championing public health nutrition centre for science in the public interest dr. carolyn bennett,...

Championing Public Health NutritionChampioning Public Health NutritionCentre for Science in the Public InterestCentre for Science in the Public Interest

Dr. Carolyn Bennett, MPDr. Carolyn Bennett, MP

October 23, 2008October 23, 2008

Towards a Comprehensive Towards a Comprehensive Food Policy for Food Policy for CanadaCanada

Food, Glorious FoodFood, Glorious Food

Comprehensive Food Policy for Comprehensive Food Policy for CanadaCanada

Healthy Canadians…. Healthy PlanetHealthy Canadians…. Healthy Planet

Good social policyGood social policy==

Good economic policyGood economic policy==

Good environmental policyGood environmental policy

National Food PolicyNational Food Policy

Food securityFood security Food protectionFood protection Ethical international developmentEthical international development Sustainable agriculture, fisherySustainable agriculture, fishery Industry - strategy like tobacco won`t workIndustry - strategy like tobacco won`t work Healthy choicesHealthy choices Multicultural buffetMulticultural buffet

Across all departmentsAcross all departments AgricultureAgriculture FisheriesFisheries IndustryIndustry HealthHealth Indian and Northern AffairsIndian and Northern Affairs EnvironmentEnvironment International TradeInternational Trade International DevelopmentInternational Development FinanceFinance Human Resources and Skill DevelopmentHuman Resources and Skill Development TransportationTransportation

Sir Michael MarmotSir Michael MarmotChair, WHO Commission on Social Determinants of HealthChair, WHO Commission on Social Determinants of Health

““The worst thing for a physician is to help The worst thing for a physician is to help someone get well and then send them straight someone get well and then send them straight back into the situation that made them sick in back into the situation that made them sick in the first place”the first place”

Canadian Institute for Advanced Research

25% health attributable to health care system 15% biology and genetics 10% physical environment 50% social and economic environments

HEALTH VS HEALTH CARE

““Reorienting health systems”Reorienting health systems”

FROMFROM

a health a health CARECARE system system

TOTO

a true system for a true system for HEALTHHEALTH

Humbling realityHumbling reality

The health of our population cannot be the sole The health of our population cannot be the sole responsibility of the Ministry of Health and the responsibility of the Ministry of Health and the health care sector.health care sector.

Canadian legacyCanadian legacy

Tommy Douglas… Father of MedicareTommy Douglas… Father of Medicare Lalonde Report 1974Lalonde Report 1974 Ottawa Charter 1986Ottawa Charter 1986 SARS, Naylor Report 2003SARS, Naylor Report 2003 WHO Commission SDOH 2005 WHO Commission SDOH 2005 Health Goals for Canada 2005Health Goals for Canada 2005

Goal of Medicare… Goal of Medicare…

Sharing riskSharing risk getting people the health care they need when they getting people the health care they need when they

need itneed it

Keeping people well not just patching them Keeping people well not just patching them up once they get sickup once they get sick

The Tyranny of the AcuteThe Tyranny of the Acute

As long as citizens think of the As long as citizens think of the sicknesssickness care care system whenever they hear the word system whenever they hear the word ‘health’‘health’ we are not going to be able to reorient health we are not going to be able to reorient health systems.systems.

FantasyFantasy

The Em The Em PHAPHA sis sis

is on the wrong is on the wrong

syl syl LABLAB le le

Fleeing the Medical Model,Fleeing the Medical Model,Embracing the Medicine WheelEmbracing the Medicine Wheel

Blame Hippocrates?Blame Hippocrates?

Affirm Hygeia

HYGEIA: Goddess of Health

The solutions are complexThe solutions are complex

For every complex human problem, there is a For every complex human problem, there is a neat simple solution, it’s just that it’s wrong… neat simple solution, it’s just that it’s wrong…

HL MenckenHL Mencken

Complex doesn’t fit Complex doesn’t fit into a 7 second sound bite…..into a 7 second sound bite…..

or on a bumper stickeror on a bumper sticker

We must fiercely defend the complex solutions We must fiercely defend the complex solutions for the complex problems ..for the complex problems ..

BUT……we need simpler messagesBUT……we need simpler messages

Citizens have to ‘get it’Citizens have to ‘get it’

More health …less health careMore health …less health care

Service contract ??????Service contract ?????? Or longer warranty ????Or longer warranty ????

