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2014 June Conference: Prevent More to Treat Less - DAY 2 - Plenary Sessions
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8:30 – 10:00 AM Plenary I

Opening Ceremonies; Make No Small Plans


Paul Roumeliotis opened the proceedings of the conference, welcoming delegates and introducing himself as someone with experience in both worlds (as a pediatrician and a medical officer of health), and expressed hope that the people in the room can seize the opportunity to bring those worlds together in an effort to Prevent More to Treat Less. He then introduced participants to the "Data On the Spot” (DOTS) survey technology that would be used throughout the conference, which allows answers from delegates to answer multiple choice questions that are aggregated in real time. Questions included how much Primary Care and Public Health delegates know about each other, what they want to learn at this conference and what they hope to contribute.  Results indicated a good awareness of each others’ functions, but at the same time both a need and a desire to learn more about each other and explore ways to work together to support the health and wellbeing of our communities.

alPHa President Mary Johnson and AOHC Chair Cate Melito were then invited to the stage to provide their own words of welcome. Each gave examples of areas of collaboration in their respective areas of the province, gave an overview of their organizations and spoke of the ongoing transformation of the Ontario health landscape as a ripe opportunity to explore new ways of working together to create a more effective, equitable and people-centred system. The goals of the conference were set early in the planning stages:  1) to investigate innovative best practices between public health and primary health care; 2) to demonstrate working upstream to promote health and wellbeing and 3) To explore how to make primary health care and public health collaboration more sustainable. Establishing and strengthening links and relationships will be essential to this work, and this conference is a perfect occasion to begin the strides required to accomplish a system that will Prevent More to Treat Less.


Angela Recollet, AOHC’s Aboriginal Constituency Director and Executive Director of Shkagamik-Kwe Health Centre in Sudbury was then invited to provide her perspectives as an Aboriginal person. She emphasized that as we move forward, we must remember that the journey is not just about locations, roles and responsibilities, but also about the relationships that are formed among the diverse and resilient people who live on the land. These relationships can be difficult to build, as we often fear what we don’t know. She observed that there are many boundaries within the human family, not the least of which are policy, legislation, jurisdictions and other man-made rules that are not always in the service of the people. She then stated that we are all leaders in our own right, and that true leadership is leadership without title. The identification of ability, duty and responsibility while respecting traditional values is an important basis for that leadership. One must also remember, "what you give, you get to keep; what you hold on to you lose forever”, as the decisions that we make today are not for us, but for the future. She then reminded everyone in the room that while there are indeed social determinants of health, sight must not be lost of the indigenous determinants of health, namely clean water & air and the other gifts of the natural world that we need to survive.

She introduced a song and video that were specially commissioned for this event, entitled "Make No Small Plans”, the title and message of which were inspired by the similarly-titled Public Health Sector Strategic Plan. Once it was over, she emphasized that its spirit was meant to capture the importance of being creative and breaking free of perceived limitations, and observed that it mirrored the holistic aboriginal approach to health and wellbeing that when properly applied can begin the redress of the health inequities and disparities that are its biggest obstacles.


Table Talk: Michael Rachlis and Rosana Pellizzari: Why is this the right time for this conference?


Dr. Paul returned to the stage to draw attention to the health care and prevention landscape that is undergoing significant shifts in direction owing to political, economic technological, environmental and human factors.  He then highlighted the shared vision and values of the conference partners that led to the planning and execution of this event, namely to improve population health, reduce inequities and contribute to a sustainable health care system.  Finally, he emphasized that the most important first step is to become more familiar with each other in order to set the stage for the required conversations.  With that, he introduced plenary facilitators and "roving reporters” Dr. Rosana Pellizzari and Dr. Michael Rachlis, and invited them to kick off the discussions by providing their own perspectives on why the time is right for forging a stronger relationship between Public Health and Primary Care.

