The appetite for genuine health and healthcare transformation today makes me optimistic” “
public policy is the result of decision makers actually picturing the people who are affected by it. A learning health system has to move from fragmentation to integration based on shared, accurate data. Complex adaptive systems measure, adapt and measure again. Local public health authorities working together with community-based organisations need the capacity to measure as they go and to be linked to the scholarly work that can determine the wise and promising practices that are evidence based, trauma informed and culturally competent. We must remove the unacceptable lag in moving from research to policy, and then from policy to practice, with embedded applied research. Data saves lives. Transparency and accountability in outcomes are required for developing and implementing healthy public policy, so the healthy choices become the easy choices. Putting the public back into public health requires serious intentionality in effective public education, health literacy and civic literacy so that citizens can advocate for real change. When SARS hit Canada, we had 44 deaths in Toronto compared to zero in British Columbia, where the system was much more integrated. Ontario’s fragmented system killed people. Moving from fragmentation to integration requires that we measure what matters. The public health data, and administrative data from the healthcare system, are insufficient. We need better community-based data. We need to provide support to the already overworked front-line community workers to collect the data and the stories and link that information with the academy so we have the evidence to fund what works and stop funding what does not work. MAPPING HEALTH OUTCOMES If a picture is worth a thousand words, then a map is worth a thousand pictures. Mapping health outcomes with social and environmental determinants can reveal inequities in ways that citizens can understand. In our fight for evidence-based practice, we also need to tell the stories of unfairness and inequity. The malicious dissemination of misinformation and disinformation is often based on anecdotes. We need stories too, and one unhelpful anecdote needs to be countered by many helpful stories and excellent qualitative research. The appetite for genuine health and healthcare transformation today makes me optimistic. The Integrated Youth Services model has been adopted by all provinces and territories in Canada with youth-led and youth-centred care for young people aged 12 to 25. Peer support, primary care, psychologists, addiction medicine, social support for housing, education and employment will wrap around each young person. IYS is now an evidence-based success. Recent federal health investments in provinces and territories have focused on four areas: attachment to family health teams, health human resources, mental health and substance use, and health transformation
using modern technology. Each jurisdiction provides action plans with indicators, data, real accountability and transparency to their citizens. We are all committed to bridging the barriers and obstacles presented by technologies such as diverse and incompatible patient record and referral systems – such harmful fragmentation. The heartbreaking toxic drug overdose crisis requires integration between public health and public safety and international cooperation on controlling fentanyl precursors and sharing wise and promising practices. All sectors are trying to do their part to end this terrible tragedy. Trade unions hand out Naloxone to members so they can be heroes. Mayors across Canada advocate for supportive housing for the complex cases of people with mental illness and problematic substance use. The largest teaching hospital in Canada – the same hospital whose merger with Women’s College Hospital we fought in 1990 – is investing in 55 prescribable housing units. They all want to be part of the upstream solutions. For decades we have quoted Tommy Douglas, the father of medicare in Canada, who knew that we would have to “keep people well, not just patch them up when they get sick” if our cherished healthcare system was to be sustainable. We need to learn from the teachings of the medicine wheel: a lifecycle approach to achieving balance mentally, physically, emotionally and spiritually. This integrated approach is clearly superior to the fragmentation of the medical model – the repair shop model I was trained in at medical school. Health is indeed a political choice. Moving from fragmentation to integration is essential for One Health and Health in All Policies. It is our moral imperative. ▪
CAROLYN BENNETT Carolyn Bennett, MD, was elected to Canada’s parliament in 1997, and re-elected eight times. She has served as the first minister of state for public health, minister of Indigenous and Northern affairs, minister of Crown-Indigenous relations and Northern affairs, minister of Crown-Indigenous relations and the first minister of mental health and addictions and associate minister of health. The fight to save the Women’s College Hospital in Toronto inspired her to enter politics. X-TWITTER @Carolyn_Bennett carolynbennett.ca
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Health: A Political Choice – From Fragmentation to Integration
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