Download Municipal Government and Public Health: Cities are addressing the

Municipal Government and Public
Health: How Cities are Addressing the
Social Determinants of Health & Health
Inequalities
Thematic Session, Suite 303 WTCC
8:30am to 10:00am,
Wednesday June 4, 2008
CPHA Conference, Halifax NS
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The Session
• Brian Ward, Moderator, PHAC
• Dr. Cory Neudorf, Chief Medical Officer,
Saskatoon Health Region
• Councillor Sheila Fougere, Halifax Regional
Municipality
• Discussion, Statements, Questions &
Responses
2
Social Determinants of Health &
Municipal Government
The health of Canadians is determined largely by the
conditions in which they live.
Different conditions lead to differences in social status.
Different social status leads to different health status.
Municipal leaders significantly shape the conditions of
people’s lives, and of their health.
3
Estimated Impact of Factors
Determining the Health Status of the
Population
Health Care
System
Social and Economic
Environment
50%
25%
10%
Physical
Environment
15%
Biology and Genetic
Endowment
Source: Estimation by the Canadian Institute for Advanced Research, The Standing Senate Committee on Social Affairs,
Science and Technology, The Health of Canadians – The Federal Role, Volume One: The Story So Far, March 2001.
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Physical Environment
• Positive Determinant when:
– Universal infrastructure: i.e. water, waste,
transportation systems, community planning,
recreational & cultural opportunities,
– Protective policies: i.e. pollutants, tobacco, health and
safety standards & inspection,
– Basic needs met: i.e. adequate & affordable housing,
• Negative Determinant when:
– Excluded populations, poor quality/ageing
infrastructure, private interests over-ride public
interests
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Social & Economic Environment
“Roy Romanow’s Advice”
• Don’t be poor
• Get a good start in life
• Graduate from high school
• Get a job
• Pick your community
• Live in quality housing
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The Municipal Determinants of Good Health
“Pick Your Community”
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•
•
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Accessible, Affordable, Safe Housing
Access to safe water & sanitation
Efficient waste management
Safe working & living environments
Health & environmentally planned land use
Food security
Public transportation
Child care
Recreational & Cultural programs and facilities
Public Health promotion & programming
Health and Crisis Leadership and Management
Immigrant & Settlement Services
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Some municipal initiatives of note I
• Social Support Networks
– City of Regina’s Urban Aboriginal Community
Grant Program
– Halifax Regional Municipality Immigration
Action Plan
• Healthy Child Development
– Toronto’s Early Child Development Initiative
– Edmonton’s Child Friendly Strategy
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Some municipal initiatives of note II
• Social Environments:
– Vancouver's Four Pillars Drug Strategy &
Wellness Walkway
– Toronto’s injury prevention initiative
– Safer Calgary initiative
• Food Security
– Ottawa’s Food Security Group
– Nourrir Montréal
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Some municipal initiatives of note III
• Environmental Health:
– Many Smoking By-laws (national leadership)
– Calgary’s Reduced Vehicle Idling initiative
• Affordable Housing
– Toronto's Streets to Home program
– Region of Waterloo’s Affordable Housing
Strategy
– London’s Convert to Rent Program
– Ottawa’s deferred property tax program
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Municipal Health Leadership
“Health for All”
• Pesticide bylaws: Hudson Quebec 1991
– Now: 135 municipalities with pesticide control
by-laws improving the health of 42% of
Canadians (October 2007)
• Supreme Court affirmed the right of
Municipalities to protect residents health
through bylaws, endorsing the
precautionary principle
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Some background on Municipal Government
• 3,700 municipal governments in Canada
• The 10 largest urban economies accounted for
47% of the GDP;
• Toronto’s GDP is larger than that of 8 provinces
and 29 American states
• Municipal employees: over 350,000
• Public transit: 1.63 billion passengers yearly
• Annual Public housing investment: $2.1 Billion
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Background (continued)
• Two types:
– Single/lower tier –cities towns, townships with
full responsibilities for municipal services
– Upper tier – regional or metropolitan
municipalities with wider area and possible
several lower tier municipalities within them
• Created by provincial legislation therefore
great variety across Canada
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Total Government Revenue as % of GDP 1989 2005
14
Tax Revenue Distribution
15
Revenues
16
Property Tax
• Horizontal equity: regressive
– Among categories i.e. business vs. rental vs.
homeowner
• Vertical equity: regressive
– Share of household income represented by the tax
goes down as income goes up
• Often inefficient:
– suburban expansion, hollow cores, elderly & fixed
income
• Highly visible
– Differentiated visibility and responsible leadership
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How others tax for revenue
Canada
Australia
Mexico
U.S.A
France
Japan
Germany
Italy
Income
Property
0.0%
0.0
0.1
5.2
0.0
44.6
75.8
21.6
91.5%
100
89.5
72.6
53.2
33.0
17.7
13.6
Sales/
Service
2.0%
0.0
2.4
22.0
11.0
21.3
6.4
23.0
Other
6.5
0.0
7.9
0.0
35.9
1.0
0.3
41.8
OECD 2004
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Expenditures
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Expenditures
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Municipal Government and the
Social/Economic Physical Determinants
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The roles and contributions of
Municipal Government on SDH
• Leaders on the determinants of health in
areas of municipal mandates.
• Partners on the determinants of health
where municipal government has the
experience, contact and relationships
• Brokers & instigators where the solution
requires a multitude of players.
• Guarantors that the local voice is heard.
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Where Public Health and
Municipal Government meet
• Inclusive Communities: barrier-free design,
programming & planning
• Environmental Health: the bio-dome
• Active Living: city/town as health club & outdoors
places
• Food Security & Nutrition: the garden & the
market
• Affordable Healthy Housing:
• Community Safety:
• Child Health & Development:
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What Public Health & Municipal
Government can do together
1. Integrated & intersectoral leadership
2. Community participation and
empowerment
3. Evidence based strategies for learning
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And Finally….
Conference Objectives:
• To provide a forum to critically reflect on our
progress, and
• To consider Canada’s future role in the reduction
of health inequalities in response to the
anticipated report of the WHO Commission on
Social Determinants of Health.
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