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Looking Forward / Looking Back: Reflections on the Year That Was and the Year Coming, Part 2

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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. The first set of reflections was distributed in the OHPE before Christmas and presented here is part two.

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II The Ontario Public Health Association (OPHA)
Submitted by Connie Uetrecht

This year the Ontario Public Health Association has adopted a more focused approach to its advocacy, zeroing in on three areas:

1. Implementation of the Capacity Review Report Recommendations. This year centered on the completion of the Public Health Standards and Protocols which will be implemented beginning in 2009. We will continue to advocate for further implementation of the recommendations in 2009.  We would like to see in place a permanent Chief Medical Officer of Health and Assistant Deputy Minister.

2. Speaking out on poverty reduction to reduce health inequity. We made presentations to Minister Matthew's staff, submitted responses to the Ministry's survey, participated in local poverty roundtables and joined forces with the Association of Local Public Health Agencies (alPHa) and the "25 in 5" Coalition. Next year we will continue to monitor progress on poverty reduction and provide assistance, through the work of our Access, Equity and Social Justice Workgroup, on the implementation of the Foundational Standard.

3. Supporting the government's commitment to regulate the use of cosmetic pesticides and to introduce toxic use reduction legislation. Bill 64 on the cosmetic use of pesticides is now out for consultation. The Toxic Use Reduction legislation is expected in February 2009. OPHA will continue to work with others through the Canadian Cancer Society to inform this legislation. In the coming year OPHA will be exploring opportunities to bring about positive change in the built environment.  

OPHA launched two new promotional initiatives this year: Public Health Today magazine which goes out to our members, and a new website. With these newly updated communication tools we will be undertaking a membership drive to increase our individual members - the cornerstone of OPHA.  

The Niagara Public Health Summit, Making Healthy Communities Count, hosted jointly by OPHA, alPHa and Niagara Region Public Health was a great success with over 400 attendees.  Next year the 60th OPHA Conference, Public Health: Celebrating our Past; Building for the Future, will be in Toronto at the Marriott Downtown Eaton Centre, November 1 - 4, 2009 and will be hosted by the public health professional associations that belong to OPHA. Watch for the call for abstracts in March.

The Programs at OPHA are anxiously awaiting decisions regarding the Ontario Health Promotion Resource System review.  The future of the resource system will markedly affect OPHA. 

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III Ontario Agency for Health Protection and Promotion
Submitted by Phil Jackson

2008. What a year.

For me personally as for many of us in Public Health and indeed in the broader public at large,  2008 was first and foremost marked for me by the passing of a close friend, colleague and co-conspirator, Dr. Sheela Basrur, who left us at a tragically young age. It is therefore somewhat bittersweet for me to look at where we have come with the creation of the Ontario Agency for Health Protection and Promotion, a project that had been close to Sheela's heart and one that she personally helped to launch.

In March of this year, after an extensive international search, the Board of Directors of the Agency, ably chaired by the remarkable Dr. David Walker, concluded an extensive international search for a founding CEO for what was and is a brand new organisation being built from the ground up. On July 1st, Dr. Vivek Goel, former Provost of the University of Toronto took up his position as CEO and on the same day I took up my new position as VP Strategy and External Relations. Looking back I can say that I do not think any of us who worked on the Agency Task Force or the Walker report ever imagined setting up a major organisation from scratch was so hard. But we are getting there. We have in our senior staff a superb set of professionals, recruited from a range of backgrounds and an atmosphere of dedication and passion for the cause seems to permeate the place.

In October of this year, a small group of friends, colleagues and family representatives met to set up the Sheela Basrur Centre fundraising activities, supported by the Agency, as a way to enhance outreach and professional development opportunities for public health students and professionals. Through the generous support both of corporate and individual donors and the remarkable generosity of Sheela's family, the efforts have been very successful to date and we look forward to sharing more news later in the year.

At the tail-end of the year, on December 15th, after major effort, cooperation and goodwill, the Public Health Laboratory System, with over 600 employees and 12 separate locations, transferred from the Ministry of Health and Long Term Care to the Agency, taking us one step closer to creating a single organisation that can bring together surveillance, research, testing and epidemiology. This was a historic decision and will ensure that the remarkable renewal efforts at the laboratories, led by Dr. Donald Low, will continue and deepen.

