Transcript Longevity and Public Health

Longevity and Public Health
IFA Global Conference
Montreal
September 7, 2008
Carolyn Bennett M.D., M.P.
Longevity
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Life expectancy ?
‘Long life’
More than numerical....
Quality of Life
ICF.... Health and Functional Capacity
The Grey
Tsunami
? Tsunami ?
The Grey
R.O.M.P.
Collingwood
April 24, 2008
Dr. Carolyn Bennett M.P.
D.O.B.
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??? Better measure
• MORTALITY RISK
• QUALITY OF LIFE
• Although…. If this is the first generation that
may not live as long as their parents….
LIFE EXPECTANCY DOES MATTER
Shortgevity
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Infectious Diseases
Chronic Disease and Injury
Mental Health
Emergencies
• Social Determinants of Health
Shortgevity – Public Health ?
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Infectious Diseases
Chronic Disease and Injury
Mental Health
Emergencies
• Social Determinants of Health
teachable moments
• 2003 - Canada… 44 died of SARS
France…14,000 died in the heat wave
• 2005 - Katrina
• 2005 - Ontario Medical Association Report
Division of Ageing & Seniors
“…It’s efforts are focused on four main areas:
emergency preparedness
active ageing
injury prevention and
mental health.”
Longevity and Public Health
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Infectious Disease
Chronic Disease and injury Prevention
Mental Health
Emergencies
Rx: Putting the Public back into Public Health
Complex Adaptive Systems
Minister of Handwashing
Lessons learned from SARS
• Naylor’s 4 C’s – November 2003
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Collaboration
Cooperation
Communication
Clarity – who does what, when
• Germs don’t respect borders !!!!!
Longevity and Public Health
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Infectious Disease
Chronic Disease and injury Prevention
Mental Health
Emergencies
Rx: Putting the Public back into Public Health
Complex Adaptive Systems
Chronic disease and injury prevention
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Diabetes
Cancer
Heart Disease and Stroke
HIV/AIDS
• Falls Prevention
Management 101
``if it`s measured it gets noticed, if it`s
noticed it gets done``
• Reportable diseases.... HbA1C
– Interventions....
• Minister Andy Kerr, Scotland
– Health outcomes down to postal code
• GIS
Longevity and Public Health
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Infectious Disease
Chronic Disease and injury Prevention
Mental Health
Emergencies
Rx: Putting the Public back into Public Health
Complex Adaptive Systems
Mental Health
• Men over 80 ...highest suicide rate in Canada
• Challenges – social and emotional isolation
• Body betrayal
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Physical ailments
Mobility
Pain
Cognitive and sensory impairment
• Retirement
– Changes in income
• Widowhood, loss of friendships through death
• New caregiving responsibilties
• GBLT community - inclusion
WISE and WONDERFUL
vs
AGEISM
• Nunavut ….ELDERS
• South of 60….ELDERLY ????
Longevity and Public Health
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Infectious Disease
Chronic Disease and injury Prevention
Mental Health
Emergencies
Rx: Putting the Public back into Public Health
Complex Adaptive Systems
Survivors
• Hispanics: had an unusually low death rate
due to heat. Hispanics at the time lived in
places with higher population density, and
more social cohesion.
• Elderly women: who may have been more
socially engaged, were less vulnerable than
elderly men
Vulnerability study
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individual-level risk factors for heat wave
victims
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living alone
not leaving home daily
lacking access to transportation
being sick or bedridden
not having social contacts nearby
not having an air conditioner !!!!
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2003 Paris Heat Wave
• Critics suggest many seniors were
abandoned by their families heading to
vacation spots for the traditional August
holiday.
• The French government cut more than
$150 million in elder funding earlier that
year
The responsibility of civil society ?
• Health Minister Mattei stated the deaths were
a “brutal revelation of a social fracture, of the
solitude and isolation of the aged.”
• "Our society doesn't display enough sense of
community“ said Paris Mayor Bertrand
Delanoe
??? Please save my granny ???
