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Looking Forward / Looking Back: Reflections on the Year that Was and the Year Coming, Part 1

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I Introduction

Each year the OHPE invites organizations and individuals working in health promotion to reflect on the past 12 months and make some predictions about the implications for the coming year. Presented here is part I of this exercise, with more to follow in the new year.

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II Public Health Agency of Canada - Canadian Best Practices Portal
Submitted by Nina Jetha and Grace Wan, Public Health Agency of Canada

On November 24, 2008, Phase II of the Public Health Agency of Canada's Canadian Best Practices Portal (CBPP) for Health Promotion and Chronic Disease Prevention was revealed at the third Chronic Disease Prevention Alliance of Canada National Conference in Ottawa.

As part of the public health infrastructure, the portal is an excellent tool that can help health promoters develop and support program planning by providing interventions that have been successfully undertaken in communities across Canada to reduce social and health inequalities and improve the health of specific populations.

New content is available for the following:

  • Mental health - in relation to home, community, school and workplace settings.
  • Obesity - in relation to protective and risk factors concerning physical activity, nutrition, tobacco, alcohol.
  • Newcomers / immigrant health - as related to general chronic disease.

All topics consider one or more priority determinants of health, such as education and literacy, early child development, food security, housing, gender, and income. As an exciting addition, the portal now includes practices with varying levels of evidence and tools to help build capacity to capture evidence of effectiveness in practice.

In addition to the expansion of the content, the portal's major changes include creating a simpler website for user navigation and information access. The additional features create a more interactive experience.

In Phase III, the Canadian Best Practices Initiative (CBPI) will begin systematically collecting practice-based evidence to further expand the body of the knowledge available through the portal. We will be assessing and tracking the change in use of evidence in practice decision-making and the nature of chronic disease prevention and health promotion intervention

By 2010, the CBPI aims to:

  • Increase awareness of the initiative with priority populations.
  • Increase the number of strategic partnerships and linkages developed within and external to the Public Health Agency of Canada, in support of a sustainable infrastructure for the CBPI
  • Improve decision-makers' access to the best available evidence regarding programs and policies that are effective in promoting health and preventing chronic disease.
  • Enhance decision-makers' capacity to identify and employ evidence related to the effectiveness of programs and policies.
  • Increase the exchange of evidence related to the effectiveness of programs and policies through a variety of interactive means.

Visit the Canadian Best Practices Portal at http://www.phac.gc.ca/cbpp for more information.

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III Chronic Disease Prevention Alliance of Canada
Submitted by Stephen Samis, Paul Lapierre and Robert Walsh

Over the past year the Chronic Disease Prevention Alliance of Canada (CDPAC) took some time to reflect on its purpose and objectives. As a start, the Alliance clarified its membership, which includes the Heart and Stroke Foundation of Canada, Canadian Cancer Society, Canadian Diabetes Association, Canadian Public Health Association, Dietitians of Canada, Canadian Council for Tobacco Control, Coalition for Active Living, YMCA Canada, the Kidney Foundation of Canada, and the Canadian Association for Mental Health and Illness. There are also strong links with the provincial/territorial (P/T) alliances, with two P/T representatives at the Members' Table.

Some effort was also spent re-examining CDPAC's role in chronic disease prevention at the federal level, including a critical analysis of where it should be focusing its priorities. Advocacy of healthy public policy through knowledge exchange was identified as the niche CDPAC can offer its members.

CDPAC hosted a two-day conference in March 2008 on food marketing to children and its impact on obesity. It offered a unique opportunity for Canadian and international experts to present the best available legal, scientific and social evidence both for and against increased regulation on food marketing to Canadian children.

At the conference a broad-based, objective panel of Canadians listened to arguments by key subject matter experts and then drafted a consensus policy statement outlining recommendations to governments, industry leaders, and other policy makers. CDPAC used this consensus statement to inform the development of its own position statement on this issue. An advocacy plan, based on this position statement, will be developed to ensure championing of this issue in 2009.

The policy consensus conference was funded by the Public Health Agency of Canada (PHAC), the Canadian Institutes of Health Research (CIHR) and the Government of British Columbia, and was planned in response to the March 2007 release of the Healthy Weights for Healthy Kids report by the Standing Committee on Health which stated that childhood obesity has become an ‘epidemic' in Canada.

Moving forward, CDPAC will be shifting its focus to a more upstream determinants of health approach. In November 2008 CDPAC held its third national conference titled Integrated Chronic Disease Prevention: Taking Action Together which built on the previous two conferences and focused on how individuals, organizations, strategies and sectors can collaboratively act on the root causes of chronic disease in Canada. Producing the greatest gains in the health status of Canadians will require urgent action that reduces the inequities that further burden those with chronic diseases such as mental illness, diabetes, cardiovascular disease, cancer, kidney disease and chronic obstructive pulmonary disease.

