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  • HEALTH: AN INTEGRAL PART OF HUMAN DEVELOPMENTAuthor(s): Monique BginSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 69, No.4 (JULY/AUGUST 1978), pp. 271-275Published by: Canadian Public Health AssociationStable URL: .Accessed: 14/06/2014 20:11

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  • Editorial


    The Honourable Monique Bgin

    It is a great privilege for our country to be the host of this meeting and for me to tell you something about the Cana- dian government's approach to primary health care.

    I take my duties as a representative of the host country seriously enough to know that one does not treat public health professionals like other visitors to one's home.

    It would be a boring visit if I just invited you to think about the good things. I will say quickly that Cana-

    Keynote address delivered to the 2nd International Congress of the World Federation of Public Health Associations and the 69th Annual Conference of the Canadian Public Health Association at Halifax, Nova Scotia on May 23, 1978.

    dians appear to be reasonably healthy compared to other people in Western developed nations. The latest compara- tive study, in 1 97 1 , shows that of 2 1 such countries we rank eighth on a composite index using such factors as perinatal, infant, and maternal mortality rates and those for people aged between 35 and 54. Life expectancy for Canadian men ranked seventh, at 69.9 years, and for Canadian women ranked second, at 76.9 years. With the exception of Eng- land and Wales, all the countries that ranked ahead of Canada on the general scale are small countries with small populations, which make it easier for them to deliver health services.

    As I said, I realize that I am talking to health professionals. I now invite you to contemplate Canada's problem areas in public health.

    To get down to specifics, I should change my tone as well as my figure of speech. At a recent meeting between provincial health ministers and my predecessor, four grim problems have been isolated as being in urgent need of study and action. They are alcohol abuse and traffic injuries, and prob- lems involving occupational health and mental health. These are the four horsemen of the apocalypse in Can- adian public health. They have struck down or crushed the hopes of many thousands of our people and cost astronomical sums of money.

    Another reason why these four prob- lem areas have been singled out is that we believe that something can be done

    to prevent them from doing so much damage. It will not be easy. It will require a long and hard effort but we believe that it can be done.

    There has in fact been a shift of emphasis in this country from sickness care to prevention. This involves pro- moting measures that prevent illness and encourage people to take personal responsibility for their health.

    This emphasis on prevention is just plain commonsense. If the bridge around the bend in the road is about to collapse, you put up a barricade and warning signs. It is not good enough just to send an ambulance and trained medical people to look after victims.

    Let me take time now to give some small idea of how much damage is being done by each of the major health problems I have singled out.

    It is just about impossible to estimate the true cost to Canadian society of alcohol abuse. It takes a while just to name the more pressing alcohol-related problems. It is a factor in liver, cardio- vascular, and respiratory disease, and cancer and certain mental illnesses. It is a grim destroyer of society, implicated in crime and violence, family break- down and industrial accidents. It is a factor in poor performance in schools and in industry.

    Statistics show how important it is to promote occupational health, including job safety. In 1974, 1,415 work-related fatalities were reported, mostly due to accidents. There has been a climb in the number of accidents on the job. In 1974

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  • they accounted for over one million injuries involving loss of work time. Over 11.5 million man-days were lost through this cause in the year, at a cost of over half a billion dollars to em- ployers in compensation assessments. It is estimated that an additional sum of over $2 billion was lost due to occu- pational injuries in terms of such things as lost productivity, material damage, and retraining. Recognizing that seri- ous problems do exist, the federal government has recently established a Canadian Centre for Occupational Health and Safety.

    An immediate activity of the Centre will be the development of a national information system on the whole spec- trum of occupational health and safety. The Centre will then begin by providing Canada and Canadians with a co- ordinated and integrated information source that up to now has been lacking in this field. The Centre will attempt through information to promote heal- thy lifestyles for all workers and to prompt the individual's own responsi- bility in this area.

    Automobile accidents are the number one killer if you think in terms of potential years of life lost. Fully 38% of victims are in the 15 to 24-year age group. In 1974, automobile accidents caused injuries to one out of every 100 Canadians, and 28 Canadians out of every 100,000 met their deaths on the road in that year alone. These are appalling figures. If you were to multi- ply that yearly rate by 70, more or less the average life-span, you would arrive at a truly horrifying figure. At that rate most Canadians would sooner or later be hurt in an automobile accident. And to this must be added the heavy cost of automobile accidents - estimated at a quarter of a billion dollars in 1973 to the health care system alone, and in 1974, at a billion dollars in lost work effort and $1.3 billion in property damage.

    One Canadian in every six is stricken by the fourth of our grim problems, mental illness. Measured in patient days, about 35% of all hospital care is for mental illness, and it is a factor in the illness of nearly half of all patients seen in general medical practice. Suicide is

    now the second most frequent cause of death among young Canadians between 15 and 30 years of age. It is clear that this is only part of the problem of mental health in Canada. Much more remains unreported, and signs are that things are getting worse.

