Focus on HealthAuthor(s): Sharon MartinSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 87, No.1 (JANUARY / FEBRUARY 1996), pp. 6-7Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41991586 .

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EDITORIAL / ÉDITORIAL

Focus on Health

Sharon Martin, MA

At the February 1995 CPHA Board meeting, health care restructuring and the role of Public Health was identified as a priority of the Association. As a first step in responding to this decision, CPHA appointed a Working Group to develop the Board Issue Paper, Focus on Health: Public Health in Health Services Restructuring , which appears as an insert in this issue of the Journal. The paper chal- lenges people interested in the public's health to take a leadership role in health care restructuring in order to promote health. The Association believes that if this major restructuring is not based on an investment in health, it will fail. The result will be a downsized health care system that directs its resources to treating illness and does little to promote health or improve the health status of the population. Focus on Health describes the resources and tal- ents people working to promote health can contribute to this major change in health services.

My position as chair of the Working Group, which brought together Public Health professionals from across Canada, reinforced for me the value in belonging to an association with a broad and diverse membership. A volunteer association root- ed in Provincial and Territorial Branches and Associations aimed at improving and maintaining personal and community health following Public Health principles is a credible platform from which to argue for health reform. This focus on Public Health allowed people from different pro- fessions and a variety of health organiza- tions to overcome their differences and work together to produce this document. We began by working for several days with CPHA staff to create the framework and basic content of the paper. The sessions were spirited as we tried to sort through our ideas, work through our blind spots

Chairperson, CPHA Working Group on Health Services Restructuring

and articulate our values and beliefs regard- ing Public Health. The context of our work was based in the reality of health care in Canada today, and the challenge of making a difference in health.

"Health care in Canada is undergoing a major restructuring" is an understatement. Many of us have been arguing for this change for years, arguing that reform of the health sector is a prerequisite to achiev- ing equity in health status for all Canadians. Since the mid-eighties, CPHA and every Provincial and Territorial Public Health Branch and Association have argued for a shift in health care resources to promote health, particularly among populations who have the lowest health status, e.g., people living in poverty. The past 10 CPHA annual conferences have centred around the challenges of increasing our skills and understanding in the promo- tion of health among various populations. Over this period of time, many of us have presented position papers to the Provincial Royal Commissions on health care reform.

Now governments at the federal, provin- cial and territorial levels have adopted many of the arguments provided by Public Health, for example that further financial investments in health care will not increase health status and therefore a shift in emphasis from treatment of disease to the promotion of health is imperative; and that the public must be included in health sys- tem decision making. Using such terms as Health Renewal, New Directions in Health, and Health Reform, provincial and territorial governments are indicating major shifts in policy direction, namely a reduction in health care funds. We watch as funds for housing, social services, day- care and education are cut. Governments contend that reducing taxes to business and the average citizen is key to stimulat- ing the economy. Now we are in conflict.

Public Health workers know that fund- ing needs to be shifted from health care to housing, education and daycare since these are major factors in determining health sta- tus, and yet the health care system provides many of us with jobs. This is the reality that provided the context for the CPHA Working Group and describes the circum- stances that all of us face to some degree,

wherever we work and live today. The health system can be likened to an ice floe breaking into fragmented parts; this mas- sive change challenges many of our assumptions about Public Health.

People generally respond to change in three ways. Some people react in fear against the change and argue for the status quo' others become cautious, unable to move, preferring to sit on the fence; and for some people, change is seen as an opportunity to move forward. The Working Group looked for opportunities in the changing health system to influence the health outcome of Canadians through a Public Health agenda. We recognized, however, that to move forward we needed to clarify a number of questions, questions that might be answered differently by members in different provinces or different fields - academia, front line service deliv- ery, administration, nursing, and medicine, among others. Is Public Health an organi- zation, a program or an approach to health? Should we argue for the mainte- nance of Public Health units, new models of service delivery, or primary care centres? Is Public Health a service to individuals or to communities? Is it about population health or health promotion? Is community development an aspect of Public Health? Does Public Health have a public con- stituency? Are disease prevention and health promotion the sole property of Public Health? You may have additional questions.

After some discussion, the Working Group concluded that focusing on any one of these questions as the basis for the paper would dilute the limited energy available to argue the Public Health agenda. We decid- ed instead to frame this paper in terms of our history and speak to the four essential elements of Public Health: health promo- tion, disease prevention, health protection and healthy public policy. The group also decided to speak to the perspectives, skills and knowledge that Public Health workers have to contribute to restructuring issues - Public Health can make a difference in health. If we in Public Health know what we stand for and believe in our skills and knowledge, then we can seize opportunities during the major restructuring to shape the

6 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 87, NO. 1

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ÉDITORIAL

health systems to achieve improved health outcomes. CPHA's vision is that Public Health workers can influence the outcomes by taking leadership positions in health care restructuring. Aware of the barriers and the challenges, the Association con- tends that if we as Public Health workers do not know where we are going and what our response to restructuring is, we and the public will lose out.

