Taking Control of Our Own Health
The Empire Club of Canada Addresses (Toronto, Canada), 8 Apr 2004, p. 291-306
Smitherman, The Hon. George, Speaker
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A deep and unshakeable consensus in Ontario in favour of our system of public health care. The speaker's last five months as Ministe of Health and Long-Term Care in Ontario. Life expectancy in Ontario longer, but is it better? The government's goal to make Ontarians the healthiest Canadians. How that goal might be reached. Details of the government's plan for positive change and gains being made towards a healthier Ontario.
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8 Apr 2004
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The speeches are free of charge but please note that the Empire Club of Canada retains copyright. Neither the speeches themselves nor any part of their content may be used for any purpose other than personal interest or research without the explicit permission of the Empire Club of Canada.
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The Hon. George Smitherman Minister of Health and Long-Term Care, Province of Ontario
Chairman: John C. Koopman
President, The Empire Club of Canada
Head Table Guests

Charles S. Coffey, Executive Vice-President, Government and Community Affairs, RBC Financial Group and Director, The Empire Club of Canada; Cam Hardy, Grade 12 Student, North Toronto Collegiate Institute; Rev. Canon Prue Chambers, St. Nicholas Anglican Church, Birchcliffe; Helen Stevenson, President, Savattuq Inc.; Dr. Mary Ferguson-Pare, Vice-President, Professional Affairs and Chief Nurse Executive, University Health Network; Hilary Short, President, Ontario Hospital Association; Dr. Lawrence Erlick, President, Ontario Medical Association; Ken Shaw, National Editor and Anchor of CFTO News at 6, CFTO-TV and Director, The Empire Club of Canada; Mark Rochon, President and CEO, Toronto Rehabilitation Institute; Dr. Sheela Basrur, Chief Medical Officer of Health, Province of Ontario; George L. Cooke, President and CEO, The Dominion of Canada General Insurance Company and Past President, The Empire Club of Canada; and Sheldon Sturrock, CEO, Allied Medical.

Introduction by John Koopman

There was a minister in the prior provincial government who recently underwent a serious life-threatening operation. When the ex-Tory minister awoke he found himself in his hospital room and Minister Smitherman there closing the blinds. The ex-Tory minister asked Minister Smitherman why he was closing the blinds. Mr. Smitherman responded to the bed-ridden Tory and said: "There is a large raging fire across the street and I did not want you to wake up, see all the flames, and think the operation had failed."

Hospitals have undergone a long journey. At the dawn of the Christian era, hospitals did not have a curative focus; they were houses of mercy that provided great spiritual solace but little else.

By the middle ages, hospitals had become houses of refuge and dying, where moral and spiritual concerns still prevailed and where caregivers were expected to fast and do penance. Hospitalitas, the Latin root for our word hospital, implies a sharing between the patient and the caregiver.

During the Renaissance, as scientific understanding grew, houses of refuge and dying gave way to houses of rehabilitation borne by the growing conviction that the sick and wounded might be cured, not simply cared for.

In the 19th century, hospitals took on significant research responsibilities. In the late 20th century they embraced high technology.

Contemporary hospitals are arenas of miraculous technical feats where the boldest technologies are developed and where complex, diagnostic and surgical procedures sometimes overshadow the compassionate care-giving that was at the core of Christian houses of mercy two millennia ago.

In most industries, technological advances drive down costs and Improve productivity. In health care almost the reverse seems to be taking place; the more technology we (doctors and patients) get, the more we want. Health-care expenditures are rising across the western world and funding pressures beleaguer governments of all stripes.

Tommy Douglas's dream is under siege. Yet if there is one issue that unites nearly all Canadians, it is the desire to make health-care services available to all residents, regardless of their individual capacity to pay. How we can maintain our universal system is Minister Smitherman's challenge, and I am glad that it is his challenge, because I would not know how to solve it.

