Looking forward and looking back part II – reflecting on the past and coming years in health promotion

I Introduction

II Health Promotion, Chronic Disease and Injury Prevention Section at Public Health Ontario

III Health Nexus 2011:  A year in review

IV 25 years later…

V Heart and Stroke Foundation of Canada

VI Update on the Public Health Agency of Canada’s Best Practices Portal

VII Effects of early childhood last a lifetime – A life course perspective of health promotion/prevention via a social determinants of health lens

VIII Ontario Public Health Association President’s and Executive Director’s message

 


I Introduction

Each year the OHPE invites organizations and individuals working in health promotion in Ontario and across the country to reflect on the past 12 months and predict what lies in store for the coming year. This is the second part of the reflections piece. The first half of the reflections was published on December 9, 2011 (and can be viewed at http://www.ohpe.ca/node/12848). Thanks to everyone who contributed to this as well as the other features that ran throughout 2011 and we are looking forward to your contributions in 2012. Happy and healthy new year.

 

II Health Promotion, Chronic Disease and Injury Prevention Section at Public Health Ontario

Submitted by Dr. Heather Manson, Director, Health Promotion, Chronic Disease and Injury Prevention Section, Public Health Ontario

Throughout 2011, the Health Promotion, Chronic Disease and Injury Prevention (HPCDIP) section of Public Health Ontario continued to strengthen the capacity of our public health partners by providing high quality training and knowledge exchange events, consultations, tools, and evidence-informed reports and resources. The following article describes some of our key initiatives over the past year.

Since April 2011, we have been partnering with Cancer Care Ontario to provide evidence to guide action to reduce chronic disease in Ontario through population-level primary prevention. This partnership has focused on the development of a report identifying evidence-informed policy interventions addressing the four key risk factors contributing to the burden of chronic diseases: harmful use of alcohol, unhealthy eating, physical inactivity and tobacco use. In addition to risk factor specific recommendations, the report also includes over-arching recommendations for a more coordinated, province-wide approach to chronic disease prevention that reduces health inequities and meets the special needs of First Nations, Inuit and Metis (FNIM) communities. The initial draft of the report, Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario, was presented at a Cancer Quality Council of Ontario event attended by over 150 participants on December 5th.  We will be undertaking further consultations with key stakeholder groups prior to the development and submission of the final report to government in February 2012.

We have continued work on the generation of reports assessing the burden of specific diseases and risk factors on the health of Ontarians.  This includes collaborating with the Institute for Clinical Evaluative Sciences (ICES) and the Centre for Addiction and Mental Health (CAMH) on the generation of a report examining the burden of disease attributable to mental health and addictions. We are also working with ICES on a report examining the burden of disease attributable to unhealthy eating, inactive physical living, tobacco and alcohol use within Ontario’s population. Both reports will be released at the upcoming Ontario Public Health Convention in April 2012.

To ensure that public health practitioners focused on promoting the health of children and youth benefit from the best available data and evidence, we have commenced work on the development of a report identifying existing indicators and gaps in Ontario child and youth (0–19 years) health data as well as recommendations for further work on indicator development. This report, which is slated for release in early 2013, is being developed with input from multi-stakeholder scientific and advisory committees including the Association of Public Health Epidemiologists of Ontario, the Youth Excel Coalition Linking Action and Science for Prevention, and local public health units.

Internally, our capacity for research was strengthened when Dr. Ken Allison joined our team as Senior Scientist in April 2011. Ken is currently developing a 3-year research plan for HPCDIP based on consultations with key internal and external stakeholders. Possible areas of focus include intervention, equity and capacity building research, as well as research focused on the prevention of child and youth obesity.

Another key staffing development in 2011 was the appointment of Melody Roberts as our new manager of Health Promotion and Capacity Building. In her new role, Melody provides leadership for the design, implementation and assessment of HPCDIP capacity building initiatives, including the capacity building activities carried out by our four health promotion resource centres.

