canadian population health strategy;

That the Premiers announce, develop and implement in their respective jurisdiction a population health policy that is modelled on the federal population health policy;

That, in each province and territory, Premiers establish and chair a Cabinet Committee on Population Health.

Recommendation 3

That the Treasury Board of Canada Secretariat pro-actively undertake to enhance the range of models and resources available for the management of horizontal and vertical collaborations.

Recommendation 4

That the Government of Canada increase funding to the Public Health Agency of Canada for the creation of a policy and knowledge node that will act as a resource for the implementation of population health and health disparities reduction policies and initiatives both horizontally (at the federal level) and vertically (through intergovernmental collaboration).

Recommendation 5

That, wherever feasible, local / municipal governments across the country adopt and implement a broad population health approach within their boundaries and in collaboration with federal, provincial and territorial governments.

Recommendation 6

That the Health Goals for Canada agreed upon in 2005 be revived and guide the development, implementation and monitoring of the pan-Canadian population health policy.

Recommendation 7

That the Population Health Promotion Expert Group accelerate its work to complete within the next 12 months the development of a national set of indicators of health disparities;

That the indicators of health disparities be appropriately matched with the Health Goals for Canada.

Recommendation 8

That the Department of Finance, in collaboration with the Privy Council Office and the Treasury Board Secretariat, conduct an interdepartmental spending review with the aim of allocating resources to programs that contribute to health disparity reduction.

Recommendation 9

That the Government of Canada require Health Impact Assessment (HIA) to be conducted for any policy, plan or program proposal submitted to Cabinet that is likely to have important consequences on health;

That the Privy Council, in collaboration with Health Canada, develop guidelines for implementing the Cabinet directive on HIA;

That the HIA guidelines be developed using existing material;

That the Government of Canada encourage the use of HIA in all provinces and territories.

Recommendation 10

That the Government of Canada support the development and implementation of Community Accounts, modelled on the Newfoundland and Labrador, in all provinces and territories.
Recommendation 11 That the Canadian Institute for Health Information (CIHI) be designated as the lead in the development, management and maintenance of the pan-Canadian population health database infrastructure;

That CIHI immediately begin work to establish the necessary vertical integration of data with key partners.

Recommendation 12 That Statistics Canada, in collaboration with Canada Health Infoway Inc., the Canadian Institute for Health Information and other key stakeholders, develop standards to facilitate the linkages between the Community Accounts and Electronic Health Records while ensuring the protection, privacy and security of personal information;

That work on the development of appropriate standards for the protection, privacy and security of personal information be completed within the next 12 months.

Recommendation 13 That the Canadian Institutes of Health Research (CIHR) work in collaboration with relevant federal departments and agencies to assess current investment in population health intervention research and reach consensus on and determine an appropriate level of funding in this field;

That the Government of Canada increase its investment in population health intervention research to match the level agreed upon by CIHR and other relevant department and agencies;

That future population health intervention research funded by the government of Canada build on the capacity and strengths of existing networks and research centres and foster collaborative partnerships among municipal, provincial and federal research agencies as well as academic partners for a focused research agenda;

That the Government of Canada devise competitive operational funding mechanisms that will best support innovative, leading-edge research on population health intervention;

That the Government of Canada consider joint funding mechanisms for inter-provincial and international comparative research on population health interventions;

That the Government of Canada examine the eligibility criteria for human health research infrastructure funds in Canada and consider how these could be better aligned with population health intervention research involving implementation mechanisms in health and other sectors;

That population health intervention research on housing, early childhood development and mitigating the effects of poverty among Aboriginal peoples and other vulnerable populations be considered priorities.

Recommendation 14 That the Treasury Board of Canada Secretariat review and revise grant and contribution reporting requirements among federal departments and agencies to enhance horizontal and vertical coordination of reporting.
Recommendation 15 That the Treasury Board of Canada Secretariat encourage multi-year funding of projects that have multi-year timelines.  The Treasury Board of Canada Secretariat should also encourage multi-year funding among federal granting agencies, where appropriate.
Recommendation 16 That the Government of Canada include support for local analysis and evaluation capacity in the design of programs aimed at improving population health and reducing health disparities.
Recommendation 17 That the Government of Canada work with other levels of government and the non-governmental sector to support the integration or coordination of community-level services within a determinant of health framework.
Recommendation 18 That Aboriginal peoples – First Nations, Inuit and Métis – be involved in the design, development and delivery of federal programs and services that address health determinants in their respective communities.
Recommendation 19 That the Prime Minister of Canada, as a first step toward the development and implementation of a pan-Canadian population health strategy, work with provincial and territorial Premiers, as well as with First Nations, Inuit, Métis and other Aboriginal leaders in closing the gaps in health outcomes for Aboriginal Canadians through comprehensive, holistic, and coordinated programs and services.
Recommendation 20 That the following health determinants be given priority: clean water, food security, parenting and early childhood learning, education, housing, economic development, health care and violence against Aboriginal women, children and elders.
Recommendation 21 That the Government of Canada work with all provincial and territorial governments to implement Jordan’s principle for all programs, initiatives and services that address the health determinants of Aboriginal peoples in all age groups
Recommendation 22 That the Government of Canada, in collaboration with its provincial and territorial counterparts, as well as the appropriate First Nations, Inuit and Métis organizations, support and fund appropriate structures and mechanisms across the country that will facilitate the development and implementation of comprehensive, holistic, and coordinated programs and services that address health disparities in Aboriginal communities.