health matters

Improving the health of Manitobans

Harvesting grain on a prairie farm.

BY DR. MICHAEL ROUTLEDGE
Winnipeg Regional Health Authority
Wave, September / October 2016

The past century has seen incredible advances in population health.

Some of this can be credited to advances in medical science, and our ability to better diagnose and treat diseases. But most of it is due to something outside the scope of our health-care systems: advances in public health-related policies and practices.

Of the 30 years of average lifespan gained in the 20th century - an incredible advance, given that prior to 1900 there had been minimal change in life expectancy through several thousand years of human existence - 25 years of it can be attributed to advances related to public health.

The Canadian Public Health Association, following a list created by the U.S.-based Centers for Disease Control, has identified a list of 12 great public health achievements for Canadians:

  • Acting on the social determinants of health
  • Control of infectious diseases
  • Decline in deaths from coronary heart disease and stroke
  • Family planning
  • Healthier environments
  • Healthier mothers and babies
  • Motor-vehicle safety
  • Recognition of tobacco as a health hazard
  • Safer and healthier foods
  • Safer workplaces
  • Universal policies
  • Vaccination

The most striking conclusion from this list is that it's not high-tech tests that most effectively improve life expectancy. Rather, it is other societal and environmental changes that prevent disease and result in improved health, well-being and safety.

Yet despite these incredible achievements, there is much more to do. Illness, injury and poor health affect us all. People die before their time from chronic diseases and suffer from mental illness, while the health-care system strains to meet the demands of caring for the ill. And much of this is preventable.

What more can be done to improve population health? To be sure, we need to continue efforts to help individuals make good personal choices. But we also need to change the environments we live in so that it becomes easier to live healthy lives.

The effort to reduce smoking rates provides an excellent example of how we can create positive health behaviour change, and better overall health, at a population level. Increased education about the harmful effects of tobacco helped convince people that smoking is a risk. But some of the biggest factors in driving down smoking rates were environmental changes, such as making cigarettes more expensive through taxation and introducing smoke-free public spaces.

The lesson here is clear. Individuals make choices, but the environment society creates around a person can dramatically affect the choices he or she makes. Our goal as a society should be to create environments that foster good decision-making.

The opportunities for improvement are many, but here are a few to consider:

Nutrition
We know that a balanced diet is important to good health. But are we doing enough to ensure all members of society have access to affordable and nutritious food?

Healthy families
We know that the health of our children depends on them being raised in a supportive and stimulating home. But are we doing enough to ensure that families have the resources needed to create nurturing environments for all children?

Active living
Health experts often talk about the need for people to exercise more. But is there more we can do to make sure we have communities that make an active lifestyle convenient and safe?

These are just some of the public health issues we face today. My own education on how to address these challenges began as a medical student, and continues to this day in my role as a public health physician. The most important thing I have learned in this time is that promoting health and preventing avoidable disease is better for individuals, and is more efficient for a sustainable health-care system as well.

I recently led the development of the 2015 Report on the Health Status of Manitobans. The report was developed as a tool to engage all Manitobans on the critical and difficult work of improving health and well-being in our province. In addition to describing the overall health of Manitobans, the report provides examples of people at various ages in order to understand the factors that impact health for us all. The report also looks at specific topics, including Indigenous health, and the impacts of colonization; mental health; built environments that support health and well-being; and health equity.

I would encourage everyone to review the report and to use it to help create communities that prioritize promoting health and preventing disease the same way we prioritize our health-care systems.

Dr. Michael Routledge is Manitoba's Chief Provincial Public Health Officer.

Wave: September / October 2016

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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