Putting the Public back intoPutting the Public back intoPublic HealthPublic Health

Civic Literacy ….. individualCivic Literacy ….. individual

Civil Society…. Community ActionCivil Society…. Community Action

HOWEVER……HOWEVER……

Public policy usually follows public Public policy usually follows public opinion….opinion….

BECAUSE…….BECAUSE…….

Doing the right thing is very difficult is Doing the right thing is very difficult is the people aren’t onside…the people aren’t onside…

““Father knows best” not great politicsFather knows best” not great politics

Political Will Political Will to do the right thingto do the right thing

Dramatically improves with an educated Dramatically improves with an educated public…… public…… health literacyhealth literacy

Citizens pulling healthy public policy…. Citizens pulling healthy public policy…. Civic Civic efficacyefficacy

“What we have here is a failure to communicate”

Cool Hand Luke 1967

Health Literacy QuizHealth Literacy Quiz

Empowerment Pulling Healthy Public Policy

Putting the Public back into Public Health

Public Health 101 Public Health 101

1.Do you think we should have a:1.Do you think we should have a:

A) strong fence at the top of the cliffA) strong fence at the top of the cliff

B) state of the art fleet of ambulances and B) state of the art fleet of ambulances and paramedics waiting at the bottom ? paramedics waiting at the bottom ?

2. Would you prefer:2. Would you prefer:

A) Clean airA) Clean air

B) Enough puffers and respirators B) Enough puffers and respirators

for all for all

3. Would you prefer that wait-times 3. Would you prefer that wait-times were reduced by:were reduced by:

A) a falls program to reduce preventable hip A) a falls program to reduce preventable hip fracturesfractures

B) private orthopaedic hospitals and more B) private orthopaedic hospitals and more surgeonssurgeons

4.Should we invest in:4.Should we invest in:

A) early learning, child care, literacy,the early A) early learning, child care, literacy,the early identification of learning disabilities and identification of learning disabilities and bullying programmesbullying programmes

B) increase the budget for young offenders’ B) increase the budget for young offenders’ incarcerationincarceration

5.Should we:5.Should we:

A) assume that the 'grey tsunami' will bankrupt A) assume that the 'grey tsunami' will bankrupt our health care system our health care system

B) include our aging population in the planning B) include our aging population in the planning of strategies to keep them wellof strategies to keep them well

6. Is the best approach to food 6. Is the best approach to food security:security:

A) food banks and vouchersA) food banks and vouchers

B) Income security,affordable housing, B) Income security,affordable housing, community gardens and community kitchens community gardens and community kitchens and a national food policyand a national food policy

7. Pick the one that is NOT correct7. Pick the one that is NOT correct

Pandemic Preparedness should focus onPandemic Preparedness should focus on

A)A) Tamiflu for allTamiflu for all

B)B) Working with the vets to keep avian flu a disease of Working with the vets to keep avian flu a disease of birdsbirds

C)C) Making sure people wash their hands especially the Making sure people wash their hands especially the doctors and nursesdoctors and nurses

D)D) Research on vaccinesResearch on vaccines

E)E) Community care plans for our most vulnerableCommunity care plans for our most vulnerable

8.Governments should boast about:8.Governments should boast about:

A)A) how much they spent on the sickness care how much they spent on the sickness care system system

B)B) the health of their citizens, leaving no-one the health of their citizens, leaving no-one behindbehind

Social Determinants of HealthSocial Determinants of Health

vs vs

Choose HealthChoose Health(modifiable risks)(modifiable risks)

The Causes of the CausesThe Causes of the Causes

VersusVersus

The CausesThe Causes

Evolution of the Healthy Canadians TreeEvolution of the Healthy Canadians Tree

CommuniquéCommuniquéFMM September 2004FMM September 2004

““In addition, governments commit to accelerate work In addition, governments commit to accelerate work on a pan-Canadian on a pan-Canadian Public Health StrategyPublic Health Strategy. For the . For the first time, governments will set first time, governments will set goals and targetsgoals and targets for for improving the health status of Canadians through a improving the health status of Canadians through a collaborative process with experts. collaborative process with experts.

