DLSPH Blog – Why prevention is key to health care sustainability

January 24/2018

The DLSPH Blog is a digital platform that will explore issues that impact public health and health systems scholars on a biweekly basis written by Interim Dean Adalsteinn Brown in collaboration with DLSPH faculty, staff and students.
For blog ideas, feedback or comments, contact: communications.dlsph@utoronto.ca

Last fall, Canada’s chief medical officers of health published a compelling CMAJ commentary that plainly stated prevention is the key to health system sustainability. A main pillar of public health sciences, health promotion (and disease prevention) makes populations healthier, reduces health system strain, and contributes to broad economic sustainability.

When the Honourable Marc Lalonde, Canada’s Minister of National Health and Welfare in 1974, published “A new perspective on the health of Canadians,” he became a pioneering thinker around the social determinants of health and maximizing preventative efforts to improve public health. This year, Canada will celebrate the 44th birthday of The Lalonde Report, considered to be the first modern government document in the Western world to acknowledge that our emphasis upon a biomedical health care system is wrong, and that we need to look beyond the traditional health care (sick care) system if we wish to improve the health of the public.

Dalla Lana School of Public Health faculty, students and alumni have made tremendous strides in health promotion, targeting communities facing social challenges that impact their health. As academics with close community connections, our role is to demonstrate actionable insight toward improving health and social outcomes, engaging members of our target groups and making real social change. We recognize that health promotion is not a one-size-fits-all endeavour and we use different tools and strategies to target different vulnerable groups with population health efforts.

For example, members of our community have developed health promotion programs targeting support to people who use drugs, young people living street-involved or homeless, and Muslim women facing socio-cultural barriers to achieving a healthy lifestyle. We also are helping shape policy on social determinants of health through community-based advocacy and participation in government consultations, notably the Fight for $15 and Fairness movement that won the $15 minimum wage legislation earlier this year.

We know that we must think and plan beyond health care, while shifting the emphasis away from the traditional focus on disease and towards a concept of health that includes functionality, resilience, and other qualities that better capture individual and societal goals with respect to health and well-being, but are we doing enough?

Part of the issue is that the greatest return on investment is likely to be netted from policies and programs outside of health care, but will have direct effects on the health of Canadians such as poverty reduction, eliminating racial and ethnic health disparities, affordable housing, community infrastructure investment, and climate change initiatives.

We need to think big, at the system-level and outside the system to make carefully considered investments in policies strengthen that education, social supports and housing. Equity is a cornerstone public health, but it’s not always reflected in policy development and implementation. Future gains in health, public health services and health care must reach all Canadians. That’s why DLSPH promotes an intersection approach that recognizes health is shaped by a multi-dimensional overlapping of factors such as race, class, income, education, age, ability, sexual orientation, immigration status, ethnicity, Indigeneity and geography.

Engaging vulnerable communities or people on the margins to take action to improve community health is a strength of the DLSPH and there’s a noticeable societal shift in how we promote health for today’s changing communities. Building upon existing and creating opportunities for new leaders to emerge from these communities is essential.

We know our next move and we must convert this knowledge into action. I am proud to say that we’re seeing change in the system. Reading the Winter 2018 U of T Magazine, it’s refreshing to see Dr. Eileen de Villa’s take on public health data as a “necessary precursor to a rethink of attitudes and policies.” She reminds us that we must understand and be able to measure the roots of the problem — i.e. the social determinants of health — before we can address it.

Together we can come up with the shared, co-created solutions that help all communities — especially those living on the margins — to improve capacity and control over health and well-being. To do so we must ensure that supportive environments, systems and policies are in place that make healthier choices and communities achievable. As a leading school of public health that holds equity and social responsibility as shared values, we will continue to work collaboratively with communities and governments to ensure health for all.

– Professor Adalsteinn Brown, Interim Dean, Dalla Lana School of Public Health & Dalla Lana Chair of Public Health Policy, in collaboration with Charlotte Lombardo, MPH Health Promotion Program Director and PHS Master’s Graduate Coordinator and Ananya Banerjee, Assistant Professor and Assistant Program Director of the MPH Health Promotion Program.