Shannon, asked if I would add her note to the discussion as she is not
linked to CLICK4HP but is quite passionate about public health nonetheless.


----- Original Message -----
From: "Turner, Shannon TLB:EX" <[log in to unmask]>
To: "'Mollie E. Butler'" <[log in to unmask]>; "Sylvia Robinson"
<[log in to unmask]>
Sent: Tuesday, November 07, 2000 11:23 AM
Subject: RE: Discussion


> As one of the consultants who worked on the Layers of Change report I
would
> like to add my voice to this debate.  Regionalization has certainly
resulted
> in the acute care sector raiding other sectors for solutions to their
> growing problems.  Admissions directly from hospitals to long term care
> facilities are now given priority. Waitlisted clients will have to wait
> still longer. This policy will likely increase the inappropriate use of
> hospitals and emergency rooms as clients struggle to find a facility bed.
> In the Capital Health Region the MHO has lost entire programs.  The
> prevention promotion role has been drastically compromised. The office of
> the MHO has become a licensing and research body.  Regionalization should
> have strengthened the role of this community wide health office. And yes,
> health professionals of all stripes are beleaguered, and in despair about
> how to address our very real troubles.  Until we can take a systemic
> perspective, where the impact of policies are actually considered we will
> remain in a crisis to crisis management approach.  Recovery from our
current
> difficulties is not, as the press would have us believe impossible. We
need
> management that rewards those who seek to harmonize the system, and we
need
> information systems that support the policy impact assessment process.
>
> Shannon Turner
> [log in to unmask]
>
> Director, Management Services
> The Lodge at Broadmead
> 4579 Chatterton Way
> Victoria, BC
> V8X 4Y7
> (250) 658-0311 Main Number
> (250) 658-4508 Fax
>
> -----Original Message-----
> From: Mollie E. Butler [mailto:[log in to unmask]]
> Sent: Tuesday, November 07, 2000 8:15 AM
> To: Turner, Shannon TLB:EX; Sylvia Robinson
> Subject: Fw: Discussion
>
>
>  I thought this was too good an opportunity not to provide a voice to
> counter some of our collective silence.
>
> >
> > ----- Original Message -----
> > From: "Mollie E. Butler" <[log in to unmask]>
> > To: <[log in to unmask]>
> > Sent: Tuesday, November 07, 2000 7:49 AM
> > Subject: Re: Discussion
> >
> >
> > > Denise thank you for raising these concerns and calling for a
dialogue.
> It
> > > is disconcerting that health professionals who previously would have
> spoke
> > > out regularly on issues related to poverty and health feel they have
> been
> > > silenced.  I believe that many public health professionals have been
> > > silenced by new governance structures.  I too am concerned when it
> spills
> > > over into one's role as a citizen.
> > >
> > > I live in Victoria, BC and am an independent consultant so I caution
> that
> > I
> > > am not speaking from direct experience as a public health worker.
> However,
> > I
> > > have been on the Board of the Public Health Association of BC (PHABC)
> for
> > > the past seven years and speak regularly to colleagues around the
> > province.
> > > Recently the PHABC did a report called "Layers of Change: the status
of
> > > public health in BC under current governance structures" [A pdf copy
is
> > > available on our website www.phabc.org.]  Colleagues across Canada
tell
> me
> > > that our findings reflect what is happening in their provinces as
well.
> > >
> > > Perhaps the silencing has not been deliberate but a by-product of the
> many
> > > changes. In particular when one considers the dominance of the acute
> care
> > > institutions in the regional structures. My observation is there is a
> > patchy
> > > understanding in our current health system of the need for political
and
> > > collective action.  As well, the skills to act collectively within
> > > communities and regions are not always what we would hope they are.
> > > Capacity development is needed, we have not yet reoriented the system,
> > > although we have reshuffled the deck.
