8 th Meeting of the WHO Commission on Social Determinants of Health DRAFT #3 2007-06-07 5:21:36 PM Good afternoon. I am very pleased that we have had the privilege of hosting the 8 th meeting of the WHO Commission on the Social Determinants of Health. On behalf of the Government of Canada, it is an honour to welcome such a distinguished group to discuss issues of fundamental importance to health. One the fundamental, if not THE MOST fundamental changes as a social determinant of health was the decision by our nation in the late 1960s to guarantee that healthcare would be delivered on the basis of need, and not the ability to pay one of our finest achievements. Since that time, due to this and other important social policies and prevention programs, we have seen radical reductions in mortality for all age groups and overall, a diminishing of the differences in life expectancy and infant mortality between the richest and poorest in Canada. As Canadians, we are very proud of the fact that discussion of the importance of the Social Determinants of Health began, in a major way, with the Ottawa Charter and the 1 st International Conference on Health Promotion in November of 1986. It was at that Conference that then-minister of Health Jake Epp showed leadership by declaring reducing health inequalities as a priority for action in Canada. Achieving Health for All has been an explicit goal of the government of Canada as part of our health promotion framework since that time. So as we gather here today, 21 years later, it seems appropriate to revisit the original goals of the Ottawa Conference, and to take stock of where we stand now in relationship to those goals. Over the past 21 years, we have zeroed in specifically on determinants including -Income and Social Status -Social Support Networks -Education -Employment and Working Conditions -Physical Environments and Draft #3 1
-Appropriate access to Health Services. In some areas we have good news to report: Life expectancy in Canada has increased from 76.5 in 1985 to 79.9 in 2003. In urban Canada, the differences in life expectancy between the richest and poorest neighbourhoods was 5.8 years for males in 1971, but declined to 4.4 years in 2001. For females, the difference declined from 2.9 years in 1971 to 1.9 years in 2001. Canada s long term unemployment figures have fallen from 17.8 per cent in 1994 to 10.1 per cent in 2003. Overall tobacco consumption has been halved, from 30 per cent to 15 per cent of the population, and overall alcohol consumption has dropped from 9.8 litres per capita in 1985 to 7.9 in 2003. Unfortunately, in some areas we have less success to report. Both tobacco and alcohol consumption are higher at lower income levels, and those are disparities we need to continue to address. Both obesity and diabetes rates have continued to increase consistently over the past 20 years and the differences in mortality between the richest and poorest Canadian have not decreased, but widened. Draft #3 2
And despite billions of dollars taxed and spent by various levels of government over the past two decades, Canada s poverty rate actually increased slightly, from 9.5 per cent in 1995 to 10.3 per cent in 2000. It s a small move, to be sure, but I m sure we can all agree it moved in the wrong direction. One of the most pressing public health concerns we are facing in Canada is the epidemic if childhood obesity. Childhood obesity has tripled in 15 years. Among females, lung cancer mortality rates have more than tripled since 1971, and the rise is greatest among the poorest women. The disparity in lung cancer rates has widened between the richest and the poorest, as has the disparity in mortality for COPD, both of which are related to the higher rates of smoking among poorer women. And in our Aboriginal populations, obesity, diabetes, and suicide rates have gotten worse, not better, over time. What are we doing about it? Many of these statistics, particularly Childhood Obesity, have served as a wake up call indicating that new strategies, new attitudes, and new ways of thinking are needed in many areas. We recognize the need to advance health strategies that will help prevent ill health and support those at greatest risk. Our approach includes a focus on the root causes that put people at risk including poverty and physical and social environments. That is why I have committed, through the Public Health Agency of Canada, to lead and report on government-wide efforts to advance knowledge and action on the social determinants of health. The knowledge, partnerships and innovative policy approaches which will emerge from the WHO Commission s work will be of critical importance to Canada as we explore ways to fulfill this commitment. As Canada s Health Minister for the past 16 months, I am proud of the significant amount of work we have accomplished on a number of files which will have a direct impact on health outcomes; and as a member of Canada s New Government, I can point to multiple initiatives within and outside the Health portfolio which will have a direct bearing on the Social Determinants of Health. Draft #3 3