HPCDIP continues to support work on the reduction of health inequities through the development of knowledge exchange events and resources. In April 2011, we collaborated with partners to host two equity-focused events at the first Ontario Public Health convention: a session on the use of deprivation indices for mapping areas of marginalization (co-hosted with the Institute for Research on Inner City Health) and a session on public health unit activities addressing the social determinants of health (co-hosted with the Ontario Public Health Association-Association of Local Public Health Agencies Working Group on the Social Determinants of Health). At present, we are collaborating with the Ontario Ministry of Health and Long-Term Care on the development of an equity assessment “toolkit” to assist Ontario health units in planning and evaluating equity focused work. We will be field testing this product with 2–3 volunteer health units in the winter of 2012.

Other highlights of our work in 2011 include:

  • further knowledge exchange and capacity building activities focused on our 2010 report Evidence to Guide Action: Comprehensive Tobacco Control in Ontario
  • the release of a literature review synthesizing evidence on workplace and community-based interventions focused on physical activity, eating behaviours and BMI for adults aged 45–54
  • collaborating with the Propel Centre for Population Health Impact Assessment to convene a meeting focused on issues and opportunities regarding youth population health assessment
  • continued development of the On-Line Health Program Planner, including the addition of new sample plans
  • partnering with the Faculty of Physical Education and Health at the University of Toronto to conduct research focused on opportunities to advance a public health agenda provided by the 2015 Pan Am/Para Pan Am Games
  • continued development of health promotion capacity through the ongoing activities of our four health promotion resource centres: The Alcohol Policy Network, The Health Communication Unit, The Ontario Injury Prevention Resource Centre, and the Program Training and Consultation Centre.

We look forward to another year of work responding to emerging priorities in health promotion and the prevention of chronic diseases and injuries. The provincial government’s stated commitment to reduce child and youth obesity, for example, will be a key focus of our research and capacity building work for the coming year. We look forward to the development of new relationships with key stakeholders as well as the maintenance of productive collaborations with our existing partners. In the meantime, I wish all of your readers an enjoyable holiday season and a happy and health promoting 2012.

 

III Health Nexus 2011:  A year in review

Submitted by Barb Willet

My reflections on 2011 are bittersweet, for it has been a year of great achievement, but also one of great loss and challenge.

Leadership was a strong theme for Health Nexus this year. Together with 3M Canada, we created and launched the 3M Health Leadership Award to recognize and celebrate leaders across Canada who are committed to addressing the determinants of health. Our national panel of judges was very impressed with the breadth of nominations in English and French. After much deliberation, the first 3M Health Leadership Award was given to Joyce Rock (http://www.healthnexus.ca/leadershipaward/blog.html) for her work to establish Vancouver’s Downtown Eastside Neighbourhood House.  We look forward to receiving more nominations for the 2012 award which will be launched early next year.

Sadly, we lost an important leader in 2011– our founding Executive Director, Bryan Hayday.  Bryan was a leader in the fullest sense of the word, a man of vision and commitment who nurtured these skills in the people around him. He always saw possibilities, not limitations, and helped others to do the same. Bryan leaves behind an incredible legacy across many sectors. He is greatly missed.

2011 also marked an important year for early child development, and the release of Early Years Study 3: Making decisions, Taking action (http://earlyyearsstudy.ca/).  Health Nexus applauds this key report, which provides the scientific and economic rationale for more investment in early childhood education to ensure all children have opportunities to acquire the skills they need to cope in a rapidly changing world.

This milestone report was shadowed by another great loss – the passing of Dr. Fraser Mustard, co- author of the report and long-standing early child development advocate.   Health Nexus had a strong history of collaboration with the work and leadership of Dr. Mustard. He leaves a huge legacy in the field of early childhood education.

The past year also saw a greater public focus on issues of health equity, including an increased recognition of the growing income gap in Canada, and substandard conditions in Canada’s First Nations communities. Greater profile of these issues resulted in more public awareness and dialogue right across the country. In these turbulent times, however, political and economic realities could dampen our hopes for meaningful and lasting change.

Our work in health promotion will face many challenges in 2012. As we turn the calendar, we can draw inspiration from the work of Joyce Rock and the late Bryan Hayday and Fraser Mustard. These leaders offer us some important lessons about how to achieve change during difficult times:  pursue many routes to success, turn challenges into opportunities and work in partnership for collective action. Above all, never lose our passion to create a healthier society. 

