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

Contents

I Introduction
II Is Health Promotion Still Alive and Kicking in Canada?
III Heart and Stroke Foundation Reflections 2014
IV Injury Prevention: Practice and Policy in 2014 and Beyond
V Ontario Public Health Association, Going from Random to Randir
VI Women’s Health Feels the Squeeze: The Closing of the Canadian Women’s Health Network

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 are running our reflections in two parts. The first part ran on December 19, 2014.

Thanks to everyone who contributed to this as well as the other features that ran in 2014.

II Is Health Promotion Still Alive and Kicking in Canada?
Submitted by Irving Rootman

At the 2013 CPHA Conference, over seventy people participated in a workshop entitled “Health Promotion: Alive and Kicking” [1] Most participants agreed that health promotion was in fact “alive and kicking” in Canada in spite of some setbacks in recent years that saw the erosion of some of the infrastructure that developed in the last two decades of the 20th century such as the university-based centres for health promotion research. In addition, a number of suggestions were made for reinforcing the infrastructure for health promotion in Canada including establishing a Pan-Canadian Collaborative for the Promotion of Health and Well-being and a student group linked with the Collaborative.

Over the past year, some progress has been made in establishing the Collaborative, although not as much as was hoped for by the Interim Steering Committee due to limited resources and support. In addition, there has been a further deterioration in the infrastructure with the downgrading of the Centre for Health Promotion Research at the University of Alberta.

On the other hand, over the past year, a project funded by the Public Health Agency of Canada produced a draft of a document outlining competencies required for health promoters and is proposing to build a national network for health promoters in using the competencies. Health promotion values, concepts, theories, and strategies have made further inroads in influencing other fields such as mental health, gender and health, health literacy, community health, aging and social determinants of health. In addition, the Health Promotion Alignment Framework [2] developed by Jean-Marc Dupont, a lifecourse-based structure focussing on positive (health promotion) outcomes and their key influencing factors, also shows promise as a next-generation framework for prioritizing policy development and multi-sectoral action planning at all levels. A white paper on the framework has recently been drafted and is definitely worth consulting as is the Gender Transformative Framework for Health Promotion developed by Ann Pederson and colleagues. [3] Finally, Bridge for Health was founded in February 2013 as a local network in Vancouver to promote citizen engagement in health. The network brings together people with different experiences, perspectives, ages and cultures. It has expanded to reach like-minded friends and colleagues in other parts of British Columbia, Ontario, as well as U.S., Europe, Australia, and Latin-America with the goal of building a global movement to engage citizens and promote social innovation in health for all by fostering collaboration, knowledge-sharing and action.

Thus, although the infrastructure for health promotion is Canada has weakened, the ideas and tools developed by the field are still very much “alive and kicking” through their influence in other fields and sectors. In addition, many of the people who have been leaders in health promotion in Canada are now leaders in some of the other fields that I have mentioned. In other words, as has been pointed out by Ilona Kickbusch [4] health promotion in Canada and in other countries is like a rhizome that “does not respect territory but expands continuously.”

While I think that the rhizome is a good metaphor to decribe what is currently happening in health promotion and what is likely to continue happening, and I have contributed to this happening myself through my work in health literacy and other topics, I am still concerned about the continuing dismantling of the infrastructure for health promotion in Canada because there is a danger in losing the “tree” that produces the fruit that can be shared with others. That is, I believe that we need to have vehicles  in place that can continuously develop and evaluate knowledge and experience in health promotion and share it with others in health promotion and other fields and sectors.

It was for this reason, that along with other colleagues in health promotion, we organized  workshops on Health Promotion at the CPHA Conference in 2012 and 2013 and why we have proposed a followup World Café session at the 2015 conference in Vancouver. If our proposal is accepted as well as a proposal for a workshop being organized by the committee that has been managing the competencies in this health promotion project, I hope that many of you who read this statement will join us in these sessions, to further discuss and debate the matter of infrustruture as well as other important questions related to renenergizing and reforming health promotion in Canada for the future. And for those of you who can’t be there in person, I hope that you will use the vehicles such as the OHPE Bulletin and CLICK4HP keep informed and contribute to the ongoing dialogue.

[1] http://www.phabc.org/userfiles/file/HPiC-WorkshopReport2013_October17_20...
[2] Dupont, Jean-Marc (2014). The Health Promotion Alignment Framework
Aligning Multi-Sectoral Policies and Actions in Canada
. http://www.linkedin.com/in/jeanmarcdupont
[3] Greaves, L., Pederson, A. &Poole, N. (2014).Making it Better: Gender Transformative Health Promotion. Toronto: Canadian Scholars Press, Inc.
[4] Kickbusch, I., (2013). Understanding the Rhizome Effect: Health Promotion in the 21st Century. In Rootman, et al., Health Promotion in Canada. Third edition, Toronto: Canadian Scholars Press, Inc., p. 308-313.

