Beyond petri dishes: Social, economic issues that affect health need more attention
Public health needs to extend beyond lab, work with populations — not just petri dishes
Recently, the Canadian Public Health Association (CPHA) celebrated the fact that the average lifespan of Canadians has increased by more than 30 years since the early 1900s. That's something we can all celebrate.
If you asked Canadians why life expectancy in our country continues to rise — now 79 years for men and 83 for women — many might attribute the increase to advances in medicine, such as new pharmaceutical research and surgical interventions. Scientists working in labs, in other words.
Most would be surprised to find that 25 of the 30 added years in life expectancy since the early 1900s are not a result of medicines, but thanks to public health measures. Public health needs to extend beyond the lab, often working with populations — not just petri dishes.
Instead of curing disease, public health measures work on preventing disease by addressing factors that create illness in the first place: social, economic and physical environments, personal health practices and access to health services.
Examples that have significantly affected life expectancy over the decades have included improved nutrition and housing, clean drinking water, hygienic sewage disposal, safe deliveries of babies, vaccination programs, tobacco policies, workplace safety, better education and higher standards of living, to name a few.
Here's a modern example: Statistics Canada showed that from 1981 to 2011, life expectancy in Canada increased by 6.2 years. The largest gain during this time was due to the decline of cardiovascular deaths — and public health initiatives had a significant role in this reduction.
Addictive nicotine, second-hand smoke and smoking during pregnancy contribute to cardiovascular disease. Public health initiatives paved the way for effective tobacco taxation and smoking restrictions in many work and living spaces — initiatives backed up by population health research.
Most significantly, population health evidence supported legislative changes so that today, tobacco products include health warnings and cannot be sold to minors.
Sad state of affairs
All these public health measures led to a seismic shift in how Canadians view smoking and their health, saving countless lives and reducing health-care spending on premature illness.
With such a high rate of return — both in life expectancy and in dollars saved — you would think Canada would invest heavily in public health research. Sadly, this is not the case.
Last year, the research budget of the Canadian Institutes for Health Research (CIHR) was $973 million. Less than eight per cent of that budget — only $81.9 million — went to population health research, with the bulk of the budget going to biomedical and clinical research.
Yes, there are breakthroughs waiting to be found in basic science — new wonder drugs, genetic discoveries, less invasive surgery. Investments in clinical interventions aimed at curing disease are important, but public health research should not be largely overlooked in the process.
In fact, there's an important role for biomedical sciences to work together with public health research — to address issues like emerging infectious diseases, antimicrobial resistance and chronic diseases like obesity, for example — but not if we forever put public health research in the back seat.
Another chronic condition is obesity, afflicting 30 per cent of Canadians and 10 per cent of Canadian children. Yet another chronic illness, cardiovascular disease, is estimated to cost $7.6 billion health-care dollars.
Public health research, along with basic and clinical sciences, has a significant role to play in finding solutions.
Marketing unhealthy choices
Public health research is gaining a better understanding of the food system, barriers to accessing healthy food and the effects of marketing unhealthy foods. Research shows that current food marketing predominately promotes unhealthy choices and this significantly impacts children's diets. This research provides guidance on how families should get information about food and how food marketing should be restricted.
Public health research also shows how urban design can encourage active lifestyles as a route to better health. Changing policies on urban density and transportation will make the healthy choice the easiest choice as we encourage walkability in a city.
Such public health strategies for tackling food and fitness could change outcomes for the interrelated conditions of diabetes, obesity and cardiovascular disease all at once.
It's time for Canada to think outside the lab — and invest more in public health and the research that supports it.
Ted Bruce served as Chair of CIHR's Institute of Population and Public Health. He is a former Executive Director of Population Health for the Vancouver Coastal Health Authority and an expert advisor with EvidenceNetwork.ca.
David Peters is Professor and Chair of the Department of International Health at Johns Hopkins Bloomberg School of Public Health. He served as Vice-Chair of CIHR's Institute of Population and Public Health advisory board from 2012-2016.