 

IV 25 years later…

Submitted by Michel O’Neill, Consultant and trainer in Health Promotion. Adjunct Professor, Faculté des Sciences infirmières, Université Laval, Québec. Senior expert, TRAASS International, Genève, Bienne et Québec

… or rather close to 40 years later because I began working as a practitioner in what was then called health education in 1974. What can I say about the evolution of the field? Given that 2011 has been a year during which the seminal and mythical Ottawa Charter has received a lot of attention, as well as the year when we worked on the third edition of our book Health Promotion in Canada (to be released by CSPI during the Spring of 2012), I have had a lot of opportunities, as a frequently sought after old timer, to reflect upon and talk about the current situation of health promotion in Canada and abroad. My viewpoint can be summarized around two points.

First, there is no question that the Ottawa Charter has been the watershed document in the transformation of the still heavily lifestyle oriented health education of the 1950s, ‘60s and ‘70s into the much broader health promotion that we know of since 1986. And there is no question about the international leadership role played by Canada then and for the 10 following years. But for me there is no question either that the value base on which the Charter is built is not the dominant one anymore, both globally and in Canada. This is reflected for instance by the election of a majority conservative government in Canada, which will continue with even more gusto than when it was a minority one to dismantle the mechanisms of solidarity that had allowed the country, for several decades, to address with a relative success the social determinants of health. It is why in order to shake up a bit the health promoters of this land, whom I find too romantic and nostalgic when they still bask in 2011 in the aura of the Charter in a world which has radically changed since 1986, that I ripped it apart in front of a unbelieving audience at the Canadian Public Health Association conference last June.

My second point though is that, despite the very dominant “new world order” increasingly forced by the 1% orienting the global economy in the throats of the 99% suffering of it all over the planet, 2011 will most likely remain in the history as the year when the “new social movements” that are likely to very seriously challenge the current situation have emerged. Be it the Arab Spring, the Indignados movement in Spain and other European countries or, closer to home, the various Occupy movements that have blossomed all over Canada in the wake of Occupy Wall Street, something very major has begun to unfold. And I don’t think anybody is really able to predict where it will all end up. One thing is sure: the solidarity values promoted by the Ottawa Charter seem to begin to shine anew in this context and as health promoters and public health workers, it challenges us to engage ourselves in the movement locally, nationally and globally. (see http://www.change.org/petitions/public-health-pledge-to-support-occupy-movement?mid=52)

 

V Heart and Stroke Foundation of Canada

Submitted by Manuel Arango, Director, Health Policy

The Heart and Stroke Foundation of Canada has been focusing on several priority initiatives across the country over the past year, at the advocacy, program and policy levels.

As part of an election advocacy strategy prior to the federal election in Spring 2011, the Foundation asked all parties to support several health-related initiatives.

The Foundation advocated to the federal government for a commitment to four targeted initiatives from the Canadian Heart Health Action Plan (CHHAP). Two of the four received support:

1. Prime Minister Stephen Harper committed in March 2011 to include cardiovascular measures within the Canadian Partnership Against Cancer (CPAC) funded Tomorrow Project cohort study which is a world-leading population health/longitudinal examination of cancer and chronic disease among 300,000 Canadians.

2. The Foundation asked all parties to support the dissemination of automated external defibrillators (AED) and defibrillator/CPR training in communities across the country, including recreation centres. During the May 2011 federal election the Conservative government announced a $10 million plan over four years to fund life-saving automated external defibrillators and related training in hockey arenas and community recreation centres across the country.

The Foundation also recommended that the Children’s Fitness Tax Credit be increased from $500 to $1,000, to extend it to cover the purchase of sporting equipment and make it refundable in order to make it more accessible to low income Canadians. The Conservative government committed to increase the credit and make it refundable. 

The Foundation has asked the federal government for continued support of the Federal Tobacco Control Strategy, currently scheduled to end Match 31, 2012. The Foundation also supported the renewal of tobacco package warnings, which will appear in 2012, and the ban on flavoured tobacco products.

