Graduation Address

"Convocation Address" (15 October 1989). (UA Case 69, Box 3)

Madame Chancellor (and fellow nursing alumnus), Mr. President, honoured guests, fellow graduates, ladies and gentlemen:

I am greatly honoured to be recognized in this way. I must first thank the members of the faculty of nursing at UNB for nominating me for an honorary degree—I must admit, I was quite stunned when I received President Downey’s letter. I speak on behalf of my fellow honorary degree recipients when I say "Thank-you, UNB, for this great honour, and for your recognition of the ways in which we have endeavoured to contribute to this wonderful Canadian society in which we are so fortunate to live."

As I prepared for today, I found myself thinking about the many convocation addresses I have heard—I found I could remember only two speakers—Robert Kennedy at UNB—but I have no recollection of the content of his speech, and Adrienne Clarkson at Dalhousie who gave an absolutely stunning address on the need to protect our Canadian culture. Now since I have no hope of attaining the same scale as those convocation speakers either in terms of fame or content, I decided that I had better stick to the philosophy that the Convocation address most likely to be appreciated is a short one!

The celebrations in which we are engaged provide us, the graduates, with the opportunity to say thank you to the many people who made this day possible. I would ask you to take a few minutes to think about them. We do not acknowledge often enough the contributions of others to creating our good fortune.—First think about the contributions of our families, partners, and friends—My parents both passed to me genes for a fairly good brain, but, even more important, they taught me the values I needed in order to make contributions to society and my profession, and to enjoy life. No matter what, they and my sisters and my friends have always been there as important supporters and helpers. Second, think about the education that UNB has provided us—I can state that UNB provided me with a remarkable education. One of the things for which we all owe thanks to the late Dr. Katherine MacLaggan, the founder of the UNB faculty of Nursing, is the nature of the Nursing Programme she established. The clear objective of the UNB programme was, and still is, to produce graduates who will provide direct nursing care to and with people in situations of health and illness. While the UNB faculty who taught me Nursing, French, and the Sciences may be surprised that I have ended up back on this platform this afternoon, I can assure you that those who endeavoured to teach me English and Sociology and Political Science are amazed! But it is the combination of those courses that made me a good nurse, and I thank the faculty who had a part in that formation.

It was not only the formal educational activities that UNB offered that led us all to this day—the extra-curricular activities available at the university have much to do with the people we have become. For me, such activity had great impact on how I function in this world. My involvement in swimming allowed me the privilege of being coached—not just on issues of swimming and teams—by Amby Legere. What aspects of your UNB experience have had or will have the greatest impact on your future endeavours? I have no doubt that the combination permitted me to take advantage of opportunities that have led to an incredibly satisfying career in nursing. I still would not trade the privilege of being a nurse for anything! I hope that you all will find similarly satisfying career paths. But as you embark on them I urge you to take a few moments right now to thank your family, your friends and partners, and the faculty and staff of UNB for their contributions to the launching of those careers!

In many ways the educational programme that you have now completed can be regarded as an investment that will pay wonderful dividends over the years! As a nurse I am acutely aware of the impact that education has on improving our opportunities for good health—and it is further investment in health that I would like you to consider today.

We are fortunate in Canada to have a system of national health insurance that is governed by the principles of universality, comprehensiveness, accessibility, portability, and public participation. That system is, in fact, very young. Our experience with it is teaching us that it is in need of reform. We have every right to be proud of our system of health care—indeed the citizens of other countries, especially the US, would prefer our system to their own. Not just because of the difficulties within their systems but because we can boast, for example, about lower infant mortality rates and greater life expectancies than our neighbours in the south. But our system is not without its flaws: it is inefficient, is spending more in some areas than it needs to, and we all must take a hand in its reform.

Many provincial commissions over the past several years—the most recent—the McKelvey-Levesque report in NB, and the soon to be released report in Nova Scotia—have found that, in fact, health care costs are not escalating at the rate that is out of control. But they, and others, also found lack of efficiency in the current system and acknowledges the need to effect changes in the system now—in part because the advances in science and technology and the aging population will lead to extreme escalations in costs in the future. We know that unless our current orientations to health and illness care change, by the second decade of the next century, all of today’s hospital capacity will be required to take care of older people alone.

In 1986 the former minister of national health and welfare, the Hon. Jake Epp, released a paper entitled “Achieving Health for All.” In that document, Mr. Epp acknowledges the considerable progress that we, as individuals, have made toward healthier lifestyles. For instance, the 1985 Health Promotion Survey showed that 66% of Canadians do not smoke, that 78% always or almost always wear seatbelts, that there has been a drop in the use of cannabis, that more that 50% engage in vigorous exercise more than 3 times per week (Canada’s Health Promotions Survey Technical Report, 1988). However, we also know that Canadians with lower incomes, less education, and who are unemployed are more likely to rate their health as poor, and to have fewer positive health habits (Active Health Report, 1987). How do your own health habits rate?—Do you drink and drive, stop friends from driving after drinking, are your sexual practices safe? These are the kind of issues that are included in Epp’s call for implementing more self-care activities directed toward health promotion.