Michael Rachlis pointed out that Public Health and Primary Care have always shared the same fundamental goal, which is ensuring people’s health. He expressed his excitement about the possibilities and opportunities that exist right now to start moving away from what is an outmoded model of health care delivery. A greater understanding of what it takes to be healthy is more broadly shared than ever before, and primary care practitioners should be able to provide their patients with the advice and knowledge that they need to advocate for a system that best serves their health and wellbeing.

Rosana Pellizzari agreed, adding that it would be terrific if every Public Health Unit had one or more Community Health Centres that could develop partnerships to start laying the foundations for modernizing how we think about health and how we deliver health services in Ontario. She noted that 25% of the health care system in Ontario is now organized, which makes the development of partnerships and collaboration much easier.

Following these introductory remarks, the facilitators invited the delegates to take a few minutes at their own tables (which were assigned to ensure that partner organizations from similar areas were seated together) to share examples of initiatives and opportunities for collaboration in their own corners of the province, and to provide their own perspectives on the timeliness of this event.


Setting the Stage for a Strengthened Relationship: Carol Timmings and Adrianna Tetley


To carry on the conversation, Carol Timmings (RNAO representative on the conference committee and Chief Nursing Officer & Director, Chronic Disease and Injury Prevention with Toronto Public Health) and Adrianna Tetley (Chief Executive Officer of the Association of Ontario Health Centres) took the stage to add their perspectives as conference advisory committee members about the intentions of the conference and what it is hoped to achieve.

Carol opened the conversation, stating that this conference is about coming together, having conversations and identifying what we can do together to improve health in our communities. As the conversations evolve, roles are clarified, relationships are built and the issues that call for complementary actions naturally emerge. It also encourages us to look beyond the strict parameters of our respective mandates, which are often obstacles to such actions.

Adriana picked up on this thread, indicating that the increasing proportion of the health system that is organized (i.e. the CHCs and Family Health Teams that are currently serving around 25% of the Ontario population) brings with it greater opportunity for communication, collaboration  and collective action. She pointed out that there are approximately 4000 discreet primary care entities, and people’s attitudes about the system are largely informed by which part they interact with. Organized Primary Care has a different mandate and set of opportunities that come from the new model of having teams of practitioners serve the health needs of the people. These opportunities are not as obvious in individual interactions between physicians and patients. Within an organized and team-based system, leadership can be more easily identified, and planning can more easily be done at the community level to ensure that health resources are properly deployed.

Carol then focused on the idea of partnerships, indicating that this is a theme that runs strongly through the Public Health Sector Strategic Plan. We need to act on fostering those partnerships by examining our common values, identifying the health issues that are sensible platforms for collaboration and exploring additional partnerships that will add value and effectiveness. She contended that those partners need to be from and of the communities themselves. Communities have a voice and we need to bring those voices into the conversation and respond to them in order to carry out our mandate. We also have a unique role as facilitators and as an extremely important link to other services such as education, social services and even policymakers. It is where we have pooled our resources and maximized our scope that we’ve had the greatest impact.

As the dialogue continued, it became clear that there is a strong appetite for working together to serve the health interests of our communities by addressing as many of the factors that influence it as possible. The importance of keeping people well is gaining more and more traction with clinicians, decision makers and the public. It is also more clearly understood that the determinants of health go far beyond the individual and the choices that he or she makes. The result is an important opportunity for Public Health and Primary Care to form an alliance that will be on the cutting edge of re-orienting the health care system’s focus to one of prevention and wellbeing.

Champion for Public Health and Primary Health Care Award:

Recipients: Dr. Kieran Moore, Associate Medical Officer of Health, Kingston, Frontenac and Lennox & Addington Public Health; Hersh Sehdev Executive Director, Kingston Community Health Centres

The Champion for Public Health and Primary Health Care Award honours an individual for significant leadership in advancing the relationship between primary health care and public health at system, managerial and/or frontline levels.

