The Chief Public Health Officer's Report on the State of Public Health in Canada 2014 – Moving forward
The who, where and what of factors influencing public health touch on a broad range of topics, but all conclude with key priority areas that will drive public health into the future. The common underlying theme through the three independent sections of this report is one of change. Populations, environments and technologies are in flux, and public health, and other sectors, must plan and be adequately prepared for these increasingly rapid changes. Change can bring benefits, for example, technological advancements and universal design of built environments that contribute to public health. But change will also bring challenges such as caring for a growing elderly population. Public health has a role to play in building upon the benefits and addressing the challenges. However, given that we don't know exactly what the future holds, we need to be flexible and ready to respond quickly to any possible challenge that may arise. Each section in this report concludes that public health functions—protecting and preventing against disease and promoting health—are relevant not only now, but also in the future. Nor are they exclusive to what we conventionally think of as public health.
Planning for the future
People, organizations and sectors continually plan for the future. Every day, Canadians invest in education for their children, buy houses and save for retirement. People also make individual choices towards staying healthy by eating well and exercising. In addition, governments plan for appropriate infrastructure to support a vibrant sustainable economy, an educated healthy workforce, and a better future for its citizens among other mid- and long-term priorities. Many decisions are made to minimize adverse outcomes and increase benefits based on our view of future scenarios. While no one can see into the future, people can build upon resources that are available to them at the time.
Planning for public health also involves investing and making choices with the goal of securing a healthier future for the greatest number of people and reduced health inequalities in that future. To do this, public health professionals will need to build upon current strategies as well as incorporate new approaches, address new challenges and adapt to new tools. This involves considering what happens if risk factors or conditions of ill health worsen or change over time and assessing how changes to populations, environments and technologies will impact health. The health of the population now and in the future remains the primary priority of public health.
The three sections of this report outline the efforts that need to be continued moving forward and highlight certain priorities for public health in the future.
Focus on traditional public health approaches and practices
While approaches and technologies are branching into exciting new areas and capturing interest, public health will still rely on basic fundamental principles and strategies to prevent disease and injury and protect and promote health and well-being. Differences in health outcomes between populations require that public health programs and practices must continue to consider the broader determinants of health in planning. As well, the three sections of this report confirmed that lifecourse matters. Healthy aging, for example, is a lifelong process that involves many practices, decisions and adaptations to change throughout the preceding years.
Invest in health research
This report has identified several areas where research will be important to public health in the future. Having better information allows for better identification of long-term trends and areas where public health investment and efforts should focus. Further investigation is needed into how to use and capture the health information available through new technologies and social media. More research is required on specific health concerns (e.g. neurological conditions including dementia) that continue to burden Canadians. And finally, research on the effectiveness of programs and interventions and possible improvements is required. Robust evaluations can contribute to overall knowledge and provide important information on whether programs are reaching their targeted goals and populations and are applicable in other regions or situations.
Continue and improve public health surveillance
Continued and improved surveillance will be a necessary component of public health in the future. Investments in surveillance can result in improvements in early disease detection and prevention as well as in identification of associated behaviours and risk factors. Effective surveillance can also project and forecast outcomes, trigger early warnings and communicate strategies for domestic and global public health events, as well as identify issues that require further study. Using surveillance systems to facilitate early warnings and public health advisories (e.g. Air Quality Health Index) may be an effective practice to reduce the health impacts of natural and climatic change.
Continue education and awareness programs
Education programs and practices must adapt to changes in health as well as populations, environments and technologies and public health messages must achieve a balance between positive and negative messages. Programs must be evaluated to measure the clarity of the message, whether the program reaches its target audiences and if behaviours changed. For example, heat advisories are showing promise at changing behaviours (e.g. limiting physical activity on extreme heat days) to reduce health risks.
Address vulnerability and foster resilience
Differences in health outcomes, access to technologies and services, vulnerable populations and environments are common issues across the three sections of this report. These differences can result in gaps in health status among populations. Vulnerability can also influence the ability to adapt to change, ultimately widening the gaps between those with and without opportunities for good health.