The conference was well attended with approximately 460 participants, and interesting research and initiatives were presented from all levels of government. Senator Keon noted in his keynote address that the leading cause of death is not cancer or cardiovascular disease, but inequities. 

In addition, at the national conference CDPAC took the opportunity to highlight its, "Framework for Action for Primary Prevention of Chronic Diseases in Canada" - a framework that it had recently developed through an evidence-based and collaborative process. The framework includes a vision for a coherent system and plan to eliminate or substantially reduce major preventable behavioural and environmental (physical and social) determinants for chronic disease. It includes four inter-dependent components: resources, capacities, actions and impacts.

The framework can be used as a template for all health promoters to use at all levels across the country. CDPAC will be positioning itself to track the uptake and progress of the framework. Overall, the result of the conference was a renewed commitment to collectively addressing the determinants of health to prevent chronic disease.

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Highlights from Health Nexus
Submitted by Barb Willet

It's been another busy year at Health Nexus. In addition to the launch of our new name, there has been much activity. Following are highlights of just a few of the initiatives and projects we have been working on:

  • A successful application was made to the Trillium Foundation for funds to develop a toolkit and training on child obesity for Aboriginal communities.
  • A manual on reproductive health and newcomers was developed. 
  • We applied our community engagement process, Connect the Dots initiative, to areas of pediatric stroke prevention, obesity and engaging South Asian communities.
  • Family health teams were supported with the development of a guide on community partnerships and leadership was provided at the Learning Collaborative.
  • A provincial awareness campaign on physical activity and the early years is being developed and will be launched in October 2009.
  • A series of webinars were developed in collaboration with the Centre for Health Promotion and the FOCUS Resource Centre, for Local Health Integration Networks (LHINs) on health promotion and mental health.
  • The electronic resource, Primer to Action was revised and translated to support work on the determinants of health and chronic disease.
  • In collaboration with St. Michael's Hospital, an adaptation of the Connect the Dots process was developed for use within Aboriginal communities.
  • We have continued our support for and participation in the Ontario Health Promotion Resource System.

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IV Larry Hershfield's Top 10 Wishes for 2008 and Beyond: Progress to Date
Submitted by Larry Hershfield, Chair, Ontario Health Promotion Resource System (OHPRS), and Manager, The Health Communication Unit (THCU)

1. That everything we are learning about social networks (yes, that Facebook thing) pays big dividends for Health Promotion!

I am pleased to report some progress here. THCU had a webinar on this very topic (visit http://www.thcu.ca/blogs/lc/?p=146) featuring Dr. Craig Lefebvre, and we recently collaborated with Health Nexus on a workshop in Peterborough (visit http://wiki.healthnexussante.ca/index.php?title=Peterborough_workshop for more information)
With Obama's digitally-facilitated "ground game," Malcolm Gladwell, citizen-generated journalism, the blogosphere and everything, I think I can safely retire my "Kevin Bacon game" PowerPoint slide - my early attempts to explain "degrees of separation"

2. That social media (yes, that videophone thing) helps us document and disseminate important information about our communities and us!

Check out http://www.youtube.com/inmyname. I could not say anymore.

3. That the Ontario Health Promotion Resource System (OHPRS) Strategic Planning process is just that!

We continue to work on that, having identified a few strategic directions and related action steps (as the adage goes, if you have more than six objectives, you (in effect) have none!

4. That we go to dozens of websites so you only have to come to our THCU site!

Check out our new database which produces over 40 tailored search results rages, featuring over 800 resources and growing, at http://www.thcu.ca/infoandresources/resource_display.cfm. But one-stop shopping is a sentiment only for infomercials, not for the ever-growing World Wide Web.

5. That we always remember how good decision-making and good process depend on each other!

Again, online surveys, polling, clickers, blogs, online communities, listserv, and wikis all help to harness participation, but in the end it comes down to commitment, values, and good behavior.
Speaking of decision-making I am looking forward to our field fully appreciating that people and organizations do not make decisions as many of the economic, rational models suggest - for a look on the other side, check out resources from Government Social Research (GSR):
-Reference Report: An overview of behaviour change models and their uses by Andrew Darnton, Centre for Sustainable Development, University of Westminster, July 2008
-GSR Behaviour Change Knowledge Review. Practical Guide: An overview of behaviour change models and their uses.

6. That our new Minister's energies and values prove a match for the universal risk aversion machine our governments have become!