> > >
> > > The focus of the public's debate (thanks to the media's need for
> > > sensationalism) is dominated by acute care and home care.  The only
time
> > > that is given to public health is when there is a crisis (i.e.,
> Walkerton,
> > > Ontario).  In BC, Regional Health Boards are having to deal with the
> > > shortage of doctors and nurses. They are not taking enough time to
> address
> > > or move towards health promotion or issues to do with poverty and
income
> > > impact on the population's health.  Recently in one Health Region
> doctors
> > > were given an additional $10 million and in that same region the
entire
> > > budget for public health is less than 10 million. .  Hysteria was
almost
> > > created in the community with the "doctors' crisis". No one questioned
> the
> > > imbalance of spending.
> > >
> > > There is concern that funding for public health has been eroded.  A
> recent
> > > report from the Okanagan Similkalmeen Health Region on children 0-5
> years
> > of
> > > age found that only 2% of the Health budget was going to public
health.
> > > [Some in government may argue this point.]
> > >
> > > As we all know the media generally do not accurately reflect needs
> within
> > > the health system, particularly in relation to public health.
Pollsters
> > > seldom question the erosion of public health dollars in the overall
> health
> > > system. The only time public health issues are given any time is when
> > there
> > > is a crisis or another vaccine to give out.
> > >
> > > In BC most public health services focus on young children and
families.
> > > Protection and early intervention as opposed to healthy development of
> > > children, families and communities dominate the provincial
government's
> > > agenda.  Public health dollars are split between the Ministry of
Health
> > and
> > > Ministry for Children and Families.   The Ministry for Children and
> > Families
> > > direct 80% of spending which explains partly why there is such a
> dominance
> > > on children's issues.
> > >
> > > The connect to municipalities in relation to their role in public
health
> > is
> > > also at risk under our current governance structures.  For example, in
> > this
> > > province the Associated Boards of Health use to link to the Union of
BC
> > > Municipalities (UBCM).  To the best of my understanding there is no
> formal
> > > link between the new Regional Health Authorities and UBCM.   Who then
> > speak
> > > about the public's health locally?
> > >
> > > In BC the voice for public health is far too dependent on
volunteerism.
> > The
> > > PHABC (as do many other provincial public health associations) exists
> > almost
> > > entirely on volunteers which severely limits the ability to provide
> > > leadership, support, advocacy, etc.  Public health networks that
> connected
> > > health professionals have been severed making communication across
> regions
> > > challenging and generally limited to who one knows.  Membership in our
> > > public health association has decreased.  We hope to regroup this year
> as
> > > there is evidence that colleagues are interested in reconnecting. We
> have
> > > already began to plan how and are taking action to strengthen our
> > collective
> > > voice.
> > >
> > > The PHABC Board has recommended to the CPHA that a funding envelope
> should
> > > be developed by the federal government for public health.  Provinces
and
> > > Territories should be required to demonstrate what they are doing with
> > these
> > > dollars to promote the public's health.
> > >
> > > I sent your "CPHA Motion" email around to colleagues in hopes that
> public
> > > health colleagues will use their citizen's voice to speak out during
the
> > up
> > > coming political debates.  Stronger leadership and a LOUD and CLEAR
> > advocacy
> > > voice is needed right across Canada for public health issues,
> particularly
> > > in relation to poverty and low income. We must speak up for social
> justice
> > > for all Canadians not just the public whose voices are represented
> through
> > > the media.
> > >
> > > Thanks again for starting this discussion.  Look forward to comments
> from
> > > others.
> > >
> > >
> > > Regards,
> > >
> > > Mollie E. Butler
> > > President
> > > Public Health Association of BC
> > > www.phabc.org
> > >
> > >
> > >
> > > ----- Original Message -----
> > > From: "d.raphael" <[log in to unmask]>
> > > To: <[log in to unmask]>
> > > Sent: Tuesday, November 07, 2000 8:48 AM
> > > Subject: Discussion
> > >
> > >
> > > > Should Public Health Workers be Able to Address the Public's
> > > > Health?