Minister Smitherman is one of those very few politicians with significant experience at all three levels of government. He was the Chief of Staff to Toronto Mayor Barbara Hall, he was an advisor to federal cabinet ministers David Collenette and Herb Gray, and an assistant to Premier David Peterson. And this was all before his 1999 election to the provincial legislature.

Ladies and gentlemen, please join me in welcoming the Honourable George Smitherman, the Minister of Health and Long-Term Care to the podium of the Empire Club of Canada.

George Smitherman

Ladies and gentlemen, I can't tell you what a thrill it is to finally make it to the Imperial Room! My only regret is that I'm not appearing with Guy Lombardo.

These past five months have been exciting times for Ontario. And they've certainly been exciting times for me. When Premier McGuinty called me to ask me to serve as Ontario's Minister of Health, I knew Td be taking on some remarkable challenges. But I also knew that I would do so with the full support of the people of Ontario.

That's because we all want our health-care system to work. Whatever side of a particular issue we're on, there's a deep and unshakable consensus in this province in favour of our system of public health care. This support makes my job a whole lot easier.

My job is also made a lot easier by the fact that we have a fundamentally good health-care system. I've said on many occasions, that medicare is the best expression of Canadian values. That's something I believe with all my heart. But there can be no doubt that we need to make significant changes to our system to make it sustainable in the future.

Over the past five months, I've had the privilege of meeting many of Ontario's dedicated nurses, first-class researchers, inspirational volunteers, instructors at our medical schools, and doctors, pharmacists, therapists and dietitians who are among the finest in the world. I'm delighted to see many of them here in the audience today--even though Guy Lombardo isn't on the bill.

I'd also like to extend a warm word of thanks, and praise, to the health-care institutions which, in many ways, serve as the public face of our health-care system: our hospitals. Ontario's hospitals do remarkable work, provide excellent care, and serve as model members of their communities.

And the results of all this expertise and good work are clear: life expectancy of Ontarians is above the Canadian average and among the highest anywhere in the world.

We're living longer, that's for sure. But are we living better? By any number of measures, we are not as healthy as we could be.

We have all kinds of information about health at our fingertips, and an abundance of resources at our disposal--and yet so many of us fail to take care of even our most basic health-care needs.

Our government's goal is simple and it's bold: to make Ontarians the healthiest Canadians. This goal is within our grasp. But to get there we need to make some significant, positive changes to the way we think about health care and the way we deliver health care.

The McGuinty government brings a new determination to make these necessary changes; to put public health care on a sustainable path. Let there be no mistake: our cherished health-care system simply won't be there to preserve our health tomorrow if we don't take steps to make it sustainable today.

I want to take a moment to talk about our plan for positive change and the gains we're making towards a healthier Ontario.

First, we are making our hospitals--the anchors of the health-care system--sustainable. At the heart of our transformation plan is a recognition that our hospitals have been asked to do more than they are best built to do.

We are bringing stability to the funding process for hospitals. Predictable funding will give hospitals the capacity to plan. Greater predictability and stability come with clearer expectations about results. From here on in, all funding to hospitals and all health-care providers will be tied to results that matter to Ontarians: results like reduced wait times for cataract surgery or an MRI or CT scan.

If there's one solution to making health care sustainable and to refocusing our concept of being healthy it's this: put care in the community, make care available to people as close to home as possible.

Our government is investing our resources to build strong, effective community-based health care. We will revitalize home care. We will bring greater stability to long-term care facilities and protect and promote the health and quality of life of seniors who live there. We will improve access to mental health care in the community.

One of the most far-reaching changes we've made is to move decisively on renewing primary health care. We will provide Ontarians with more multidisciplinary teams of health-care professionals--family doctors, nurse practitioners, pharmacists and others--providing comprehensive health care.

These front-line care teams will assist people with their day-to-day health needs--whether it's managing a chronic condition like high blood pressure, or treating a minor illness like an ear infection. What's more, these teams will take an active role in helping people to stay well and to avoid illness all together.

To improve people's access to front-line health care, we're increasing opportunities for international medical graduates.