Health Goals for CanadaHealth Goals for Canada

Overarching GoalOverarching Goal

As a nation, we aspire to a Canada in which every person is as As a nation, we aspire to a Canada in which every person is as healthy as they can be – physically, mentally, emotionally and healthy as they can be – physically, mentally, emotionally and spiritually.spiritually.


Canada is a country where:Canada is a country where:Basic NeedsBasic Needs

(Social and Physical Environments)(Social and Physical Environments)Our children reach their full potential, growing Our children reach their full potential, growing up happy, healthy, confident and secure.up happy, healthy, confident and secure.The air we breathe, the water we drink, The air we breathe, the water we drink, the food the food we eat,we eat, and the places we live, work and play and the places we live, work and play are safe and healthyare safe and healthy - now and for generations - now and for generations to come.to come.


Canada is a country where:Canada is a country where:

Belonging and EngagementBelonging and Engagement

Each and every person has dignity, a sense of Each and every person has dignity, a sense of belonging, and contributes to supportive belonging, and contributes to supportive families, friendships and families, friendships and diverse communitiesdiverse communities..

Health Goals for CanadaHealth Goals for Canada Canada is a country where:Canada is a country where:

Belonging and EngagementBelonging and Engagement We We keep learningkeep learning throughout our lives through throughout our lives through formal and informal education, relationships with formal and informal education, relationships with others, and the land.others, and the land.We We participate in and influence the decisionsparticipate in and influence the decisions that that affect our personal and collective health and well-affect our personal and collective health and well-being.being.We work to make the We work to make the world a healthy placeworld a healthy place for all for all people, through leadership, collaboration and people, through leadership, collaboration and knowledge.knowledge.


Canada is a country where:Canada is a country where:Healthy LivingHealthy Living

Every person receives the support and Every person receives the support and information they need to make information they need to make healthy healthy choices.choices.

Health Goals for CanadaHealth Goals for Canada Canada is a country where:Canada is a country where:

SSystem for Healthystem for HealthWe work to We work to prevent and are prepared to respond to prevent and are prepared to respond to threats to our health and safetythreats to our health and safety through coordinated through coordinated efforts across the country and around the world.efforts across the country and around the world.

A strong system for health and social well-being A strong system for health and social well-being responds to responds to disparities in health statusdisparities in health status and offers and offers timely, appropriate care. timely, appropriate care.

Health GoalsHealth Goals

Choose indicatorsChoose indicators Include stakeholder in choosing meaningful Include stakeholder in choosing meaningful

and realistic but bold targetsand realistic but bold targets Develop real strategies….Develop real strategies….

what, by when and howwhat, by when and how

French ParadoxFrench Paradox

Celebrating FOOD & DRINK…… thinnerCelebrating FOOD & DRINK…… thinner

North America North America Food = GuiltFood = Guilt Obesity epidemicObesity epidemic

Canada’s Food GuideCanada’s Food Guide?? Evidence ?? Changing behaviour?? Evidence ?? Changing behaviour

Canada’s Food Rules - 1949Canada’s Food Rules - 1949

Canada’s Food Guide -1961Canada’s Food Guide -1961

Canada's Food Guide to Healthy Eating -1992Canada's Food Guide to Healthy Eating -1992

Eating Well with Canada's Food Guide - 2007Eating Well with Canada's Food Guide - 2007

Previous US Dept of Agriculture Previous US Dept of Agriculture PyramidPyramid

Walter Willett’s Healthy Eating Pyramid Walter Willett’s Healthy Eating Pyramid (from (from Eat, Drink and be HealthyEat, Drink and be Healthy))

New USDA PyramidNew USDA Pyramid

What are Canadians to do ?What are Canadians to do ?

farmed salmonfarmed salmon blueberriesblueberries pomegranatespomegranates red winered wine Carbs yes, carbs noCarbs yes, carbs no No fats, good fatsNo fats, good fats

Dr. Jay WortmanAlert Bay Project

National Food PolicyNational Food Policy

Food securityFood security Food protectionFood protection Ethical international developmentEthical international development Sustainable agriculture, fisherySustainable agriculture, fishery Industry - strategy like tobacco won`t workIndustry - strategy like tobacco won`t work Healthy choicesHealthy choices Multicultural buffetMulticultural buffet

Community ActionCommunity Action

Food SecurityFood Security Farmer`s MarketsFarmer`s Markets Community GardensCommunity Gardens Community KitchensCommunity Kitchens Schools…. Schools….

