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

Contents

I Introduction
II Association of Public Health Epidemiologists in Ontario (APHEO)
III Ontario Healthy Communities Coalition: Reflections on 2014 Themes
IV Building Healthy Public Policy: A Case Study of Effective Health Promotion
V The Chronic Disease Prevention Alliance of Canada (CDPAC) 2014 Year in Review
VI Health Nexus Reflects on Fiscal trends for Non-Profits and Health Promotion
VII 2014 – A Year of Politics

I Introduction

Each year the OHPE invites organizations and individuals working in health promotion in Ontario and across the country to reflect on milestones and events of significance over the past year and provide insight on what might lie ahead in the coming 12 months. Due to the number and substance of the submissions we received we will run our reflections in two parts.

Thanks to everyone who contributed to this as well as the other features that ran throughout the year.

II Association of Public Health Epidemiologists in Ontario (APHEO)
Submitted by Cameron McDermaid MHSc

2014 has been a great year. The Association of Public Health Epidemiologists in Ontario (APHEO) continues to support excellence in professional practice and promote the integration of epidemiology within public health decision-making in Ontario.

APHEO’s many working groups have kept very busy in 2014. The core indicators working group continues to oversee the work in the core indicators project: definitions for over 120 public health indicators. This resource enhances accurate and standardized reporting of information across public health units in Ontario. The BORN working group continued its collaboration with Ontario’s Better Outcomes Registry and Network (BORN) to help ensure public health unit access to data about pregnancy, birth and childhood. The capacity building for small, rural, and northern health units working group is finishing up its work on an orientation binder for new epidemiologists, a very useful tool, particularly for smaller health units. The APHEO website working committee has almost completed a new website which will be a welcome asset in the years to come.

The core indicators project was also the topic of the 2014 APHEO workshop, Core Indicators – Making it Count in Public Health, which was hosted in Toronto in September. The many excellent presentations, available on the APHEO website, highlighted the variety of topics supported by the core indicators project. We look forward to the 2015 APHEO conference in June which will focus on effective communication, a necessary element to direct high quality data into informed decision-making.

High quality data was the basis for APHEO writing political decision-makers about our concerns about National Household Survey data quality for small area decision-makers, particularly for data that informs us about the socioeconomic position of Canadians. APHEO’s resolution on the same topic was accepted and adopted by the Association of Local Public Health Agencies (alPHa) in June of 2014. Diligence on the quality of data will be important in the future as will interpretation and communication of that data. Those involved in public health information and promotion appreciate the intimate relationships of society’s structure, health and chronic disease. In the upcoming years it will continue to be important for us to effectively communicate to keep these issues front-of-mind for the public and for decision-makers.

III Ontario Healthy Communities Coalition: Reflections on 2014 Themes
Submitted by Lorna McCue

The Ontario Healthy Communities Coalition (OHCC) promotes and supports healthy communities by engaging in collaborative initiatives that address the underlying drivers of community health and well-being. We provide consultations, learning activities, educational resources and communications in English and French, through a central Toronto office, regionally based community consultants and three regional satellite offices. OHCC is a member of HC Link, a collaborative of three resource centres funded by the provincial government, and leads several other collaborative projects and networks.

Over the course of the last year or so a few recurring themes have occurred in our work, instigating an expansion from responding to singular requests for service to planning and implementing collaborative, proactive initiatives in order to increase the magnitude of our contribution. A brief summary of these themes and our related activities are described below.

Rural Transportation: Lack of transportation is a significant issue in all rural and remote communities in Ontario which affects most of the determinants of health. The lack of viable transportation options in rural areas make it difficult for many adults and youth, especially those with low incomes, to take advantage of employment and educational opportunities, attend health and social service appointments, or participate in social and leisure activities. This is a persistent issue and, given the aging demographic of rural Ontario, the need for affordable and accessible transportation services will increase in the future. Many communities are tackling this complex and challenging problem, through inter-organizational collaboratives aimed at developing coordinated, sustainable rural transportation programs. Working with the Rural Ontario Institute, OHCC compiled resource materials, conducted webinars and developed case studies to assist communities in their efforts. We are continuing to receive requests for consultations and webinars on rural transportation, most recently in response to the announcement by the Ministry of Transportation about its new Community Transportation Pilot Grant Program.We are watching with interest as new models of collaborative rural transportation solutions emerge, and applaud their leaders for engaging numerous and diverse stakeholders to develop solutions to rural transportation issues.

