Social Determinants of Health - Debra Lynkowski Responds

Ms. Debra Lynkowski, CEO, Canadian Public Health Association

The Canadian Public Health Association (CPHA) congratulates the Health Council of Canada on the launch of this important report that highlights the need for an intersectoral and multifaceted national effort to address the determinants of health as a means of achieving Health for All in Canada.

At the opening plenary session of CPHA’s 2008 Conference, Sir Michael Marmot reminded us that all government ministers are health ministers. We have been speaking about “determinants of health” for over three decades. CPHA, along with many other professional associations, non-governmental organizations and health groups, has advocated for investment in the “up-stream” population health issues. There is now mounting strong evidence, including the recent Manitoba study referred to in the Health Council’s report, as well as data from other countries, demonstrating the “business case” for investment in a determinants of health approach that addresses health equity.

As the Senate Subcommittee on Social Affairs, Science and Technology noted in its landmark 2009 report, Canada is far from where it should be in terms of the health status of our population. This is especially true for our country’s Indigenous peoples, for many population sub-groups in rural and remote areas, as well as those who fall into the lower socio-economic strata in our urban centres. Leadership by the federal government is essential to propel a national agenda for a pan-Canadian population health strategy. This report’s first two recommendations articulate what would be the foundational blocks of this national effort: that the Prime Minister take the lead in announcing, developing and implementing a population health policy at the federal level through the establishment and chairing of a Cabinet Committee on Population Health, and that the Prime Minister convene a meeting with First Ministers to establish an intergovernmental mechanism for collaboration on a pan-Canadian population health strategy.

This year marked a historic moment in the United States, when its Congress enacted the Affordable Care Act. Included in this landmark legislation are explicit, comprehensive prevention provisions with funding allocations that promote health and wellness. The Act addresses the fragmentation of policy and action and the lack of coordination across local, municipal, state and federal agencies through two initiatives. The first of these is the establishment of the National Prevention, Health Promotion and Public Health Council. Chaired by the U.S. Surgeon General, it is tasked with coordinating and implementing the national prevention agenda. The second initiative is the Prevention and Public Health Fund, designed to invest in prevention and public health programs to improve health outcomes and reduce health care costs. While we often criticize the US for failing to facilitate access to basic health care services for millions of its citizens, we might want to examine the provisions of the new health reform legislation and consider some of its progressive aspects, particularly those pertaining to public health.

Over the past few decades CPHA has called consistently for a population/public health approach here in Canada. Our Association fully endorses all of the recommendations of the Senate Subcommittee report. It wrote a letter to the Prime Minister urging him to take a lead role in putting into place a process that would result in the formulation of a pan-Canadian population health strategy.

Given the importance of income, employment and job security, housing, education, food security, and early childhood development, CPHA urged the Government of Canada, through the 2009 Budget, to create a special fund dedicated to supporting initiatives that take action on the social determinants of health. CPHA suggested an initial investment of $60,000,000, equivalent to approximately 10% of PHAC’s annual budget. This fund, to be administered through the Agency, would be dispersed in support of national, provincial/territorial and local level initiatives.

CPHA has called upon the federal government on several occasions to consider putting into place a new funding mechanism for public health, given that it is not included in the Canada Health Act, nor are public health services explicitly covered through the Canada Health Transfer (CHT). Given the lack of funds earmarked for public health through the CHT, CPHA recommended in its 2010 Budget brief to the Department of Finance the creation of a National Public Health Infrastructure Fund, valued at $1.0 billion over three years. The intent of this Fund would be to assist public health units across the country to implement the programs required to meet their client populations’ present needs. This Fund would also support national, provincial/territorial, and local-level disease prevention and health promotion initiatives, including those related to the social determinants of health.  As noted by Informetrica Limited, a $1 billion investment in health-related services could boost GDP by a factor of 1.8 and create almost 18,000 jobs.

Canada cannot mask the fact that a very serious situation exists in our country in terms of disparities in health across population groups. Public health is a public good. The federal government has an obligation and responsibility for national leadership that results in a high level of health equity for all Canadians. Investing in public health is critical, whether through core support to the Public Health Agency of Canada, through transfer payments to the provinces and territories which include funding earmarked in support of public health functions and/or programs, or through mechanisms that increase the amount of money available to Canadians to provide for their basic needs and which protects and enhances their health and well-being. The goal of Health for All is achievable. As the WHO Commission highlighted, “[a]chieving health equity within a generation is achievable, it is the right thing to do, and now is the right time to do it.“ Collectively, we can make a difference, and the time to do this is now.

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Ms. Debra Lynkowski is the CEO of the Canadian Public Health Association.