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Pierrette Ringuette

The Hon. Pierrette  Ringuette, B.A., M.B.A. On December 12, 2002, Senator Ringuette was appointed to the Senate by the Rt. Honourable Jean Chrétien to represent the Senatorial Division of New Brunswick.

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Study on Impact and Effects of Social Determinants of Health

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Statement made on 18 June 2009 by Senator Lucie Pépin (retired)

Hon. Lucie Pépin:

Honourable senators, I rise to speak after Senator Keon, whom I congratulate for demonstrating leadership in our committee and in promoting a population health approach.

Many experts feel that it is time Canada took an active rather than passive approach to health. Our understanding of health is generally limited to diseases and treatments. We focus our energies more on treating diseases and less on what makes people sick. Yet research shows that 15 per cent of a person' health is attributable to biology and genetic factors, 10 per cent to the physical environment, 25 per cent to the reparative work of the health care system and 50 per cent to socio-economic conditions, which are generally beyond people's control.

Some Canadians are less healthy than others because of low family income, inadequate housing, adverse conditions during early childhood and adolescence, lack of education, illiteracy or poor working conditions.

These socio-economic conditions, known as the socio-economic determinants of health, are also the main causes of the huge health disparities between Canadians.

There are major differences in the health outcomes of various population groups. It is unacceptable that a wealthy country such as ours tolerates such disparities. Every Canadian has the right to be healthy, regardless of ethnic origin or socio-economic status.

These health disparities can be diminished by implementing well-designed government policies. We must intervene at that level.

To deal with the factors that make some people more prone to illness than others, a whole-of-government approach to population health must be adopted.

That is the conclusion reached by the Senate Subcommittee on Population Health after two years of study.

The population health approach requires a profound structural change in government policies and coordinated action by the entire government organization. Our report is very explicit about that. Our colleague, Senator Keon, chaired the committee and has already outlined the main planks of this policy. I will not go into the details.

However, I would like to insist on the need to involve communities in implementing any policy of this nature.

To obtain the desired results, governments cannot act alone. They must work closely with community organizations on those measures that can most effectively improve health and well-being, increase productivity, promote social cohesion and reduce the crime rate and that must be undertaken locally and managed by the communities themselves.

That is why the approach adopted by the Subcommittee on Population Health emphasizes the community context. We believe that community interventions are those that best reach vulnerable populations, create local networks and attract a portion of the resources.

It is important to focus on concerted efforts based on local needs. For that reason, the subcommittee recommends that the Government of Canada work with the other levels of government and the non-governmental sector in order to support the coordination and integration of community services in a framework of health determinants. The subcommittee was extremely impressed to learn of the vast array of fruitful initiatives implemented locally to contribute to good health, well-being, productivity and reduced crime.

Local and integrated means of intervention are the result of combined socio-economic and environmental objectives that can have a positive influence on a good number of health determinants. They take root in the communities themselves, are supported by volunteers and geared to the population. One such example is Stella Burry Community Services in St. John's, Newfoundland, which we visited while conducting our study.

Stella Burry Community Services provides help to adults struggling with serious social and psychological problems. These people have access to support and counselling, training and development programs and affordable housing.

Stella Burry Community Services also launched Stella's Circle, which is a social enterprise whose goal is to provide job and training opportunities in the food service industry, and to offer low-cost meals to Stella Burry members who must eat on a limited income.

Through these initiatives, Stella Burry Community Services can not only generate revenue, but can also make a difference in terms of many more health determinants in the population it serves.

There are many initiatives across the country that deserve to be recognized and supported. There is no single model that can apply to all situations.

An action that yields results in a particular community may not necessarily yield the same results in a different community.

Each set of circumstances is unique, so local leadership is required to draw upon the experience of what has worked elsewhere and adapt it to the specific needs of each community. Therefore, we must provide better tools to communities and we must support them, so that they can adopt solutions that meet their needs.

Our report includes several recommendations on how governments can establish partnerships and support the initiatives of Canadian communities, so that they can focus on the determinants of health. The success of a whole-of-government approach to population health can, to a large extent, be measured by the ability of communities to navigate between the various orders of government.

Since the programs on the determinants of health come under various federal, provincial and municipal bodies, local initiatives to reduce health disparities could receive funds from many sources.

In order to reduce the administrative burden and promote local leadership, the subcommittee recommends that these three orders of government review and harmonize the information, reporting and audit requirements that they impose on community groups for grants and contributions.

It should possible to account for funds received without creating an administrative burden. The beneficiaries of funds provided through various programs should be able to group their accountability reports together.

Short-term, project-based funding as a principal source of revenue weakens community organizations by creating insecurity and preventing long-term planning. Multi-year funding agreements would provide greater stability in the sector and reduce transaction costs for the government. Therefore, we recommend that the Government of Canada encourage multi-year funding of community projects that seek to reduce health disparities.

Honourable senators, the federal, provincial and territorial governments have already spent a lot of time on the issue of population health. Canada is a leader when it comes to understanding the usefulness of an approach based on population health. However, we are slow to act. There is no national plan to reduce health disparity and improve population health in general.

Now is the time to act. We cannot keep putting money into the health system indefinitely without dealing with the root causes of the problem or wait until we are confronted with diseases before taking action. The population health approach to dealing with the causes of disease has many advantages. A healthy population is a more productive population and, in turn, this increased productivity fosters economic growth.

A healthy population requires less government expenditure on income support, social services and so on. Simply put, Canada's economic health depends on the health of all Canadians.

A whole-of-government population health approach would present the advantage of allowing people to experience a better start in life, even from the prenatal stage and early childhood. Health is a basic human right, and it is essential for individuals and societies to function well. Governments have an obligation to create and maintain the conditions necessary for all citizens to live their lives in good health.

Honourable senators, I encourage you to read the report of our Subcommittee on Population Health and give your input so that Canada can soon take a proactive approach to health.

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