Food Systems: The local food movement continues to gain momentum with increasing emphasis on policy development, infrastructure development and advocacy. OHCC has three windows on the food movement in Ontario: community consultations on various food issues and initiatives through HC Link; our collaboration with six other organizations on the “Healthy Food for All Project”; and our support for FoodNet Ontario, a province-wide network focussed on sharing information and resources among its 500+ members. Through these windows we have seen increased interest in developing food charters, conducting community food assessments, creating community food “hubs”, facilitating peer sharing and advocating for healthy food policies.

Youth Engagement has been a strong theme within OHCC over the past year, as it has with many organizations that recognize both the difficult challenges that youth face today and the many benefits of the meaningful inclusion and participation of youth. The OHCC Youth Engagement Committee, of which the majority of members are youth, has conducted research, developed an OHCC Youth Strategy and reached out to other youth-serving organizations. In 2014 we had a record number of youth involved in OHCC as board members, committee members, practicum students, and volunteers. Recently we held the first orientation session for our new Youth Healthy Communities Champions program, a self-directed Healthy Communities outreach and promotion initiative.

Collective Impact: OHCC has always conducted most of its work through collaboration. Since our inception we have actively promoted the development of local and regional community coalitions in which large and small organizations work together to improve community conditions. Our concepts around collaboration have been affirmed and extended by the “Collective Impact” approach, which is receiving a great deal of attention as an effective means of addressing complex community issues. Many of the ideas found in the resources section of the Collective Impact Forum have influenced our work recently, and we have taken to heart the statement that “the power of collective impact comes from enabling ‘collective seeing, learning, and doing,’ rather following a linear plan.” (Blog, Sept 2, 2014.)

IV Building Healthy Public Policy: A Case Study of Effective Health Promotion
Submitted by Sandra Laclé, Sudbury District Health Unit

Health promotion has been widely accepted as the process of enabling people to increase control over and to improve their health. The Ottawa Charter identified five strategies for health promotion action. Building healthy public policy, one of those strategies, has been identified as a key strategy for effective health promotion (Jackson, S. et al., 2006). At the Sudbury & District Health Unit (SDHU), health promotion action on policy serves to raise awareness of health issues with policy makers. Our goal is to provide evidence to make the healthier policy choice the easier choice for policy makers and thereby to make the healthy choice the easy choice for the population we serve or, in other words, to enable all people to more easily increase control over and improve their health. Sometimes this work requires that we put other work aside temporarily, to focus on a policy opportunity that will have the greatest impact on health at a population level.

One example of the Sudbury & District Health Unit’s policy focus relates to the Healthy Kids Strategy.  Medical Officer of Health, Dr. Penny Sutcliffe, accepted an invitation to sit on the Healthy Kids Advisory Panel. Viewing this as an opportunity for policy action, a responsive team of SDHU staff reprioritized their work, put other less policy-focused projects aside, and convened to provide research, model design, data, best practice, and experiential input and support to Dr. Sutcliffe. The team developed a model that could be used to facilitate dialogue among the panel members on the multitude of complex issues contributing to healthy weights. At the direction of Dr. Sutcliffe and the panel, team members conducted a focus group with local parents and caregivers to ensure challenges and recommendations from all segments of the population were provided to the panel members for their consideration. Acting quickly on the panel’s recommendations in the report, No Time to Wait: The Healthy Kids Strategy, the Board of Health passed a resolution citing its authority in this field, why it was important for the government to adopt the panel’s recommendations and shared this motion with other health units in Ontario for their consideration. The team, also, quickly developed a SDHU report card, comparing SDHU work against the recommendations within the panel’s report and shared this report card with local stakeholders to influence readiness for action should the panel’s recommendations be adopted by government.

It is noteworthy to the health promotion field that many of the panel’s recommendations have been supported by government. This investment in policy will make the healthy choice the easier choice for child health. We believe that health promotion action informed the government on this issue and that the resultant policy actions will pay large health dividends for child health in Ontario.