Primary Health Care is the foundation of our health care system, and if people and communities don’t have access to primary health care providers --- or if they can’t access the right kind of primary health care provider to address their special needs, that’s a problem.

A few years ago the South East Local Health Integration Network decided it wanted to develop a better and more comprehensive primary health care system within its catchment area. The first step was to understand what needs people had in the region – the factors that were impacting health and wellbeing.  The LHIN also wanted to understand the barriers people and communities faced accessing the type of primary health care services they most urgently needed.

Enter our award winners: Hersh Sehdev, Executive Director of Kingston’s Community Health Centres and Dr. Kieran Moore, Associate Medical Officer of Health for KFL&A Public Health. Hersh and Kieran spearheaded an intensive research project.  The project systematically identified and analyzed the primary health care needs in the region with a clear focus on the determinants of health.

When their report came out, the LHIN had some eye-opening findings - findings that the LHIN can apply as it moves ahead planning for more equitable access to Primary Health care services.

The report clearly revealed that places with populations who have the most number of people who live on  lower incomes, have higher unemployment, less educational achievement as well as  more single parent families,  higher proportions of residents who living alone, or are separated, divorced, or widowed are overwhelmingly co-located in areas with the lowest accessibility to primary care physicians.  Not good…..and something the LHIN can now move forward correcting as it takes over more responsibility for regional primary health care planning.

The report also incorporated the lived experiences of vulnerable and marginalized populations as they struggle trying to access services they need to restore and then stay in good health. Their stories have provided a powerful voice and context for the LHIN to further understand the population’s health needs.

Accepting the award, Hersh Sehdev described how the process came together, resulting in a three-way partnership (the LHIN, Public Health Unit and the CHC) with shared values and a common understanding that vulnerable voices need to be heard. The question of how this kind of planning is turned into serving the community is the subject of Learning Session B12.


LEARNING SESSIONS (A): 10:30 AM – 12:15 PM

A full list and summaries of the Conference Learning Sessions Is available here.



1:15 – 2:30 pm - Plenary II


Media Award:
Recipient: Laurie Monsebraaten,
Social Justice Reporter, Toronto Star

​The Media Award honours a journalist, body of work, or media outlet which has highlighted the importance of addressing the determinants of health to improve population health and advance health equity.

We know that income is a key determinant of health, and that raising public awareness so decision makers make more concerted efforts to reduce poverty is critically important. The challenge is to explain poverty as a health issue in a compelling way, especially to those who are not living with it. Toronto Star reporter Laurie Monsebraaten meets this challenge.

She is a relentless researcher, who drills down into policy reports many other reporters leave aside searching for the story behind the story.  She takes the complex facts and figures and weaves them into compelling news stories that capture the attention of both the public and politicians.  She does this by reaching out to people living in poverty, and letting them tell their stories with their own voices.

She has covered a long list of important issues:  the need for affordable housing, income security, child benefit policy, child care issues, dental health, minimum wage and precarious work, social assistance, as well as the health impacts of poverty.

Her latest story tells of the desperate need for accessible publicly-funded dental health programs among low-income adults and seniors. It reveals how people’s lives can be transformed by simple oral health interventions and echoes the call from the Ontario Oral Health Alliance for the Province to expand access to publicly funded programs.

Through her persistence, she has succeeded in raising awareness about the profound impact poverty has on people’s health and wellbeing.  Her continuous coverage of poverty issues in Ontario has kept them in the public eye and on the Government’s agenda. Laurie tells the powerful stories that we need to compel action on preventing more to treat less.

In accepting her award, Ms. Monsebraaten shared that her initial reaction was wondering why a group of health workers would be presenting her with this award. As she learned more about alPHa and AOHC, she realized that the upstream work that these groups do has much in common with her aims as a social justice reporter. She pointed out that there was no such thing when she began, but each reporter was expected to bring that lens to his or her stories.

