Longevity and Public Health

1. Longevity and Public Health IFA Global Conference Montreal September 7, 2008 Carolyn Bennett M.D., M.P.

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

3. The Grey Tsunami ? The Grey Tsunami ? R.O.M.P. Collingwood April 24, 2008 Dr. Carolyn Bennett M.P.

4. D.O.B.?

5. ??? 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

6. Shortgevity • Infectious Diseases • Chronic Disease and Injury • Mental Health • Emergencies • Social Determinants of Health

7. Shortgevity – Public Health ? • Infectious Diseases • Chronic Disease and Injury • Mental Health • Emergencies • Social Determinants of Health

8. teachable moments • 2003 - Canada… 44 died of SARS France…14,000 died in the heat wave • 2005 - Katrina • 2005 - Ontario Medical Association Report

9. Division of Ageing & Seniors “…It’s efforts are focused on four main areas: emergency preparedness active ageing injury prevention and mental health.”

10. 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

11. Minister of Handwashing

12. Lessons learned from SARS • Naylor’s 4 C’s – November 2003 • Collaboration • Cooperation • Communication • Clarity – who does what, when • Germs don’t respect borders !!!!!

14. 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

15. Chronic disease and injury prevention • Diabetes • Cancer • Heart Disease and Stroke • HIV/AIDS • Falls Prevention

16. 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

17. 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

18. 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

19. WISE and WONDERFULvsAGEISM • Nunavut ….ELDERS • South of 60….ELDERLY ????

20. 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

22. 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

23. 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 !!!!

24. 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

25. 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

26. ??? Please save my granny ???

27. Soup lady should dish out factsWinnipeg Free Press, Mon Oct 3 2005Monday, 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?"

28. Based on the 2007 Winnipeg International Workshop on Seniors and Emergency Preparedness Winnipeg, Manitoba, February 6–9, 2007For presentation to the United Nations Commission for Social Development.

29. 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

30. 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”

31. Rx: Longevity Put the ‘public’ (especially SENIORS) back into PUBLIC health

32. "An army of useful citizens" can do what no one person can. Dr. Ethel Percy Andrus

33. Canadian Institute for Advanced Research • 25% health attributable to health care system • 15% biology and genetics • 10% physical environment • 50% social and economic environments

34. 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

35. 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”

36. Attitude2+2=5 Knowledgeable Stakeholders + Committed Politicians = Better Public Policy

37. Political Will to do the right thing • Dramatically improves with an educated public…… health literacy • Citizens pulling healthy public policy…. Civic efficacy

38. Putting the Public back intoPublic Health • Civic Literacy ….. individual • Civil Society…. Community Action

39. Public Health 101

40. 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 ?

41. 2. Would you prefer: A) Clean air B) Enough puffers and respirators for all

42. 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

43. 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

44. 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

45. 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

46. 7. Pick the one that is NOT correct Pandemic Preparedness should focus on • Tamiflu for all • Working with the vets to keep avian flu a disease of birds • Making sure people wash their hands especially the doctors and nurses • Research on vaccines • Community care plans for our most vulnerable

47. 8.Governments should boast about: • how much they spent on the sickness care system • the health of their citizens, leaving no-one behind

48. social determinantsvs.‘choose health’

49. The Causes of the Causes Versus The Causes Sir Michael Marmot

50. Evolution of the Healthy Canadians Tree