Jackson, S., Perkins, F., Khandor, E., Cordwell, L., Hamann, S., and Buasai, S. (2006) Integrated health promotion strategies: a contribution to tackling current and future health challenges, Health Promotion International 21 (supplement 1): 75-83. Retrieved from http://heapro.oxfordjournals.org/content/21/suppl_1/75.full

V The Chronic Disease Prevention Alliance of Canada (CDPAC) 2014 Year in Review
Submitted by Bill Callery and Craig Larsen

The Chronic Disease Prevention Alliance of Canada (CDPAC) is an alliance of national organizations sharing a common vision for an integrated system of research, surveillance, policies, and programs that promote health and prevent chronic disease in Canada.

There has been significant progress on chronic disease prevention globally, across Canada, regionally and locally over the past several years. In 2014, the momentum continued to grow and it is inspiring to press on in new and increasingly effective ways. In this year’s reflection we review some of the key issues of importance to chronic disease prevention efforts in 2014, and what we anticipate as key foci in the 2015 year ahead.

On April 8 – 11, 2014, we were delighted to welcome nearly 300 delegates to the 5th Pan-Canadian CDPAC conference entitled New Partnerships and Approaches for Chronic Disease Prevention. Mobilizing knowledge for action has continued to be a core function of CDPAC’s mandate and events such as our conference allow the Alliance to bring stakeholders together for real-time exchange and action on the issues of highest importance. The conference provided an opportunity to explore several topic areas including multi-sectoral partnerships for chronic disease prevention, the economics of chronic disease prevention and the importance of taking an inclusive approach to our work. New Partnerships and New Approaches for Chronic Disease Prevention showcased many exemplary partnerships for chronic disease prevention, covering a wide range of sectors and settings.

There were important lessons shared from the examples that were profiled throughout the conference.

The 2014 conference proceedings report is available on CDPAC’s website (http://goo.gl/XpnUrk) and provides a glimpse into just a few of the countless new chronic disease prevention approaches and partnerships that are evolving across Canada and were highlighted at the conference. We hope that it will provide greater insights into ways that we can accelerate action on chronic disease prevention and inspire the pursuit of new partnerships and new approaches.

Planning for the fall 2015 CDPAC conference is underway, and CDPAC is refreshing its strategic plan for the coming years. We anticipate a continued focus on some of the key issues of importance for chronic disease prevention in Canada, including how to stimulate and work in collaboration and multi-sectoral partnerships, how to address the health gradient resulting largely from the social determinants of health, and how to better understand the social and economic costs of chronic disease and benefits of chronic disease prevention.

We look forward to continuing to move forward on these issues in 2015, and the CDPAC wishes everyone a safe and happy holiday season and a wonderful new year.

VI Health Nexus Reflects on Fiscal trends for Non-Profits and Health Promotion
Submitted by Barb Willet and Alison Stirling

Rather than provide an overview of our past achievements (for that – see Health Nexus’ Annual Report  at  http://en.healthnexus.ca/sites/en.healthnexus.ca/files/resources/annual_...), we want to use this opportunity to highlight a number of fiscal trends pressing the nonprofit sector in general, and those working to further health promotion. Within that pile of government statements, reports, conferences and briefings on the edge of our desk (or overloaded Inbox) there is clear indication of developments to which we need to pay close attention.

Here’s a sampling of trends we feel are not just noteworthy but critical to our sector:

1. Austerity is not gone; there is a continued and increasing emphasis on cost-effectiveness and accountability. The recent Ontario Government finance statement (http://www.fin.gov.on.ca/en/budget/fallstatement/2014/chapter1a.html] indicates a review of “program transformation opportunities” to assess outcome effectiveness and to identify costs savings. More than ever, we need to be sure we can demonstrate that our programs are relevant, make a difference and are sustainable.

2. “Return on investment, demonstrating value, measuring social impacts” are approaches and terms that we need to not only understand but integrate into our language and thinking. Funders, potential sponsors and partners want to know that we are indeed making a difference in the large scheme of things in addition to simply ensuring effectiveness. The challenge for our sector is to embrace business thinking while not losing the fundamental social service values that attracted us to this work in the first place.

3. Finance models are also changing rapidly as funding is increasingly scarce and we are expected to do more with less. As the Mowat Centre (http://mowatcentre.ca/) on public policy pointed out, interest in social impact bonds, (http://mowatcentre.ca/tag/social-impact-bonds/) outcomes-based funding, ( http://mowatcentre.ca/tag/outcomes-based-funding/) and value-based measures is growing. Such models may not be initially welcomed in our sector but they are here. Rather than take a passive approach, the Mowat Centre suggests that the nonprofit sector be involved in shaping when and how they are used.