Her role as such began when reforms to the Canadian social safety were announced in the mid-90s. Subsequent governments at federal & provincial levels made more and more decisions that eroded so many social programs, including child care, housing, minimum wage, child welfare, and developmental services. Twenty years later, she still worries how much longer this erosion will be allowed to continue and what effects it will have on Canadian society. She observed that when people don’t have access to these things, health suffers, and this takes a toll on the country as a whole.

She also observed that the degree of control a person feels he or she has on his or her life has an important impact as well, and cited two organizations that are beginning to address this by giving voices to those who are too often not heard. Voices from the Street and Voices for Change are examples of initiatives that are allowing those affected by poverty and other vulnerabilities to tell their own stories to engage and feel more involved in influencing policies. She has also noted that health professionals are starting to pay far more attention to these issues and are in turn engaging directly in advocacy , such as was done for a $14 minimum wage and the defense of health services for refugees.

In closing, she expressed gratitude for the recognition and for the complementary work that we do.


Table Talk, Keynote Address & Discussion: Advocacy


To set the stage for the keynote address, Rosana Pellizzari and Michael Rachlis returned to introduce the idea of advocacy and what it means for us in our work as public health and primary care providers. Michael gave a basic definition of the "A-word”, which is the act of pleading for / supporting / recommending. He contended that all health care practitioners have a basic responsibility to advocate for their patients, and added that some professional colleges include obligations for advocacy on policy in their ethical statements.

Rosana added that advocacy is an inevitable consequence of the nature of the work that we do, and revealed that her decision to move into public health was based on the desire to do more of it. She did note that none of the foundational documents in public health explicitly uses the "A-word”, but the Ontario Public Health Standards imply it through their directions to address the health needs of vulnerable populations, often in partnership with other organizations by influencing public policy.

Delegates were then invited to have a short discussion at their tables about issues in their respective areas where a joint advocacy approach would be effective.

Keynote Address Dr. Ryan Meili -
Ryan Meili is a family doctor at the West Side Community Clinic in Saskatoon. He also works for the College of Medicine at the University of Saskatchewan, where he’s responsible for helping ensure that Saskatchewan’s future doctors are equipped to meet the health needs of the diverse communities they will serve. Ryan also serves as vice-chair of the national advocacy organization, Canadian Doctors for Medicare.He has recently published his first book A Healthy Society: how a focus on health can revive Canadian democracy. Last year, Ryan founded the non-profit organization Upstream: Institute For a Healthy Society, a movement to create a healthy society through evidence- based and people-centred ideas.


Dr. Ryan Meili took the stage to offer some insight on how Public Health and Primary Health Care might work together as more effective advocates for upstream interventions and healthier public policy by giving it a more prominent place in the public discourse. He gave a short autobiography, characterizing his decisions to practice medicine as being rooted in social justice and service of underserved populations. He loves his work, but it is naturally frustrating. He illustrated this with an anecdote about a young patient who presented with addictions and multiple conditions, including HIV and related infections. His diagnosis was that she was sick from poverty, and his conclusion was that treating these conditions with medicine wasn’t going to solve the patient’s underlying problem.

 He then cited Rudolf Virchow’s observation that "politics is nothing else but medicine on a large scale”, arguing that this is what is meant by the increasingly popular health in all polices approach to decision making, which demands that question of policy asks questions about health. If we acknowledge that governments are in the business of improving our lives, health can and should be used as an indicator of its success. He referred to the Canadian Index of Wellbeing as an apt example of this, while pointing out that there is actually very little relationship between population health and the more commonly used indicator of economic strength.

We therefore need to reframe the discussion, and there are important opportunities to do so.  He drew attention to the fact that our language is replete with the word "health” and it is always at or near the top of the political agenda regardless of class or political stripe. As such, it is used as a convenient qualifier for other things: healthy policy, healthy economy, healthy business, healthy partnerships and so on.  We need to understand that and use it to communicate that health is a destination, that the Social Determinants of Health are the way to get there, and that every single intersection (income, education, employment, food, housing , social inclusion, etc.) is subject to policy.

