Abstract
Health goals and targets have been widely used to indicate strategic direction and priority for health improvement on a population basis. This paper provides an overview of Australia’s experience in using health targets and considers the relevance of this experience for Canada. It gives special attention to the challenge of developing a broadly based set of targets that reflect the social, economic and environmental determinants of health alongside more traditional measures of health status. It examines how the technical challenge of measurement, the bureaucratic barriers between government departments, and the political conservatism inherent in federal systems of government present formidable barriers to effective action on comprehensive national health targets.
The paper concludes with a reminder of the need for intersectoral action to address the determinants of health. Based on the Australian experience, it suggests for Canada an ideal combination of a national population health framework to guide direction and priority, to be implemented through action at a more local level, through well-defined partnerships.
Abrégé
Les objectifs et cibles en santé ont été largement utilisés pour indiquer les directions stratégiques et les priorités pour améliorer la santé du point de vue de la population. Cet article donne une vue d’ensemble de l’expérience australienne dans l’utilisation des cibles de santé et évalue la pertinence de cette expérience pour le Canada. Il porte une attention particulière sur le défi de développer une large gamme de cibles qui reflètent les déterminants socio-économiques et environnementaux de la santé en plus des mesures plus traditionnelles de l’état de santé. Il examine comment le défi technique de mesure, les barrières bureaucratiques entre ministères et le conservatisme politique inhérent aux systèmes fédéraux de gouvernement représentent des barrières considérables aux actions concrètes sur les cibles globales de santé nationales.
L’article conclut en rappelant le besoin d’actions intersectorielles afin d’agir sur les déterminants de la santé. Basé sur l’expérience australienne, il suggère pour le Canada une combinaison idéale entre un cadre national de la santé de la population, pour indiquer les directions et priorités qui devraient être implantées par des actions aux niveaux les plus locaux, à travers des collaborations bien définies.
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