HALIFAX, THURSDAY, MARCH 20, 2003
STANDING COMMITTEE ON COMMUNITY SERVICES
9:00 A.M.
CHAIRMAN
Ms. Mary Ann McGrath
MADAM CHAIRMAN: Good afternoon, my name is Mary Ann McGrath, and I am the Chairman of the Community Services Committee. I want to welcome our guests from the Wellness Network. We have Jane Farquharson, Mary-Lou MacDonald and Clare O'Connor, and you can introduce yourselves in a moment. We are very excited to have you here. I've seen a bit of the proposal before, and it's very interesting stuff. I will ask the committee members to introduce themselves, and then I will turn the floor over to our guests. We allow two hours for the meeting, so an hour, maybe a little less for a presentation would be nice, and then we will have lots of opportunity for questions.
[The committee members introduced themselves.]
[The witnesses introduced themselves.]
MS. CLARE O'CONNOR: First of all let me thank you for inviting us here today. We are very happy to be able to come and talk with you. I want to extend a special thanks to Mora for helping to organize this and for putting together this incredible binder of information. It's nice to see it all together, and it's very extensive, so thanks for all your work with that.
We're really happy, like I said, to be able to come and talk to you today. Some of the presentation that we're going to give is a bit of an overview of some of the material that we presented at each caucus office over the past few months, but it's not exactly the same. It's a new, more exciting version. We put it together specifically for this meeting today. We hope that you will enjoy it and promise that it won't be redundant in any particular way. At the end of our presentation, as Mary Ann said, there will be time for questions, and although Jane and Mary-Lou will be doing most of the speaking with this presentation, please feel free to ask any of the three of us or all of us whatever questions you have in mind. With that, I will just turn it over to the executive director, Jane.
1
MS. JANE FARQUHARSON: Good afternoon everyone, such a beautiful one as well. We would like to take a few minutes this afternoon to outline the condition or the status of the population in Nova Scotia around chronic diseases. I think many of you have been hearing press and information over the last number of months about the health condition of Nova Scotians. We would like to talk to you a little bit about that and about some of the things the Heart and Stroke Foundation in particular is doing to address that, and highlight some of the activities and programming and so on that's happening across the province right now, trying to connect some of those dots. Then we're very interested to hear your perspective on how we should go about tackling this issue in Nova Scotia.
As many of you know, we have the highest rates of death from cancer in Nova Scotia, as well as the highest rates of death from respiratory disease and the second-highest rates of disability days. Some of you may have seen in the paper over the last week or so, we had an article in the paper about the fact that Nova Scotia has the second-highest rate of disability day usage across Canada. We also have the second-highest rates of circulatory deaths, and that's the area, of course, that we're responsible for, heart disease and stroke, and the second-lowest life expectancy, which makes sense, based on the fact that we have all those rates of disease.
As you know very well from many of your constituencies, we also have a very rapidly aging population in Nova Scotia. All of those things in culmination will mean that not only are we in a crisis right now in this province, around the status of chronic disease, the problem will only increase exponentially as the baby boomers, many of us in this room, begin hitting middle age and older ages.
This burden of chronic disease accounts for nearly three-quarters of all deaths in Nova Scotia, and because of these high rates of disease they really are the primary reasons for premature death and hospitalization. I'm sure many of us have either been impacted personally or have family members or friends who have been impacted by the chronic diseases that I'm mentioning. The biggest killer is cardiovascular disease. It actually accounts for 36 per cent of all deaths in Nova Scotia. One of the reasons for that, I will show in this slide, which basically shows the primary risk factors for heart disease and stroke across the country.
You will see on this slide, the yellow line at the top is the Canadian average or the mean, and this is based on the risk factors of smoking, high blood pressure and elevated blood cholesterol, and of course there are other risk factors but we're just focusing on those three. You can see Nova Scotia, the third from the right, at 69 per cent, 70 per cent of Nova Scotians have at least one of the major risk factors for heart disease and stroke. The next slide will show how this fits together. Really, there is a commonality of risk factors. This, I think, will make a lot of sense to you. The risk factors are in the left, smoking, unhealthy diet, overweight, sedentary lifestyle or inactivity, alcohol abuse and psychosocial stress.
Well, you can see that those risk factors don't only have an impact on cardiovascular disease, but they also have an impact on all of the other major chronic diseases.
Basically, we have high risk factors, therefore, we have high rates of chronic disease, and it's not as simple as that. If it were that simple, we would probably have rectified the problem. It's really more complicated than that, which the next slide indicates. We're moving on to - actually not the slide I was thinking about. We just want to go back one slide. This really is not just because of risk factors, it's also because of the determinants of health. We not only have high rates of risk factors in Nova Scotia and high rates of disease, but the underlying factors that relate to that are low income levels, high unemployment, looking at social income status, and many of the other major determinants of health are also in this mix, which makes Nova Scotia and actually all of Eastern Canada, all of Atlantic Canada have higher rates of disease and risk factors. As you move from east to west, the population is healthier. So we have a higher burden of disease and therefore higher health costs and a rapidly aging population.
[1:15 p.m.]
One of the things that the Heart and Stroke Foundation has been talking about is a program that was put together in another country, Finland, that really, in our view, has pulled together comprehensively, how to go about tackling this particular issue or problem. So we would like to share a little bit of that information with you this afternoon so we don't despair. Yes, we have the highest rates of disease but there are some very practical, common-sense, policy-driven things that Nova Scotia could be doing and is already beginning to tackle.
So the North Karelia project, and I actually had the privilege of going to North Karelia in 1989. I formerly was the Director of Heart Health Nova Scotia at the Dalhousie Medical School and a very major part of our orientation was how to decrease cardiovascular disease in Nova Scotia. So in 1989 I travelled to Finland to view what they were doing and to begin to bring some of those ideas back to Nova Scotia.
MR. PAUL MACEWAN: How far north did you go?
MS. FARQUHARSON: I didn't get to Lapland but I was very far north.
MR. MACEWAN: Did you see Santa's reindeers?
MS. FARQUHARSON: I didn't see them. I wish I had.
There are a lot of parallels between Finland and Nova Scotia. This particular province in North Karelia has the lowest socio-economic status in the country. They have very high rates of all of the major risk factors that we do in Nova Scotia, poor diet, high rates of smoking, low levels of physical activity and they had very high alcohol consumption rates.
All of those factors combined, in 1972, to mean that they had the highest recorded death and disability rates of cardiovascular disease in the world and, as you can imagine, as a country, and as a population, they were trying to figure out what to do about that.
Over a 20-year period, they put together an initiative that was driven by the Government of Finland by the Finnish Heart Association and other partners to comprehensively address this fact that they had the highest death and disability rate of cardiovascular disease in the world. These are the results of the impact of that particular program. They had incredible outcomes. Cardiovascular disease mortality declined by 68 per cent. Coronary heart disease mortality declined by 73 per cent. Cancer mortality declined by 71 per cent and all-cause mortality declined by 49 per cent. You can see that that makes sense, based on the slide that I showed you previously around the commonality of risk factors. If you address these risk factors, in addition to the determinants of health, then you begin to see decreases in death and disability rates in all of the major chronic diseases. So it's not that if you address heart disease, you don't address diabetes, cancer, respiratory conditions and other chronic diseases. They are all inextricably linked, really.
In addition to having these incredible outcomes from a population basis on death and disability rates that you can imagine had an impact on health care utilization and so on, they also had some additional positive consequences. The director of this particular project was so well-liked by the constituency in North Karelia that he ran for government and was elected as the MP representing this particular province and then became the Minister of Health for the country. So you can imagine that that ensured that they had the political support as well as the resourcing that was required to actually implement this. To implement an initiative like this, it can't be done in a piecemeal fashion. It has to really be part of an overall comprehensive strategy with many different programs and activities that are going on but it's an integrated, comprehensive approach.
They had decreases in annual costs of $600 million U.S. a year and that was more focused on the population aged 35 to 64. They started off working with the men because it was really the younger, middle-aged and older males who were having the problem. So they started working with men in the beginning and then quickly moved over to family health because really that's how you create change at the community level. Basically, this was an innovation, you can imagine way back in 1972, we haven't done this yet in 2003 in Nova Scotia, so they were very innovative and basically the results were published in peer review journals around the world, widely accepted and basically they formed a lot of the basic scientific evidence that's demonstrated that investment in prevention actually does pay. It really is worth doing it.
The fellow who was the physician, an epidemiologist, who was the head of this project was Dr. Pekka Puska and he has gone on now to become the Director of Chronic Disease Prevention with the World Health Organization in Geneva. I've known Pekka since 1989 so I got some additional information from him. This is from a presentation he did in
Moscow last December. Basically he's saying here that, "Population based prevention is the only cost effective and sustainable public health approach to chronic disease control." It's only if we address this from a population perspective in addition to maintaining an adequate primary health care and publicly-funded system. He also stated that, "Many results of prevention occur surprisingly quickly (CVD, diabetes) and also at relatively late age." So basically that's good news. It's never too late to begin impacting on your life, no matter what your age, from a primary prevention perspective and if it's a well-organized, sufficiently resourced initiative with buying in from the stakeholders, then you can actually, within a four-year mandate, have quite a significant impact on the health of the population.
