Chapter 2: The Chief Public Health Officer's report on the state of public health in Canada 2008 – What is public health?
Public Health in Canada
What is public health?
In Canada, there is a tendency to equate health with health care. That is understandable, given that Medicare is not only a source of national pride but also an important contributor to Canadians’ health. Yet, there is certainly more to health than hospitals and medical services.Footnote 3, 4
Public health is defined as the organized efforts of society to keep people healthy and prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians.Footnote 5
While health care focuses on treating individuals who are not well, public health works to keep people from becoming sick or getting sicker. Both work to limit the impact of disease and disability.3 While individuals receive and benefit from services of the public health system, public health programs target entire populations − not just individuals – by identifying and reducing health threats through collaborative action involving many sectors of society.
Public health challenges Canadians to recognize that physical and mental health are intricately connected to the environment and society.Footnote 7 The way Canada, as a country, deals with issues such as poverty, housing, sanitation and environmental protection directly and indirectly influences the health of the population. The presence or lack of family support and social networks, access to education and jobs, workplace safety, and community cohesion and development also influence health.Footnote 8
Those involved in public health are often invisible to Canadians until serious health events such as SARS, Avian Influenza or West Nile Virus occur. Emergency preparedness and response, in the face of infectious disease outbreaks or other health-related emergencies, is certainly one of the primary functions of public health. However, disease and injury prevention, and the promotion of healthy lifestyles and environments are also central responsibilities of public health.Footnote 6 Unhealthy eating habits, too little physical activity, smoking, alcohol and drug abuse are major contributors to many chronic diseases, as are environmental factors and social conditions that do not support healthy lifestyles or that directly impair health. For this reason, disease prevention and health promotion efforts are applied to a range of largely avoidable or deferrable conditions such as heart disease, diabetes, cancer and Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome (HIV-AIDS).
Figure 2.1 Factors that influence our healthFootnote 9
Although Canadians are among the healthiest people in the world, public health data and research reveal that some groups are more likely to experience poorer health and earlier death than others.Footnote 2 Understanding the causes of these inequalities through health surveillance and population health assessment activities, and developing interventions that reach these groups are also essential elements of public health action.Footnote 10
Public health is a responsibility shared by many actors including federal, provincial and territorial governments, municipalities as well as Aboriginal Peoples’ organizations and their governments.Footnote 3 Governments enact laws and regulations to protect the public from health hazards posed by such things as contaminated water, second-hand smoke or working conditions that endanger employee health and safety. Health professionals, in a variety of settings, work under or in concert with these laws and regulations at the community level.Footnote 6 Among other things, they monitor and assess health conditions and chronic diseases, investigate infectious disease outbreaks, inspect restaurant kitchens and water supplies, provide vaccinations, and offer advice and support/counselling on issues including nutrition, physical activity, tobacco and alcohol control, injury prevention and sexual health.
While governments enact laws, develop policies and provide resources to fund public health organizations, it takes the combined effort of networks both within and outside the public health system to address population-wide health challenges. These health networks include professionals such as physicians, nurses, public health inspectors, health promoters, dental workers and nutritionists.Footnote 6 They may also include community agencies, volunteer organizations, the academic community and international bodies that work toward common goals. Equally vital are indirect players, including media outlets that report health-related news in Canada and provide healthy living information, social marketers, fitness instructors, adults who set good examples for children by taking care of their own health, and employers who provide time or flexible work arrangements for employees to be physically active and to care for children or older or sick relatives. So too, are engineers and transportation workers who make Canada’s highways safer, food producers who follow regulations to ensure that what we eat is safe, and not-for-profit groups that fight poverty and encourage Canadians to get active, recycle and reduce energy consumption.
While there are many ways to describe public health activities, within Canada and in the legislation for the Public Health Agency, the below six activities are generally referenced.
Health protection – Actions to ensure water, air and food are safe, a regulatory framework to control infectious diseases, protection from environmental threats, and expert advice to food and drug safety regulators.
Health surveillance – The ongoing, systematic use of routinely collected health data for the purpose of tracking and forecasting health events or health determinants. Surveillance includes: collection and storage of relevant data; integration, analysis and interpretation of this data; production of tracking and forecasting products with the interpreted data, and publication/dissemination of those products; and provision of expertise to those developing and/or contributing to surveillance systems, including risk surveillance.
Disease and injury prevention – Investigation, contact tracing, preventive measures to reduce the risk of infectious disease emergence and outbreaks, and activities to promote safe, healthy lifestyles to reduce preventable illness and injuries.
Population health assessment – Understanding the health of communities or specific populations, as well as the factors that underlie good health or pose potential risks, to produce better policies and services.
Health promotion – Preventing disease, encouraging safe behaviours and improving health through public policy, community-based interventions, active public participation, and advocacy or action on environmental and socio-economic determinants of health.
Emergency Preparedness and Response – Planning for both natural disasters (e.g. floods, earthquakes, fires, dangerous infectious diseases) and man-made disasters (e.g. those involving explosives, chemicals, radioactive substances or biological threats) to minimize serious illness, overall deaths and social disruption.Footnote 6, Footnote 11
The population approach to improving health is not really new; it has played out in various forms over the history of humankind. As it has evolved, it has not been without serious challenges and failures. Many health problems that have plagued the developed world in the past – such as previously common infectious diseases, unsafe water and sewage, and workplace hazards – may no longer seem important, but their absence should not be taken for granted. It is important to remember that public health advances often involved great struggles to overcome major obstacles and sometimes fierce opposition. As well, societies’ solutions may not have always been appropriate and, in some cases, may even have worsened the problems or helped some people but not others.
Obesity – An Illustration of the Public Health Approach In Canada, 65% of men and 53% of women are either overweight or obese.12 Among children and youth (aged 2 to 17 years), rates of obesity have almost tripled – from 3% in 1978 to 8% in 2004, and another 18% are considered overweight.13 Obesity is a key risk factor for heart disease, joint problems and Type 2 diabetes, so it is critical that Canada find a way to reverse this trend.14 How is this done? The public health approach first requires an understanding of the causes of obesity in the population and then of the ways to influence or mitigate these causes. On the surface, the cause of obesity may seem simple: individuals consume more energy, or calories, than they burn. But why do some people consume more calories than others and/or lead less active lives? Is it simply that people do not realize the impact of their choices? Or is it that behaviours are part of a broader situation determined by life experience: early childhood development; education; the stress and pace of life; the cost, availability and accessibility of nutritious food; super-sizing; and lack of opportunities for physical activity? To address obesity, then, there needs to be an understanding of these broader influences, how to help people make healthy choices the easy choices and how to create conditions for better health. This will, in turn, involve an examination of the factors that affect access to healthy food, food choices, consumption, recreation and physical activity. These include, for example, agriculture practices, food processing, advertising, education, income, time pressures, urban planning, transportation systems, urban green spaces and recreation facilities. The more the causes and effects of obesity are examined, the clearer it becomes that solutions must address a complex and inter-connected network of underlying issues. It requires the right mix of interventions, followed by an evaluation of those interventions. This is a difficult, but worthwhile, endeavour. When this type of effort is made and the root causes of obesity are examined and tackled, other positive impacts on health and quality of life result.
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