Childhood obesity is another priority for the Foundation, with a national director recently hired to coordinate efforts on children and youth across the country to ensure a focused and long-term effort.

The Foundation supports the federal/provincial/territorial Declaration on Prevention and Promotion and the Curbing Childhood Obesity Framework for Action. A written submission was sent to federal/provincial/territorial Ministers of Health as part of the consultations Our Health Our Future: A National Dialogue on Healthy Weights. The submission outlined the Foundation’s priority areas, including:

  • Supporting physical activity and nutritious diets in schools
  • Supporting community design that encourages active transportation and physical activity.
  • Reducing the marketing of unhealthy food and beverages to children
  • Reducing consumption of sugar-sweetened beverages

Following the federal/provincial/territorial Health Ministers’ meeting in late November, a report was released outlining progress to date and recommendations for future directions. The Foundation is supportive of the future directions including the need to work with industry to increase the effectiveness of the voluntary approach to decrease marketing of food and beverages high in fat, sugar and/or sodium to children. 

CLASP (Coalitions Linking Action & Science for Prevention) funding enabled the Foundation to develop a workshop guidebook and related outreach materials for its Shaping Active, Healthy Communications Toolkit (see March 2010 OHPE feature http://www.ohpe.ca/node/11202).

The workshop guidebook helps stakeholders to bring a health voice to the land use planning table and boosts capacity for intersectoral work. To date workshops have been held in Parry Sound and Lanark County in Ontario, at the municipal level in Peel region and Metro Vancouver, and in Nova Scotia. These workshops have become a valued resource for non-governmental groups, policy makers and politicians.

 

VI Update on the Public Health Agency of Canada’s Best Practices Portal

Submitted by Nicki Sims-Jones, Manager, Chronic Disease Interventions, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada

In 2011, the Public Health Agency of Canada added over 100 new interventions and three new topic areas to its Canadian Best Practices Portal, a virtual front door to community and population health interventions related to chronic disease prevention and health promotion. 

In early 2011, 28 physical activity interventions for older adults were posted to the Portal. As well, collaboration with the Promoting Relationship and Eliminating Violence Network (PREVNet) led to the inclusion of 38 new interventions on preventing violence and promoting healthy relationships. 

A new Oral Health section was also added. Launched in June, it houses Canadian interventions on oral health best practices, summaries of evidence, and information on oral health planning, assessment, and surveillance.

New features were also added to the Portal in 2011. These include a new homepage layout with rotating spotlights, which replaces the introductory video. As well, two new menu bars now appear on the right-hand side of the homepage, and this new area includes a “New” or “Featured Topics” section to highlight topics which do not fall under the standard Portal categories. A “Key Tools” menu on the homepage makes key tools more accessible.

The Agency is now moving into Phase 3.0 of the Portal’s development. In 2012, the focus will be on enhancing the content on the Portal to ensure it is the highest standard possible, and on introducing new features and improved search capabilities.  The Agency is looking forward to highlighting these Portal developments at the Chronic Disease Prevention Alliance of Canada conference, which will take place from February 8th to10th, 2012.

To see these new changes, and to access our new content, please visit the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention at http://www.phac.gc.ca/cbpp.

 

VII Effects of early childhood last a lifetime – A life course perspective of health promotion/prevention via a social determinants of health lens

Submitted by Dr. Paul Roumeliotis MD CM, MPH, FRCP( C), Pediatrician and Medical Officer of Health, Eastern Ontario Health Unit, President, Association of Local Public  Health Agencies (alPHa)

I am delighted to have been asked to submit my thoughts on health promotion as we enter a new year, especially during this time when our health care system is at a critical point. Now, more than ever is the time to focus on “HEALTH AND WELLNESS” rather than “health care.”

The Ottawa Charter, over 25years ago recommended integration of health promotion and prevention into acute care settings and we have a lot of work to do in that regard, However, we also know that the determinants of health, most of which are outside of the Ministry of  Health and Long Term Care budget and mandate, need to be addressed.  Our conversation needs to stress the need for a “whole government or system approach” to health. This means taking into consideration the social and other determinants of health that are the responsibility of multiple government ministries and agencies. For example: Finance, Employment, Housing, and Transportation. In fact, 75% of what makes one healthy (or unhealthy) is outside the scope of a Ministry of  Health. Yet almost 50% of our total budget is spent on “ health care”; a real paradox. 