Prevention will be as much a part of their care strategy as treating illness.

By providing people with access to a range of health professionals, at the right place, at the right time, we will transform health care in this province.

I could focus my remarks today on any one of these change strategies. But instead I'd like to use this opportunity to talk about a topic which, to my mind, is even more fundamental than any of these; a topic that our government is absolutely passionate about. It's this: we want to change the way Ontarians think about their health. We want to broaden our understanding of what it means to be healthy.

Ladies and gentlemen, it's time for a revolution, a revolution in which we take back control of our own health. Today, I'll tell you what I mean by that--and I'll enlist your help.

The reality is that we don't yet have a "health-care" system in this province. We have a "sick-care" system. We're very good at providing "sick care." But we have to move beyond that. We have to provide true "health care."

Taking our health back won't be easy. It will demand that we challenge some of our long-standing assumptions and perhaps even shake up the status quo a bit. But it's vitally important.

Again, people can't get healthier all on their own. We need to have vibrant complementary community-based health care in place to support them along the way.

There are two parts to this job. The first consists of these community-based investments I've just mentioned. The second element is more challenging and it's profoundly exciting--inspiring people to take back their health. inciting all of us individually and collectively to take steps to make Ontario a healthier place.

I'm talking about infusing a healthy culture in all areas of community life--in our families, in our schools, and in our workplaces.

And, I'm talking about convincing people that they have the power to take real action to improve their health. I encourage people to look for opportunities each and every day to make an improvement in their own health.

Walk that extra block. Take the stairs. If you smoke, smoke less. Have some fruit instead of a chocolate bar. We have to take control of our own health.

For many people, this represents a significant attitude-shift. Many of us have come to expect that there will always be a pill or a procedure to relieve whatever ails us. We've got to change our way of thinking.

Good health isn't something you can pick off the shelf at a hospital. And you can't just "fill up your tank" when you visit your doctor.

People in positions of influence--people in this room today who are legislators, parents, teachers, health providers and employers--all have a critical role to play. The decisions we make and the messages we deliver have a powerful impact on personal health choices.

Let me start by telling you about some of the progress our government is making on the first front: investments and reforms to the existing system.

Our government is taking real steps to make health care more accessible to Ontarians at the community level. The health of Ontarians is our most precious resource. And we're going to bring the system into the 21st century.

One area where we're ushering in changes is the role of hospitals. As I said earlier, our hospitals do terrific work, but we've been asking them to do too much.

Our hospitals cannot and should not be the sole access points for health care. Far too often people end up in a hospital emergency room for a minor illness or injury because their doctor's office is closed or because they don't have a doctor at all.

That's not good for that patient. It's not good for others who have pressing health emergencies. And it's certainly not a good use of health-care resources.

If you don't have a doctor, that's the real emergency! When people have a non-emergency health problem they should be able to turn to a family physician or health-care team in their community.

Our government's vision includes a range of health-care providers working to deliver health care tailored to that community's and that patient's unique needs. And we're taking real steps to make this a reality.

During the past several weeks, we've taken action, funding new initiatives which will bring together family physicians, nurse practitioners, pharmacists, dietitians and other front-line health professionals to deliver around-the-clock care, as close to home as possible. These teams are available to provide a full range of treatment and care to bring people back to health and keep them healthy in the first place.

These front-line health teams will allow all health professionals to benefit from the complementary knowledge and skills of members of their team. And as a result, patient care will be enhanced.

These kinds of announcements don't always make the front pages. But they represent important steps in making our health-care system more accessible, more integrated, and more responsive.

But while this community component to improving the system is crucial, the second element, the individual component, is even more important and more difficult to tackle.

We need to take more personal responsibility for our own health; it's that simple. As health-care spending in Ontario inches closer to the $30-billion mark, there may be a tendency for citizens to expect that money is the answer to every health-care need. But the real power is not in the dollars, but in a new commitment on the part of Ontarians to take control of their own health. Let this be a call to arms.

