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Municipal Government and Public Health: How Cities are Addressing the Social Determinants of Health & Health

Inequalities

Thematic Session, Suite 303 WTCC 8:30am to 10:00am,

Wednesday June 4, 2008

CPHA Conference, Halifax NS

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The Session

• Brian Ward, Moderator, PHAC

• Dr. Cory Neudorf, Chief Medical Officer, Saskatoon Health Region

• Councillor Sheila Fougere, Halifax Regional Municipality

• Discussion, Statements, Questions & Responses

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Social Determinants of Health & Municipal Government

The health of Canadians is determined largely by the conditions in which they live.

Different conditions lead to differences in social status.

Different social status leads to different health status.

Municipal leaders significantly shape the conditions of people’s lives, and of their health.

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Estimated Impact of Factors Determining the Health Status of the

Population

50%25%

15%10%

Source: Estimation by the Canadian Institute for Advanced Research, The Standing Senate Committee on Social Affairs,

Science and Technology, The Health of Canadians – The Federal Role, Volume One: The Story So Far, March 2001.

Social and EconomicEnvironment

Health Care System

Biology and GeneticEndowmentPhysical

Environment

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Physical Environment

• Positive Determinant when:– Universal infrastructure: i.e. water, waste,

transportation systems, community planning, recreational & cultural opportunities,

– Protective policies: i.e. pollutants, tobacco, health and safety standards & inspection,

– Basic needs met: i.e. adequate & affordable housing,

• Negative Determinant when: – Excluded populations, poor quality/ageing

infrastructure, private interests over-ride public interests

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Social & Economic Environment

“Roy Romanow’s Advice”

• Don’t be poor

• Get a good start in life

• Graduate from high school

• Get a job

• Pick your community

• Live in quality housing

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The Municipal Determinants of Good Health“Pick Your Community”

• Accessible, Affordable, Safe Housing• Access to safe water & sanitation• Efficient waste management• Safe working & living environments• Health & environmentally planned land use• Food security• Public transportation• Child care• Recreational & Cultural programs and facilities• Public Health promotion & programming• Health and Crisis Leadership and Management• Immigrant & Settlement Services

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Some municipal initiatives of note I

• Social Support Networks– City of Regina’s Urban Aboriginal Community

Grant Program– Halifax Regional Municipality Immigration

Action Plan

• Healthy Child Development– Toronto’s Early Child Development Initiative– Edmonton’s Child Friendly Strategy

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Some municipal initiatives of note II

• Social Environments:– Vancouver's Four Pillars Drug Strategy &

Wellness Walkway– Toronto’s injury prevention initiative– Safer Calgary initiative

• Food Security– Ottawa’s Food Security Group– Nourrir Montréal

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Some municipal initiatives of note III

• Environmental Health:– Many Smoking By-laws (national leadership)– Calgary’s Reduced Vehicle Idling initiative

• Affordable Housing– Toronto's Streets to Home program– Region of Waterloo’s Affordable Housing

Strategy– London’s Convert to Rent Program– Ottawa’s deferred property tax program

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Municipal Health Leadership“Health for All”

• Pesticide bylaws: Hudson Quebec 1991– Now: 135 municipalities with pesticide control

by-laws improving the health of 42% of Canadians (October 2007)

• Supreme Court affirmed the right of Municipalities to protect residents health through bylaws, endorsing the precautionary principle

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Some background on Municipal Government

• 3,700 municipal governments in Canada• The 10 largest urban economies accounted for

47% of the GDP; • Toronto’s GDP is larger than that of 8 provinces

and 29 American states• Municipal employees: over 350,000• Public transit: 1.63 billion passengers yearly• Annual Public housing investment: $2.1 Billion

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Background (continued)

• Two types: – Single/lower tier –cities towns, townships with

full responsibilities for municipal services– Upper tier – regional or metropolitan

municipalities with wider area and possible several lower tier municipalities within them

• Created by provincial legislation therefore great variety across Canada

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Total Government Revenue as % of GDP 1989 - 2005

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Tax Revenue Distribution

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Revenues

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Property Tax

• Horizontal equity: regressive– Among categories i.e. business vs. rental vs.

homeowner

• Vertical equity: regressive– Share of household income represented by the tax

goes down as income goes up

• Often inefficient: – suburban expansion, hollow cores, elderly & fixed

income

• Highly visible– Differentiated visibility and responsible leadership

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How others tax for revenue

Income Property Sales/ Other

ServiceCanada 0.0% 91.5% 2.0% 6.5Australia 0.0 100 0.0 0.0Mexico 0.1 89.5 2.4 7.9U.S.A 5.2 72.6 22.0 0.0France 0.0 53.2 11.0 35.9Japan 44.6 33.0 21.3 1.0Germany75.8 17.7 6.4 0.3Italy 21.6 13.6 23.0 41.8

OECD 2004

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Expenditures

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Expenditures

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Municipal Government and the Social/Economic Physical Determinants

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The roles and contributions of Municipal Government on SDH

• Leaders on the determinants of health in areas of municipal mandates.

• Partners on the determinants of health where municipal government has the experience, contact and relationships

• Brokers & instigators where the solution requires a multitude of players.

• Guarantors that the local voice is heard.

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Where Public Health and Municipal Government meet

• Inclusive Communities: barrier-free design, programming & planning

• Environmental Health: the bio-dome• Active Living: city/town as health club & outdoors

places• Food Security & Nutrition: the garden & the

market• Affordable Healthy Housing: • Community Safety: • Child Health & Development:

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What Public Health & Municipal Government can do together

1. Integrated & intersectoral leadership

2. Community participation and empowerment

3. Evidence based strategies for learning

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And Finally….

Conference Objectives:

• To provide a forum to critically reflect on our progress, and

• To consider Canada’s future role in the reduction of health inequalities in response to the anticipated report of the WHO Commission on Social Determinants of Health.