A recent federal government study revealed that 20% of all heath care costs are related to the effects of poverty. The same study also suggested that a direct annual investment of 12 billion dollars nationally would ensure that every Canadian is above the poverty level.  Yet we spend 24 billion annually on a scattered range of “poverty reduction programs.”

Simply put, by frugally and efficiently investing in poverty elimination, we  will  substantially save on annual health care costs. A very solid example of using “Non-healthcare” money to save on health-care expenditures. Time to think outside of the box!

Child health and development is a stunning and very heart wrenching example of the effects of the determinants of health and this forms the basis of a life course perspective on health. Children who suffer insults, be they biologic, social or psychological during the first 27 months of formative life (9 months prenatal and 18 months post natal), suffer long-term effects. These effects just precipitate the disparities that we see today in children and adults when compared by socioeconomic strata. Once children start off with a mal-development, their gene expression will not reach full potential in terms their productivity, career success as well as overall wellness and longevity over the course of their lifetime.  From conception to the first few years of life, babies need a nurturing, safe and supportive environment in order for the many behavioural, cognitive and neurophysiologic developmental changes to take place normally.

During early childhood, the determinants of health play an integral role in subsequent neuro-developmental progress and school readiness as well as future rates of chronic disease. In Canada, there is a disparity between cognitive maturity and school readiness when comparing children from poorer and richer households. This disparity is not apparent in countries where the health-social network is set up to optimally and equitably support all babies. This system seen in Scandinavian countries is an example of an “all government” approach which stresses support and fostering of the optimal development of all children and their families.

So, when I talk about life course perspective skew of health promotion and prevention with a  determinants  of health lens, I mean looking at a uniform, joint and equitable system that supports our children. This is real health promotion!...an angle that starts early in life and invests in an efficient and equitable process that simultaneously prevents chronic disease while fostering  the ability of  all our children to reach their  full potential. Below you will find a article that I wrote for our local Cornwall newspaper that focuses on early child development and the need to support it:

As a paediatrician and public health practitioner, I am well aware of the importance of a child’s first few years of life. One of the roles of the paediatric check-up is to ensure that a baby is growing and developing normally. During the routine check-up, a health professional weighs and measures the child and assesses the development. This means seeing if a child is developing normally in terms of both motor and cognitive function. Motor function includes the age at which a baby turns over, sits up and walks. Cognitive function looks at how a baby interacts with parents and strangers, if he or she is talking normally, and if behaviour is appropriate for age.

The goal is to ensure that babies develop as normally as possible in order to reach their full potential as adults. This concept has been examined very closely recently. In fact, there is a new term, “Life Course Perspective.” This recognizes that early effects on a child’s development, growth or behaviour can have lifelong consequences. We know that genes play a role, but this focuses on the environmental (home or family surrounding) effects that can modify one’s genetic potential or programming. This means even during pregnancy. For example, babies born small for gestational age were once thought to simply catch up and develop normally without any other long-term effects. Now, studies have shown that these babies (referred to as IUGR, for Intra Uterine Growth Retardation) as adults have higher rates of diabetes, high cholesterol and heart disease as compared to babies born with normal birth weight. This means that our genes can be somehow modified or affected by the environment. In this case, it is in uterus, perhaps due to malnutrition or other factors. This demonstrates the importance of prenatal care during pregnancy. We also know that physical and emotional stress or abuse can result in long-term health effects. Persons who are prejudiced against have higher rates of chronic disease than those who do not face such discrimination.

A recent study by the University of Toronto reports that people who were abused as children had a higher risk of having heart disease as adults than those who were not abused. This finding highlights the importance of the need of a nurturing environment for both a child’s present and future life. Babies need to be loved, cuddled, played with and stimulated in order to grow and develop normally. Young children who are abused or neglected are robbed of this effect, and indeed end up with higher rates of both mental and physical illness in the future.