In Nova Scotia, we have a number of challenges. We have a higher prevalence of risk factors and disease in Nova Scotia due to a number of things. We have a higher proportion of multiple chronic diseases, which I have already alluded to in the presentation; we have a higher rate among females in Nova Scotia than some areas of the country; we have an earlier onset of chronic disease because we have children, as you know, who are extremely unhealthy; we have 50 per cent of the population of our youth as obese already; and we also have a higher prevalence among middle and higher income and higher education groups. You can always expect that because people living in lower economic circumstances have less access to resources, that they will have a higher rate of chronic disease but in Nova Scotia we also have higher rates of disease with our middle and upper income groups. We would like to talk to you about a number of initiatives that we are involved in that work with both population groups.
This is just a pictorial depiction of the previous slide that shows that the presence of chronic disease by income, you can see that in Nova Scotia and Canada, Nova Scotia is flatlined across the top where we actually have similar levels of disease in all incomes in Nova Scotia, where in the rest of Canada there is a higher preponderance of disease in lower income groups. That means that basically that's a problem for every Nova Scotian that we have to deal with. It's not only certain populations. You would work with different populations in different ways but we actually have a problem that runs across every person in Nova Scotia who is at risk for chronic disease.
This determinants of health slide I think is really important to underscore because it's not just the risk factors of unhealthy eating, physical inactivity, smoking and having high stress in your life. There are many other things, as I have already suggested, that have an impact on whether or not you are healthy. You will see on the bottom right-hand slide, the second-last bullet, Health Services. Health services is actually an extremely small component of what determines whether or not our population is healthy. We need a sufficiently funded system to certainly deal with the population when we're sick. We want excellently funded health services but really and truly that's not what determines whether or not we have a healthy population.
There was a study done actually by the Canadian Medical Association over 20 years ago that basically showed that really at that point we had reached saturation for investing more dollars in the system to improve health. We invested more money in the system and continued to do because we have such an unhealthy population but it's not improving the health of the population. These other factors do. Income and social status is number one. If people are living in lower socio-economic circumstances, they are much more vulnerable to the diseases I'm talking about but in Nova Scotia you can see that it's not just that income group, it's everybody that's at risk.
I would like to move down to employment and working conditions. That is why Mary-Lou is working with us, because we have an innovative workplace wellness program where you can reach all of the working population of adult Nova Scotians, through developing workplace wellness programs.
It is also very important that people have access to a social support network. If you are living in isolation, no matter what your age, and you don't have family, friend or a collegial support from work, then if you have a crisis in your life related to a chronic disease or other issue, it is much more difficult for you to manage that. That is just common sense. I mean, from personal experience, we would know that.
Education is also a very important determinant because if we don't have a well-educated population, then people are not as eligible for jobs that are well-paying and, in addition to that, they may not have access to the kind of information and be able to integrate it into their personal life practices. We have more universities per capita, I think, in Nova Scotia than anywhere else so, really, this should not be an issue for us but it is.
Social environments, our physical environment, whether or not we have healthy places to run, work, play and take our families, our culture, whether or not we are discriminated against from a cultural perspective, obviously has an impact on your health.
Personal health practices and coping skills are individual things that can be engendered in the population. How you cope with stress, whether you have the resources personally or financially to be able to join a gym, or to buy a new pair of running shoes to start a walking program, how you cope with stress, all of those factors are important but not as important as income, social status and education.
Development of healthy children is another one. There have been a number of things in the media lately around that and we need to invest in our children if we want to decrease the amount of chronic disease and the burden on the health care system that we currently have in Nova Scotia.
Some of us are luckier than others. We have a biology and genetic endowment that really enables us to achieve a healthier life than others who have genes that predispose them to ill health. However, if you know that you have got "bad genes", then you also know that you have to be even more careful about what you do around your personal health practices.
Health services, I have already mentioned. Also, we know that there are differences in equity around health, around gender. Whether you are male or female also has an impact on your health status.
So that is just a bit of background about where we are in Nova Scotia and why we are in the situation we are currently in. The organization that we work for, the Heart and Stroke Foundation of Nova Scotia, as you know, is a community-based, voluntary-led, Atlantic organization. We are really concerned about the cardiovascular and cerebrovascular health of Nova Scotians. We know that to address that effectively we really need to work with partners across Nova Scotia from a policy and programmatic perspective. We also fund a lot of research in this area.
The approach that we are going to mention to you today is not everything we are involved in but we are going to stress two particular initiatives. One that we are involved in, called the Leaders Among Us Project, is really working with women living in lower economic circumstances, lower socio-economic circumstances, women and children, working with family resource centres. The other program that Mary-Lou will talk about is a workplace wellness project called HealthWorks, that we are in partnership with a number of organizations in the metropolitan area.
The first project that I will talk about is the Leaders Among Us Project. This is funded through Health Canada, through the diabetes strategy. It is a community-based project that completely focuses on building capacity with family resource centres across Nova Scotia, and with women and children and their families in these particular communities.
It is designed to reduce the prevalence of risk factors, so we are definitely interested in improving women and their children's health around the risk factors we mentioned, but we are most anxious to improve their ability, and their capacity, to not only access services at the community level, but also to feel empowered, really, to take control of their health and to also be concerned about public policy issues and things that are happening that they could comment on.
It offers meaningful, accessible and health-promoting programs so initiatives are being designed specifically for women and their families, working with the staff at family resource centres. It is also very much focused on women living in lower socio-economic circumstances of which we have sufficient numbers across Nova Scotia to be of concern.
[1:30 p.m.]
We also want to ensure sustainability by working with these family resource centres to assess their needs and deliver relevant programs. The idea isn't that we would continue to do this forever, but that we build capacity within the family resource centres and our other partners to ensure that this is an ongoing, sustainable program for women and their families across Nova Scotia.
Our role in this is we have developed health leadership training to these family resource centres, which is an ongoing capacity-building initiative, we provide continuing education sessions, not only for the staff but for the women and our other partners. We evaluate and monitor to support and/or modify these programs and resources. So it's not a canned program, we are really taking all of the comments and all of the feedback that we're getting from the women and the staff who work in the resource centres. So things are changed. If it doesn't work, it's changed. It's not something that's static.
We are also identifying gaps and challenges within existing policy that have an impact on women and their families and resources that are available through family resource centres. The whole idea is to coordinate a network of family resource centres around health wellness programs, funding and resources, to develop something that's integrated and comprehensive where all of the organizations that are interested in working with this particular population are brought up to speed.
This is something that you would have seen in the paper recently, a study on Poor Moms Sacrificing Diets, that was just in the news this week. This study basically showed that, "Poor mothers in Atlantic Canada routinely sacrifice their own nutritional needs to feed their children . . .", according to Lynn McIntyre's study from the Med School, Dalhousie University, Faculty of Health Professions. This, obviously, is a concern to women and their families who are affiliated with the family resource centres and something that we will be working on through this particular project. It's nice to have something that's ongoing that actually allows you to address these kinds of issues when they're raised.
As far as return on investment and being involved in these kinds of initiatives, what we've seen thus far, and the project has another year to go, is improved personal and family health practices of women and their families, an increased number of healthy eating programs at these resource centres - this is a very practical application of what needs to be done - increased community links and health networks, because we really need to support each other at the community level because there aren't a lot of resources to go around, and we don't want any redundancy because we need to be using all the resources we have very cost effectively. So, this kind of network and collaborative effort really ensures that we avoid duplication.
We've seen increased chronic disease prevention, knowledge and skills among the participants, so women and their families and the staff at the family resource centres - the staff are really the continuity here. They're going to be there after women have gotten the information and the knowledge and secured a secure enough income that they can move forward and then new women will come into the family resource centres. So the idea isn't that they would be there forever, but that they develop their capacity and then move on and other women and families move in.
Also, we've seen an increased knowledge within the health organizations that we're partnering with that partnering with family resource centres is an excellent way of actually targeting this particular population group. It's just a perfect venue at the community level for us to be able to do that.
So that's really the overview and the information about how we're, as one organization, partnering with others, focusing on women and children living in lower socio-economic circumstances. Mary-Lou is going to move on from here and talk about the initiative that we have underway with a number of important partners, addressing the adult population that we know is also very much at high risk for chronic disease.
MS. MARY-LOU MACDONALD: Thank you, Jane. One of the things that we do know is that two of the biggest audiences for us to focus on, when we're talking about population groups, are those in our school system, our youth, and the Nova Scotia Sport and Recreation Commission has specifically targeted youth fitness and health; and the other largest audience that we can reach is adults in the workplace. We don't currently focus specifically on worker health, employee health. Other provinces do, particularly in Ontario. They have quite a strong network through their public health, have direct responsibility. Their mandate is to focus on employee health and to educate and assist and support not only employees but employers in creating a supportive environment. We don't currently have that here in Nova Scotia, specifically and directly. Through Jane's guidance, we recognized that this really was an area we wanted to take some leadership on and get involved with specifically.
I'm just going to spend a few slides introducing you to some of our ideas around this area and talk to you about what we are specifically doing as an initiative with regard to workplace health. The interesting thing about the workplace is it's an environment that both contributes to employee ill health, we all know that, I'm sure there's no one in this room who's ever been stressed because of their job, among other things. (Laughter) It not only contributes mostly to the ill health of employees, but it also simultaneously, as I mentioned, offers the most potential for improving the health of a huge population in the workforce.
This is from a recently released Canadian Council on Integrated Health Care report, "While Canada's health care system is under intense scrutiny, little attention is being paid to the role of workplace culture on employee health." We're not really talking about it here
in Nova Scotia, and I think it's a huge issue. I think we will start talking about it, and I will tell you why.
