How Public Health is Influencing our Health System: Lessons in Creating Change
On the evening of December 6, 2011, Dr. David Mowat, Medical Officer of Health at the Region of Peel Public Health , met with 
ELF members to discuss the role of public health in the sustainability of the healthcare system. Dr. Mowat’s presentation focused on the rise of chronic diseases, such as cancer and diabetes, which have surpassed infectious diseases as the leading cause of mortality and are the biggest threat to the sustainability of the healthcare system.
Rather than focusing on the causes of disease, Dr. Mowat suggested we look at the “causes of the cause”, which are the determinants of health. Determinants of health can be social and economic factors such as income, social status, education and literacy, working conditions, culture, gender, and social support networks. Currently in the Peel region there is a nine-year life expectancy difference between the population at the highest income level and at the lowest income level. While addressing determinants may seem like an overwhelming and nearly impossible challenge, Dr. Mowat argued that strategic, targeted action on determinants could have a greater impact on population health, and the sustainability of our health system, than most medical interventions.
Insights from Dr. Mowat’s experience as Medical Officer of Health:
- Need to ensure that everyone understands the difference between public health and publicly-funded healthcare – if public health efforts are successful, the use of publicly-funded healthcare can be decreased.
- Once identified as “welfare medicine”, helping the least fortunate, modern public health looks at probabilities and whole populations and, therefore, outcomes are very long term (e.g., the anti-smoking campaign). It is a less concrete, and therefore less politically attractive investment than capital, like hospital buildings.
- There is a relationship between urban planning and health. For example, low population density and increased car dependencies have reduced opportunities for utilitarian physical activity. Research shows a direct link between the “walkability” of a neighbourhood and the prevalence of chronic diseases within the area. Peel Region is addressing this in new housing developments, along the entire spectrum of policy – through more than a dozen levels of regulation.
- Governments will allocate more of their budget to healthcare; however, even with the additional funds there is no guarantee that the system will be sustainable. For example, if we were to completely eliminate class 3 obesity (BMI:40+) say, through bariatric surgery, it would only result in a 3% reduction in the prevalence of diabetes, and a 1% reduction in the prevalence of cardiovascular disease, at a cost of $460,000,000!
- The critical social question in public health will always be the role of the individual vs. the state. The government pays for healthcare through public funds, so what is the public’s responsibility to be healthy? How much importance should be placed on individual autonomy compared to the good of the public?
How can we influence change?
- Engage and inform the public – efforts to continue elevating health literacy will enable people to make better choices and help to de-normalize unhealthy choices.
- Guide choices through incentives and policy changes. Restrict and/or eliminate unhealthy choices.
- Make the healthy choice the easy one. People have a tendency to do the “easy” thing so leverage this behaviour to improve health in the overall population.
Five Fun Facts about Dr. Mowat – Rapid-Fire Questions:
ELF: Convertible or SUV?
Dr. Mowat: Convertible
ELF: Favourite junk food?
Dr. Mowat: Pizza
ELF: If you weren’t Medical Officer of Health, you’d be…?
Dr. Mowat: A landscape gardener
ELF: If you could magically fix one problem in healthcare, it would be…?
Dr. Mowat: Underfunding of Peel Public Health
ELF: If you could only have one item on a deserted island?
Dr. Mowat: A wine cellar!
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