The Working Group did not want to present a grand vision of what is possible without grounding the vision in work that is already being undertaken by Public Health workers, decision makers and Provincial and Territorial Public Health Branches and Associations in influencing health system restructuring. We included examples of strategies and the names of people who can act as resources to others as they are confronted with change in their workplace. In analyzing the strategies you will see that there are three common themes: develop and provide health infor- mation in an understandable way; build partnerships; and involve the public, the people most affected by the decisions, in the development of health policy. Successful strategies are grounded in facts and an investment in health.

Education of the public cannot be overemphasized. New regional health boards need clear, well-organized informa- tion to support them in making policy

decisions. Communities need information to assist them in evaluating the changes. Individuals need health information to understand the support required to man- age their own health. Many of the strate- gies demonstrated that Public Health workers have much to contribute to reforming the system by concentrating our energy on one of the things we do best, providing credible and clear information about health and health outcomes.

An equally important strategy is collabo- ration and partnership with others who share our vision in order to build a move- ment for health reform. Members of the public, community organizations, unions, churches, municipalities, and many other groups who share a belief in the impor- tance of health are key allies in arguing for health outcomes and reform.

The public have traditionally been excluded from setting the agenda for health. They have been included in the governance of specific health care organiza- tions but not of the health system. Governance of the regional health system is the responsibility of public trustees who, in a sense, govern on behalf of the owners - the public. In my experience, if you involve the public in the identification and priori- tizing of health issues, they focus on health outcomes. A key strategy for health reform is the involvement of the public in the development of the Public Health agenda.

A review of these various strategies reaf- firmed for the Working Group that Public Health must be proactive to successfully influence health care restructuring.

CPHA has taken the position that restructuring must be based on an invest- ment in health. Public Health will be a full partner if it is flexible and open to struc- tural changes but inflexible in its commit- ment to the importance of disease preven- tion and health promotion as key elements that contribute to health. This position represents one step in a long and continu- ous process. The paper is a foundation for future policy and advocacy work of CPHA, its Provincial and Territorial Branches and Associations and other peo- ple interested in the public's health.

An integral part of this issue paper is CPHA's communication and advocacy strategy which builds on the skills and knowledge of the membership, promotes networking among the members to share strategies, and connects with national and provincial media to promote our ideas. Public Health workers know what makes a difference for the health of individuals and communities. We need to articulate our understanding locally, provincially and nationally. We can build a movement for Public Health if we stay focused on our vision of health while taking opportunities to move the key principles of Public Health forward.

Priorité à la santé

Sharon Martin , MA

À l'occasion de la réunion du Conseil d'administration de l'ACSP en février 1995, la réforme des soins de santé et le rôle de la santé publique ont été identifiés comme prioritaires par l'Association. À la suite de cette décision, la première mesure prise a consisté à nommer un groupe de travail chargé de rédiger un document de discussion intitulé Priorité à la santé : la santé publique dans la réforme des services de santé que l'on trouvera sous forme d'encart

Présidente du Groupe de travail de l'ACSP sur la réforme des services de santé

dans ce numéro de la Revue. Ce document met au défi tous ceux que la santé publique intéresse d'assumer un rôle de leadership dans la réforme des soins de santé pour mettre la santé au premier plan. L'Association est d'avis que si cette réforme en profondeur n'est pas accompagnée par des investissements correspondant dans la santé, elle est vouée à l'échec. Il en résul- tera un système de soins de santé rétréci, dont la majorité des ressources iront au traitement des maladies mais qui fera peu pour promouvoir la santé ou pour amélio- rer l'état de santé de la population. Priorité

à la santé recense les ressources et les com- pétences que tous ceux qui oeuvrent à la promotion de la santé peuvent mettre à la disposition de cette réforme importante des services de santé.

Mes fonctions de présidente du groupe de travail, qui regroupait des professionnels de la santé publique de toutes les régions du Canada, m'ont confirmé tout l'intérêt qu'il y a à être membre d'une association dont les intérêts sont aussi diversifiés que les membres. En effet, une association bénévole qui plonge ses racines dans les associations et les directions provinciales et territoriales, et qui s'est donnée en outre comme mandat d'améliorer et de préserver la santé communautaire et individuelle conformément aux principes de santé publique, ne peut être qu'une instance

JANUARY - FEBRUARY 1996 CANADIAN JOURNAL OF PUBLIC HEALTH 7

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