What is workplace wellness? It's interesting, when we talk about wellness people who aren't in this work tend to glaze over and say, okay, here come the fitness instructors, but hopefully I will dispel some of those myths by the time I'm done. What is workplace wellness? It's really healthy individuals working within healthy organizations. Not a lot to ask, I don't think, but it certainly is a complex problem that we can tackle if we focus on it. Healthy individuals are those who are able to maintain their physical, intellectual, social, emotional and spiritual health. What we don't always understand is that most of us, when we focus on wellness, think of our physical health and we don't think about our emotional or intellectual health, but if any one of these areas, dimensions of wellness is at risk it affects the whole of who we are because we're made up of many dimensions. So those are the things that we think about as an individual.
A healthy organization is one that's able to achieve its business objectives in an environment that supports its employee health. Who says they have to be mutually exclusive? (Interruptions)
Why should we be focusing on this issue? Employers are interested in this issue and it has been an issue in the U.S. for 20 years now, it has been on their radar. In Canada, mostly in the last 10 years; in Ontario, it's big and in B.C., Manitoba and scattered throughout the rest of the country but very little attention is focused here. It's become an issue for employers because we know it affects, positively, their bottom line, financially. So that's an issue for them. When your employees are more engaged, when they're happier, when their morale is up, they're more productive, missing few sick days. That can only help your bottom line.
It's important for government because if employees are healthy, if they're supported by their employers in their workplace, it is definitely going to positively affect the broad social determinants of health, which Jane mentioned, because it crosses all of those divides. It will also, one would expect, if our employees are healthier, decrease health care costs, it will improve the quality of life, effect on social determinants, but most importantly it's going to improve the economy of Nova Scotia. If we target this group of individuals, provide the supports they need, provide support for employers, it is going to affect our economy positively.
What is workplace wellness after all? What I'm finding going into these businesses, it's really the same thing. Most of us really don't understand what comprehensive workplace wellness or wellness itself really means. Most of us associate wellness with our physical self, so if I have a cold, I'm not well. We don't really get beyond that. In the workplace, it's not so complicated. When I explain this it will, hopefully, be quite clear to you.
In the workplace, the things we need to focus on, the left-hand side of that triangle obviously, are the individual health practices. For example, in the workplace, what do we have on-site that's going to support our employees' personal health? Do we have maybe exercise facilities, or do we have healthy food in the cafeteria, or do we have a kitchen that people can spend time in, or do we have a private area that people can go to, those sorts of things that will support their personal choices. Do we allow for individuals to, if they want to exercise at lunch, do stuff like that? We're being supportive about an individual's personal choice to maintain a healthy lifestyle.
As well, the physical work environment, and all of these things, I must say, have to work together in order to create change in the workplace. The physical work environment is just this, if you cannot work in your environment because it's too hot, it's too cold, there's mould in the walls, the lighting is poor, it's too noisy, we're cramped in cubicles, these sorts of things are the physical environment. Under this falls occupational health and safety. Currently we focus on occupational health and safety because it's legislated, but mostly we focus on the safety side of things. We haven't quite put the health in health and safety yet, but we've done an excellent job with OH&S. We really need to get a little bit beyond that, really, is what I'm suggesting.
The most important driver that most people have no understanding of, particularly business owners and managers that I speak to have little understanding that the psychosocial work environment is really the main driver of employee health. So what's my stress like at work? How is my work organized? Is my schedule flexible? How much control do I have over my work and so on, which I will talk about a little bit later.
When I go into businesses, often they think I'm going to talk to them - when I'm talking about workplace wellness program, okay, you're going to have a program for me, a fitness instructor is going to come in at lunch and they're going to work with my staff. It's not that at all. If those are the sorts of things that come out of what the staff are telling me, and the management, it's a whole team situation here, if it's what needs to be addressed, that we would like the business to support us in that regard, then we go down that track. But largely the driver we know is about stress and satisfaction and the demands that are on employees and the work/life balance issues that they're talking about in Quebec right now.
As you may have heard recently in the press release that Jane mentioned, absenteeism is a big problem in this country. It's extremely big in Nova Scotia. When I alluded to improving the economy, this is a big way in which we could do that. Employee absences cost Canadian employers an estimated $8.6 billion a year. Full-time employees missed 70 million workdays for personal reasons in 2000, up from 66 million in 1997. A 2000 Watson Wyatt survey showed direct disability and absenteeism costs were 7.1 per cent of payroll, for the people they surveyed, the companies they surveyed. GPI Atlantic and the Heart and Stroke Foundation recently reported, last week, that Nova Scotia has the second-highest rates of absenteeism in Canada in 2001 and the highest in 2000, so you can see the connection here.
MS. O'CONNOR: A copy of that press release is in the packet of information that you have.
MS. MARY-LOU MACDONALD: Our challenge and our opportunity - which I think is good news - research is suggesting that workplaces are negatively affecting the health of employees. We have reams of research, short and longitudinal studies that are showing this. It's very clear, it's a proven fact. It would be wise for us to take a look at that and see what we can do in that regard. It's not surprising then that absenteeism rates, for all reasons, are increasing. So your own individual illness - you're going to be sick if you're stressed, you're going to be sick if your job is too demanding.
Those are obvious things, but what falls in this absenteeism number as well, besides disability, is the need to be absent for family reasons. In the studies that I've been reading, on average, 15 per cent of the time they were missing is because we have sick children or parents, we need to take care of issues with our parents or whatever. This is the reality that we're living in right now, but that's also the opportunity to address those sorts of things.
The work environment, as I said earlier, has a powerful effect on worker health. What we're focusing on in this psychosocial area of wellness is demand and control. For example, if your job is very demanding, which I'm sure it is, that's an issue, but the more control you have over your job - so as a manager and an owner, sure, your job is really demanding but you can control how your day rolls out. You can make your own decisions around your work. So that tends to neutralize your stress.
[1:45 p.m.]
If you are an individual that may be lower on the food chain that has a very demanding job but they have no control over it - and someone I think of - because I did this as a teenager, working on a cash register at K-Mart, very demanding; absolutely no flexibility, no control in that situation. I couldn't stay there. It was the greatest education I had in my life because I knew I never wanted to have only this as an option. In fact, I was only 18 and I developed an ulcer. That is how stress affects an individual when you don't have any control over that.
Effort and reward is similar. You may give a lot of effort to your work. It is very demanding on your head. A lot of effort goes into it but if you feel that you are rewarded appropriately, you will deal with that. If you don't feel that you are rewarded appropriately, what happens is, your health starts to break down.
You can see why the psychosocial side of the workplace health is the driving factor. That is primarily what I focus on now when going into businesses and tying employee health to the bottom line of the business, so it is integrated into the business strategy.
Canadian workers reported experiencing stress in balancing their work and their life responsibilities. That has increased over the last decade from 27 per cent to almost 50 per cent in 1998. That's huge. Work-related mental and nervous disorders - this comes from the Council on Integrated Health Care, again - are rapidly becoming a major health concern with serious cost implications.
This, I hear often going into businesses, that people are our best asset. Well, if that's so, why aren't more businesses and organizations in Nova Scotia creating work environments that contribute to the health and well-being of their workers, as opposed to creating ill health, when we recognize that that is so.
Well, a number of reasons that make sense. A lot of employers, particularly private business, are afraid of, what is this going to cost me? That is the first question I hear, what is this going to cost? They are worried that the more responsibility they take for an employee's health, the more responsibility they will be expected to take.
Most are not educated with regard to this whole avenue and issue. When I walk in the room, really, they think, okay, here we go, she is going to talk about fitness again. When I leave they understand that it is really not about that at all. That is just one small piece of it. Then they understand, okay, I'm in jeopardy if I am not paying attention to this. This is kind of the way it rolls out when I go into the office of a CEO or business owner.
Really, the other major issues, there is no support system in Nova Scotia right now to help someone. If I am a business owner, who do I call to say, could somebody come help me? So that support system isn't there right now, directly.
It is important to note that workplace health promotion should not be construed as a means of making employers responsible for employee well-being. Rather, the focus is on creating an environment at work that is conducive to improving health behaviours and fostering well-being. As a business owner or the head of an organization, I need help to do that. Really, I know about my business, I don't know about employee health.
Our response to this issue, which we recognize as critical in this province, is Health Works, which is the name of the project that I am directing, through the Heart and Stroke Foundation. It is a Health Canada-funded study which will go to a year from now, next March. The purpose of the project is to increase the capacity within those businesses and organizations to employ these strategies, workplace health promotion strategies which I talked to them about, for the prevention of chronic disease, including Type II diabetes. You can see how it marries with our mandate.
The other issue with this program, my mandate, as well, is to develop national and provincial support networks for sustainability. We don't want, when this project ends in a year, for it to be over. The businesses that I work with as pilots benefit for a while but once
I am removed from this process, then it's over. This is something that my dream is, that the fire will catch and other businesses will become aware of this and the importance of this, and you folks, obviously, as well. We will then put what we need to put in place to support these businesses and organizations, all, really, workplaces to be thinking about this important issue, not only for themselves, but for the economy of Nova Scotia.
The folks that we are partnering with - and this is a really exciting project - the Metropolitan Halifax Chamber of Commerce - they actually have a subcommittee, HealthWorks that has recognized and produced their own documents on the fact that worker health is a serious issue in Nova Scotia.