In the coming year we will all face the challenges of a remarkably changed economic environment. I am sure we will continue to see that system change and evolve, in health promotion, in health protection and in the way we support each other in addressing emergent and re-emergent challenges to the health of Ontarians. We have achieved much, we have much more to do, and the year ahead will be busy. I wish all of your readers a healthy, happy and productive year ahead.  

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IV Health Nexus / Nexus Santé Part II
Submitted by Connie Clement

The OHPE editors asked me to write a reflection as part of a new year bulletin. Because today is my first day back at work after a six-month leave from my health promotion work at Health Nexus, I wondered ‘why me?' and then immediately realized that this might be a perfect moment from which to comment upon work-life balance.
My leave of absence was planned far in advance with lots of organizational preparation for transition into, during, and out of the leave (including new management experiences for two colleagues). I took my leave in the spirit of a ‘4 over 5' planned leave: in good health and aiming for renewal (not recovery or recuperation). I'm the kind of person who sets personal goals that I want to achieve. I also generated a ridiculously long list of tasks that I might do during my leave, and immediately granted myself permission to accomplish only a few. I was lucky enough to have no unexpected hurdles lurch up in my path. The six months flew by.

The time was a gift and a blessing. I am physically, emotionally, intellectually and creatively better for having taken the time off to do other things. My new challenge will be to sustain my commitment to retaining my greater relaxation, openness and creative drive as I embrace the daily tasks of being an effective executive director at Health Nexus.

I'm not sure if I learned a lot new from the contrast between working full-time and not working at all for a period, but I was reminded of what contributes to good health. And, I re-start work with good intentions and have asked colleagues and friends to check in with me during the coming months to see how I'm doing. Walk slower; meditate every day; build exercise into daily life instead of on top of it. Keep my fresh fruit and water intake high; eat only when hungry; have one bite of chocolate a day, but no more routinely; occasionally splurge. Regularly have some creative/arts-linked endeavour on the go, and take it just as seriously as the other-oriented tasks. At work, take time to listen, encourage reflection, and multi-task less by blocking time to heighten focus.  Contribute in my community, give to others, be kind, laugh at every opportunity, strive to keep my heart open. Encourage others to take a leave, so there's a larger group of us to sustain healthy behaviours.

What the workplace does is equally important: support leaves of various sorts; use sick allowances for family care as well as personal illness. Encourage everyone to take vacation; don't model - and actively encourage - long hours or overtime. Find ways to support variable work hours and reduce commuting. Credit excellence, achievement, effectiveness and efficiency; carve out some time for innovation and reward it. Help staff manage their own workloads, practice saying ‘no,' and back them up when they do; encourage the kind of collegiality whereby co-workers pitch in together on key tasks.

I'm excited to be back and I look ahead to working with new and long-standing colleagues across Canada to increase policy levers to ameliorate/maximize social conditions that influence health and health equity; build commitment to preventing chronic diseases; and advance interventions to foster early child development. Specifically, in the coming months in Ontario it will be exciting to help influence the revitalization of health promotion capacity building and infrastructure and encourage a strong health promotion commitment within the Ontario Health Protection and Promotion Agency.

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V Canadian Public Health Association (CPHA): The social determinants of health update
Submitted by James Chauvin

The Canadian Public Health Association (CPHA) is a national, independent, not-for-profit, voluntary association representing public health in Canada. CPHA's members believe in universal and equitable access to the basic conditions which are necessary to achieve health for all Canadians.  

The CPHA 2008 Annual Conference "Reducing Health Inequalities through Evidence and Action" included the creation of a Call to Action to address health inequalities in Canada. The Call to Action resulted in a very clear message: we have the knowledge; we have the conceptual frameworks for understanding that knowledge; we know a lot of what needs to be done. We need to take action, now! (Visit http://www.cpha.ca/en/conferences/archives/conf2008/action.aspx.)