Enrichment ClustersEnrichment Clusters Home EconomicsHome Economics

Structure Structure Gridlock Gridlock

horizontal – departmentshorizontal – departments vertical - jurisdiction vertical - jurisdiction

StructureStructureSilo- busting - HorizontalitySilo- busting - Horizontality

Ministries or Ministers Ministries or Ministers

Cabinet committees Cabinet committees

ParliamentParliament

Officers of Parliament - Commissioners Officers of Parliament - Commissioners

StructureStructure

Jurisdictional squabbleJurisdictional squabble

SARS …. Naylor report..SARS …. Naylor report.. CollaborationCollaboration CooperationCooperation CommunicationCommunication Clarity of who does, what, whenClarity of who does, what, when

Population Health: Population Health: Keeping Canadians healthy….Keeping Canadians healthy….

‘‘Citizen centered’ federalism…Citizen centered’ federalism… bottom upbottom up

ComplexityComplexity Strong common purposeStrong common purpose Local wisdom, local knowledge to get it doneLocal wisdom, local knowledge to get it done

Whole of governmentWhole of government

`total cost accounting``total cost accounting` Marilyn Waring Marilyn Waring …`Who’s counting …`Who’s counting ?’?’

Annual Report of the Chief Public Health Annual Report of the Chief Public Health Officer for CanadaOfficer for Canada

Process ….Health in all PoliciesProcess ….Health in all Policies

Article 54 in PQArticle 54 in PQ HIA…. All MC’s , budget, TB guidelinesHIA…. All MC’s , budget, TB guidelines Citizen EngagementCitizen Engagement Parliament:Parliament:The Use of Societal Outcomes for The Use of Societal Outcomes for

Parliamentarians, 2002.Parliamentarians, 2002.

Process – role of legislationProcess – role of legislation

Vit DVit D Folic AcidFolic Acid Seat beltsSeat belts Childhood immunizationChildhood immunization ExerciseExercise DietDiet Drinking and drivingDrinking and driving

ResearchResearch

Evidence-informed practiceEvidence-informed practice Practice-informed evidencePractice-informed evidence

Courage to fund what worksCourage to fund what works Courage to stop funding what doesn`tCourage to stop funding what doesn`t

Complex adaptive systems…Complex adaptive systems…

Sir Michael MarmotSir Michael Marmot

““Evidence is not enough. There has to be the Evidence is not enough. There has to be the desire, the political will for change. Given that desire, the political will for change. Given that will - a big given but I am an optimist - the will - a big given but I am an optimist - the evidence of what works will be a great help.”evidence of what works will be a great help.”

No time for pessimists

Research

Practice Policy

Research

Practice Policy

KT

Research

Practice Policy

KT

Political will

Research

Practice Policy

KT

Political will

Appliedresearch

Research

Practice Policy

ENGAGED CITIZENS

KT

Political will

Appliedresearch

What do we mean by food security?What do we mean by food security?

Food and the Quality of Life Food and the Quality of Life

the social, cultural and local economics the social, cultural and local economics impacts of food production and impacts of food production and consumptionconsumption


Food, Health, Social Justice and Food, Health, Social Justice and Security in the Canadian ( & Security in the Canadian ( & regional) contextregional) context


Food Production and consumption in Food Production and consumption in the global context & Canada’s the global context & Canada’s responsibilty responsibilty global consequences of agricultural global consequences of agricultural

practices and food distribution systems practices and food distribution systems on human well being and the on human well being and the environment environment

Towards a Comprehensive Food Towards a Comprehensive Food Policy for CanadaPolicy for Canada

Symposium – Symposium – was supposed to be October 14 !!!was supposed to be October 14 !!!

