Health in all policies

The following are the speeches in the Legislature delivered on May 1, 2018 by Peter Bevan-Baker and Hannah Bell in support of Peter's Motion 40, Encouraging government to adopt a “Health in all Policies” approach to governance.

Peter Bevan-Baker's speech

Improving the physical and mental health of Islanders is often viewed as the work of the healthcare system. But in reality what we currently call health care could better be described as illness management, as it is primarily tasked with caring for individuals when they are sick or injured.   That is, of course, a critically important service. We all need to know that we will have access to timely care when we are ill. Indeed in Canada, we rightly take pride in providing all citizens with access to critical interventions that often mean the difference between life and death. Yet these systems are mostly designed to respond to the absence of health and rarely focus on building health and resiliency nor do they bring significant improvement to the health of the population.

In her 2016 Chief Public Health Officer’s Report for PEI, Dr. Heather Morrison delved deeply into the issue of what makes Islanders healthy, focusing on the Social Determinants of Health.  The report defines the social determinants of health as “the societal conditions that influence people’s health”. More specifically, this includes a long list of factors: “income and social status, social support networks, education and literacy, employment and working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender, and culture”.   

According to Dr. Morrison, estimates indicate that socioeconomic factors account for 50% of all health outcomes, while health care accounts for 25%, genetics for 15%, and physical environments for 10%.  I don’t know about everyone else here, but I often look to my parents’ and grandparents’ longevity to predict my own, when the actual genetics play a small role, compared to the social determinants of health.  But the good news, for me and pretty well everyone sitting here inside the rail, is that even if we did not win the genetic lottery for good health most of us enjoy even greater benefits from our relatively privileged socio-economic positions.

As caring communities, we long to see a society where all members enjoy sufficient income, support networks, good working conditions, safe social and physical environments and all of the other factors that contribute to the wellness of both individuals and the population as a whole.   Unfortunately, the social-determinants of health are not equally distributed throughout our Island and as Dr. Morrison points out “Differences…..often lead to health inequality: differences in health outcomes that are systemic, unfair and avoidable.” For example, we have varied income and education levels; it’s difficult, sometimes impossible, to afford a nutritious and well-balanced diet on a low income; the chronic stress associated with insecure or unsafe housing leaves families vulnerable to mental health issues.  Islanders should all have the same opportunity to enjoy a healthy life, but that is not the reality in our province.

This presents both a challenge and an opportunity for us here in this legislature.  Often when we talk about health-care we focus on access to doctors and other health professionals, building and maintaining health care facilities, ensuring Islanders can afford medications, while remaining blind to the equally important social and economic factors.  Indeed, relative to other factors, the healthcare system actually plays a comparatively small though critical role in improving the overall health of a population.

In addition to the social determinants of health we must recognize the ecological determinants of health, something which is becoming an important concept in promoting a healthy society. There is growing evidence that the impacts of human activity on our environment affects our health. Climate change, water quality and quantity, energy resources, waste management, the health and fertility of soils, the stability of natural ecosystems, and other environmental factors need to be taken into account when designing policies to promote a healthy population. Like the social determinants of health, access to the ecological determinants of health are also not distributed evenly in society.

Of course, almost none of the social-ecological factors affecting health lie within the traditional scope of our health care system, but lie within a multitude of departments and programs. That is why Dr. Morrison’s report, a report I encourage you all to read if you have not yet had an opportunity, calls for, among other things, a “health in all policies” approach.   This would be a more holistic approach applied across government and would require that all departments consider the impacts that their policies and decisions have on the social-ecological determinants of health. By breaking down the artificial barriers that exist between and among departments we can enlist all of government in the common objective of promoting the health and wellness of Islanders.

This new approach might seem like a monumental shift, but it really isn’t. We already see kernels of this sort of holistic thinking in some parts of the public service. The Bridge model, for example, brings together professionals from public safety, education, family and human services, and Indigenous organizations to help individuals or families who are at risk of harm. This recognizes that complex situations require multi-faceted solutions. Using the social-ecological determinants of health across departments is a similar multi-pronged solution to the complex policy challenge of improving the health of Islanders. It recognizes that a wide range of factors affect health and wellness, and that an equally broad solution is required.

It is our responsibility as the leaders of this province to work on and find solutions that will allow all Islanders to live healthy rewarding lives, and for that reason I call on all members of the legislature to support this motion.

Thank you.

Hannah Bell's speech as seconder of the Motion

Thank you, Mr. Speaker, for the opportunity to speak to this motion. It is such a privilege to be here and to participate in meaningful debate on the future of all Islanders.  As a newly elected MLA it is easy to become overwhelmed by the complexity of issues that face Islanders, and it can be tempting to focus one or two things, like the economy or population growth, as the panacea for all our ills. And I would never deny that those metrics are important, but I don’t feel they really tell a complete or human story.  

I did not seek public office so I could do my bit to improve the GDP - I did it so I could tell the stories of my constituents and make a difference--whether those stories are about the chronic stress of insecure employment, the barriers to social mobility within our current social assistance programs, the profound indignity of being unable to afford your colostomy supplies or the extraordinary risks homeless women must navigate daily.  Some would argue that, with the exception of ostomy supplies, these aren’t healthcare stories, but for me every one is a story about how we are collectively failing to provide our fellow Islanders with the basic minimum socio-economic supports necessary to enjoy good health.

Of course, poverty is only one of the social determinants of health; we must also hear the stories coming out of our education system and our justice system; the challenges that families face with limited employment opportunities and housing options; and the tales that our depleted soil and water may be telling us.  We need to be measuring not just the employment participation rates, but also whether Islanders have secure jobs with benefits, livable wages, child care and safe working conditions. These are the larger challenges we must address when we talk about health and wellness, and for that reason I am proud to stand today and support this motion.


*Thank Susan Hartley, Gary Roberts and Karla Bernard and others who did the background / research work for this.