    What are we doing about it? What are we planning to do about it in the future? Clearly, government and health pro- fessionals cannot do away with these problems. All of them, and particularly alcohol abuse and traffic injuries, ulti- mately depend on the public. People must do more to promote and maintain their own good health. What profes- sionals and government can do is pro- vide them with the information they need to take up better lifestyles. We can also promote such commonsense things as i safer vehicles and highways, and call for public support of safety mea- sures such as compulsory seat-belt legislation and controls on the advertis- ing of alcohol.

    It is good news that many are not only more willing than ever before to take their health into their own hands - they demand it. Just look around here in Halifax or any other Canadian city or town. Joggers and cyclists are every- where. Until a few weeks ago there were cross-country skiers as well. Hardly a week passes without local papers ad- vertising the opening of still another sporting goods store, and still more opportunities to take courses in yoga, weight reduction, or giving up smoking; in becoming better marriage partners and better parents; in choosing the right foods for good health and the right strategies for coping with stress. To judge from the displays in Canadian bookstores, you would think that the time-honoured categories of "fiction and non-fiction" are about to be re- placed by "health promotion and non- health promotion".

    The consumer movement has also reached a high degree of sophistication in the health field. People want to know what they are getting not only in personal health care, but also in en- vironmental health, health promotion, and health research as well. To pro- fessionals and government, these head-

    long challenges can be a little exhaust- ing at times. But it is well worth the extra time and trouble that profes- sionals and government must spend in explaining things to an alert and knowl- edgeable minority. The important thing is to encourage more to join the ranks of the consumerists.

    It is also encouraging to see the growing trend for those with common health problems to band together in mutual help associations. These groups now work alongside the more tradi- tional voluntary agencies which em- phasize service to others. We need both kinds of groups to make the most of the great potential of volunteer work, a subject to which I will return later.

    This brings up the specific problem of what we professionals and government health people can do to encourage the trend of self-help. It is a truism that individuals change more quickly than organizations, including the health care system. What can we do to catch up?

    First of all, we can see to it that concerned invididuals have the knowl- edge and confidence they need to make sensible choices. These relate not only to their personal lifestyles, but also to the use they make of preventive mea- sures and treatment services, and to their participation in the planning and delivery of health services.

    Health education must begin in early childhood. Normally, health profes- sionals, and particularly public health nurses, work with parents to help them understand what is best done for chil- dren in these very crucial first years. It is a question not only of what we can do for pre-school children and their fami- lies, but also what we can help them do for themselves.

    We also have to think about the effect of television on pre-schoolers. Make no mistake about it, for better or worse, television is usually right there along- side the parents in forming the attitudes of very young children. We know this from the pressures the kids can exert on parents to buy a certain kind of break- fast cereal, a special game or doll or hot- rod set. Most parents know what I am talking about.

    But does this not also indicate that

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  • TV can be used as a useful tool for the health education of our children - and indeed, people of all ages? I suggest to you that it does. And with this in mind, my Department of National Health and Welfare is, at this moment, co- produc- ing a series of television programs to promote good nutritional habits among Canadian children. And I would not be terribly upset if the kids passed along to their parents some of the information they may have gleaned from these programs.

    Once children enter school, the public health system becomes a more impor- tant direct influence on their lives. Professionals can ensure a healthy school environment, screen school chil- dren for health defects, and provide such preventive measures as immuni- zation and topical fluoride applica- tions. They can instruct teachers and students about the importance of these measures, and participate in school health programs that not only promote healthy lifestyles but also prepare people to look after their own and their families' minor ailments and to make good use of health services. They can, in other words, prepare them to take on more personal responsibility for their own health.

    At the same time, public health professionals can teach the young to look after others as well as themselves. They can teach interdependence as well as independence. For example, teen- agers can be prepared to serve as volunteers in hospitals, nursing homes, and other places, and, perhaps, to go on from there in later life to help plan and operate health services.

    We Canadians, in fact, are very proud of our history of voluntary participa- tion in the health field. The action of volunteer workers is at the heart of a great many worthwhile activities in Canadian life. Behind every Canadian in elected office, for example, there is a voluntary political association at the grassroots level. In the health field, there are great numbers of volunteer health agencies and boards, operating at local, provincial, and federal levels. Hospitals in Canada have been mainly operated by voluntary boards of direc-

    tors, a situation that persists even now that most of their financing comes from government. In most parts of the coun- try, government-financed public health services are also administered by vol- untary boards. There are voluntary health agencies to represent the interests of people with particular health prob- lems, and finally, there have been many opportunities for community participa- tion in numerous task forces, royal commissions, and public hearings on various aspects of health services in Canada.

    The emphasis we give to self-help measures does not make us any less sensitive to the need to help others. If someone is about to step in front of a speeding car, you normally shout a warning. If it happens to be a small child or any other person who might have trouble negotiating traffic, you go be- yond a warning and lend a hand. In Canada like every other country, there are some who should be given a helping hand in health matters. Some who have only limited opportunities to adopt healthy lifestyles and only a limited ability to meet their own health needs. They are deprived in relation to other Ca...


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