To begin, for the first time we are establishing national strategies to deal with two of the diseases that cause the greatest health and economic burden for Canadians Cancer and Cardiovascular disease. In Budget 2007 we announced $300 million in spending to ensure young women across Canada can be vaccinated against HPV. We also announced the establishment of Canada s first Mental Health Commission. Mental disorders have doubled among men and quadrupled among women in Canada since 1971! This new agency will play a significant role in the years ahead in promoting research and understanding into the plethora of diseases and disorders that are wreaking havoc in the lives and communities of Canadians, preventing many from living happy, balanced, productive lives. As a government, we understand that that too many Canadians face an uphill battle not just from birth and through life, but in the months BEFORE birth. Statistics Canada data show clearly that children born to mothers in the lowest income brackets are at a disadvantage even long before they are born, suffering lower weights and often exposure to substances like alcohol and tobacco which affects their development forever after. Recognizing this disparity, we recently released the Healthy Pregnancy Guide which we promoted using a number of novel means including posting ads and literature in the bathrooms of bars and restaurants. It has proven to be one of the most successful pieces we have ever created. Healthy Eating and Physical Activity This government is taking concrete action to promote healthy eating and physical activity. In February I launched the first new version of Canada s Food Guide in 15 years. To give you an idea of how starved Canadians have been for this kind of information and guidance, 3 million of the first 4 million copies were delivered in the FIRST WEEK. I released the first ever Aboriginal Food Guide two months ago, and that print run also ran out almost immediately. Clearly Canadians care about what they eat and they want to know their government cares, too. Draft #3 4
Canada s New Government has recognized the importance of promoting the healthy development of children through investments ranging from tax benefits and direct transfers to parents with children, to education savings supports to community based programs and cutting edge research. Draft #3 5
Our recent introduction of the Children s Fitness Tax Credit, which allows parents to claim a tax credit for expenses from sport and physical activity programs for each child under the age of 16, is designed to encourage sport participation. This winter I helped re-launch Participaction, one of the most successful health promotion programs in our history, which the previous government had allowed to lapse. Environment Canada s New Government takes the impact of our Environment on Human Health very seriously. Our new Chemicals Management Plan, introduced last December, puts the onus on industry to prove they are using chemicals safely. Our program leads the globe and many other nations, who are just beginning the management program we already have underway, have come to ask Canada s advice on how to design their programs. Our Eco-Trust program, announced earlier this year, will allow us to work with provinces and territories on environmental clean up projects. Draft #3 6
Our Clean Air Regulatory Framework is introducing mandatory industrial targets to tackle climate change and reduce air pollution. I expect these changes, over the coming years, to help reverse the alarming trend we have seen over the past years in which asthma and cardio-pulmonary disease rates have skyrocketed more than doubling among women. Taxation and The Economy Budget 2007 created a new $2,000 Child Tax Credit that will provide up to $310 per child of tax relief. Our Working Families Tax Plan will benefit over 3 million taxpayers, and remove 230,000 low-income Canadians from the tax rolls. This is in addition to the Universal Child Care Benefit launched in 2006, providing families $100 per month for each child under 6 years old. Aboriginal Health Tomorrow I will be launching the 19 th International Conference on health promotion, which I understand some of you will be attending. This milestone event has strong focus on health inequities, particularly the health of indigenous peoples. Draft #3 7
I am particularly pleased that we are working in close partnership with the Commission to examine policy approaches for improving the health of Indigenous peoples here and around the globe. This issue is of particular importance to me. In my months as Federal Health Minister I have worked very closely with the leadership of our Aboriginal communities to improve the design and delivery of health care services to them. In fact, while I am here in Vancouver I will meet with First Nations leadership and the Premier of British Columbia to advance our work on the historic agreement we signed last November, which will create fundamental change for the improvement for the health status of First Nations people in this province. I hope this agreement will serve as a model for other provinces and territories in the future. Canada s New Government recognizes that a strong and healthy sense of cultural identity and respect for the views of indigenous peoples in the decision making process is directly linked to positive health outcomes. Draft #3 8
Conclusion Canadian Investments in WHO Commission I am proud that the Government of Canada is playing a strong role in these efforts, including through our support of two Commission Knowledge Networks. A third is supported by the International Development Research Centre. I wish you a very fruitful and productive afternoon and much success in the further development of the Commission s Interim Statement. I look forward to receiving updates on the progress of the Commission s work and to our continued partnership to improve health and reduce inequalities around the world. -30- Draft #3 9