CARRFS eNews spoke with Dr. Paul Roumeliotis, Medical Officer of Health and Chief Executive Officer, Eastern Ontario Health Unit about the future of Public Health in Canada.
Article was published in March 2013.
What have been the reasons for the changes we have seen in public health over the last 10-15-20 years?
Historically there have been tremendous changes in public health. The Eastern Ontario Health Unit (EOHU), has seen tremendous growth–not only in its ability to provide services, but also in population growth. Some parts of the Health Unit are bedroom communities to Ottawa with high population growth. Additionally, the Government [of Ontario] has over the last 10 years–certainly in the last six years since I have been there, increasingly transferred programs to us. For example the enhancement of the Healthy Babies Healthy Children program; adding several nursing positions for social determinants of health; imposing the Ontario Public Health Standards in 2008; and being mandated to deliver foundational standards of surveillance and epidemiology. The fact that our health unit has grown from one epidemiologist to four and probably a fifth underscores the importance of surveillance in order to deliver high quality services. The scope under the Health Protection and Promotion Act (HPPA) emphasizes the regionalization of public health services. In order for us to regionalize and customize our approach, we need to have data–we need to know the demographics as these particular demographics and health profiles drive our programs, prioritization and resource allocation.
What role does public health play today in the general health of the population?
Public health plays an important role which many underestimate or don’t really understand. In the public health circle, we struggle to make people aware of what we do. What has happened unfortunately is a bit of a dichotomy between acute care mindset/setting and public health. Public health is really health prevention and promotion at is best–even many health protection activities are preventative in nature. These would include immunization and food and water safety. So a lot of what we do results in people not being sick. If you are not sick you are not going to think about us, but if you are sick–say you got H1N1 or there was another SARS-like outbreak, you will need us.
“I think public health is at its strongest position in a long time as we are at a cross-road of healthcare transformation.”
I think public health is at its strongest position in a long time as we are at a cross-road of healthcare transformation. We have decreased infectious diseases that were killing us over 50 years ago, but we are now faced with an incredible tsunami of obese teenagers which will become obese adults and precociously overwhelm an already stretched health care system. So what is the solution? The solution is to “connect the dots between acute care and health protection and promotion”. We have been working at our health unit locally and I have been working provincially as president of the Association for Local Public Health Agencies (alPHa), with our LHIN [Local Health Integration Network] counterparts and others in the health care environments to see how we can effectively harmonize and integrate many of the health promotion and prevention approaches that we use in public health. We have a pivotal role in the transformation of health care in helping stop the onslaught of chronic diseases that is overwhelming the health care system today and in the near future.
What tasks are provided by the public health system today that were not there 20 years ago?
The evolution of public health–especially over the last two decades has been substantial. One of the cornerstones of public health was sanitation, disinfection and prevention of infection. Our health unit was driven by the fact that we had tuberculosis and infant mortality rates among the highest in Ontario. The establishment of our health unit in 1935, quickly addressed these issues. Our focus over the last 20 years has been on health prevention, promotion and particularly chronic disease prevention. Probably one of the biggest impacts that we have had is the involvement of the public health units in Smoke-Free Ontario. It has been a struggle in getting the public health to not only teach about smoking cessation and prevention, but to be involved in the enforcement process. Together the advocacy, the education and the enforce-ment are making a huge difference. To me this is one of the major changes in terms of the mandate given to public health.
What do you think are the critical factors for success in public health in general and for EOHU specifically?
There are two factors in my opinion in being able to move forward to ensure health and wellness in an optimum way among the communities that we serve in Eastern Ontario. I spend a lot of time talking to our community stakeholders and presenting our data. We have to know where we are; our specific nuances; our specific weaknesses and needs in terms of gaps of services and support. For example EOHU has one of the highest rates of chronic diseases compared to the rest of Ontario. The life expectancy in our area is several years lower the Ontario average. We also have higher rates of mortality in terms of accidents and suicide among the young men compared to the rest of Ontario. We can’t begin to have successful public health programs unless we understand our population profile. This highlights the importance of data collection, data mining and making it local. We cover close to 5,500 square km area organized into six fully functioning offices. Each office has a different demographic profile and our Epidemiology, Surveillance and Research (ESR) department has broken the population demographics and status down to the regional office level. For example our office in Rockland, which is 12 km from Ottawa, reflects middle class families in Ottawa, while our office in Hawkesbury reflects a population made up of 20 percent of families of single mothers, who disproportionally contribute to the poverty rates.
