Public Health Renewal: Building a System to meet the Needs of Nova Scotians

1. Public Health Renewal: Building a System to meet the Needs of Nova Scotians Dr. Robert Strang, Chief Public Health Officer Public Health Association of Nova Scotia Nov. 13th, 2007

2. Public Health • Science and art of promoting health, preventing disease, prolonging life and improving quality of life through the organized efforts of society. Public Health in England (Acheson Report), 1988

3. Public Health – Contributes to: • Improved levels of health status of the population and decreased health disparities • Decreased burden on the personal health services system and thereby contribute to its sustainability • Improved preparedness and response capacity for health emergencies F/P/T Improving Public Health System Infrastructure Report, 2005

4. Public Health System Core Functions • 5 core functions: • Population health assessment • Health surveillance • Disease and injury prevention • Health promotion • Health protection F/P/T Advisory Committee on Population Health (ACPH)

5. How we do our work: Using a Population Health Approach • Focus on the health of populations • Address the determinants of health and their interactions • Base decisions on evidence • Increase upstream investment • Apply multiple strategies • Collaborate across sectors and levels • Employ mechanisms for public involvement

6. Historical Perspective • Learning from SARS (November 03) • Public Health Review Process • Terms of Reference of Review approved (CEOs, SLT) • Expert External Review Team • Provincial Advisory Committee • Engagement of local and provincial levels • External Consultant – Dr. Brent Moloughney • Public Health Review • Oct 04 Consultant hired and review begun • Sept 05 final report completed • Jan 06 Cabinet approval • Feb 06 Dept of HPP established • April 06 Report released • Spring-Winter 06 establishing the new Dept • April 07 Major budget increase • Aug 07 CPHO appointed

7. Review’s major findings • Improve structure & capacity provincially • Improve structure & capacity locally • Improve integration between system levels • Improve integration with rest of health system • Address infrastructure - people - information - organization

8. Review’s major findings • 21 Actions for system renewal • Significant work required • Deterioration over a decade; fix will take a decade • Actions for Renewal are all inter-dependent • Cannot pick and choose • Most “actions” are projects unto themselves • Many important decisions within the actions • Will require system thinking and involvement of all players • System renewal must occur while system remains operational • Comprehensive in nature • Provide the path for renewal

9. What’s happened to date? • New Department announced in Feb 2006 (#4) • Chief Public Health Officer appointed (#2) • Provincial organization re-organized and implemented and major recruitment underway (#3) • Interdepartmental activity and commitment to environmental health secretariat (#6) • Liaison with Atlantic Provinces and academic partners on opportunities for collaboration (#7, 8, 9, 17) • PANORAMA:CDC component of information system development (#10) • Public health laboratory project (#13) • Ongoing Pandemic planning in partnership with DOH (#15) • Multi-year budget for system renewal completed (#16) • Ongoing liaison with Public Health Agency of Canada (PHAC) (#19) • Project team for implementation under recruitment (#21)

10. HPP Vision Helping Nova Scotians to be healthier and safer

11. HPP Mission We will lead the collaborative effort to prevent illness and injury, promote and protect health and reduce disparities in health status

12. HPP Strategic Goals Improve the health of the population. Support capacity building within government, communities, families and individuals. Create supportive social and physical environments. Develop and influence policy that supports improved health. Create and sustain a sufficient, competent and healthy workforce in HPP and throughout the public health system.

13. Guiding Principles • Foundation. We are grounded in the principles of community development and committed to a population health approach to our work. • Partnership. We will work in a collaborative, transparent and responsive way. • Integration. We will work within and across disciplines, sectors and organizations. • Evidence Informed. We will make decisions based upon the best available information. • Accountability. We will be responsible for our individual and collective actions.

14. LEADERSHIP We believe in creating a culture that inspires all of us to achieve our best. We believe in being responsive and decisive. INTEGRITY We believe in openness, honesty, trust, respect and acknowledging the contributions made by all. COLLABORATION We believe in the importance of teamwork and open communication. INNOVATION & EXCELLENCE We believe in achieving our goals through a spirit of creativity and exploration. PEOPLE DEVELOPMENT We believe in continuous learning, self –improvement, personal wellness and professional development. Practice what we preach Doing the right thing The whole is greater than the sum of its parts Thinking outside the box Life-long learning HPP Values

15. New Departmental Structure

16. Key Public Health Issues and Why Are These Important To Nova Scotians • Environmental Sustainability → future generations • Chronic Disease and Injury Prevention → sustainability of health care system economic impact • Mental Health & Addictions → under-recognized; societal impact; underlying factor for other key issues • Early Childhood Development → primordial prevention • (Re) Emerging Infectious Diseases → credibility and risk management • Shared theme of health disparities → equity

17. How To Address These Issues More Effectively • Provide leadership • Enhance partnerships • System’s thinking • Longer term thinking • Build capacity • Create supportive environments • Strong public health system

18. Requirements for a Strong PH System • systems approach • commitment to all PH functions • information & evidence • integrated settings based approach • leadership & catalyst for change • collaboration • community development

19. Key Public Health Partners • Prov. Govt departments • Academia • NGOs • PHAC/Health Canada/Environment Canada/ CFIA • FNIHB/ First Nations communities

20. Key Partners & PH System • Need shared dialogue to develop common understanding of • PH functions & PH system • system level roles & responsibilities • leadership • decision making • accountability • communication • integration with rest of health system

21. Short Term Goals (where to next) • Establish presence of CPHO • Build teams at provincial, local and systems level • Engage partners at local, provincial and national level • High gear business planning for 08-09 • Maintain momentum

22. Discussion Points • How to strengthen links between PH system and PHANS? • Role of PHANS in PH renewal?