When we received the funding for this project they agreed to work with us because they recognized the importance of this and certainly wanted to be a partner with us to get the word out through the Chamber. That is what we are doing, very closely. Capital District Health Authority is heavily involved with us, Dalhousie University, Atlantic Health and Wellness Institute and Health Canada. These are the folks we are working with right now. We have been underway for three months and are continuing to talk to other partners and convince them of the importance of this and get them on board to help us with the network.
The View Through a Different Lens. I guess this is my closing when I am talking about the workplace wellness issue. As discussions on the future of our health care system continue, there is an opportunity here to develop new approaches, revitalize existing programs that we have and create new solutions that will benefit not only organizations but also the communities in which they operate.
That is my job over the next year. I am working with four pilots for Chamber businesses. We are, right now, interviewing a number of them. Once they saw our press release they started calling us. Many of them are already doing quite a bit in this area. Most are doing nothing or are totally unaware but they are recognizing that, hey, we need help, can we be one of your pilot sites. That is what I am doing right now for the Heart and Stroke Foundation.
MS. FARQUHARSON: That leads us into the closing slides which basically take all the information that we have talked about and wrap it up in a health and social policy framework. Really, our view is that the two things we just talked about are very interesting initiatives and they are very important to improving the health of the population. But they are just pieces of what really needs to exist in this province which is an overall social and health policy framework.
There are a couple of examples in sister provinces that we would like to point out to you that you might want to follow up on. In particular, the Newfoundland social policy framework is very comprehensive. We think it would be a very nice strategy to employ in Nova Scotia. It was done through a very open, consultative process across Newfoundland.
The population had input into it. The population, going through this process, can begin to see how these things all fit together. Sometimes you really need to get the big picture in focus before people can then see what piece of the puzzle they actually are using in their particular job or volunteer role.
The next slide is the actual cover of the Newfoundland document. Not only did they use a very positive process to put this together in that province but they also have defined some measures, some goals, some targets around behaviours that need to change in the province. I will just highlight for you. There are just a couple of examples of what the document actually includes.
One is a very - this particular one, the five-year planning targets, the first goal is to improve the health status of the population. Then you can see through the objectives, this particular one is increasing healthy behaviours and supports, that they have defined targets and dates so that there can be a very systematic accountability measure that is put in here so that everybody knows where we are going and how long it is going to take to get us there. Obviously, based on this, specific programs and activities need to be plugged in.
The first target is decreasing adult smoking rates from 31 to 26 per cent by 2007 and so on. I think that what we are basically saying is, this is a pretty effective tool, I think, that we could look at here in this province.
The next one is a more general one, not focused on health but obviously would have a direct impact on health, is goal number two, improving the capacity of communities to support health and well-being, recognition that government isn't going to do this alone, that we need to partner with communities and community organizations to do this.
The first objective under that is developing and enhancing community partnerships and resources that focus on health, increasing the number of family resource programs by 25 per cent by the year 2007. So there are some very definitive statements that they're making that then they can develop the initiatives and the programming with other stakeholders at the community level and actually measure their progress and explain why or why not things are working.
We have a lot of great stuff happening in Nova Scotia right now and we have just listed a few things here. This is not meant to be definitive of everything that's happening, but we have a physical activity strategy for use, Active Kids, Healthy Kids, that has been announced with some funding, that is beginning to look at the inactivity levels and the huge issue of childhood obesity we have in our whole province. The tobacco strategy, that has been funded to a certain level that we have had great success with and it's really a model across the country but again, there's still a lot of work to do in the tobacco area, particularly in the policy piece of it.
There is an Atlantic wellness strategy that the four Atlantic provinces' deputy ministers, are looking at. There is the Nova Scotia integrated stroke strategy, which the Health and Stroke Foundation spearheaded. We now have the transitioning of the ICONS project, which is focused on cardiovascular health, transitioning with help from the department into a provincial action toward cardiovascular health strategy. We have the Health Charities Network, which we are a member of, but all the major health charities: cancer; lung; and Alzheimer are all part of that and interested in improving the health of the population. We have the development of the Nova Scotia chronic disease prevention strategy that the unit for population, health and chronic disease prevention under the medical school is involved in.
Just more specifically around the chronic disease strategy, you will know that the Department of Health is sponsoring this initiative, that it's a comprehensive development process looking at the primary prevention of these chronic diseases that we have been talking about. It is being developed with the input of stakeholders across the province, including the district health authorities and all the major health charities, that they are developing long- and short-term goals for the province, that there will be recommendations around budget considerations when it goes back to the Department of Health. It is very much focused on a population health approach, looking at the determinants in addition to the risk factors and figuring out how, as a province, we should be tackling this.
This is one of the most important strategies that has come out of this province as being developed that we really need to pay close attention to and ensure that when it goes back to the government, to the department, that it's sufficiently resourced over a long period of time to ensure that we can impact on the health of population in the way they did in Finland.
In closing, we believe that even though there are many positive things happening in this province right now, that we really need to consolidate these in a social and health policy framework. Many of you were probably at the press conference this morning, where the Department of Health and the Office of Health Promotion released the document, Your Health Matters and there were many, many positive things in this document. But what we feel is they need to be pulled together under a social health policy framework so that as a province we know exactly where we're going, we know the targets, we know the goals, it's sufficiently resourced and to do that we think that we really need something like what was developed in Newfoundland but not just Newfoundland; Finland, the U.K., Australia, Sweden, there are many examples and models of documents and processes that we can draw on to develop a comprehensive policy strategy involving all government departments. It's not sufficient for Health and the Office of Health Promotion to be involved in this. We need the Department of Transportation, we need Community Services, we need the Department of Economic Development, we need the Department of Justice because there's an impact on children, the Department of Education.
If we had a senior level decision-making body put together - and Tom Ward was talking this morning about a social policy group that he chairs, which we didn't know about, so it would be interesting to see what the mandate is of that group - that take determinants of health focus, that use a consultative process, that develop accountability measures and outcome measures within the context of that social policy framework and they do it over a 20 year period, so that really we are focusing on Health 20-20 or Health Nova Scotia 20-20, that really with all of us working together we will achieve the results that we need to in this particular province.
Investing in Nova Scotia's Health is going to take all of us working together to do this. I think the department made some very important announcements this morning, many of which were already public, but I think what's required is really an integration of this with more of a focus on policy, with some accountability measures developed in that so that we know, as a province, where we're going and how we're going to get there and whether or not we are there. Thank you very much for listening to our presentation and we would be very happy to entertain questions or just have a discussion about what we presented.
[2:00 p.m.]
MADAM CHAIRMAN: Thank you very much. That's certainly a lot to chew on. We will open the floor to questions now. Mr. Hendsbee. did you want to start?
MR. DAVID HENDSBEE: Not at the moment.
MADAM CHAIRMAN: Mr. Gaudet.
MR. WAYNE GAUDET: Just a couple of questions to start off. I'm looking at this HealthWorks pilot project that was submitted by the foundation. You're focusing on metro Halifax, is it the intention of the foundation to submit additional projects for other parts of the province?
MS. FARQUHARSON: This is a national project actually, Wayne, and we are the pilot site, for all of Canada, in Nova Scotia. The initiative is only happening in the HRM, singularly because we didn't have the resources in the project to do it across the province. We would have loved to have had the resources to do this in several areas, Cape Breton and your area, for example. However, we only have resources to do it in one area and HRM, their chamber had already made statements of commitments saying that they were concerned about the cost of health care in Nova Scotia and they were concerned about the health of their employees, so it seemed like a logical place to start.
Our intention is to do this pilot with the four businesses Mary-Lou will be working with and during this time, develop a mechanism with the corporate sector and with the Department of Health to figure out how we are going to sustain this kind of an initiative
across the province. So we don't have any answers for you today but we would love to talk to you along the way as we figure out, by working with the corporate sector and with government and with non-governmental organizations like ours, how we are going to fund this.
As Mary-Lou has said, in Ontario, public health is really involved and as you know, we really have a decimated public health system in Nova Scotia. We do not have the resources to permit public health professionals like public health nurses, public health dietitians, public health educators, to really do what they're qualified to do at the community level. The work they do is enormously important, but they have many other skill sets, like working with workplaces and improving employee health, that they can't get to right now because there are not enough of them in the province doing the work that they can do.
MR. GAUDET: Coming back to the project for here, have those four businesses been identified?
MS. MARY-LOU MACDONALD: No, they will be identified by April 10th. I have spent the last week and this week, and will next week, interviewing them. We have identified a number of them through the provincial steering committee of most likely to be involved. Because of the short duration of the project I couldn't spend six months convincing businesses this was a good idea, although, probably 75 per cent of the businesses that I'm talking to who really don't know a lot about this are open to hearing, so likely I will end up working with businesses that really at the beginning had no idea about this but really will benefit from it. The short answer is no, we haven't selected them but will within the next two weeks.
MR. GAUDET: I'm sure by hearing about this, it is certainly going to generate a lot of interest, especially with the chamber promoting this with their subcommittee.
MS. MARY-LOU MACDONALD: Yes, that's the intention.
MR. GAUDET: Thanks.
MADAM CHAIRMAN: Barry Barnet.
