Fighting poverty, helping children at risk key to public heath care

from the Chronicle Herald

By JOHN GILLIS

Many of the problems that traditionally fall in the domain of public health have clear solutions, such as vaccinating people against diseases.

But as people in the field turn their attention to more fundamental problems, such as the roots of the poverty that puts many people at risk of poor health, they’ll need to collaborate to find more complex solutions, a renowned thinker and author said in Halifax on Wednesday.

"Don’t think that there’s a magic bullet to something like public health," Thomas Homer-Dixon of the University of Toronto’s Trudeau Centre for Peace and Conflict Studies told an audience at the Canadian Public Health Association’s annual conference.

The conference has focused on how to reduce social, economic and other inequalities that predispose some parts of the population, such as aboriginals and women, to poorer health.

The best way to build the multi-faceted approaches that will have an impact on complex problems like poverty is not by gathering experts in a room but by having many people in different places and situations experimenting on their own, said Mr. Homer-Dixon, who has a doctorate in political science from the Massachusetts Institute of Technology.

And that includes front-line workers dealing with everyday situations, he said, earning applause from the audience.

Their intuition and innovation is a form of evidence as valid as that of rigorous scientific studies, he said.

Mr. Homer-Dixon noted the failure of some of those efforts is an inevitable and fruitful part of problem solving.

"The more heads working on a problem, the better off we are," he said.

Nova Scotia’s public health system has moved in that direction in recent years, Dr. Robert Strang, the province’s chief public health officer, told the conference.

The SARS outbreak in Toronto in 2003 focused attention on public health and sparked a renewal process that led to the creation of the provincial Department of Health Promotion and Protection.

Dr. Strang said the agency works as a system that transcends the traditional divisions of government departments and district health authorities.

"You have communities in the centre," he said. "And how do we organize around those communities to be most efficient and effective in addressing their health needs?"

A good example was the department’s involvement in the creation of a child and youth strategy for the province, he said. This was part of the response to the Nunn inquiry, held after the death of Halifax teaching assistant Theresa McEvoy three years ago in a crash involving a young offender in a stolen car.

Dr. Strang said the strategy aims to support children before they head in the wrong direction.

"How do we take prevention all the way back to early childhood and look at the total population of children and families and not just the ones who ultimately and up in trouble at age 10 in the youth justice system?" he said. "That’s been a fundamental shift in thinking across government."