III Heart and Stroke Foundation Reflections 2014
Submitted by Manny Arango

Sugar position statement

The Heart and Stroke Foundation released a position statement  in September proposing a maximum daily limit of added sugar to help Canadians improve their diets and their overall health (http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.9201361/k.47CB/Sugar_...). It is the first organization in the country to provide this concrete guidance. The Foundation recommends that Canadians limit their intake of added (or “free”) sugars to not more than 10 per cent or ideally less than 5 per cent of total calorie intake per day.

Added sugars are those added to foods and drinks and include glucose, fructose, sucrose, brown sugar, honey, corn syrup, maple syrup, molasses, fruit puree and juice etc. Added sugars do not include the sugars that are found naturally in foods such as vegetables, fruit, milk, grains and other plant-based foods (e.g., legumes and nuts).

The position statement includes recommendations for Canadians, all levels of government, workplaces, schools, researchers, health organizations and industry to help reduce added sugar consumption across the population.

The Foundation developed the position statement with input from a panel of national and international experts, and the recommendations are in line with draft guidelines released by the World Health Organization in March 2014.

E-cigarette position

The Heart and Stroke Foundation released a statement on e-cigarettes in October (http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.9207931/k.D09C/Heart_... ) highlighting health concerns and calling for more research on their potential benefits as a quit smoking tool.

Although e-cigarettes have the potential to help with quitting smoking, there are safety concerns given the unknown health impacts of e-cigarettes including the effects of second-hand exposure. There is also potential for these devices to renormalize smoking behaviour across the population, particularly for youth, and to be a gateway to nicotine addiction, or promote use with traditional tobacco cigarettes.

The statement calls for immediate Canadian policy solutions including banning e-cigarette use in public places where smoking is banned; prohibiting sales to minors and where tobacco sales are banned; regulating advertising and promotion; actively enforcing the existing ban on the nicotine varieties; and funding research around potential cessation benefits.

Implementation of AEDs

The Foundation has made progress in the installation of what will eventually total 2,000 automated external defibrillators (AEDs) in arenas and recreation centres across Canada. The AEDs are part of a $10 million program funded by the federal government and administered by the Foundation to put life-saving AEDs into communities in every province and territory, and to train more than 20,000 facility staff and users to know how to respond to a sudden cardiac arrest.

Federal Budget 2014

The Foundation was pleased to see the 2014 federal budget included a commitment to amend the Criminal Code to allow charities to use computers and other modern technologies to run lotteries. This is a welcome change that will result in millions of dollars in savings each year for Canadian charities that operate lotteries, with no cost to taxpayers. Modernizing the lottery ticket process will greatly reduce administration costs.

Flavoured tobacco

The Foundation provided comments on the proposed amendments to the schedule of prohibited additives in the Tobacco Act. Specifically the Foundation asked that further restrictions be imposed regarding weight, size and product format; that all flavours, including menthol be banned; and that all tobacco products (including chewing tobacco, water pipes, etc) be included in the revised legislation.  

Nourishing School Communities

Nourishing School Communities is a collaborative, evidence-based initiative that aims to get more healthy and local foods into the minds and onto the plates of school children across Canada. Led by the Foundation, it aims to support important changes to school food environments, changes that aim to shift policies and practices in a way that makes access to healthy local foods easier and fun to eat.

The initiative is funded through a Canadian Partnership Against Cancer (CPAC) Coalitions Linking Action and Science for Prevention (CLASP) program grant, with partners from YMCA, Federations of Saskatchewan Indian Nations, Propel from University of Waterloo, University of New Brunswick, and Farm to Cafeteria Canada. The objective of the CLASP program is to improve the health of Canadians by preventing chronic disease through the exchange of knowledge and best practices.

IV Injury Prevention: Practice and Policy in 2014 and Beyond
Submitted by Stefanie Menezes

Preventable injuries cost the Canadian economy $20 billion per year and are the number one cause of death for Canadians between the ages of 1 to 44. Injury prevention practitioners continue to work to raise awareness and implement solutions addressing this critical public health issue. Parachute is a national charitable organization dedicated to preventing injuries and saving lives. Parachute houses the Ontario Injury Prevention Resource Centre (OIPRC), which supports practitioners to prevent injury in Ontario. From our perspective, here are some significant developments in injury prevention this year that will continue to impact health promotion in the year(s) to come.