MR. BARRY BARNET: That was one of the questions that I had but first of all, let me apologize for being late, I thought the meeting was at 2:00 p.m. I wasn't sick. (Laughter)
I'm specifically interested in the Newfoundland and Labrador study and the one in New Brunswick, and we have already asked our clerk to get us copies of that if we can. I know you couldn't put everything in that document in your presentation but it appears to me that what you have put here is the goals. Are there specific steps that they intend to take to reach those goals and is that spelled out in the document?
MS. O'CONNOR: There is a discussion on process that is in the document. The New Brunswick document is a bit more generic in nature and is very focused on kind of an umbrella approach, whereas this has that same umbrella approach where it says, this is where we want to get to and then it spells out the specifics on how to do that. You will see when you look at the document itself that there is a fair bit of information in terms of how they plan on reaching their goals.
MR. BARNET: Okay, great.
MS. FARQUHARSON: The other Web site that we should have put on the slide and didn't is the Health Promotion Clearing House . . .
MS. O'CONNOR: Mora has it.
MS. FARQUHARSON: It's in this. On that Web site there is a page on the chronic disease prevention strategy, which I think you would find very useful. On that Web site, there is also another link to the strategies in Australia and the U.K. and Denmark that are fascinating to read because you get to see the whole process that they've used. They're further along in the process than, perhaps, we are in some of the provinces of Canada. You will find that very useful.
MR. BARNET: One more thing, if I can, Madam Chairman. With respect to the stress in the workplace, you talked about the increase from 1988 to 1998, I think it was, and I kind of wonder if maybe it may not be a greater awareness, if people in 1988 weren't already experiencing a higher level of stress but because of the fact that people are more aware of what it is those feelings are now compared to then, that in fact the stress levels may have been higher, they just weren't reporting them. Do you have that same sense?
MS. MARY-LOU MACDONALD: No, not at all. It could be, sure, but mostly what's being reported now is fewer workers, more demand on those individual workers, computers have made everything . . .
MR. BARNET: That will add stress.
MS. MARY-LOU MACDONALD: All that stuff. That's the kind of stress, as well as work/life balance stuff. So single moms having difficulty trying to get the kids to school, to get to work, to deal with everything, that's the kind of stuff. Relationships in the workplace, because there is more to do and there is less time to do it, management also has goals to reach, so the relationship breakdown in the workplace is a result of the sheer volume and demands on the individuals. That's what's flushing out in the literature, actually.
MADAM CHAIRMAN: Mr. Hendsbee.
MR. HENDSBEE: In regard to the family resource centres that you're trying to participate with, has there been a determination of which ones they have been located at, within the study group?
MS. FARQUHARSON: Yes, they've been working with 13 resource centres across the province. Again, the resources for the project wouldn't permit the staff that we have to work with all the family resource centres, but the information that we learn from the work that we're doing now certainly will be shared with all the resource centres. At this point, again, we're trying to determine how we're going to sustain this particular initiative by working with the partners that we're working with because, again, this is a grant-funded initiative. We have to figure out what kind of a mechanism we can develop to ensure that what's learned from this project is really disseminated and used long after the particular funding for this project is over. Again, David, it ends up coming back to a resource issue for this. The need is there and the desire is there, and the family resource centres are extremely interested and would like to keep it on, but they don't have the resources either.
MR. HENDSBEE: Is there a list of those resource centres that are presently participating?
MS. FARQUHARSON: No, but we certainly could give those to Mora. We would be happy to do that.
MADAM CHAIRMAN: Mr. Chataway.
MR. JOHN CHATAWAY: Basically, as a smoker - I used to smoke, that is. You give it up and then you realize it should have been done a long time ago. I read some of the information and we're certainly going in the right direction. We were 30 per cent, now we're down to 25 per cent and maybe it's 22 per cent or something like that, but we're going in the right direction. Of course, I think everybody is well aware that the sins from smoking still cost more than we can get through taxation. It's in the millions of dollars every year.
Could you sort of fill me in on some smoking cessation programs? Could you tell me, when you looked in that direction, what did you look at, and are other places in Canada or around the world looking into smoking cessation programs?
MS. FARQUHARSON: As you know, we have a comprehensive provincial tobacco strategy that includes protection and prevention and regulation, which would also include cessation. Because we have this comprehensive strategy, as you're suggesting, the rates, the percentage, the prevalence of tobacco smoking is going down. We need to do more work in that area.
As far as smoking cessation specifically, there are a number of programs and initiatives. As you know, there is staff that has been hired and the district health authorities around that through the tobacco strategy. Tobacco cessation initiatives really depend, again, on some of the determinants. So around gender, if you're a woman, your issues around tobacco and why you smoke and how difficult it is for you to quit are different than they are if you're a man. The programs that tend to be the most successful are the ones that have actually been developed for the particular target group, whether it's youth, women or men. There's a litany of programs, if you're interested in, we certainly could provide you with some information. Your own Nancy Hoddinott at the Tobacco Control Unit is really the expert in Nova Scotia around that.
Either way, we could provide you with more specific information about cessation that would include things like the patch and some of the nicotine replacement things, in addition to counselling from physicians, one-on-one counselling. There is a lot of literature around that. I just actually reviewed some grants around that that are looking for funding. If there is anything in particular around any group or whatever, Mora could contact us in the future and we would be happy to provide that.
MR. CHATAWAY: I certainly would appreciate that. I think the other thing is that I think many people feel, of course the taxes on cigarettes are going up all the time, and I know there is an agreement in Atlantic Canada that all provinces, basically, if the taxes are going to go up they go up the same amount, which is common sense because otherwise you start smuggling from one province to another, and all that sort of stuff. I think many people feel that yes, they should have the patches and things like this, there should be some incentive to reduce the cost of this, just to encourage people to go on this program or that program, not forever and ever but to go in that direction. Have you ever studied that?
MS. FARQUHARSON: There is lots of research done and the effectiveness of smoking cessation aids and how much that reduces the person's ability to smoke, and it would be a really good idea if we could support people in their endeavours to quit smoking. Obviously that would fit into the workplace wellness initiative as well. If we were able to actually support that through public funds, that would definitely help people who are ready to quit smoking.
There's a whole body of research around not only behaviour change around tobacco but all the studies look at pre-contemplation, whether you're thinking about quitting smoking, contemplation and there are actual time frames and questions that you can ask around this to determine where an individual smoker is in their desire to quit smoking. Based on where they are in that behaviour change continuum depends on the specific information that you provide that person and the support that you give them. There's a whole body of literature around that that you would find really interesting.
MR. CHATAWAY: I'm sure that many of the cessation programs, at least some people in the government feel that we have to do within our means, we can't afford everything you want, if it's just one whimsical idea, you can't do it all. Any costing on that, have other places where they do afford the patch, et cetera, been studied in order to . . .
MS. FARQUHARSON: Yes, definitely. I don't have the figures with me today but, again, if that's something you're interested in we could give Mora the information.
MR. CHATAWAY: Thank you.
MS. FARQUHARSON: There are more cost-effective approaches than others.
MR. CHATAWAY: Yes, that's right.
MS. MARY-LOU MACDONALD: If I may, particularly employees who smoke are an issue for employers because, although I don't immediately have in my head the exact statistic, smoking employees cost employers significantly more than to have an employee who doesn't smoke because of absenteeism from work.
MR. CHATAWAY: According to the quote I'm reading here, smoking costs Nova Scotia taxpayers $461,000 a day in health care costs and businesses $571,000. Obviously, the employee is out having a smoke.
MS. MARY-LOU MACDONALD: Or isn't at work because they're ill because of the effects of smoking. It is an issue with employers and perhaps one of the approaches, and I'm not familiar with the research but we might take care of supporting employers in providing - which they do in many workplaces - either smoking cessation programs or whatever other areas they want to focus on with regard to helping their employees stop smoking, because it is to an employer's advantage. You can see where this is connected.
[2:15 p.m.]
MR. CHATAWAY: I think it's very important too that you encourage people to give up smoking, not just tax them to death.
MS. MARY-LOU MACDONALD: Absolutely.
MR. CHATAWAY: We are all aware that if you raise the taxes on them, eventually (Interruption) basically to encourage them to do this. You really have to look into ways to encourage this behaviour.
MS. MARY-LOU MACDONALD: That leads to a lot of things, particularly in the workplace, what we can do to support employers in supporting their employees, and this is one of the most popular programs that are implemented in a workplace, dealing with the smoking issue, because it affects not only the smoker but the other individuals as well.
MS. MAUREEN MACDONALD: A great presentation. I don't know where to start and I don't really have a question as much as comments. When I look at the information you present and I look at what Newfoundland is trying to do, it strikes me that one of the things we require is some fundamental structural change in our province. Jane, this will come as no surprise to you, for sure but I always feel that if we don't do something to address poverty and low income as a result of low-wage work, we're going to continue to see - even though the health status across the income scale is all pretty bad, the latest Stats Canada census data that came out that talked about where we are in terms of income is equally as bad as our health status. It's incredible.
When I look at not just the dismantling of the public health care system, but social assistance rates were de-indexed 10 years ago, and I want to know, do you think it's possible for an adult in this province to be healthy if they're receiving $130 a month for food, clothing and all of their personal needs like haircuts and any of these kinds of things, laundry? At $130 a month, can you be healthy in that situation?
MS. FARQUHARSON: There's no question that there's been a lot of research done in the area of not only incomes but also control. I'm just going to start the answer to this question from afar. There's been a lot of research done in the U.K. in particular, two very famous studies called Whitehall studies that, again, I think you would be really interested in reading that really showed that even within higher income groups in the U.K. Civil Service that - again, this gets back to integrating the workplace stuff - if you were at the top of the heap then you had control, see you were accountable but you also had control, even moving down a couple of rungs on the scale within that high-income group, there was a much poorer health status.
