Pitching Healthy Public Policy in Victoria

Last week BCAHL had a great opportunity. Well, actually three great opportunities – the kind that policy people like me live for. No, it wasn’t a big announcement (although if I’m honest that is what we truly live for). But second to that, we live to pitch our policy positions to decision-makers who have the power to implement the changes we seek.

Last week we had the opportunity to meet with and present our position on health promotion and disease prevention to the BC Liberal Caucus, the Deputy Minister of Health and the inter-ministerial Assistant Deputy Minister Committee on Population Health Improvement. What a great chance!

Here are BCAHL’s priorities that we shared with decision-makers:

1.   The chronic disease status quo is expensive – but it could be much less.

  • As noted in the Provincial Health Officer’s 2010 report, ‘Investing in prevention – improving health and creating sustainability’:
    • One in three British Columbians (32%) are living with one or more diagnosed chronic conditions, and a further 2% of the population is living with four to six chronic conditions accounting for approximately 80% of the combined Medical Services Plan, PharmaCare and acute care budgets.
  • And yet we know that a significant proportion of cancers, heart and respiratory diseases and diabetes are preventable, including approximately 50% of cancer and type-2 diabetes as well as 80% of premature heart disease and stroke.

2.   The potential of health promotion and disease prevention to bend the health cost curve and create a sustainable healthcare system cannot be underestimated.

  • Recent Health Affairs report illustrates the potential of health promotion to bend the cost curve in health over the long term. The findings: only health promotion / protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity.
    • Year 10: potential to save 90% more lives and reduce costs by 30%.
    • Year 25: could save about 140% more lives and reduce costs by 62%.

3.   Over the next 5 years the funds from the Canada Health Transfer (approximately $4.032 B annually, about 25-30% of provincial healthcare programming) will continue to increase at the rate of 6% a year.

This presents a 5-year window of opportunity to make investments in a shift to an innovative approach focusing on health promotion and disease prevention.

4.   Risk Factors for Chronic Disease: It is important to recognize that healthy living is not just a matter of personal choice. Economic, social and environmental factors influence one’s ability to engage in healthy living. Governments have a vital role to play using both “carrots and sticks”. This will include policies and programs to create supportive environments for healthy living but also regulation and taxation as appropriate.

We need to continue to emphasize the importance of addressing the risk factors for chronic disease – unhealthy diet and weights, lack of physical activity, smoking and inappropriate use of alcohol. 

Different strategies are required at different stages of life, but most importantly, those affected should be involved wherever possible in developing interventions. Generally there is more take up when we work at the local level and with peer to peer programs rather than broad advertising approaches. 

5.   Combination of behavioural, socio-economic and environmental factors at play – this underscores the need for, and importance of, an integrated, inter-ministerial approach

The estimated impact of determinants of health on health outcomes – provides a rationale for looking at innovative ways to improve conditions for health with 50% from social and economic environment; 25% from the healthcare system; 15% from biological and genetic factors; and 10% from physical environment.

BC population data affirms what is widely acknowledged in international and Canadian studies, that disadvantaged populations have increased susceptibility to a broad range of chronic conditions and are more likely to be living with chronic illness. For example, the rate of diabetes among people with low incomes is double those with high incomes and for heart disease it is almost double.

The Public Health Agency of Canada has calculated that “Socio- economic inequities in health are responsible for more than 20% of healthcare costs.”

6.   A Coordinated Poverty Reduction Plan is required if BC is to slow the rate of chronic disease in BC because income insecurity is a major risk factor.

Several weeks ago Nunavut joined the growing majority of provinces and territories with poverty reduction plans, strategies or legislation. The list now includes all of the Maritime Provinces, Quebec, Ontario, Manitoba, Nunavut and the Yukon. 

We were encouraged to see that the Ministry of Children and Family Development is taking the lead to work with other ministries, the UBCM, community organizations and the private sector to “develop strategic, measurable plans in seven communities focused on reducing poverty, mitigating its effects and supporting services for low income families”. We hope that the plans in these seven communities will inform an expanded effort to reduce poverty across the province.

7.   Whole of Person, Whole of Government and Whole of Society Approach

In order to effectively change social norms around healthy living, we need a holistic and comprehensive approach – a “whole of society” approach. No one sector can do it alone – we need to align our priorities and work on a common agenda to see real results.

Within governments at all levels – there also needs to be a “whole of government” approach – whether to redress the underlying social and economic determinants of health, or enact specific policies or actions, the Health Ministry alone cannot do it alone. We need accountability requirements for all departments to address the health and health equity impacts of their policies and programs as well as commitments from the Ministers to put this issue at the top of their agendas. Only in this way will we move towards a healthier BC which will also be a wealthier and more productive British Columbia.

It is imperative to include representatives from a range of sectors in addition to health, including: academia, business, social service agencies, other levels of government and the non-profit sector. The non-profit sector has the relationships, trust and experience that come from working with communities.

If you managed to make it this far….then you must be truly interested. And if you’re that engaged then you may want to know some of the specific policies that BCAHL raised at the meeting of Assistant Deputy Ministers (although these were tailored to the ministries present you can find many of them in our policy section).

Rita Koutsodimos
Manager, Advocacy and Communications
March 2012

Post a comment