Making Strides in Fall Prevention

While the injury prevention field has been aware of the significant burden of falls-related injury and death for some time, seniors fall prevention received a great deal of attention in 2014. Interest in fall prevention by healthcare providers, arguably, has been bolstered by improving organizational compliance with Accreditation Canada’s Falls Prevention Strategy and Home Safety Risk Assessment Required Organizational Practices. [1] Whatever the driving factors, 2014 set a promising foundation for progress in fall prevention through 2015 and beyond. Here are some highlights:

  • In April 2014, the Public Health Agency of Canada published Seniors’ Falls in Canada: Second Report, with data supporting the continued need for effective fall prevention interventions aimed at seniors in Canada.
  • In May 2014, Canada’s second National Fall Prevention Conference was held in Toronto, co-chaired by the BC Injury Research and Prevention Unit and the OIPRC. The two-day event was attended by over 400 participants sharing research excellence, practice-based experience, clinical advances and policy innovations in fall and injury prevention among older adults. Challenges, opportunities and recommendations were summarized in a final report released in September 2014 (http://www.oninjuryresources.ca/publications/item/watch-your-step-2014-n...).
  • Since the conference, the Ontario Falls Prevention Community of Practice (http://seniorshealthknowledgenetwork.com/community/falls-prevention-comm...) has grown by 130 members.
  • In October 2014, proposed changes to the National Building Code of Canada regarding stair dimensions in private residences underwent a Public Review Process. The proposal was strengthened by research conducted by the Toronto Rehabilitation Institute’s Technology Team indicating that changes to step dimensions could significantly reduce falls on stairs. (Note: At the time of publication, the proposal’s outcome is unknown)
  • High demand for the Canadian Falls Prevention Curriculum (http://www.canadianfallprevention.ca<http://www.canadianfallprevention.ca/) among practitioners in Ontario has continued in 2014 and into 2015
  • Parachute has identified seniors’ fall prevention as one of three national priorities and will be focusing efforts in this area in 2015.

The Ontario Injury Prevention Resource Centre and Parachute provide ongoing support for practitioners to develop and implement evidence-informed fall prevention strategies. For more information, visit www.oninjuryresources.ca<http://www.oninjuryresources.ca/ and www.parachutecanada.org<http://www.parachutecanada.org/.

Policy Updates for 2014

2014 saw a number of noticeable changes to injury prevention policy in Canada that will help to turn the tide on these startling statistics. Distracted Driving: British Columbia passed and implemented new penalties for distracted driving, increasing the amount of the fines and introducing demerit points to accompany distracted driving penalties. Ontario reintroduced legislation that had previously died on the order table with the last election that also increased the fines for distracted driving (to up to $1,000) and also introduced demerit points (points points) with convictions. Parachute is pleased to see this commitment to road safety. Distracted driving has surpassed impaired driving as the most dangerous bad driving behaviour in terms of fatalities and motor vehicle collisions and we hope that other provinces and territories continue to show a commitment to end these unnecessary injuries through increased penalties for distracted driving.

In addition to distracted driving legislation, Parachute launched National Teen Driver Safety Week in Canada during the third week of October. This annual event will raise awareness of distracted driving in the teen population. In its inaugural year, Parachute gained the support of eight provinces, several municipalities and the federal government.

Carbon Monoxide Detectors: Ontario implemented legislation that requires carbon monoxide alarms in all residential homes. More than 50 people unnecessarily die each year from carbon monoxide poisoning in Canada. Yukon is currently the only other jurisdiction in Canada that requires carbon monoxide detectors.

Booster Seats: Saskatchewan implemented mandatory booster seats for children under the age of seven. Booster seats are proven to save children’s lives in motor vehicle collisions. With this new law, Alberta, Northwest Territories, and Yukon become the only province and territories to not require booster seats in Canada.

References

1. Accreditation Canada, Canadian Institute for Health Information and Canadian Patient Safety Institute. (2014). Preventing Falls: From Evidence to Improvement in Canadian Health Care. Ottawa, ON: CIHI.

The Ontario Injury Prevention Resource Centre is supported by Public Health Ontario, the Ministry of Health and Long-Term Care and the Province of Ontario.

The views expressed in this publication are the views of the OIPRC and do not necessarily reflect the views of Public Health Ontario, the Ministry of Health and Long- Term Care or the Province of Ontario.

V Ontario Public Health Association, Going from Random to Randir
Submitted by Pegeen Walsh

As I go about my day, I often make notes about the events I’ve attended, people I’ve met and things I’ve read. I would like to share these with you as they provide a mirror on the happenings of 2014.

Some notes spoke to the challenges experienced in health promotion and public health over the past year:

We Have the Answers, But Lack the Will

Health Promotion – Still Misunderstood and Underfunded

Show Me the Money

  • Dr. Doug Manuel’s new study (http://www.cbc.ca/news/health/hospitalization-calculator-tallies-ontaria...) found inactivity, poor nutrition and other risk behaviours cost hospitals $1.8B. When sharing this with government advisors, the message back was show us concrete examples of how and where health care costs can be saved in the next two-three years – as there’s no new money.