You can imagine, if that's the impact that lack of control and not feeling like you could impact on the decisions of where you were going with your life is true within that elite population within the U.K. then what the impact would be on your health if you were living in a situation where, from a resource perspective, you did not have sufficient resources to be able to make decisions for your family, you know what to do but you cannot actually do it.
Also in response to that, if the middle- and upper-income people in Nova Scotia - and we're in this room - if we can't make healthy choices with the resources that we have access to, then how can we expect people with only that much leeway in their income to impact their health in a positive way? It really is common sense, because you need resources to be able to make choices, but yet in the upper- and middle-income groups, even when we have
a lot of the knowledge and we have the income, we're still not making the healthy choices, as was evidenced by the graph we demonstrated.
So certainly Nova Scotians need to have a sufficient income, in addition to the knowledge, the support and having the capacity built within them and their families and having the community infrastructure that's required to support them. It's a very complex issue and something that really is not only government's responsibility but all of our responsibility to make sure that that actually happens.
It's going to take all of the best brains in this province, using the evidence that's available from all over the world, to figure out how we're going to change the current situation that we have and I really believe we can do it. We have a lot of skilled, professional people, not just in this room but at the universities. My goodness, we have more university-educated people in this population and more universities. We can be the best, healthiest population in Canada, than the worst. Tom Ward said it this morning and I do believe him, we have to put a framework in place and pull all of us together to figure out how we're going to solve the problem that you have identified.
MS. MAUREEN MACDONALD: I guess the other question then I would like to ask, and I think in some ways you have answered this but in a very pointed way, how do you avoid blaming individuals for their health in the process? This is something certainly I think about a fair amount as I listen to some of the discourse around health status.
MS. FARQUHARSON: There is no question that individual responsibility is a component of this but you can't be individually responsible completely. It's not your fault if you don't have the resources to be able to make the decisions that need to be made, perhaps you're in a situation where you're very low income or perhaps you're on social assistance. So whatever the case, if you are living in lower socio-economic circumstances, your ability to access information and data and to make those healthy decisions is much more difficult, particularly if you're living in an environment that's not supportive of you making those decisions. Tom Ward mentioned that this morning, as well.
I think that victim blaming - people who smoke are addicted to a drug, right, there are addicts to tobacco and to the products that are in tobacco. So the approach that you take with them is based on the fact that there is an addiction there and there are buckets full of evidence about how to take that approach based on who the individual is and what their situation is. Again, as a society we need to create a situation where people can take responsibility for their health and I think people do, if the circumstances surrounding them are supportive because who doesn't want to be healthy? Who doesn't want to live in a situation where their children have access not only to services if they're sick, but are involved in athletics, are active, have lettuce and oranges in the fridge, as opposed to only foods that may not be that healthy. So I think personally that Nova Scotians will make the healthy choices if they have the support they need to do that.
MS. MAUREEN MACDONALD: Thank you.
MADAM CHAIRMAN: Before we start the second round of questions, is there anybody who hasn't gone?
MR. MACEWAN: I haven't gone yet.
MADAM CHAIRMAN: Go ahead.
MR. MACEWAN: It was a very comprehensive presentation here this afternoon and I would like to note that the length of the book that has been prepared will make a hefty addition to my library.
MS. FARQUHARSON: I'm glad it's going to be a library addition and not a doorstop, that's really good to hear. (Laughter)
MR. MACEWAN: I found the presentation very focused. I noticed that there was reference made to the North Karelia situation in Finland and they didn't identify where that is but this map will show you exactly where it is, it's the northern part here of this area that I have yellowed on this map. It's on the Russian-Finnish border and a larger part of Karelia was in Finland before 1940 - from 1918 to 1940 - but it was lost as a result of the Russo-Finnish war of 1940 and also World War II. I won't get into that but there is a much larger area of Karelia on the Russian side which was formally the Russo-Karelian Soviet Republic until 1956. So you can see that most of it is in Russia and they speak their own language. I won't get into that because I don't speak it. Anyway, it's on the Russian-Finnish border and I never heard any detailed analysis of the health habits of the people there before. You normally associate Finnish people with healthy living generally, they have that image, I think. Certainly, Finnish hockey teams that I've seen on the ice looked pretty competent but if they had an area where the people were smoking and drinking all day long, no wonder they got in trouble.
If your colleague was able to persuade them to change their ways to make them healthy I can commend him and I have got to commend the Minister of Health. We had a fellow in our Party who thought he would heal the people of all their problems and he got to be Minister of Health but I won't get into that. But he had a résumé that was 27 pages long, it was the longest résumé I had ever seen on anyone, so enough on that Minister of Health. I'm not saying that was what your colleague in Finland was like.
MS. FARQUHARSON: In response to your comment about the connection between North Karelia and Russian Karelia is a really interesting one because the North Karelia project was only a project in that province for five years. Because they had such successful results, it actually was disseminated across the whole country of Finland, which is why they have a healthy status now. These initiatives were not just done in that one little province, it
actually was done over the last 15 years in the whole country, Paul, so I think that's a really important point to make and it wasn't done on the Russian side.
I have done a lot of work in Russia, actually, with the World Health Organization and they have incredibly high levels of death and disability from cardiovascular disease and all the other diseases . . .
MR. MACEWAN: They're smoking the worst cigarettes you could ever smell all day long.
MS. FARQUHARSON: . . . and do you know, of course, that once we developed the excellent public policy that we have here, the tobacco companies made a mad dash for Russia and the former Soviet Bloc countries immediately, so they do not have the luxury of the kinds of things, even though we want to improve what we have, they don't have what we have. When I was over there I was actually doing work with them on workplace health back in 1990 and health promotion programs. I was over there training nurses and physicians how to take a health promotion approach and we were doing everything through translation. I was facilitating groups and so you would say it in English and it was translated into Russian and then back again and by the time we finished this work with this community, the Minister of Health for all of Russia was there and these people who were nurses that I was dealing with, they got up and made presentations about health promotion to the whole audience.
It was totally touching because, of course, they got it, these are very smart people and they are very dedicated and they want to improve the health of the population but they are in the box that Maureen was talking about, of not having choices and options. It has really been a privilege to work over there and I'm happy that you got the map and there is a lot more assistance that we, as a country, could be providing countries like that, with the knowledge that we have about how to do this.
MR. MACEWAN: That was the area where most of the fighting took place during the Russian-Finnish War of 1940 and it was quite an exercise. The Russians finally overcame them but for a large country to take on a small country, as is happening right now, the small country fought back and made quite a defence.
MS. FARQUHARSON: They are a very resilient people, I'll tell you that.
MADAM CHAIRMAN: Mr. Hendsbee.
MR. HENDSBEE: I have a series of a few questions. My colleague, the member for Halifax Needham talked about a fundamental shift in structural changes and stuff. Do you think it might be time, perhaps, to look at modified work weeks? We hear Quebec during its political campaign talking about a four day work week and it was just recently announced that B.C. was considering a four day school week. Therefore, those are two fundamental
suggestions from other places in the country that would change lifestyles, family styles, with regard to having perhaps more time with family to do these kinds of things. Any comments?
MS. MARY-LOU MACDONALD: I think the approach I take when I go into any business or organization is let's put everything on the table. First of all the first thing we do is talk to the individuals in that organization and say, what are your issues? What is it that is affecting you mentally, physically and otherwise? Then we address each one of those specific issues and put all of our minds at the table, have people there from management, from operations, across the board and say, what issues do you have in your particular situation and how can we, as a group - which ultimately is a family situation, you spend more time with these people than you do at home every day - what can we do collectively in this workplace to address these issues. Every workplace has a totally different culture, has totally different chemistry based on whatever they're producing, whether it's intellectual property or technical products and they have different workdays, whether it is shift work or whatever.
[2:30 p.m.]
To broadly say this is what we should do, I think, you have to go into every case and every situation and take a look at it. Different businesses individually function differently in that regard, depending on how far along they are in this continuum of understanding about the delicate issues within the workplace, particularly stress. So I think to broadly swipe it with, let's go to a four day work week, I think the best approach would be let's really look at the individual circumstances, perhaps, within each of the organizations.
I know in Denmark, for example, a study that I have read and had the privilege of listening to someone like Jane, who has been there and been involved in the study, a couple of years ago I listened to Dr. Martin Shain, who is an expert with addictions and mental health in Ottawa, and he talked about - as did Ron Colman report on - what they're doing in Denmark in this regard. Some of the practices there we recognize and the literature shows that if we do cut their work week by 20 per cent, therefore cutting from five days to four days, they've demonstrated an increase in productivity of 10 per cent.
One of the approaches that some of the employers have taken there in Denmark is, okay, they would offer employees the option of, if we reduce your pay by 10 per cent, you will in turn get 20 per cent reduction in the time that you have to serve at work, so you are giving something up and we're giving something up. The employer wasn't losing, according to this research because the four days the individual was there, they are more engaged in their work and more productive at their job because on that fifth day they can take care of the needs of their family or whatever issues they have to deal with. They did show in Denmark this worked in this particular study, by reducing the work week by 20 per cent the increase in production went up 10 per cent, but the employee also agreed to take a 10 per cent reduction in wages. Now that may be, I may not agree to do that, I may prefer to work the
five days and have 100 per cent of my pay. It's not something that necessarily you would want to say, okay this is what we're doing.
