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Chapter 16: The political economy of public health: Public health concerns in Canada, the U.S., U.K., Norway, and Sweden

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Health Studies
HLST 1010
Dennis Raphael

HLST 1010: Introduction to Health Foundations Chapter 16: The political economy of public health: Public health concerns in Canada, the U.S., U.K., Norway, and Sweden By: Dennis Raphael and Toba Bryant Introduction  Promoting health as organized governmental activity comprises 3 distinct activities: -Actions carried out by federal, provincial, and municipal public health agencies. -Governmental development of health-related public policy that supports Social determinants of health. -Health care organizations and professions delivering health care services.  The integration of public health and health related public policy can be determined by the MODEL OF HEALTH that is dominant in each jurisdiction - If health is seen as highly individualized: o PRIMARY FOCUS is given to PUBLIC HEALTH APPROACHES that assess behavioral and biomedical risk factors (eg. Cholesterol levels) - If health is understood as being shaped by societal factors, such as the distribution of wealth: o PRIMARY FOCUS is given to developing STRUCTURAL APPRAOCHES that increase public understanding of the social determinants of health (eg. Public policy that promotes employment) o Best health outcomes are achieved through STRUCTURAL APPROACH  Canada lags behind other nations in applying concepts to public health activities and implementation of health-related public policy. 2 levels of analysis:  First level focuses on activities of public health agencies and local health units  Second level focuses on governmental activities in developing public policy HLST 1010: Introduction to Health Foundations  Sweden is an outstanding example of how public health combined with health determinants influence public policy o Both Canada and U.S. lag behind Sweden and U.K. in implementing STRUCTURAL APPROACH Canada  Canada is seen as a leader in innovative approaches to public health o Are also strong contributors to health promotion principles of:  Equity  Participation  Population health focus on the determinants of health  There has been little application of these concepts within Canada Canadian approaches as presented in documents  Federal governments A new vision of health for Canadians identified four fields that determine health: o Human biology o Lifestyles o Environment o Health care  Ottawa charters definition of health promotion: o “The process of enabling people to increase control over their health and its determinants, and thereby improved their health”  In 1990s saw health promotion concerning with public policy and community engagement. o This was eclipsed by the field of population health and this represented the adoption of an EPIDEMIOLOGICAL APPROACH Canadian approaches as presented in activity  Active translation of these concepts by the government is SPORADIC  Provinces are currently focusing on behavioural approaches to health  Also provincial and federal health ministers have focused on disease and infection control and programs promoting healthy lifestyles  Public knowledge of the broader determinants of health and structural analysis are NON-EXISTENT HLST 1010: Introduction to Health Foundations o Therefore Public Policy that addresses social determinants of health does not appear to be informed by policy-makers’ awareness of the concept of the social determinants of health. Toward the future  World Health Organization—said Canada is “Social determinants of health powerhouse”  Report on the state of public health in Canada 2008— o Focused on HEALTH INEQUALITIES:  Health inequalities are differences in health status experienced by various individuals or groups in society  The Canadian Public Health Association —Tremendous Health inequality across social gradient in Canada.  The emergence of H1N1 flu distracted federal and provincial health authorities to establish BROADER APPROACH TO HEALTH United States  One of the LEAST DEVELOPED WELFARE STATES  Only modernized nation that doesn’t provide Healthcare for all its citizens National policy documents and reports  Healthy people 2010 is the national plan for public health —including objectives o It’s model of health is consistent with broader determinants perspective o Emphasizes issues of access to healthcare —although 45 million Americans are uninsured  The Leading Health indicators: o Obesity, Tobacco use, Sexual behavior, substance abuse etc.  The Leading environment quality indicators: o Daily living of income, Food and hosuing security, early life etc.  American Public Health Association (APHA) o Concerns themselves with access to healthcare, health differences between racial and ethnic disparities, and behavioral risk factors for disease HLST 1010: Introduction to Health Foundations Exemplars of broader approaches  Americas Health: state health rankings o Ranked states based on 4 indicators  Child poverty  Spending on health care  Public health  Lack of health insurance  Emphasis of this report was on primarily health care related —No attempt at addressing disparities National association of county and city health organization  NACCHO —began initiative to address health inequalities o Provided support to health units on how to undertake structural anaylsis on health issues. Unnatural Causes: Is inequality making us sick?  Documentary series that illustrates how Americans health are profoundly affected by social determinants of health Robert Wood Johnson to build a healthy America  The commission considers preoccupations of Early childhood and healthy places John D. And Catherine T. MacArthur foundation research network on Socio-economic status and health  Focuses on Socio-economic determinant of health Centers for disease control and prevention (CDC)
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