We have to find a way to get people thinking about their own health and wellness before they're diagnosed with high blood pressure. Before they have a cancer scare. Before they one day step on the scale and realize they can't see the dial.

Whether you're overweight, or a smoker, or haven't exercised, my message to you is this: it's not too late. Our goal isn't a province where every single person is an Olympic-calibre athlete, but a province where every single person makes a commitment to continuous improvement.

The good news is that it can be done. I know--because I'm doing it. February 12, 2003--the date of my 39th birthday-was a turning point for me. At my birthday party that evening, I was heavier than I'd ever been in my life. I weighed in at close to 245 pounds and I wasn't happy about it. On that day, I made a decision to turn things around. It wasn't easy, especially at first. But I'm doing it.

And, while I may not be a poster child for physical fitness, I now exercise much more regularly, I eat somewhat better, I drink much less, and I fight, every day, to bring my weight to a healthier level.

The biggest benefit of my new commitment to good health is my energy level--something which has proved rather helpful in this great new job of mine. Today I weigh in the 210 to 215 pound range.

I've embraced the motto of continuous improvement--the same goal that I encourage all Ontarians to embrace. But let's be clear.

We're not going to get people to embrace this message of personal responsibility simply by spending dollars or passing laws. The only way to do it is for each one of us to make that personal commitment.

The great reward is that a commitment to one's own health immediately contributes to the sustainability of medicare--the gift that keeps on giving.

Part of "personal responsibility" means giving people access to their health-care information and a direct say in how that information is used. That's why I recently introduced legislation giving patients more access to their health-care files, and creating greater privacy for their health-care data.

We're also moving forward with a plan to give people accurate, timely, unbiased health-care information. Not partisan, self-serving rhetoric, but honest information presented in a clear way.

I think everyone could agree on the urgent need to provide Ontarians with an annual report on our health-care system and the health of Ontarians. We're going to gather an impressive array of Ontarians and call them the Ontario Health Quality Council and ask them to do just that.

Another of our tools is Ontario's Web site--HealthyOntario.com. The Web site is on display outside the Imperial Room. This bilingual Web site provides practical, up-to-the minute information about healthy lifestyles and prevention. I'm proud to say that HealthyOntario.com has been ranked one of the top-10-best health Web sites in Canada.

Information is a crucial tool and an important start. But we're doing more. In the coming months, you will see a co-ordinated effort on the part of this government to tackle obesity by getting kids to eat better and getting them more active.

And you're going to see a determined, flat-out battle against smoking.

Let me tell you about these upcoming battles, and why I'm convinced we will win them. We will and we must. Obesity, especially childhood obesity, is a health-care crisis, which is exploding. It's estimated that 37 per cent of Canadian kids are overweight, and that the proportion of obese kids has tripled since 1981. And the implications of this couldn't be more serious.

New research shows that overweight pre-teens have arteries as thick and stiff as a 45-year-old smoker. Doctors have identified signs of "vascular dysfunction" in children as young as nine! According to the American Heart Association, these kids are three to five times more likely to have a heart attack or stroke before the age of 65.

There's also new evidence that one in four obese children has early signs of acquired Type 2 diabetes--the kind once almost never seen in children.

This link to diabetes is particularly devastating. Let me give you some of the facts. Diabetes inflicts more morbidity than any other disease in Canada. It accounts for 50 per cent of all cases of blindness, more than 50 per cent of all renal dialysis and kidney transplants, 43 per cent of heart failure and 30 per cent of strokes.

Diabetes is a personal health tragedy for those afflicted, creating enormous disability and depriving too many Ontarians of a full and productive life.

Diabetes represents a major pressure on our entire health-care system. The cost to the Ontario health-care system of diabetes alone is estimated to be $1 billion and growing fast.

While the facts are sobering and the projections are frightening, the good news is that this kind of damage can be prevented and even partially reversed through exercise and a healthier diet.

It gives new meaning to the old phrase: "You can pay me now or you can pay me later."