But it is clear in the Epp document and in other reports that much more personal attention to health habits and the current illness care system is necessary to effect further improvements in the health of the nation’s citizens. It is your contribution to the necessary reforms that I am calling on you to consider. For more than ten years, the Canadian Nurses’ Association had been calling for major reform of the health care system. We believe that a restructuring within the framework of primary health care will provide us with a system that is consistent with the principles of the Canada Health Act that we can afford, and that will have a real and positive impact on the health of the Canadian population.

All across the country, provincial commissions on health care are making recommendations that echo the changes we have promoted, the major changes called for have been a shift to community based services with increased emphasis on prevention and health promotion, and community involvement in the planning and implementation of health care. Such changes will have considerable impact on each of us.

The notion of community involvement in the planning and implementation of health care means that we all have to become much more knowledgeable about health, health care options, the appropriate use of technology, and the costs of acute care services. Public participation is not only a viable option; it must be present in order for the services and the ways they are delivered to fit the society they serve. Such involvement will change the programmes to fit the needs of the particular communities—for example, to establish prenatal and parenting programmes in some communities but foot care, activity, and nutrition programmes for the elderly in others.

The authors of several provincial reports have also called for the involvement of the public in setting the objectives for the health care system. In New Brunswick, the model advocated is Regional and Provincial Health Councils. Such a structure that is a permanent, independent body representing consumers, governments, and health care professionals, is also necessary at the federal level to examine issues in health care and to recommend health policy for the country. We need national health objectives—otherwise how can we determine the effectiveness of the billions of our own dollars that are spent annually on health care. What will your involvement in such a council be? What would you set as the goals?

The second major call for change that the nurses of Canada have advocated, and that is being repeated in the various provincial reports on health care, is the call for a deceased emphasis on illness and hospital care, and an increase in community based care with emphasis on prevention of illness and health promotion. Such a shift would see, in the McKelvey-Levesque vision, cuts in the numbers of acute care beds and improved programmes in extended care and home care. We need alternatives for our high cost, highly technical illness care services—for example we need to establish multi-disciplinary community health centres. In Ontario, it has been found that people using such services spend nearly 17% fewer days in hospital than those who use traditional forms of care. A major shift in the system would also see use of the providers who are best prepared and the most cost-effective for certain services—for example, Nutritionists, Physiotherapists, Nurses, Occupational Therapists and other health care professionals would become insured points of entry to the system of assessment, care, and referral. There are many examples of such systems being more cost-effective—both in terms of their impact on people’s health and in terms of actual cost.

But how will you, your families and other Canadians react to calls for cuts in acute care beds? What part can you play in changing the commonly held view that whether a community is well-served in its health care is determined by the number of hospital beds it has, whether the local hospitals offer full services, and whether they have the latest in technical equipment such as monitors and scanners? The change will require much greater public awareness of the issues and we must all take a part in increasing that awareness. I challenge you to be active participants in change, and to invest in your futures by helping to shape the health care system for the next century. No matter what degree you are graduating with, today the future of the health care system is an issue for you. Be an active and informed agent in its reform!

In closing, let me extend to you my very sincere congratulations on your success in your studies at the University of New Brunswick. I congratulate your partners, your families and your friends as well—for none of us would be here today without their contributions. And I wish you great success in your chosen careers—may you flourish in good health!
Congratulations!


Reference Material

Canadian Nurses Association. Statement to the Special Committee of the Senate on Preventive Care. September, 1988.

Canadian Nurses Association. Health for All Canadians: A Call for Health Care Reform. September, 1988.

Epp, J. Achieving Health for All: A Framework for Health Promotion. Ottawa: Health and Welfare Canada, 1986.

Gallant, J.C. ”Empowerment through Participation” Remarks by the Chairman of the N.S. Royal Commission on Health Care to the Annual Meeting of the IWK hospital. September, 1989.

Health and Welfare Canada. Active Health Report-Perspectives on Canada’s Health Promotion Survey 1985. Ottawa, 1987.

Health and Welfare Canada. Canada’s Health Promotion Survey. Technical Report. 1988.

McKelvey, E.N., Levesque, Sister B., et al. Report of the Commission on selected Health Care Programs. New Brunswick, July, 1989.

McKelvey, E.N., Levesque, Sister B., et al. Summary of the Report of the Commission on Selected Health Care Programs. New Brunswick, July, 1989.

Rochon, J. Summary of the Report: Commission d’enquete sur les services de santé et les services sociaux. Québec, 1988 (?)

Rootman, I. Knowledge for Health Promotion : A Summary of Canadian Literature Reviews. Draft paper to be published in 1989 issue of Health Promotion (W.H.O.)