This is why at the public health level, we advocate for a Best Start for all babies. Such a good start, not only includes providing for a child’s physical needs, but also for fostering and providing a safe, loving and nurturing home and family environment. This is the best investment in a child’s future that parents, child caregivers and society as a whole, can make! 

 

VIII Ontario Public Health Association (OPHA) President’s and Executive Director’s message

Submitted by Siu Mee Cheng, Executive Director, OPHA

As we come to close on the calendar year, it is worth taking time to reflect on all that has occurred. In the space of a year, we have refocused our energies towards increasing our commitment to Ontario Public Health Association (OPHA) membership. We have created knowledge exchange and transfer opportunities that contribute towards professional development for our members and offering up networking and engagement opportunities.  We initiated a series of webinars for our membership with topics on youth engagement, results-based accountability, alcohol prevention and built environment, to name a few. 

We will soon initiate a mentorship program which will be accompanied by a Leadership Series to foster professional development and leadership amongst public health professionals. We also hosted, in partnership with Health Promotion Ontario (HPO), a very successful annual Forum on Engaging Priority Populations with over 220 delegates in attendance.

We are engaged in a number of provincial advocacy and strategic public health efforts including:

  • Provincial Policy Statement Review which will direct the planning within the province over a 5-year period. OPHA is the only public health-based organization represented in these review tables through the expert leadership of our Built Environment Work Group.  In the following months, OPHA members will be given opportunities to contribute in the coming months.
  • OPHA is represented in the review of the Healthy Babies Healthy Children provincial program and we actively made contributions towards this review.
  • OPHA has contributed towards the development of the proposed Ontario Food and Nutrition Strategy which is intended to advance a plan that will contribute towards the province’s efforts towards chronic disease prevention, healthy eating and accessibility to quality food. 
  • OPHA contributed to the Cancer Care Ontario / Public Health Ontario Chronic Disease Prevention Blueprint.
  • OPHA was also very active during the provincial 2011 elections advancing public health as a key component to the solution in slowing health care costs in the future.
  • These advocacy efforts are intended to support OPHA’s priorities in chronic disease prevention, healthy ageing, health equity, accountability, quality and access.

OPHA continued to support its very active work groups:  Health Equity (joint work group with Association of Local Public Health Agencies (alPHa)), Child and Youth Health, Reproductive Health, Breastfeeding, Public Health Alliance, Food Security, Built Environment, Environmental Health, Violence Prevention, Injury Prevention, Marketing to Children, Alcohol Prevention and Core Competencies. Some examples of work group efforts in 2011 included:

  • The completion and launch of a report on public health unit activities impacting social determinants of health by the joint work group on Health Equity. 
  • Advocacy on increased active transportation through enabling safer roads for cyclists and pedestrians.
  • The initiation of several projects on built environment including a planning resource to guide enable better collaboration between land use planners and public health.
  • Advocacy for improved water and air quality at a provincial and national level.
  • Call to action document on food security.

In addition to supporting our work groups, OPHA continued to operate a number of government and agency funded programs including in 2011:

  • Injury Prevention Initiative (divested back to Public Health Ontario)
  • Youth Engagement Initiative (Health Canada funded and sunset in September 2011)
  • Towards Evidence Informed Practice (Ministry of Health Promotion and Sport and sunset in summer 2011)
  • Nutrition Resource Centre (Ministry of Health Promotion and Sport)
  • Alcohol Policy Network (Public Health Ontario)
  • HC Link (Health Nexus from Ministry of Health Promotion and Sport).

These programs continued to move forward on chronic disease prevention, healthy community development, and health equity within the province.

Lastly, OPHA was very active in a number of inter-organizational collaboratives including:

  • After School Initiative (Lead: Parks and Recreation Ontario)
  • Healthy Partnerships (Lead: Ophea)
  • Sugary Drinks (Lead: L'Association pour la santé publique du Québec)

These changes and initiatives were exciting and have helped to lay the foundation for better impacting top of mind issues in the public health and health systems: chronic disease prevention, health equity, access, and accountability to name a few.