Other notes highlighted opportunities on the horizon and steps that we can take to ring in the next era of health promotion within the province.

Together We’re Stronger

  • OPHA’s 2014 membership survey indicates people value being part of a community working together to influence healthy public policy.
  • Ontario Professional Planners Institute and OPHA collaborate on an online course to build understanding about how planners and public health can work together to build healthier communities.
  • Longwoods healthcare papers outline different models for public health and primary care to work more closely.   
  • Dr. Patrick Fafard argues that public health practitioners could benefit from understanding more about politics at The Ontario Public Health Convention 2014.
  • Dr. Cory Neudorf suggests that we need to reach out to new audiences like the business sector at OPHA’s Building the Business Case Panel during CPHA.

Others Have Done it; Why Can’t We?

New Approaches Are Working

  • A Prevent More, Treat Less (http://aohc.org/news/prevent-more-treat-less-public-health-and-primary-h...) conference session on new research shows giving income support to patients improved their health.
  • Karen Loney from Chatham-Kent Public Health explains at The Ontario Public Health Convention how health promoters can bring different sectors together to build a healthy community.

Use Media to Spread the Word  

  • Following some media interviews about the importance of prevention, a journalist says OPHA “has an important perspective that needs to be heard.”
  • Health Promotion Ontario’s technology conference features examples of how social media can reach more people and expand impact.

New Directions are Afoot

  • Ontario’s Premier uses terms like “activist” and “justice” and commits to poverty reduction, a Healthy Kids Challenge, tobacco control measures, new income supports and more.
  • The new Associate Minister of Wellness’ Chief of Staff tells OPHA that her minister wants to hear ideas for a wellness strategy.

We All Have the Capacity to be Leaders

  • Dr. Buckingham emphasizes at OPHA’s fall forum that we are sleeping in the shadow of lions – those leaders who have gone before – and we need to roar.

At first blush, these notes may appear to be random, but they represent important themes in health promotion and public health, and point to possible directions for 2015 and beyond. While there is more health promotion knowledge, capacity and innovation today than ever before, a systems approach would allow us to accelerate our progress rather than carry on in the same “random” way. With a more comprehensive plan, including a health-in all policies approach, and a forum where we can better align everyone’s efforts, we could truly randir – or gallop – towards improved health for all.

VI Women’s Health Feels the Squeeze: The Closing of the Canadian Women’s Health Network
Submitted by Anne Rochon Ford

For 21 years, the Canadian Women’s Health Network (CWHN) provided commercial-free information and research on women’s health, with a strong focus on health promotion, the social determinants of health and ensuring a gendered perspective was brought to health policy discussions at the national level. Funded by Health Canada along with four women’s health research centres and one other network in Quebec, that funding was completely withdrawn from all of these agencies early in 2013. Some moved to close their doors right away, others of us have been trying valiantly to raise the money to keep operations going. The CWHN gave up the fight in October of this year. We gave it our best shot through various forms of fundraising, but ultimately, when we had to close our offices in Winnipeg and gradually lay off staff, the Board decided it was time to stop trying.

As we wrote in our final message to several thousand subscribers to our on-line monthly news bulletin, Brigit’s Notes, “We feel this is a loss for the women of Canada, just as the de-funding of the Centres of Excellence for Women's Health and a host of national NGOs across the country has been a loss, and the cutting of scientists in key federal departments has been a loss. We believe that in a democracy, tax dollars should go towards sustaining these important voices, and yet...”

The CWHN made a vital contribution to a host of critical women’s health issues and questions over the years, and provided a voice that will now be lost on the national scene. We encouraged a focus on breast cancer prevention to balance out the disproportionate attention to “finding a cure” (see our resources for this here http://www.cwhn.ca/en/resources/breastcancerprevention and here http://www.cwhn.ca/en/resources/womenplasticsandbreastcancer.)

In collaboration with other women’s NGOs, we were instrumental in making emergency contraception more readily available in pharmacies across the country. We asked important questions about safety and effectiveness when the HPV vaccine was introduced with significant federal dollars behind it. We convened a national working group of experts in women's mental health to jointly offer critical feedback and a missing gendered perspective to the Mental Health Commission of Canada report. We were there to provide input when the federal government was poised to approve silicone gel breast implants, ensuring that the voices of women who had suffered harm from these devices were heard.

We believe in the possibility of a second chance and that phoenix may rise from the ashes for women’s health. If the future holds the possibility of a federal government that is more open to including women’s health researchers and advocates around policy discussion tables, we hope to be there. In the meantime, our very resource-rich website (www.cwhn.ca) will not be updated but will remain in place for the foreseeable future.