Who is to say, but the Government of Ontario's poverty reduction strategy definitely moves the yardstick.

7. That everyone enjoys This is Your Brain on Music (by author Daniel Levitin), Juno (by director Jason Reitman) and Raising Sand (album by Alison Krauss and Robert Page) as much as I do!
That everyone enjoys Wikinomics (yes, I am finally getting to it), $5 per day (if and when it gets released), and Balkan Beat Box as much as I do

8. That we think more about communication for social change!

Go see http://www.youtube.com/inmyname (channel on YouTube) - you will see what I mean.
This year, I really had a chance to look back. I did a workshop in Sault Ste Marie in November, and only after beginning did I realize that the first time we presented our Overview of Health Communication Campaigns was 15 years earlier in that very city. And indeed while many of the basics remain the same, it blew me away how much our ideas, resources, and possibilities for health communication have grown in that time.

9. That we identify priorities and specific policy changes among the broad determinants of health, and never forget the E-words (empowerment and engagement)!

Check out Health Promotion in Canada: Critical Perspectives (2nd edition). Here is an excerpt from a recent review by Reg Warren in the Canadian Journal of Public Health:
"Written by a veritable "who's who" of academics, policy-makers and practitioners throughout Canada and to a lesser degree internationally, the book provides a critical appraisal on how health promotion is practiced in Canada and how this links to what is happening in the rest of the world. The book strives for inclusiveness, making a deliberate effort to include a diverse range of younger and more experienced voices into the dialogue. And it is extremely well written... In all, this book makes an outstanding contribution to the field on a great many levels. It is one of the most well-researched and thought-provoking books that I have read in a long time. Over all assessment: must read; must discuss; must apply."

10. That we all learn how to not drown in information, while quenching some of our thirst for wisdom!

Not to harp on my epiphany in the Sault, but the information digital explosion might explain why I spent the evening of day one some 15 years ago singing Karaoke in the US Casino and dancing to Hound Dog Taylor and the Housebreakers inside a Winnebago, and why I spent the night a few weeks ago eating room service and answering emails in my hotel room!
I am barely keeping my head above water myself, but remain grateful for the Knowledge Management movement in Canada. Bless the Knowledge Utilization / Utilizations des Connaissances (KUUC) newsletter and Ontario's National Coordinating Centre on Methods and Tools - the home and still a champion of evidence-informed decision-making.

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V Reflections on the past and future
Submitted by Brian Hyndman

The OHPE editorial team asked me to ponder the following questions. Here's my best attempt at a reply after 3 procrastination-induced email checks and an additional 5 minutes staring at my computer screen.

1.    What were the most significant developments over the past year in
 health promotion / public health in Ontario, across the country or
  internationally?

Well, in no particular order, I would say:

  • The launch of the Ontario Health Protection and Promotion Agency
  • The release of the new Ontario Public Health Standards stipulating the program and service requirements of Ontario's 36 public health units
  • The release of the final report of the World Health Organization (WHO) Commission on the Social Determinants of Health, a report on the determinants of health by the Senate Subcommittee on Population Health, the Chief Public Health Officer's Report on the State of Public Health in Canada, which focused on the reduction of health inequalities, and a report by the Conference Board of Canada laying out the business case for action on the social and economic determinants of health (I hope you are noticing an emerging trend here, and I hope this finally leads to some concrete action).
  • The announcement (full implementation pending) of a multi-strategy poverty reduction strategy by the government of Ontario
  • A joint consensus statement on health promotion competencies released by the International Union of Health Promotion and Education and the Society for Public Health Education (I have been asked to write a short commentary comparing their take on health promotion competencies with the proposed set of Canadian health promotion competencies I helped to develop. Stay tuned)


2.    What implications will these developments have over the next year?

2009 will likely be a transitional year for health promotion / public health in Ontario. Public health units will be re-assessing their current range of programs and services in light of the new standards. At the provincial level, the Agency will be initiating a strategic priority setting process that will presumably include priorities for health promotion and chronic disease prevention. There is also the rather daunting task of determining an optimal working relationship between the Agency, the Ministry of Health Promotion and the Ontario Health Promotion Resource System.

Like most of you, I am mindful of the ever-worsening economic crisis that has cost Ontario hundreds of thousands of well-paying jobs and lost revenue that will likely impede progress on many of the promising developments I noted in response to question one.  Well, keeping in mind the fact that the Chinese word for crisis combines the characters of danger and opportunity, I do see a way in which the current situation could help to spur some long-needed remedial action on the reduction of health inequalities in Canada. But that is another topic for another Bulletin article I plan to submit in the New Year. In the meantime, have a happy, health promoting holiday season.