The past century has seen incredible advances in population health.
Some of these advances can be credited to improvements in our ability to diagnose and treat disease. However, most of these changes are due to the development of public health-related policies, which have been credited with 25 of the 30 years of lifespan gained in the 20th century.
In 2010, the Canadian Public Health Association released a list of 12 great achievements in public health from the 20th century. Vaccination, improved motor-vehicle safety, healthier mothers and babies and recognition of tobacco as a health hazard are included as examples of successful public health work that has had major effects in improving population health. The most striking conclusion from this list is that it’s not newer, high-technology health care innovations that are most effective in improving health. Rather, it is societal and environmental changes that prevent disease and result in improved health, well-being and safety.
Yet despite these advances, we can do better. There are large gaps in health between some communities in Manitoba. These gaps suggest that there is something at work that is negatively affecting the health of some Manitobans much more than others. And the effects are significant. People are dying before their time from chronic diseases and injury, while the health-care system strains to meet the demands of caring for the ill.
What can be done to close these gaps? To be sure, we need to continue efforts to support individuals to make healthy lifestyle choices. But we also need to make changes at all levels of society to make healthy choices the easier options.
The effort to reduce smoking rates provides an excellent example. Public education about the harmful effects of tobacco helped in this effort. But one of the most important factors in driving down smoking rates were environmental changes, such as making cigarettes more expensive through taxation and introducing smoke-free public spaces.
The lessons are clear. Individuals make choices, but the environment society creates around people can dramatically affect these choices. Our goal as a society should be to create environments that foster healthy lifestyles.
My own education in this area began as a medical student. Many of the patients I saw suffered from conditions that could have been prevented, which helped convince me that promoting health and preventing disease is both better for individuals and communities, and more efficient in maintaining a sustainable health-care system. This education has continued every day since, including in my role as Manitoba’s chief public health officer.
In the months ahead, I will be using this column to explore some of the factors that make some people healthy and others sick. In doing so, I hope to focus our collective energies on ways to create healthier communities.