Our schools are a crucial part of the solution. And my colleague, the Minister of Education, is as committed to this project as I am.

Another key player Td like to introduce to you is my parliamentary assistant, Peter Fonseca. I can't think of anyone more qualified to help deliver the message of health and fitness than a former Olympic athlete.

With respect to our schools, let me put this in very blunt terms: we don't believe school boards should receive financial incentives from people like soft drink companies for providing kids with unhealthy food.

An overwhelming majority of Ontarians strongly agrees that junk food should be banned from public schools--so it will. And an even larger majority agrees that governments should make it mandatory for all students from kindergarten to grade eight to have at least 20 minutes of physical activity each school day. We are committed to moving forward on these changes. The time has come.

The battle against tobacco is another story. This battle has been fought for many years, on many fronts. But the battle is about to escalate. In last fall's general election, my party made a commitment to a public smoking ban within three years, a promise I'm going to deliver ahead of time. Ahead of time because tobacco is the number-one preventable cause of death of Ontarians, because tobacco kills people and those it doesn't kill it afflicts with chronic health problems. Our mission is to reduce and ultimately eradicate the impact of tobacco on our health and on our health-care system. Because for us, keeping families alive is job one!

In the coming months you will see an anti-tobacco effort like you've never seen before. We're going to protect those who don't smoke from the dangers of tobacco. And we're going to discourage young people from taking up smoking, not by trying to coerce them--as all parents know, that can be tough--but by educating them and helping them to educate one another. And, even more importantly, by getting out of the way while kids get involved on the front lines of this battle.

When you're young, it's hard to make the link between a cigarette today and cancer or heart disease tomorrow. The cold hard fact is that approximately half of all long-term smokers die from a smoking-related illness. About 16,000 Ontarians will die needlessly this year as a result of tobacco use.

We're going to help people quit.

Just consider this, within only a few hours of quitting, your risk of having a stroke drops by about 40 per cent. After one day, your risk of a heart attack drops off. The personal rewards of quitting are immediate and they're powerful.

We're planning tough controls on tobacco advertising in public and retail spaces. We're going to make cigarettes more expensive and harder to purchase. In fact, we've already increased taxes on cigarettes by $2.50 a carton.

On the legislative side, we will take aggressive action to ban smoking in all work and public places. And if anyone doesn't believe me when I use the word "aggressive," I invite them to stand in our way. Within three years we will make all work and public places 100-per-cent smoke-free.

This year will be the year we launch our Comprehensive Tobacco Strategy. We will build on the momentum that we had, but lost, under the previous government. We will build on the important work of former health minister Ruth Grier.

Yes, I know that "'Big Tobacco" will resist these changes. They always do. They'll fight back. They'll throw obstacles in our path. They'll recruit expensive lawyers and high-priced lobbyists. They'll mobilize restaurant and bar owners, and convenience store operators and the like. They'll talk about a loss of jobs and a loss of personal liberty, but they will not refute the fact that consuming their product is a deadly habit. That's why I wrote to the Organizing Committee of the Ontario Tobacco Control Conference to share my concerns about the tobacco industry with representatives registered at the conference. The tobacco industry profits from the use of tobacco. They have no place at a conference about fighting tobacco use. I strongly encouraged the committee to de-register the members of the tobacco industry from this important conference.

I've seen and felt these fights before. And I'm ready for them.

We've built a great team and we've already recruited someone who's also been through these anti-tobacco battles before, someone who will add awesome depth and leadership to our anti-smoking strategy. Dr. Sheela Basrur is sitting here at the head table today.

A big part of the challenge is changing the way people think. As I said at the outset, that's my goal: to persuade people to think about their health in a different way.

Right now, we live in a society where popular culture still glamourizes smoking and views junk food as harmless.

We don't think twice about allowing school cafeterias to sell kids a staple of pizza and heaping plates of fries for lunch. We shake our heads at the problem of childhood obesity, but don't seem to draw the link to food courts where shockingly high-fat foods are consumed.