That is why it is important that every individual organization or business that I go in, it's a completely different culture, the models are there, the models are quite common, so we know what the steps are as we do with everything Jane's presented, we know what the strategy should be but how we get to that end result is very different in each organization because the culture and the people are not the same. Painting anything broadly with one brush, you might want to reconsider something like that. Maybe it will work in more than 50 per cent of the businesses and maybe it won't, who knows. My approach, from my experience, would suggest looking at things on an individual basis. I would certainly love to have a four day work week, so really it's an individual thing and some people wouldn't. If that answers your question in a roundabout way.
MR. HENDSBEE: Pretty much so but the question would be, you are saying though there should be more of an industry self-determined thing instead of having government dictate it?
MS. MARY-LOU MACDONALD: With the experience that I have had, I don't think it's something that should be dictated by government. In a business or an organization, I think it's their own culture. There are other things a government can do, certainly, to support business owners in providing a supportive environment for their employees. Perhaps it's things like sponsoring smoking cessation programs through the business. There are all kinds of initiatives across this country that are partnerships that government can support, ways in which governments can support employers in the workplace.
MR. HENDSBEE: Perhaps payroll incentives in regard to the modified work week and payroll incentives to supplement that.
MS. MARY-LOU MACDONALD: Absolutely, and that's something the Chamber of Commerce is interested in as well, awards for businesses that have integrated a health strategy for their employees within their business strategy, so that every decision that is made in a business or an organization considers the impact on employee health. Those are businesses that, in fact, the National Quality Institute in partnership with Health Canada, has developed the national healthy workplace awards. There are companies winning these awards, mostly coming from Ontario and British Columbia and they're demonstrating that in their mission and their vision of the business in the organization within the culture, they're considering the impact on the employee health in every decision that they make. They also recognize that it's positively affecting their bottom line not only financially, and currently, presently financially, but one of the major issues we are going to be faced with with our aging population in the next 10 years is competing for talent.
There is going to be a point where the next generation coming behind, there are fewer of them than there are employers looking to have all of the baby boomers that have retired, replaced. The next generation is going to be a lot more - as they are now becoming - specific about the needs that they have around their workplace: I need a flexible job that allows me - maybe I function best from 9:30 to 5:30, for example, or on a four day work week would work best for me. Single moms have particularly difficult issues in this regard because they have so many responsibilities with regard to the children: getting them to school; getting them to daycare; and picking them up when they need to pick them up. The stress often that's involved and the butting heads with the responsibilities of their home life and their work life for many is, they just can't handle that and they end up in circumstances that maybe they wouldn't want to be in.
An example I can offer in that regard, Prince Edward Island, the Human Resources Development group is also serving right now as a pilot for Dr. Martin Shain's study around this stress satisfaction index that's being created, a business health culture index. I met with those folks last week and an example of a really simple but an important strategy that they put in place was one that was around working, single mothers. When they sat down to discuss what are our issues, let's talk, let's have open discussions about what the issues are in this workplace to help us provide for a positive and healthy culture here, because who doesn't want to go to work and love not only their work but the environment that they work in? It has got to make you feel better. They sat down and had open discussions and one of the issues that was identified, particularly with the working mothers is, the stress that's involved in getting to work on time, because of what they have to do before they get there and that's no secret to any of us.
One of the things that did come up in this discussion is, by the time we get to work - and this didn't happen in Prince Edward Island, it happened in an HRDC in Ontario but it was delivered to me through Prince Edward Island - parking is an issue, we have nowhere to park, we're the last ones here and that again, we're circling, looking for somewhere to park so by the time we get in the door we're late, I'm stressed because I know my boss is upset and so on and so on and it's stuff I really can't control. They discussed the issue and management, of course, said what can we do about this and of course, all management had designated parking spots for themselves, which is a very common practice, and what came out of this discussion, this open-space discussion it's called was, let's find out exactly how many people we're talking about here and see what we can do. When all the discussion shuffled down, they were really only talking about four individuals so what they did was reserve four parking spots for those individuals. The stress that was relieved through that simple policy change - and this is really what all this is about, policies in the workplace - made a fabulous impact on those individuals and again, on their managers, on the people that they're working with. So you can see how really simple things can create really positive changes which then impact positively on an individual's health.
MR. HENDSBEE: My other question would be with regard to other tax incentives for government initiatives. Tax incentives could be either sales tax rebates or tax credits for encouraging healthier lifestyles. For instance, if a person went through a monitored weight loss program and lost a considerable amount of weight, they would get a tax credit for that, it could be called a fat tax credit, or just a fat tax perhaps. If you lost 75 pounds and it has all been monitored and checked by the doctors then you should be eligible for a $75 tax credit,
pound for pound, dollar for dollar, whatever the case may be.
The other thing may be, we talk about all the multiple hip and knee replacements we're seeing in this province, some provinces or some states are talking about should they have elective surgery for radical gastrointestinal stapling to fight obesity and stuff, should those be government-funded operations or should they be things that would be considered elective operations and therefore paid by the patient, or would the government win in the long run by offering those types of surgeries?
MS. FARQUHARSON: Those decisions, of course, are between the patient and the physician, the way our system is currently established. If a physician feels that the patient requires this particular procedure, then that's what happens because we have a publicly-funded system. The whole concept of giving people tax credits for health, I would be leery of that because, again, we don't want to get into the victim-blaming. People end up in the situations that they're in for a host of reasons, and perhaps if we were in that person's situation we would end up with the same issues or problems.
I would prefer to take the other approach, which is a positive one, a reinforcing capacity-building with stakeholders and with government to create an environment that really supports people in being healthy, so that you don't need a Ph.D. in food science to go into the grocery store and figure out what you want to buy that's healthy. There are some very specific things, the Heart and Stroke Foundation has a health check program where we actually take businesses' food products and we assess them and analyze them according to very stringent criteria, and if we feel that that product is a healthy product, we put our stamp on it.
We can do very simple things like that that are, as you suggested, policy-driven kinds of things, but they don't penalize anyone. It's an approach where everybody has access to this information, and not only do they have access to it but let's say we have public health nutritionists, just with that one food example, that are working in healthy mothers, healthy babies programs and that are in the schools helping children make healthy choices, and we have food available in cafeterias that's almost 100 per cent healthy for children to make those selections.
I think we can do what you're suggesting but from the other end, taking a very positive approach, so that, really, we make it easy for the population of Nova Scotia to make healthy choices. The evidence is there, not only from work that we've done in Nova Scotia
but from work that's been done around the world, that we could take your interest in this particular component of the problem and figure out how we could do it from a government incentive point of view, but do it in a positive way rather than focusing on disease-specific things, because it boils down to healthy food, having a healthy environment to be walking in, and being able to address the whole tobacco issue and the psychosocial stress issues of the workplace.
MS. MARY-LOU MACDONALD: There's a lot you can do in the workplace policy-wise to support employers and that requires sitting with employers and saying, what can we do to support you? Lots flushes out with me and there's lots in the literature.
MS. FARQUHARSON: We know for sure we can work with all the caucus offices, because we've been to see you all. We know you have very stressful jobs, and the media too, there's no doubt about that. (Interruptions)
MR. CHATAWAY: If you could just update me, I read some of the information but you're more knowledgeable than I am, on the Active Kids, Healthy Kids, physical activity strategy and how important it is to the youth, and the obvious issues facing the health of adults. Tell me about the Active Kids, Healthy Kids. It's a pilot project in so many schools?
MS. FARQUHARSON: Yes, it is. Actually it's a comprehensive strategy that has been developed through the Sport and Recreation Commission, and I was actually involved in the planning of that. It's somewhat leaner than the actual report that was driven out. I think that there's certainly room to expand it. There are many components, some in schools, some at the community level, some working with health professionals.
I don't think we have time to go into the whole thing today, but I would say that it's a very comprehensive approach that probably needs additional resources, because if we don't improve the health of our children and they don't begin to incorporate healthy habits and behaviours as youth, then we know, right now we have a crisis because we have all these overweight children who we know, ultimately, are going to be putting huge pressures on the health care system around heart disease, stroke, cancer and diabetes.
[2:45 p.m.]
So your question is a really good one, and the strategy that has come out through the Sport and Recreation Commission and now probably under the Office of Health Promotion is a beginning point to address that. Again, it's not funded well enough at this point, but it's a very good beginning to creating the change that we need to make.
MR. CHATAWAY: I understand it's sort of like a pilot project, it's not in all schools, et cetera.
MS. FARQUHARSON: That's correct.
MR. CHATAWAY: But it is a pilot project, so they're studying this pilot project and saying what's the good, what's the bad, where can we improve. I would just like to be updated. I would assume there's more good than bad in it, stuff like this . . .
MS. FARQUHARSON: It's a terrific idea and, as you're suggesting, it's happening in a number of pilot schools, so it's not every school. The evidence and the data from that, then, will be disseminated, hopefully, across the province. That's something that we're going to keep a very close eye on because we would really like to be supportive of that kind of initiative happening in every school across the province.
MADAM CHAIRMAN: Mr. Barnet.
