The Chief Public Health Officer's Report on The State of Public Health in Canada 2008

The Chief Public Health Officer’s Report on The State of Public Health in Canada 2008
Dr. David Butler-Jones
Canada’s Chief Public Health Officer

A Message from Canada’s Chief Public Health Officer

This is the first annual report of the Chief Public Health Officer and, as such, it represents a significant moment in public health in Canada. The intention of this report, and those in future, is to speak to aspects of health in the population, as well as to a specific issue or theme. It will serve to define some key public health issues of the day and consider how they can be approached. It is intended to inform Canadians and stimulate dialogue on the many factors that contribute to good health and what can be done individually and collectively to advance public health in Canada.

Public health has been defined many ways, but I find it best described as “the organized efforts of society to improve health and well-being and to reduce inequalities in health.” In simple terms, this involves different segments of society working together for the good of all. Public health is that collection of programs, services, regulations and policies, delivered by governments, the private sector and the not-for-profit sector, that together focus on keeping the whole of the population healthy. It is also a way of thinking about, and an approach to, how we tackle the health issues we face. Fundamentally, it is focused on understanding and addressing the factors that underlie illness or good health and asks questions like “what are the causes of poor health?” and “how do we address those causes before they become problems?” Health care, in turn, focuses on our needs as individuals and what we can do to restore or improve health. Health care and public health are complementary and both are necessary in the pursuit of good health.

The position of Canada’s Chief Public Health Officer was created in 2004, along with the Public Health Agency of Canada. These actions were taken, in part, in response to the SARS outbreak of 2003. The Chief Public Health Officer has a dual role, something that is unique in governments. One is to serve at the Deputy Minister level in the federal public service, heading the Public Health Agency and advising the Minister of Health on matters of public health and the function of the Agency. At the same time, the CPHO communicates directly with Canadians on important public health matters. One means of achieving this is through the requirement that the Chief Public Health Officer report annually on the state of public health in Canada.

This is the first of those annual reports. A separate report by the Agency later this year will address the progress we’ve made since the outbreak of SARS.

Among the good news found in this report is the fact that the majority of Canadians enjoy good to excellent physical and mental health. We are living longer lives and, over the past century or more, we have made significant strides in improving our collective health.

The bad news is that not all health trends are improving, and not all Canadians are benefiting to the same degree from these improvements over time. For example, there is a growing prevalence of obesity and diabetes in Canada that – if unchecked – may open the door to the possibility that this generation of children may be the first in Canada to have a shorter life expectancy than their parents.

Our goal is to be healthy as long as possible. Although it is important to focus on the number of extra months or years we might gain, it is even more critical to reduce the number of those years that we are ill or disabled. Most understand this concern from a quality-of-life perspective, but there is another issue to consider. People who are less healthy put pressures on the health and welfare systems. This leads to longer wait times for those seeking medical treatment and increases costs for Canadian taxpayers as a whole. There are also other costs to society, such as high rates of absenteeism and lower productivity in workplaces, not to mention the toll that ill health takes on affected individuals and their families as they suffer the physical and emotional, as well as economic and social fall-out of poor health. Healthy people contribute to healthy economies.

As we strive to achieve good health for as long as possible, it is important to note that while some health challenges can be related to our genetic make-up, evidence shows that Canadians with adequate shelter, a safe and secure food supply, access to education, employment and sufficient income for basic needs adopt healthier behaviours and have better health.

Beyond these basics are two very important underlying factors: having a sense of control or influence over our own lives and future; and loving, being loved and having family, friends and other social connections that give us a sense of being part of something larger than ourselves. These things matter because health is more than physical – if people care about you, and you, in return, care about others, if you have work you enjoy, if you can read, write and can function well in society – it makes you a healthier person. It is no coincidence that those who volunteer, who give of themselves and who take an active part in their community end up, on average, healthier and happier.

The choices we make, the work we do, the friends we keep and the lifestyle we live all matter to our health. Although they are a personal responsibility, these choices are often shaped and limited by our environment and circumstances. These factors along with others have come to be known as social determinants of health and they are vital to helping us understand and improve the health of Canadians.

How these determinants contribute to the differences in our health matters because some groups of Canadians experience lower life expectancy than others. Some have higher rates of infant mortality, injury, disease and addiction. Some are more obese and overweight. These differences in health status are referred to as health inequalities.

It seemed appropriate that the theme of this first report would focus on the determinants of health and how they contribute to health inequalities. In some ways what I am reporting is not new, and should not come as a surprise. Unfortunately it will be a surprise to many, given the magnitude of the inequalities that still exist despite our being among the richest countries with one of the most sophisticated health and social systems in the world. Why is it that – although we are, on average, the healthiest we have ever been – many in Canada have not shared in that health and well-being?

I have chosen to focus this report on gaining a better understanding of these inequalities, and on how we might reduce them. The reason for this choice is simple: I would argue that a society is only as healthy as the least healthy among us. We cannot rate our collective health and well-being by looking only at those who are healthiest. Nor can we focus only on averages, as these mask important differences between the least and most healthy. We must also consider those left behind: those who are less healthy, illiterate, on the streets, or have little or no income.

In fact, this report highlights a variety of projects and programs in operation throughout the country and on an international level that are already making progress. Simple examples include: an initiative to support the needs of at-risk pregnant women; a tri-partite agreement to improve an inner-city community; an organization that works to break the cycle of poverty by providing low-income families with affordable housing; programs that help children prepare for school and reach their full potential; and a city where at-risk and economically challenged youth are being given academic, social and financial support, and where a mobile health unit operates to assist immigrant women. It is not as if we have no answers or that they need be overwhelming, as many communities are already engaged and solutions are being delivered.

In short, health inequalities are fundamentally societal inequalities that we can overcome through public policy, and individual and collective action. Just as there is no sector of society that is untouched by health inequalities, there is no person or organization that cannot make a positive contribution to their resolution.

Because we determine our health by the type of society we choose to create, each of us has a part to play in creating a healthier Canada. Now that’s an intriguing challenge!

Dr. David Butler-Jones
Chief Public Health Officer of Canada


Dr. David Butler-Jones is Canada’s first and current Chief Public Health Officer. A medical doctor, David Butler-Jones has worked throughout Canada and consulted internationally in public health and clinical medicine. He is a professor in the Faculty of Medicine at the University of Manitoba and a clinical professor with the Department of Community Health and Epidemiology at the University of Saskatchewan. He is also a former Chief Medical Health Officer for Saskatchewan, and has served in a number of public health organizations, including as President of the Canadian Public Health Association and Vice President of the American Public Health Association. In 2007, in recognition of his years of service in public health, Dr. Butler-Jones received an honorary Doctor of Laws degree from York University’s Faculty of Health.

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