Develop opportunities for remote communities
Remote communities were noted as having harsher environments, unequal access to resources and other factors that adversely influence health outcomes. While technology can be used to deliver some aspects of public health programs in remote communities, it is not complete and limited access, lack of trained human resources (and reduced capacity to train) as well as cultural and regional relevance impede use of technology.
Collaborate to create supportive and sustainable environments
Establishing partnerships and working collaboratively to support community efforts to create sustainable conditions can enable and promote good health. Successful programs and initiatives, such as age-friendly communities, rely on the participation of seniors and other community members at all stages of program development and implementation.
Build community capacity
Investments in disadvantaged communities and people will make a difference in creating public health for all and achieving health equity. The underlying issues are as diverse as individuals, and need to be understood and addressed accordingly. Despite a focus on the role global systems will play in public health in the future, communities are the critical players in the development and implementation of comprehensive and effective public health strategies. Every effort must be made to build on the knowledge, experience and investments already in place in Canadian communities.
Take intersectoral action
Encouraging collaboration with non-health related sectors to create and promote healthy public policies is key since health issues involve many factors that fall outside the mandate of public health and the healthcare sector. To effectively prevent adverse health outcomes and improve health opportunities in the future, all levels of government, non-governmental organizations, the private sector, communities and individuals must work together towards integrated and coherent policies and actions. In addition, many changes and health issues are linked to global systems such as a changing climate. Future public health efforts will rely on international collaborations, partnerships, knowledge sharing and international laws and policies. Opportunities continue to exist for Canada to play a leadership role and work across sectors to tackle multiple determinants of health and develop broad cross-sectoral strategies.
A way forward
Preparing for the future means adapting to, and planning for, change. Public health in the future will involve building on the strengths of current public health approaches, adapting practices to meet changes and working with partners across sectors and various levels of government. Progress will involve capitalizing on these areas:
- furthering investment in public health programs and services to enhance health, reduce risks and to support the development of strong evidence, being accountable to this evidence, and increasing capacity for further research and surveillance;
- focusing attention on education and awareness and maximizing the benefits of technologies to communicate messages and breakdown misinformation;
- building supportive and sustainable environments that incorporate natural and social factors;
- fostering strong public health leadership in Canadian communities and internationally; and
- promoting for policies across all sectors and levels of government that help create and support healthy populations.
Looking to the future
Our collective health is influenced by the type of society we choose to create. When we look forward, we need to ask not what will drive public health, but how we can work together and leverage ever-changing factors to achieve health for all. Understanding the issues and connections will better prepare us for the unknown, build resilience and give us the resources required to meet future needs.
Healthy aging is important to all Canadians. Our seniors continue to benefit society through their active participation in the workforce, in the voluntary sector and as active members of our communities and families. It is troubling that young populations, our future seniors, are showing signs of ill health and, in some cases, at a greater level than their predecessors. These trends indicate that public health still has much work to do in preventing disease and promoting good health and well-being across the lifecourse.
There are numerous known health impacts of changing physical and social environments. We must adapt and find ways to build resilience and support among those who have not shared the same benefits. We must build communities in tune with the physical environment. We must create urban communities that are universally accessible and adaptive. As well, we must work with our community and global partners to make the necessary changes as public health risks respect no borders.
Technology has changed how we interact and communicate. Much can be learned about health and perceptions of health through, for example, what people are posting online. Technology allows us to expand our understanding of public health issues, to increase surveillance and monitoring as well as create an understanding of susceptibility. While technological change is exciting, we still need to be cautious and respect ethical and privacy concerns. We must ensure that the new technologies are truly benefitting those we are targeting and that we are not creating new inequalities.
Public health in the future will be the realization of the efforts we make today. We can all work together to:
- establish healthy practices from childhood to old age;
- participate in society and volunteer to benefit ourselves and others;
- sustain our physical environment, protect natural spaces and enhance built environments;
- participate in the global community;
- challenge stigma and raise awareness about health; and
- recognize that inequality harms us all and work to improve opportunity for everyone.
If the future is all about change, we can be the change that sets the future.
- Dr. Gregory Taylor
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