One of the major pre-occupations that I have is child health and infant development. We have a huge problem with the school readiness of our children–especially in the Hawkesbury and Cornwall areas. The EDI [Early Development Instrument] score, which is given to all children 5 years of age before they enter school, measures different parameters of school readiness including language and cognitive functions, overall health and socializing ability. Over 40 percent of the kids in Hawkesbury have one or more failing grades compared to 27 percent for the rest of Ontario. This has a lot to do with speech delays–so in Hawkesbury we focus on providing speech therapy which is not necessarily a priority need in e.g. Rockland.
Where do you focus your effort in collecting public health data?
I think the priority right now is to collect child health and development data because I think it is quite important as we are implementing a community wide parenting program–the Positive Parenting Program or “Triple P”. We need to establish a baseline and move forward in evaluating the program’s effectiveness. We obviously continue our infection control and surveillance activities as they are our mandated duty. Risk behavior is another focus area. We did a youth risk survey at schools by interview and survey about 4,500 students. For the first time, we asked questions about mental health. The results were very disturbing in terms of the rates for cyber bullying, depression and even suicidal ideation and attempts. We used our data to act. We can’t act unless we understand the situation in its context. To me this is vital to what we do and very often I present these data to community leaders and politicians.
What are the challenges you face in collecting public health data, analyze it and publish the results?
One challenge we face in terms of data collection is that there are multiple data sources, standards and requirements. In EOHU, we do have certain areas that are very small and we can’t get enough data that are statistical significant. These are statistical limitations. But overall I find the issues of the multitude of data sources really take a lot of time for our team to data mine and to break the data down into something that we can use and be a guide for our programs.
“One challenge we face in terms of data collection is that there are multiple data sources, standards and requirements.“
What success stories during your leadership of the EOHU could other public health units learn from?
We were the first stand alone public health unit in Canada to be accredited by Accreditation Canada and we had a second round of accreditation last year and passed it with exemplary standing. Many health units are calling us and talking to us about the process. As a matter of fact, the ministry is consulting us as well since they are looking at organizational performance management standards which greatly intersect with the accreditation standards and process. Secondly, we have been able to do certain surveys that other health units have not. For our BMI [Body Mass Index] survey we were the only health unit in Ontario that went out to actually measures the weight and height of grade 5 students to obtain actual BMI’s rather than rely on personal or parental estimates. Thirdly, something I personally find stimulating and gratifying is that we are starting to be recognized as a health communications leader in Ontario–if not in Canada. We have established an in-house communications production facility with a talented team of communication writers and producers that create highly cost-effective digital media content in various formats including emerging social media platforms. We are one of a few health units with a television and radio presence. We share this with the rest of the province and are working towards a more cost effective way of sharing the resources through bulk media buying for province wide campaigns.
How do you see public health units evolving in the future? And what kind of role do you think that the public health units can play in improving the future health of the people in Ontario?
I think that the public health units can play a pivotal role in re-tooling the Ontario health care system. I think that there needs to be a de-emphasis on acute care and more emphasis on preventive and health promotion services with focus on child health. I believe that public health can lead by aligning with existing acute care institutions and providers to better integrate and deliver more efficient “wellness” services. One of the most unique and vital attributes that we can bring to the table, is our interconnectivity with the communities that we serve. The number of community agencies, politicians and/or councils that the public health units intersect with on regular basis cannot be matched by other health agencies in Ontario. Our tremendous pre-existing networking and community roots can be used to an advantage as we leverage the system collectively towards a prevention and promotion mindset approach. Combining this with an inter-agency and all-of-government approach addressing the social determinants of health, is going to be critical in preparing our health care system for the future. <>
By Jostein Algroy