On August 28, 2008 the World Health Organization's (WHO) Commission on the Social Determinants of Health released its long-awaited report entitled Closing the gap in a generation: Health equity through action on the social determinants of health (available at http://www.who.int/social_determinants/final_report/en/index.html).

The Commission's report demonstrates that differences in health outcomes are shaped considerably by the broad conditions in which we live and work, and that policies acting on these social determinants of health could effectively reduce health inequalities in Canada over a relatively short period of time. The work of the Commission makes a compelling case that health is a concern for all, and not just those involved in the health sector.

CPHA published a response to the report confirming the association's commitment to a social-determinants-of-health approach to achieve health equity for everyone in Canada (available at http://www.cpha.ca/uploads/Advocacy/CPHA_WHO_sdoh_e.pdf). It also describes a set of actions that CPHA plans to undertake over the next year to contribute to the achievement of this goal. Our efforts and actions fall under three broad categories: leadership, public health capacity and infrastructure/investment. These areas of focus have also been articulated in recent submissions that CPHA has presented to both the Senate Subcommittee on Population Health (June 2008) and the Standing Committee on Finance (August 2008).

Canada can no longer mask the fact that we have a very serious public health problem. As the WHO Commission highlights, "[a]chieving health equity within a generation is achievable, it is the right thing to do, and now is the right time to do it."  CPHA is prepared to do its part and is keen to work with non-governmental partners, provincial and territorial public health organizations and professionals and government(s) to find and support the application of inter-sectoral and whole-of-government solutions that make sense in Canada. CPHA will be seeking input over the next few months from its members to help define practical and effective policies, programs and interventions at the federal, provincial/territorial and regional levels that will contribute to the achievement of health equity for all in Canada. We also intend to draw attention to the social determinants of health as a centerpiece of the discussions and deliberations at the 2009 CPHA Annual Conference in Winnipeg, June 7 -10, 2009.

Should you wish to learn more and/or contribute to the social determinants of health discussion with CPHA, please feel free to email us at policy@cpha.ca.

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VI Poverty and Inequity main issue for 2008 - Reflections on health promotion resources, reports and presentations
Submitted by Alison Stirling

As an OHPE editorial team member, Health Nexus knowledge management developer, and health promotion researcher-librarian, I've seen many reports, presentations, articles and this year that should be shaping tour health promotion practice, policy and research. In the last issue of OHPE (Looking forward / looking back: Reflections on the year that was and the year coming, part I), Brian Hyndman commented on some of these significant reports, and how poverty and inequity affect the health of all people.

He noted 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.

Every week there are more studies, reports, frameworks and statements related to specific health determinants of poverty, equity/inequity, environment and their impact on health. For example, the Ontario Association of Food Banks recent report The Cost of Poverty (available at http://www.oafb.ca/assets/pdfs/CostofPoverty.pdf) which notes that "there is a relationship between poverty and poor health outcomes, lower productivity, lower educational attainment, and children's future income;" and that reducing poverty with targeted policies and investments over the life course generates an economic return. News sources are full of stories on poverty, housing, mental health issues and more - and at Health Nexus, we track, synthesize and report on such news and reports that are related to health promotion and determinants of health. In 2008 we had 100 blog postings (see http://www.blogs.healthnexussante.ca/). As an example, see our blog Action Day on Poverty posting on Income and Employment at http://www.blogs.healthnexussante.ca/?p=317. My colleague Robyn Kalda keeps an excellent set of links to Canadian reports at http://delicious.com/robynk/canada+reports that include a number of resources on poverty and inequity, and calls to action.

Not only reports, but strategies and actions on equity and poverty are required.
As Brian noted in his reflection piece the importance of the announcement (full implementation pending) of a multi-strategy poverty reduction strategy by the government of Ontario (see more at http://www.blogs.healthnexussante.ca/?p=436 and critiques at http://www.blogs.healthnexussante.ca/?p=448).  

A hopeful sign of concrete action comes with the document First Steps to Equity: Ideas and Strategies for Health Equity in Ontario, 2008-2010 (available at http://www.healthnexus.ca/policy/firststeps_healthyequity.pdf) which provides some ideas, steps, examples and resources to support people and organizations working for equity in health in Ontario. It is focused on the new Ontario Public Health Standards in which  "Health Inequities and social determinants of health are integrated into mandates for Boards of Health - including to identify and report publicly on health inequities; and programming is expected to be dependent on evidence and experience." Let's hope that these first steps to equity are followed by many more in 2009. Health promotion needs to be action focused, and deliberative.

