Longevity and Public Health

IFA Global ConferenceMontreal

September 7, 2008

Carolyn Bennett M.D., M.P.

Longevity

• Life expectancy ?• ‘Long life’• More than numerical....• Quality of Life• ICF.... Health and Functional Capacity

The Grey Tsunami ?

R.O.M.P.Collingwood

April 24, 2008Dr. Carolyn Bennett M.P.

The Grey The Grey Tsunami ?Tsunami ?

D.O.B.

?

??? Better measure

• MORTALITY RISK• QUALITY OF LIFE

• Although…. If this is the first generation that may not live as long as their parents….

LIFE EXPECTANCY DOES MATTER

Shortgevity

• Infectious Diseases• Chronic Disease and Injury• Mental Health• Emergencies

• Social Determinants of Health

Shortgevity – Public Health ?

• Infectious Diseases• Chronic Disease and Injury• Mental Health• Emergencies

• Social Determinants of Health

teachable moments

• 2003 - Canada… 44 died of SARS France…14,000 died in the heat wave

• 2005 - Katrina• 2005 - Ontario Medical Association Report

Division of Ageing & Seniors

“…It’s efforts are focused on four main areas:emergency preparednessactive ageinginjury prevention and mental health.”

Longevity and Public Health

• Infectious Disease• Chronic Disease and injury Prevention• Mental Health• Emergencies• Rx: Putting the Public back into Public Health• Complex Adaptive Systems

Minister of Handwashing

Lessons learned from SARS

• Naylor’s 4 C’s – November 2003

– Collaboration– Cooperation– Communication– Clarity – who does what, when

• Germs don’t respect borders !!!!!

Longevity and Public Health

• Infectious Disease• Chronic Disease and injury Prevention• Mental Health• Emergencies• Rx: Putting the Public back into Public Health• Complex Adaptive Systems

Chronic disease and injury prevention

• Diabetes• Cancer• Heart Disease and Stroke• HIV/AIDS

• Falls Prevention

Management 101

``if it`s measured it gets noticed, if it`s noticed it gets done``• Reportable diseases.... HbA1C– Interventions....

• Minister Andy Kerr, Scotland– Health outcomes down to postal code

• GIS

Longevity and Public Health

• Infectious Disease• Chronic Disease and injury Prevention• Mental Health• Emergencies• Rx: Putting the Public back into Public Health• Complex Adaptive Systems

Mental Health• Men over 80 ...highest suicide rate in Canada• Challenges – social and emotional isolation

• Body betrayal– Physical ailments– Mobility– Pain– Cognitive and sensory impairment

• Retirement– Changes in income

• Widowhood, loss of friendships through death• New caregiving responsibilties• GBLT community - inclusion

WISE and WONDERFULvs

AGEISM

• Nunavut ….ELDERS

• South of 60….ELDERLY ????

Longevity and Public Health

• Infectious Disease• Chronic Disease and injury Prevention• Mental Health• Emergencies• Rx: Putting the Public back into Public Health• Complex Adaptive Systems

Survivors

• Hispanics: had an unusually low death rate due to heat. Hispanics at the time lived in places with higher population density, and more social cohesion.

• Elderly women: who may have been more socially engaged, were less vulnerable than elderly men

Vulnerability study

• individual-level risk factors for heat wave victims

• living alone • not leaving home daily • lacking access to transportation• being sick or bedridden • not having social contacts nearby• not having an air conditioner !!!!

2 2003 Paris Heat Wave

• Critics suggest many seniors were abandoned by their families heading to vacation spots for the traditional August holiday.

• The French government cut more than $150 million in elder funding earlier that year

The responsibility of civil society ?

• Health Minister Mattei stated the deaths were a “brutal revelation of a social fracture, of the solitude and isolation of the aged.”

• "Our society doesn't display enough sense of community“ said Paris Mayor Bertrand Delanoe

??? Please save my granny ???

Soup lady should dish out facts

Winnipeg Free Press, Mon Oct 3 2005

Monday, October 3, 2005

Public Health Minister Carolyn Bennett says what bothers her about a flu pandemic is delivering chicken soup to victims.

At last month's annual meeting of the Canadian Public Health Association, she told Canadian Press that mutual support among citizens is one of the most important elements of the response to a pandemic.

Then she added: "The part that bugs me most is the bottom-up part. Does every Canadian know who their three neighbours are...and would we be able to get them the chicken soup and not get infected?"

Based on the 2007 Winnipeg International Workshop

on Seniors and Emergency Preparedness

Winnipeg, Manitoba, February 6–9, 2007

For presentation to the United Nations Commission

for Social Development.

Longevity and Public Health

• Infectious Disease• Chronic Disease and injury Prevention• Mental Health• Emergencies• Rx: Putting the Public back into Public Health• Complex Adaptive Systems

Tyranny of the Acute

• “As long as citizens think of the sickness care system whenever they hear the word ‘health’, it will be very difficult to reorient the health CARE system to systems for HEALTH”

Rx: Longevity

Put the ‘public’

(especially SENIORS)

back into PUBLIC health

"An army of useful citizens" can do what no one person can.

Dr. Ethel Percy Andrus

Canadian Institute for Advanced Research

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

Goal of Medicare…

• Sharing risk– getting people the health care they need when

they need it

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

Sir Michael MarmotChair, WHO Commission on Social Determinants of Health

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

Attitude 2+2=5

Knowledgeable Stakeholders

+ Committed Politicians

=Better Public Policy

Political Will to do the right thing

• Dramatically improves with an educated public…… health literacy

• Citizens pulling healthy public policy…. Civic efficacy

Putting the Public back intoPublic Health

• Civic Literacy ….. individual

• Civil Society…. Community Action

Public Health 101

1.Do you think we should have a:

A) strong fence at the top of the cliff

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

2. Would you prefer:

A) Clean air

B) Enough puffers and respirators for all

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

A) a falls program to reduce preventable hip fractures

B) private orthopaedic hospitals and more surgeons

4.Should we invest in:

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

B) increase the budget for young offenders’ incarceration

5.Should we:

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

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

6. Is the best approach to food security:

A) food banks and vouchers

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

7. Pick the one that is NOT correct

Pandemic Preparedness should focus onA) Tamiflu for allB) Working with the vets to keep avian flu a disease of

birdsC) Making sure people wash their hands especially

the doctors and nursesD) Research on vaccinesE) Community care plans for our most vulnerable

8.Governments should boast about:

A) how much they spent on the sickness care system

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

social determinantsvs.

‘choose health’

The Causes of the Causes

Versus

The Causes

Sir Michael Marmot

Evolution of the Healthy Canadians Tree

Evolution of the Healthy Canadians Tree

Longevity and Public Health

• Infectious Disease• Chronic Disease and injury Prevention• Mental Health• Emergencies• Rx: Putting the Public back into Public Health• Complex Adaptive Systems

Research

• Evidence-informed practice• Practice-informed evidence

• Courage to fund what works• Courage to stop funding what doesn`t

• Complex adaptive systems…

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

Rx: Civic ParticipationIt’s good for your health

Physical and mental energy comes from

feeling in control of your life, having real choices, and being involved with others to find ways of organizing change

for the betterBarbara

Rogers

BONUS !!!!!!!!

GREY POWER.....plug it in !!!!!