He reported that this concept is beginning to be more widely understood, referring to a book called The Upstream Doctors to illustrate the growing interests of physicians not only to know about the determinants of health but also to find ways of intervening. He then added that the concept itself is fairly easy to explain, and this is one of the objectives of his own organization, Upstream, which advances policy solutions designed to change the systemic conditions that contribute to poor health.  They conduct research, educate key decision makers, create influential coalitions, and elevate public health issues through public forums and advisory groups across and region. 

Panel Discussion:

Trish Hennessy (Founding director of the Canadian Centre for Policy Alternatives’ (CCPA) Ontario office), Hon. Elinor Caplan (Chief Executive Officer of Canada Strategies Inc. and a former Ontario Health Minister), Dr. Ryan Meili.

Trish Hennessy & Elinor Caplan were invited to join Dr. Meili on the stage to spark further discussion on
the partnerships, messages and strategies required to convince decision makers to advance healthy public policy by focusing on upstream actions.

Ms. Hennessy suggested that a sensible thing to do for a start is to have an open and honest discussion about taxes, and the time may in fact be right for this. She reported that her own research has revealed that the frame on this discussion is beginning to shift, as people identify taxes as an important contribution by a good citizen and as politicians step away from the notion that supporting taxation is tantamount to political suicide. Telling powerful stories about how taxes can be deployed in the best interests of the public will only help shift the frame further. She would start by expunging the words "taxpayer, tax relief and tax burden” along with their negative connotations from the lexicon.

Elinor Caplan added that advocacy is a great way to define priorities. Governments rarely make decisions in a vacuum, and even they have to rally support, assess the degree to which a given policy is going to anger or please different groups, and decide which ones are going to be louder. She also stated that non-partisan organizations can get as much value out of standing with a government that is doing things right as speaking out when it isn’t. She also urged a careful examination of all of the angles of building a strong case, using the example of the high proportion of unimmunized health care workers as a significant weakness where practitioners are advocating for immunization.

Ryan Meili then raised the idea of recognizing values and giving credit where credit is due as a step towards building the relationships that are so essential to achieving the desired outcomes. Ms. Caplan agreed, stating that praising a "small first step in the right direction” is not good advocacy, as it still contains an element of confrontation that doesn’t support relationship building.  

Responding to a question about how to mobilize the public, Trish Hennesy contended that there is a tendency among many advocates to be overly timid and limited in focus. She characterized advocacy as an essential element of a healthy and vibrant democracy, and when correctly executed can easily change perceptions and conversations about what is possible. Assuming that it all has to be directed at politicians and decision-makers traps us into a certain discourse that doesn’t resonate with anyone but them. There are other audiences that can be mobilized with the right stories and conversations and they are as important to the process as the people who make the policies. It is especially important to focus persuasion efforts on the audiences who have not yet formed an opinion on a given matter.

On the question of how all of this is paid for, Elinor Caplan remarked that the implementation costs of a given policy initiative cannot be ignored. As long as governments feel they need to operate within existing financial parameters, policies that involve additional spending are going to be a difficult sell. Proposing reallocation and alternate models of delivery can be viable strategies, as can arguments about the eventual costs of not underwriting a given intervention. In any case, advocates need to be at every table at the outset of the discussion so that when the issue of money is raised, they can effectively respond to it.

Dr. Meili added that persuasion requires paying attention to the values and beliefs of a given audience, as we need to tailor arguments that address their concerns and relate to their priorities. This often requires identifying "native speakers”, or allies within those audiences that can effectively do this. He also reiterated the importance of engaging the unengaged.  Trish Henessy echoed this, adding that while it is important to identify champions within various groups, the conversation must always start with what we have in common with them.



A full list and summaries of the Conference Learning Sessions Is available here.


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