10 Working Groups10 Working Groups RuralRural/Urban Collaboration – /Urban Collaboration –

Eluminate softwareEluminate software

The Global forces of Food SecurityThe Global forces of Food Security

Failed economic policies have privileged Failed economic policies have privileged food as a commodity, not as a human rightfood as a commodity, not as a human right

NAFTA & trade concernsNAFTA & trade concerns Fair Trade-ethical international developmentFair Trade-ethical international development

Ecological Threats to Food SecurityEcological Threats to Food Security

Climate change and green house gasesClimate change and green house gases Water issuesWater issues GMO’sGMO’s

Pesticides & chemicalsPesticides & chemicals

domesticallydomestically SPP with U.S.SPP with U.S. Race to the bottomRace to the bottom China !!China !!

Biodiversity and Food SovereigntyBiodiversity and Food Sovereignty

Aboriginal / traditional foods Aboriginal / traditional foods ““put the put the cultureculture back into agriculture” back into agriculture” MulticulturalMulticultural

Redressing Food Security: New Redressing Food Security: New Approaches to Farming/FishingApproaches to Farming/Fishing

Sustainable agriculture Sustainable agriculture Sustainable fisheries-fish Sustainable fisheries-fish

farming/overfishingfarming/overfishing urban agricultureurban agriculture

bee hives on top of Royal York bee hives on top of Royal York CubaCuba

Food Security and Public HealthFood Security and Public Health

Education/Healthy schoolsEducation/Healthy schools NutritionNutrition Tax PolicyTax Policy LabellingLabelling MarketingMarketing

Food Security and Food SafetyFood Security and Food Safety RegulationRegulation Labelling Labelling Making informed choicesMaking informed choices

ethical, religious, health ethical, religious, health GMO’s GMO’s nutraceuticals nutraceuticals functional foods functional foods ingredients from elsewhere ingredients from elsewhere masking a poor food system with newly enhanced foods masking a poor food system with newly enhanced foods

and vitamins is not the way to go. and vitamins is not the way to go. Address the root cause by growing healthy food Address the root cause by growing healthy food

from good soil that doesn’t have a huge carbon from good soil that doesn’t have a huge carbon footprint in the first placefootprint in the first place

Food Security and PovertyFood Security and Poverty

Pay the Rent or Feed the Kid?Pay the Rent or Feed the Kid? Affordable housingAffordable housing Food banksFood banks Income securityIncome security Community gardensCommunity gardens Community kitchensCommunity kitchens

Food Security and Land UseFood Security and Land Use

Ethanol-land and water for food or fuel?Ethanol-land and water for food or fuel?

Food Security and Local EconomiesFood Security and Local Economies

Marketing regionally, not just national Marketing regionally, not just national (federal support)(federal support)

institutional food procurementinstitutional food procurement federal government could adopt a 10 % federal government could adopt a 10 %

purchasing policy of local foods like U. of T. purchasing policy of local foods like U. of T. ban all bottled waterban all bottled water

urban/ruralurban/rural culinary/agri-tourismculinary/agri-tourism local food marketslocal food markets

Addressing the public’s concerns through Addressing the public’s concerns through Practice & PolicyPractice & Policy

Rationale for a Comprehensive Food PolicyRationale for a Comprehensive Food Policy``walking the talk``walking the talk````

Jurisdictional Platform-Jurisdictional Platform- Root Causes of the Food CrisisRoot Causes of the Food Crisis

intergovernmental regulationsintergovernmental regulations subsidiessubsidies sliding regulatory system based on scale sliding regulatory system based on scale

new meat regulations are ruining small producers new meat regulations are ruining small producers like the lamb on Salt Springlike the lamb on Salt Spring

Germany has addressed this issue very well)Germany has addressed this issue very well)

Research

Practice Policy

ENGAGED CITIZENS

KT

Political will

Appliedresearch

““We are not tinkers, who patch and mend what is We are not tinkers, who patch and mend what is broken. We must be watchmen, guardians of the broken. We must be watchmen, guardians of the life and health of our generation, so that life and health of our generation, so that stronger and more able generations may come stronger and more able generations may come after.”after.”

Dr. Elizabeth Blackwell Dr. Elizabeth Blackwell first woman physician first woman physician

“ “A politician thinks of the next election, a A politician thinks of the next election, a statesman thinks of the next generation”statesman thinks of the next generation”

James Freeman ClarkeJames Freeman Clarke

championing public health nutrition centre for science in the public interest dr. carolyn bennett,...

Documents

goddess of health slide

health goals

ministry of health

word health

health attributable

health care system

health care sector

canada slide