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VII Community and public health - human resource reflections
Submitted by Nancy Dubois

We are facing a general challenge in Canada's workforce as our "baby boomer" generation reaches retirement age. Are we fostering a generation in their wake who will be ready to take on the senior roles which will be left vacant? I worry that, in the public and community health sector, with all the important work that needs to be done NOW, one of the areas that falls through the cracks is the mentoring, management training and leadership skill development that will allow our powerful current frontline staff to fill the shoes of those who are moving on.  Similarly, have we, as a field, been working with the curriculum of the post-secondary education institutions to ensure that we will have access to enough graduates with the passion, skills, and knowledge to move population health forward?  I recently had the opportunity to work with the National Collaborating Centre for Methods and Tools investigating the field of knowledge management, specifically regarding public health in Canada. Two kinds of knowledge are typically described as an organization's intelligence assets - explicit (recorded) and tacit (personal know-how) knowledge. As we approach a new year, that brings with it the opportunities and challenges of new Public Health Standards, it is my hope that we consider how to foster the explicit and tacit knowledge needed to take us into the future.

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VIII News from the Public Health Division, Ministry of Health and Long-Term Care

The Public Health Division is transitioning to a new structure. This has resulted in the need to recruit for some leadership positions. Liz Walker, currently on maternity leave from her role as acting Director, Strategic Planning and Implementation Branch (SPIB), was successful in the competition for Director, Public Health Planning and Implementation Branch. In the interim, Tiffany Jay has agreed to extend her acting appointment as Director of SPIB. Likewise, Phil Graham has agreed to stay on as interim Director of the Emergency Management Unit. Dr. Erika Bontovics is currently the Acting Manager of Communicable Diseases. She will be the Manager of Prevention and Control in the new Public Health Protection and Prevention Branch. Active recruitment for the Director, Public Health Protection and Prevention Branch is underway and the search for the Manager of Planning within the Planning and Implementation Branch (vacated by Liz Walker) will be underway shortly. In addition, recruitment for the Chief Medical Officer of Health and the Assistant Deputy Minister positions continue.

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IX Christmas Carol in Toronto (2008)
Submitted by Michael Shapcott

In Charles Dickens' classic novel A Christmas Carol, Scrooge is approached by two gentlemen seeking to raise a charitable fund for a Christmas meal for poor people in Victorian London. Scrooge asks three questions, and then suggests that the "surplus" people should simply die.

Here are Scrooge's questions, and some contemporary answers, from Toronto in the first decade of the 21st century:

"Are there no prisons," asked Scrooge.
The number of homeless admissions to adult jails in Toronto grew by 68% from 296 in 2001 to 496 in 2004 [1].

"And the Union workhouses, are they still in operation?"
Toronto's hostels provided 1.377 million bed nights of emergency shelter (3,770 per night, 365 days a year) in 2008. [2]

"The Treadmill and the Poor Law are in full vigour?"
oronto Police issued 10,584 tickets under the Safe Streets Act to people asking others for change, in 2007 - up 288% from 2004. [3]

"I help to support the establishments that I have mentioned: they cost enough: and those who are badly off must go there," says Scrooge. "Many can't go there, and many would rather die." "If they would rather die, they had better do it and decrease the surplus population..."

The poorest one-fifth of Toronto men has a standardized mortality rate 54% higher than the richest one-fifth. [4] The rate of premature death for poor women is only slightly less: 34% higher for the poor than the rich.

1. Novac, Sylvia et al, A Revolving Door? Homeless People and the Justice System in Toronto, University of Toronto Centre for Urban and Community Studies, Research Bulletin #36, July 2007.

2. Analysts' Notes, City of Toronto Budget 2008, February 2008.

3. General Manager, Support, Support and Housing Administration, report to City of Toronto Executive Committee, April 21, 2008.

4. Toronto Public Health, The Unequal City, October, 2008.