We have to change our attitudes.

I know this will be tough to do. I'd like to give you an example of just how deeply engrained this is in our society.

There's a commercial I've seen on TV a few times during the past month or two. Perhaps you've seen it. A team of peewee hockey players from Stouffville are on a road trip to a hockey tournament. It's a good ad. Well produced. Kind of funny. But part of the ad's story line has these kids consuming quantities of cheesies, donuts, sugar-filled pop, and chocolate bars on a bus ride.

Let me be clear: I have no quarrel with the company behind the ad. The problem is much more fundamental. This ad isn't the problem; it's a symptom. It's a symptom of inattention that far too many of us have for the implications of our decisions and implications of the messages we send.

You know how big our challenge is when one of the largest advertisers in the world unintentionally promotes what I refer to as the "Acquired Diabetes Diet."

There are no easy solutions, but, as with smoking, I know that we can stop glamourizing it and we can stop normalizing it. We can take steps toward making it less acceptable, less "cool." At the very least we can raise awareness to the point where people ask more questions.

And next year, or in three years, when a similar ad is being produced, a creative director or a producer might think for a moment about what kind of message is being conveyed. Or the ad might be tested in focus groups and a small but growing number of people might react negatively. Because chances are that one of them knows somebody whose life has been cut short by a preventable illness.

Because we all do.

Changing behaviour and changing attitudes take time. But I know that it can be done. We can educate people and, over time, we can modify behaviour, especially among young people.

A generation ago, when we set out to raise awareness of environmental concerns and to promote recycling, we started with kids. And kids, in turn, helped to bring their parents on side. I think that may be the way to go with this mission as well.

A few weeks ago, I visited a grade six and seven class in Markham, and I said to them: "I want you to start a revolution--a revolution to take back your own health!" Because, based on statistics, society is failing them. I told each of them about my health-care hero Kristopher Knowles, a sweet, spirited, courageous grade-eight kid from Sarnia who badly needs a liver and so he's taken a year off school to promote organ donation.

The power of grassroots youth leadership is thriving in Ontario.

I'm delighted that some of those leaders are here with us today. I'd like to acknowledge Jennifer Ravshi of Saint Paul Secondary School in Mississauga, sitting right here in front. Jennifer is a founding member of the "Smoking Isn't Cool Program." This program is making teens think twice about smoking.

And there's Christine Delaney from the One-Step program at the Peel District School Board. Christine is an adult who understands the power of kids helping kids and changing their communities. The One-Step program is creating a healthy movement in every school in the district.

Another group is the students of St. Peter's Catholic High School in Ottawa. These young activists organized a petition for a smoke-free Ontario. They distributed 18,000 blue ribbons in support of this campaign.

These are complex issues--politically, legally, and philosophically.

I didn't get into politics to meddle in people's lives, but I did get into politics to make a difference. And this is an area where I want to make a difference.

The reality of the situation could not be more clear or more stark.

Bad decisions today are depriving families of loved ones tomorrow. The time for talk is over. It's time for action.

Premier McGuinty often reminds us that no one among us is as strong as all of us, together. Together, there is no limit to what we can achieve.

All that's needed now is for us to join together and begin this revolution--not with shrill rhetoric or isolated hit-and-run attacks, but with our heads held high, speaking with one strong, clear voice, moving forward with confidence and determination.

And we will win because there is strength in numbers and there is strength in truth.

The appreciation of the meeting was expressed by George L. Cooke, President CEO, The Dominion of Canada General Insurance Company and Past President, The Empire Club of Canada.

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Taking Control of Our Own Health

A deep and unshakeable consensus in Ontario in favour of our system of public health care. The speaker's last five months as Ministe of Health and Long-Term Care in Ontario. Life expectancy in Ontario longer, but is it better? The government's goal to make Ontarians the healthiest Canadians. How that goal might be reached. Details of the government's plan for positive change and gains being made towards a healthier Ontario.