Soup lady should dish
out facts
Winnipeg Free Press, Mon Oct 3 2005
Monday, October 3, 2005
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?"
Based on the 2007
Winnipeg International Workshop
on Seniors and Emergency Preparedness
Winnipeg, Manitoba,
February 6–9, 2007
For presentation to the
United Nations Commission
for Social Development.
Longevity and Public Health
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Infectious Disease
Chronic Disease and injury Prevention
Mental Health
Emergencies
Rx: Putting the Public back into Public Health
Complex Adaptive Systems
Tyranny of the Acute
• “As long as citizens think of the sickness care
system whenever they hear the word ‘health’,
it will be very difficult to reorient the health
CARE system to systems for HEALTH”
Rx: Longevity
Put the
‘public’
(especially SENIORS)
back into
PUBLIC
health
"An army of useful citizens" can
do what no one person can.
Dr. Ethel Percy Andrus
Canadian Institute for
Advanced Research
– 25% health attributable to health care system
– 15% biology and genetics
– 10% physical environment
– 50% social and economic environments
Goal of Medicare…
• Sharing risk
– getting people the health care they need when
they need it
• Keeping people well not just patching them
up once they get sick
Sir Michael Marmot
Chair, WHO Commission on Social Determinants of Health
“The worst thing for a physician is to help
someone get well and then send them straight
back into the situation that made them sick in
the first place”
Attitude
2+2=5
Knowledgeable Stakeholders
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Committed Politicians
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Better Public Policy
Political Will
to do the right thing
• Dramatically improves with an educated
public…… health literacy
• Citizens pulling healthy public policy…. Civic
efficacy
Putting the Public back into
Public Health
• Civic Literacy ….. individual
• Civil Society…. Community Action
Public Health 101
1.Do you think we should have a:
A) strong fence at the top of the cliff
B) state of the art fleet of ambulances and
paramedics waiting at the bottom ?
2. Would you prefer:
A) Clean air
B) Enough puffers and respirators
for all
3. Would you prefer that wait-times were
reduced by:
A) a falls program to reduce preventable hip
fractures
B) private orthopaedic hospitals and more
surgeons
4.Should we invest in:
A) early learning, child care, literacy,the early
identification of learning disabilities and
bullying programmes
B) increase the budget for young offenders’
incarceration
5.Should we:
A) assume that the 'grey tsunami' will bankrupt
our health care system
B) include our aging population in the planning
of strategies to keep them well
6. Is the best approach to food security:
A) food banks and vouchers
B) Income security,affordable housing,
community gardens and community kitchens
and a national food policy
7. Pick the one that is NOT correct
Pandemic Preparedness should focus on
A) Tamiflu for all
B) Working with the vets to keep avian flu a disease of
birds
C) Making sure people wash their hands especially
the doctors and nurses
D) Research on vaccines
E) Community care plans for our most vulnerable
8.Governments should boast about:
A) how much they spent on the sickness care
system
B) the health of their citizens, leaving no-one
behind
social determinants
vs.
‘choose health’
The Causes of the Causes
Versus
The Causes
Sir Michael Marmot
Evolution of the Healthy Canadians Tree
Evolution of the Healthy Canadians Tree
Longevity and Public Health
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Infectious Disease
Chronic Disease and injury Prevention
Mental Health
Emergencies
Rx: Putting the Public back into Public Health
Complex Adaptive Systems
Research
• Evidence-informed practice
• Practice-informed evidence
• Courage to fund what works
• Courage to stop funding what doesn`t
• Complex adaptive systems…
Research
Practice
Policy
Research
KT
Practice
Policy
Research
KT
Practice
Policy
Political will
Research
Applied
research
KT
Practice
Policy
Political will
ENGAGED CITIZENS
Research
Applied
research
KT
Practice
Policy
Political will
Rx: Civic Participation
It’s good for your health
Physical and mental energy comes from
feeling in control of your life,
having real choices,
and being involved with others
to find ways of organizing change
for the better
Barbara Rogers
BONUS !!!!!!!!
GREY POWER.....plug it in !!!!!