MR. BARNET: Jane, can I talk to you about fundraising? Okay. I know there's been some attention recently in the media about - I don't know if you would describe it as imposter charities or charities that kind of sound like a charity. The Heart and Stroke Foundation are great and they're at my door on an annual basis and we support them. Have there been any challenges around that with respect to people less inclined to donate because of the fact that some of these charities have had negative - recently in the Daily News there was one specifically around a disease, where it sounded like a national organization, it wasn't, and people were donating money thinking it was going to a more reputable organization. Have there been any challenges around that, and how have you dealt with that?
MS. FARQUHARSON: It's a big concern to us, not only in Nova Scotia and not just the Heart and Stroke Foundation but all the health charities, and it's a concern across the country, needless to say. It hasn't impacted on the Heart and Stroke Foundation at all because, as you said, there is such a name recognition and we haven't had an imposter, there's been nobody who has tried to say they are affiliated with us. We haven't personally had the difficulty, but it certainly is a concern across the country with the whole sector. We know that there's a drop in volunteerism because of this work/life balance that Mary-Lou has been talking about. There are fewer volunteers available to us in Nova Scotia and across Canada, because people are so stressed because their lives are so full with everything they have to do.
So we really want to keep an eye on it, not only because we raise all our own money. Other than the fabulous government grants that we've been talking about that are funding these initiatives, all of the staff that I have and all of the office functions, everything, we raise all our own money. So we have to be very careful. We haven't done this, but it probably would be a good idea to make some public statements. I would like to see more uniformity, even around Revenue Canada and the way information is reported so that it's easier for the public to see, very transparently, where the money comes in and where it goes. I think there are some improvements that we could suggest to Revenue Canada if we had time to do that.
MR. BARNET: Are there other ways that the Heart and Stroke Foundation could guard against similarly named types of things, like corporations do. They will register a number of ways in which their name can be utilized and guard against that name.
MS. FARQUHARSON: That's a good idea.
MR. BARNET: Do you know if there's any idea that could be happening, and have you taken steps to guard against that type of thing?
MS. FARQUHARSON: No, that's a really interesting idea. We haven't done that as of yet because there has been no impact on our organization. We've just, as you know, gone through our February door-to-door campaign because February is Heart Month, and although it was very difficult this year because there were so many storms, for people to get out and knock on doors, the majority, actually, of our money is raised during Heart Month on that door-to-door campaign. So, it's vitally important to us as an organization to be able to continue to do the work that you've seen here today. I like that suggestion, and I will follow up on that, to determine if there is something like that that we could do.
Fortunately, in Nova Scotia, we have not been impacted by that, and neither have we across the country because we are a federated model, just like Canada is, and we're in touch with our colleagues across the country. Luckily, it hasn't impacted on our donations at this point.
MADAM CHAIRMAN: We're nearly out of time, and I would like to close with a couple of questions of my own, if I may. There's a heck of a lot of information here this afternoon. Some of the recurrent themes that I hear coming out are the challenges around communicating what one person and one group is doing with another person you mentioned, for instance, Tom Ward mentioned a health policy group that even you hadn't heard about this morning. We're all very clear that there's so many people working, hopefully in one direction, but the need and the ability to keep everybody in the loop is increasingly becoming a challenge. It seems to me that there's a lot going on, and I sense a need to make sure that we all know what it is that's going on while we're headed down this road.
One of the things that I didn't hear mentioned that seems to be relevant is not only the communication aspect but recognizing and understanding challenges. One thing that drew this to my attention, I think about a week or two ago there was a piece in the paper about a group of heart specialists who put themselves on a challenge over the last year of actually following the diets that they give their patients, and were quite astonished at what they discovered they had to go through in order to do what they continually tell other people to do. I thought it was a very interesting observation, but a very timely reminder that it's not just do as I say, sometimes to do that yourself is a little bit tougher. And since it's something I'm supposed to do, I was kind of amused by that. It sort of brings another aspect to the table of what you also have to consider in all of this.
Given everything that is going on, and this is a loaded question, you have lists of things that other provinces are doing, you have lists of things that we have done or are doing or are headed toward, and you talk about the five-year planning targets, for instance, that Newfoundland is undertaking, what would you recommend are the immediate first, second and third steps for what we should be focusing on and encouraging our Cabinet and our departments to focus on?
MS. FARQUHARSON: Because of the comment that you made, Mary Ann, about the communications, I think that really sets me up very well to answer your question. There are a lot of really good things happening. The issue as we see it is the overall social policy framework. We have very important things that were disseminated in this document this morning, however, they are bits and pieces, it's a patchwork approach to a comprehensive policy framework where everyone in the whole population and politicians can say, this is ours and we're going here and we know where we're going and we have the best minds in the country in Nova Scotia figuring out how we're going to get there based on scientific evidence and research, and we're going to put an accountability framework in there because we know it's the right thing to do and we're not scared to do it.
We are going to hold ourselves up to our constituents and say, this is where we're going and we have the evidence to back it up, and we are making a commitment to do it, not just in four years but over a 20-year period, because we cannot change the focus of this every time we have an election. We cannot do that. That's why we're in the mess we are now. We have to have a long-term strategy that all Parties buy into over time. It's really important to do that, because then all the other pieces, all the other important things that your government is currently doing fit within that framework and provide the activities and the program and the direction that needs to happen.
MADAM CHAIRMAN: So the pieces are there, they're just not organized in the framework with the goals and the targets.
MS. FARQUHARSON: That's part of it, but we also are not funding public health to the level it needs to be funded at. That's another major piece. Tom Ward was talking a lot about health human resources, and he really is an expert across the country in that. But in addition to funding the medical specialists and the nursing staff and the LPNs that need to be funded, we also need to fund and build up again our capacity in public health, because that is the tool, that is the mechanism that's really going to drive this whole primary prevention angle.
We also need to keep our eye on the chronic disease prevention strategy ball. The department has mobilized a huge amount of stakeholders in this process. I've never seen such a group committed to making a difference in the long-term health of this population. So when that fabulous document is presented to your department, to Health in October of next year and begins to be part of the business-planning cycle of the department and the Office
of Health Promotion, it really, again, needs to be - Transportation and Community Services, those kinds of recommendations will be in that document. The whole country is looking at what we're doing with chronic disease prevention, and we can be a leader in that regard.
The other area that wasn't mentioned in this document that I think is really important is the whole concept of working with vulnerable populations, not only single moms that we've been talking about here but other groups that we know, seniors and others who are living in low-income situations that need special attention, special programming. We know how to do it, but we need some resources.
The one other area that's not mentioned in this particular document and wasn't mentioned in the briefing book that Mora put together for you is the whole area of health research. The Nova Scotia Health Research Foundation has been funded by government to do health research in Nova Scotia, but we need more research that's happening in this province that shows what is working and what isn't working. There are a lot of clinicians and academicians in this province. The Heart and Stroke Foundation funds research. There is a lot more than can be done if there were more resources available. Research and funding for research has a huge impact on the health human resource situation.
As research becomes more focused and as more chairs are developed at the university levels, chairs around cardiovascular health and cancer, for example, that draws the best clinical and academic minds in the country and across the world to want to work in Nova Scotia. If they come here to work in Nova Scotia, that has an impact not only in the data and the evidence that's available but, as well, on the clinical practices of health professionals within Nova Scotia. It also has an impact on all of Atlantic Canada. I would also urge you to look at the whole health research funding area, as well, as another area to figure out where we're going in Nova Scotia.
MADAM CHAIRMAN: I think I heard Dr. Ward - maybe it was him - mention that it's not just our access to academics but it's the fact that we have a relatively stable, relatively consistent population with well-identified cultural backgrounds in specific areas of the province that makes us an ideal research rat, so to speak.
MS. FARQUHARSON: We are the ideal population, and we have the health professionals and we have the community leaders and the social workers. We have a huge resource in this province that could be mobilized to . . .
MADAM CHAIRMAN: There's a sign over our heads that says come study us, please.
MS. O'CONNOR: We're also small and we're sick.
MADAM CHAIRMAN: So we should be very interesting. Well, thank you very much. I think you've given all of us a great deal to chew on. This will be one transcript that I will definitely be rereading. Thank you very much for coming. It's been a pleasure.
MS. FARQUHARSON: If there is any further follow-up, please just contact us. (Applause)
MADAM CHAIRMAN: Just a reminder to the committee that we meet again on April 24th at 9:00 a.m. with Professor Susan Batt, a breast cancer survivor.
MR. HENDSBEE: Just a question in regard to the breast cancer survivor, Professor Batt and stuff, is there anyone from Cancer Care Nova Scotia, for instance Emmie Luther-Hiltz, who is also working with that. Would she be invited to . . .
MADAM CHAIRMAN: That wasn't suggested as a part of this. This was a specific aspect of breast cancer. This is a specific direction. I think it dealt with environmental indicators. As a follow-up, we may want to go that route. I don't know that we would want - it might get too complicated to be going in two directions at the same time.
MR. HENDSBEE: On a future agenda item with the recent Mental Health Awareness Month coming and the recent mental health care units, and I also had an opportunity to meet with the Schizophrenia Society, and I think they have been meeting with some of the caucuses. I thought there might be an opportunity for us to have, perhaps, the mental health presentation at a future date.
MADAM CHAIRMAN: We still have maybe two or three approved items on the agenda, but if you want to maybe give Mora a specific list of those and we will put it in the file marked for future consideration. A motion to adjourn?
MS. MAUREEN MACDONALD: I so move.
MADAM CHAIRMAN: We are adjourned.
[The committee adjourned at 2:59 p.m.]