Rethinking public health
What does it mean to 'rethink public health'? The association of Public Health agencies (alPHa) in Ontario posed this question as the organizing theme of their annual conference held in June 2015.
The morning panellists shared thoughts from local, provincial, national and international perspectives on trends in public health. I particularly enjoyed comments from Dr. Peter Donnelly President and Chief Executive Officer of Public Health Ontario who noted three international trends:
- A more diverse disciplinary leadership of public health than is seen in the Canadian context
- A growing acceptance and inclusion of mixed methods and qualitative approaches and
- The growing importance of knowledge translation between researchers, policy makers and others.
Turning his attention to globalization Dr. Donnelley highlighted that this is not a new phenomenon. Drawing on the example of the cotton industry in the Americas, he noted that the growth of this industry relied on the appropriation of indigenous lands, enslaved African labour, and the use of child labour in factories. He called on public health to engage in understanding the detrimental impacts of globalization on health and to act in three ways:
- Recognize that Ontario is not an island and engage in global conversations
- Put social justice at the heart of public health
- Invest in the early years
In a subsequent session, Dr. Jeff Turnbull of Health Quality Ontario framed health equity as a critical dimension of quality although this integration is not yet well developed. Citing the National Health Services scorecard on equity, Dr. Turnbull noted that there is an opportunity for HQO's Common quality agenda to include measures on income, poverty, gender, race and other social determinants of health.
Dr. Doug Manuel argued that public health was up for the challenge of return on investment (ROI) analysis as this played to public health's strengths. Many in the room agreed with him. Dr. Manuel further expanded on the importance of matching ROI analysis to the scope of the intervention. Questions to consider include what can be measured, how well can it be measured and how long is reasonable.
I shared a panel with Dr. Ron Labonté, one of the pioneers of health promotion in Canada who spoke to 5 roles public health can play with regards to the SDH:
- Educator watchdog
- Resource broker
- Community developer
- Partnership developer
In my talk I highlighted the role of organizational capacity and leadership as important drivers for public health equity action. Public health leaders are ideally positioned to create the space for action. As employers and public institutions look inwards at public health practices and policies, reflecting on how we embody equity in the DNA of organizations is of critical importance. Working towards health equity calls us to put values of fairness and social justice at the forefront of public health decision-making. The required endeavours are difficult yet necessary to tackle inequities at their core. Asking how unequal power relationships are produced and reproduced in our ways of engaging is essential. Reflecting on the conversations throughout the day it was clear to me that public health is up for the challenge.