> > > >
> > > >   I recently had the opportunity to give a "How Does Poverty
> > > > and Low Income Affect Health" presentation to close to 100
> > > > health workers at the Canadian Public Health Association
> > > > Annual meeting in Ottawa.1 This presentation had previously
> > > > been given to Health Canada staff, members of the social
> > > > development sector, and a number of community forums in
> > > > Toronto. This was the first time however, that the audience
> > > > had been mainly public health workers. The reaction of these
> > > > health workers to this presentation forms the basis of this
> > > > commentary.
> > > >    After outlining the indisputable evidence concerning the
> > > > adverse effects of poverty and low income, I usually consider
> > > > the ideological, political, institutional, personal and
> > > > attitudinal barriers to health workers raising issues of
> > > > poverty and income. I recognize that it is difficult for
> > > > health workers to raise issues within an institution that
> > > > contradict the "party line" that may be emanating from
> > > > government officials and institutional mandarins.
> > > >     Public health workers were in complete agreement with my
> > > > thesis that poverty and low income pose direct threats to the
> > > > health of Canadians. Indeed, no one suggested that pursuit of
> > > > neo-liberal policies of increasing economic inequality,
> > > > weakening social infrastructure and weakening social cohesion
> > > > was good for population health! I was not prepared however to
> > > > hear the stories in the question and answer period following
> > > > my presentation of how health workers feel they are unable --
> > > > in addition to raising the issue within their organizations --
> > > > to raise these issues in their role as private citizens.
> > > >    I was repeatedly told that public health workers cannot
> > > > speak out on how poverty and low income affects health in
> > > > letters to editors, to local elected representatives, or even
> > > > to fellow citizens.  To do so would risk advancement in their
> > > > careers and even the future of their careers in public health.
> > > >         I was stunned to hear this.  As I stated at the next
> > > > day's Annual General Meeting in support of the CPHA resolution
> > > > concerning the effects of poverty on health, "It is
> > > > frightening that those who know the most about the health
> > > > effects of poverty -- public health workers -- feel unable to
> > > > raise these issues in their role of citizens." I see no such
> > > > reticence among teachers, social workers, and others in
> > > > publicly raising issues they see as affecting the well-being
> > > > of the public.
> > > >    Considering the growing literature on the health effects of
> > > > poverty and low income on health, and the increasing incidence
> > > > of poverty in Canada, thes issue of the ability of public
> > > > health workers to participate in societal debate as citizens
> > > > demands attention.  Perhaps the passing by CPHA of its strong
> > > > motion concerning the effects of poverty upon health will help
> > > > stimulate this discussion.2
> > > >
> > > > References
> > > > 1. Raphael, D. Addressing Health Inequalities in Canada.
> > > > Presentation given at the Annual Meeting of the Canadian
> > > > Public Health Association, October 24, 2000. On line at
> > > > http://www.utoronto.ca/qol/cpha2000.pdf
> > > > 2.   Reducing Poverty and Its Negative Effects on Health.
> > > > Resolution Adopted by the Canadian Public Health Association
> > > > at the CPHA Annual Meeting in Ottawa, October 25, 2000
> > > >
> > > > -----------------------------------------------------------
> > > >
> > > >
> > > > Our Web Sites have information and reports from all of our
> > > > Quality of Life Projects!
> > > > http://www.utoronto.ca/qol     http://www.utoronto.ca/seniors
> > > >
> > > > *************************************************************
> > > > In the early hours I read in the paper of epoch-making
> > > > projects
> > > > On the part of pope and sovereigns, bankers and oil barons.
> > > > With my other eye I watch
> > > > The pot with the water for my tea
> > > > The way it clouds and starts to bubble and clears again
> > > > And overflowing the pot quenches the fire.
> > > >
> > > >  -- Bertolt Brecht
> > > > **************************************************************
> > > >
> > > > Dennis Raphael, Ph.D.
> > > > Associate Professor
> > > > Department of Public Health Sciences
> > > > Graduate Department of Community Health
> > > > University of Toronto
> > > > McMurrich Building, Room 308
> > > > Toronto, Ontario, CANADA M5S 1A8
> > > > voice: (416) 978-7567
> > > > fax: (416) 978-2087
> > > > e-mail:   [log in to unmask]
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> >