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Trevor Hancock: ‘Whole government’ health approach needed

In the first two of this set of three columns, I looked at reforming our health-care system and developing a comprehensive self-care support system.

In the first two of this set of three columns, I looked at reforming our health-care system and developing a comprehensive self-care support system.

But all the health-care reform in the world won’t solve the problem if our population is unhealthy; we need to improve the health of the population.

For the most part, health does not come from the health-care system, but from our environmental, social and economic conditions and the policies and practices shaping them. It is the decisions made by ministries beyond the health sector — and other sectors of society beyond government — that determine our health.

So what we really need to reform is our system of governance; we need to put health (and more broadly, human development) into all our policies and societal and economic practices, so they all improve our health and well-being.

This approach, when within government (at any level), is called a “whole of government” approach and it results in “healthy” public policies. Beyond government, it means we need a “whole of community” approach at the municipal level, and more broadly a “whole of society” approach. So what would this look like?

If we start locally, the Healthy Cities and Communities movement is all about engaging municipal government and the whole community in creating a healthier place for people to live, learn, work and play. This approach has its roots in Canada, and specifically in work I helped develop in Toronto in the 1980s.

The idea was taken up by the World Health Organization in Europe and has since spread around the world.

There are networks in Quebec (since 1987) and Ontario (since 1992), as well as in B.C. (in the interests of transparency, I founded the Ontario network and am vice-president of B.C. Healthy Communities).

What we have learned is that for this approach to work — for the creation of healthier communities — we need political and civic leadership and commitment, collaboration across municipal departments, true community engagement and action in partnership with all the other sectors of the community — private, NGO, faith, academic and so on.

Recognizing that it takes a whole community to raise healthy people, we need to find common vision and purpose among all those players. Maximizing well-being and human development for all, in an ecologically sustainable manner, can be such a shared purpose.

As to how we get a healthier community, every community is different, although the areas for action noted above need to be followed. A civic leadership group, preferably chaired by the mayor, can help provide the necessary leadership and support.

Each community needs to determine its own priorities and find the areas where people can agree to work together. They need to be in it for the long haul; while some things can change quickly, others might take years, even decades or generations.

But if we start to put equitable and sustainable human development at the centre of our urban planning, transportation, housing, economic development, parks, education and other policies, we will start to make some different choices.

In practice, as is so often the case, the municipalities are well ahead of the provincial and federal governments. But in 2008, the Senate recommended that the federal and provincial governments establish cabinet committees on population health, chaired by the premier, and develop a population-health policy.

There are precedents internationally that can point the way to reform for health and human development. The best current model is the “Health in All Policies” system in South Australia. Leadership comes from the highest levels of government, with deputy ministers reporting to a cabinet committee. Priority setting is overseen by the Department of Premier and Cabinet, and health impact assessments in priority areas are carried out.

The purpose is to “facilitate policy work of mutual benefit to the health sector and the partnering sector” and thus to improve the health and well-being of the population.

We need to be even more radical, making human rather than economic development the focus and central purpose of government.

I look forward to the day when the minister of human development, not the minister of finance, is the most important minister, and when governments do not boast about the GDP, but about the human development index.

Now that would be reform for health.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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