4. Inter-sectoral learning is vital. Increasingly, there are amazing opportunities to learn beyond the usual roster of sector related events. This fall, the Collective Impact summit (http://tamarackcci.ca/resource-library/collective-impact-summit-2014) challenged us to co-develop robust practice efforts in shared impact measurements across diverse collaborations. The SIAA Talking Data event (http://talkingdata2014.org/) immersed us in social impacts analysis, demonstrating value and social financing issues. As partners and participants, the Community Knowledge Exchange (CKX) summit  (http://ckx.org/summit) allowed us  many opportunities to engage in sharing research, stories and data, and to take ‘wise crowd’ counsel about social innovation. More reflections on CKX are available at http://en.healthnexus.ca/news/panorama-reflections-recent-ckx-summit.

At Health Nexus, we’ve been aware of these developments but until recently we’ve been content to leave those reports and briefs sitting on the edge of the desk. Like many of you, we were cautious observers. However, we realize that we need to be more active and carefully reflect on their implications, and the potential opportunities for our organization, and for the sector. Let’s remain cautious but not be passive about these trends that will, whether we like it or not, have a significant impact, on our work.

VII 2014 – A Year of Politics
Submitted by Frank Welsh, Ph.D., Canadian Public Health Association

Public health is, at its core, the intersection between what should be done and what can be done, where the realities of budgets, law and politics are as prevalent as good public health practice – except during an outbreak response. This juncture was most visible in 2014, when the Supreme Court strongly influenced public policy in Canada. In fact, the Macdonald-Laurier Institute named it “Policy-maker of the Year!” On the other hand, the world has faced a major outbreak response that both reaffirmed the best of public health and the influence of politics on our chosen profession.

The Supreme Court’s influence on public health policy began in 2013 with the decision concerning “InSite” (September 30, 2013) and a subsequent decision striking down laws limiting prostitution (December 20, 2013), followed by hearings concerning assisted suicide during Fall 2014. The influence of these decisions resulted in the introduction of Bill C-2 concerning the legal requirements to permit the opening of supervised consumption facilities (still in Parliamentary review), and the passing of anti-prostitution laws based on the “Nordic” model (which will likely be challenged in the courts when the opportunity arises).  Unfortunately, the legislative models that respond to the Supreme Court decisions appear to lack an evidence-informed public health basis.

Meanwhile, the concerns about e-cigarettes continue to unfold at the municipal and provincial levels, as several municipalities have established or are considering establishing limits on their use, while Health Canada continues to wait for a manufacturer of nicotine-containing e-cigarettes to come forward with an application for their use as a smoking cessation device. The irony is that information is becoming available which appears to support the notion of e-cigarettes as a harm reduction tool for smokers. At the same time, the Standing Committee on Health, Environmental and Social Affairs (HESA) of Parliament has held hearings to investigate their health, safety and social implications.

Then there is the change in authorities proposed for the Chief Public Health Officer (CPHO) of Canada.  Buried in the depths of a financial administration bill were changes to the Public Health Agency of Canada Act and the Financial Administration Act that could result in a bureaucrat running PHAC. The CPHO would be relegated to being an officer of the Agency, responsible for providing public health advice, developed on a scientific basis, to the Minister of Health and the President and CEO of PHAC.  This action has caused discussion concerning the proposed governance structure, where the arguments revolve around issues of responsibility and authority – an age-old conundrum in bureaucracies.

Woven among these developments, CPHA has continued to pursue evidence-informed policy development and advocacy, as we released statements concerning anti-microbial resistance in animal agriculture and missing and murdered Aboriginal women, as well as a discussion paper on public health approaches to managing illegal psychoactive substances. Before the end of the year we’ll also be releasing a paper concerning public health approaches to managing sex work.

While these Canadian issues have been developing, a public health crisis unfolded in Western Africa.  The outbreak of Ebola, the largest in history, has resulted in close to 16,000 cases with over 5600 deaths as of November 28, 2014. Although case totals continue to rise, the outbreak seems to be coming under control. The response to this outbreak has demonstrated both the strengths and weaknesses of the international public health community’s capacity to respond to large scale, international emergencies.   Once again, politics and policies have entered into the discussion both here and abroad, as the public health community continues to struggle with developing a culturally sensitive response that reflects the best available advice.

So, 2014 has truly been the year where politics and public health have inter-mingled at all levels!