Focus on health: public health in health services restructuring

Executive Summary

The Canadian health system is at a crossroads. Significant health services restructuring is occurring across the country. This restructuring process provides a unique opportunity for Public Health and others to reorient the system away from illness to a focus on health-the health of individuals and communities.

The purpose of this paper is to motivate and equip Public Health workers to take leadership in the restructuring, to outline key responses and strategies for Public Health associations, to raise public awareness about restructuring, and to challenge decision makers to integrate the Public Health perspective into the restructured health system.

This Issue Paper describes the unique contributions Public Health has to offer health services restructuring, outlines the Public Health response to specific restructuring issues, and identifies some successful strategies for influencing change. Two key messages are explored in the paper:

1. Restructuring will be successful if it is based on an investment in health. The health of the public can be maintained and improved through changes to the institutional sector and support for health promotion, disease prevention and health protection services.
2. Public Health must be a full partner in the restructuring of health services. The Public Health perspective includes a broad understanding of the issues that are relevant to the health of individuals and communities. The skills and knowledge base offered through Public Health provide balance and equity in decision making, by ensuring full and representative involvement of community workers and the public.

The uniqueness of Public Health is manifested in three distinct ways: its approach within an organized system of practice; its historical contribution; and its purposeful combination of perspectives, skills and knowledge.

In partnership with communities, other health professionals and other health-determining sectors, Public Health works to protect, maintain and improve the health of Canadians. While other sectors undertake some of the functions outlined below, what makes Public Health unique is that these contributions are offered collectively through an organized system of practitioners to create a synergistic effect. Eight contributions of Public Health are identified in this paper.

Specifically Public Health:

• Focuses on individuals and communities in a societal and global context.
• Builds capacity in individuals and communities to improve health.
• Facilitates community mobilization through community participation.
• Embraces promotion, prevention, protection.
• Influences the orientation of the health system toward health outcomes.
• Provides disease surveillance and control.
• Builds partnerships among sectors at the local level.
• Advocates for the health of the public.

In addition to describing these contributions, the Issue Paper addresses the major trends in health services restructuring by providing an overview of the issues and outlining the Public Health response. While there is no one single model of restructuring occurring in the provinces and territories, many common themes exist.

This paper highlights four categories of restructuring issues:

1. Making a Difference in Health
2. Skills and Knowledge Base
3. Allocation of Financial Resources
4. Governance and Management

Through discussion of these four themes, important elements are identified which are necessary for an effective restructuring of our health system. If investing in the health of all Canadians is to be the focus of restructuring, the health system must:

• Foster collaboration between professionals and communities to identify, develop and deliver a broad range of needed services which recognize all of the determinants of health to improve the health of individuals and communities.
• Encourage collaboration between health and other sectors to develop services addressing the broad determinants of health and to maintain healthy public policy initiatives.
• Reflect an integrated continuum of services encompassing health promotion, disease prevention and health protection; wellness and health maintenance; community-based care, facility-based care; and specialized institutional care.
• Support the development of strong links within the health system, within and across disciplines and across geographic boundaries (at the community, regional, provincial, territorial, national and global levels) to provide peer support and share information, skills and experiences.
• Ensure an appropriate realignment of professional perspectives, skills and knowledge to reflect changes in the system.
• Enable individuals to make healthy choices by providing needed information and facilitating skill development.
• Be responsive to and support advocacy efforts aimed at improving the effectiveness of the health system and the health of populations.
• Be publicly funded with the federal government providing sufficient funding to ensure equitable access to needed services by all Canadians.
• Take direction from legislation mandating appropriate, core health services and develop population-based funding mechanisms which provide flexibility in meeting the needs of different populations.
• Shift a portion of available resources within the health system from facility-based care to community-based promotion and prevention strategies.
• Build governance and management systems that involve and are representative of the individuals and communities they serve.
• Maximize the effectiveness of the health system through evidence-based practice, needs assessments and evaluations.
• Provide health and wellness outcome indicators and other information on health impacts and health status to the public, providers and decision makers for use in the planning, delivery and evaluation of health services and systems.

While the organizational and physical structures of Public Health may change, the identifiable presence and unique contributions of Public Health are needed to ensure that restructuring invests in health. Following the discussion of restructuring issues is a summary of the pragmatic and concrete strategies and tools that have been used successfully by Public Health workers, associations, and decision makers to influence health services restructuring.

The Canadian Public Health Association is committed to working with others to position Public Health in a leadership role in health services restructuring. To achieve this, the Association has developed a number of communication and advocacy strategies which will enable CPHA members, Public Health workers and associations, the general public and decision makers to ensure that the unique contributions and experiences of Public Health are reflected in a restructured health system which focuses on investing in the health of all Canadians.