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Hospitals, Health Promotion & Community Action

1. Hospital Network in Support of Community Action
2. To Join the HNSCA
3. Examples of Hospital Involvement in Community Action

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A. Hospital Health Promotion Network
B. The [Canadian] Hospital Health Promotion Network
C. Health Promotion Exchange Newsletter
D. Joining the Hospital Health Promotion Network

Note: Don't forget to check out OHPE 75.2 for resources related to Hospitals & Health Promotion

Hospital Network in Support of Community Action

The Hospital Network in Support of Community Action (HNSCA) was formed in 1996 with the mandate of bringing together individuals and organizations involved in, committed to, and advocating for hospital
involvement in community action. We wanted a forum for sharing our experiences and developing knowledge in relation to the effective role of hospitals in improving community health through community action.

This was understood to include (but not necessarily be limited to) the following:

(a) identifying opportunities to work collaboratively on community action initiatives

(b) promoting the utilization of hospital resources to facilitate/support community action

(c) exploring and developing opportunities for the promotion of hospital cultures sensitive to, and supportive of, community action

(d) initiating and participating in the creation and dissemination of knowledge regarding effective ways for hospitals to engage in community action

(e) advocating for public policy that protects and enhances health

By 'community action', we mean a continuum of approaches that include: community-based initiatives, community development, social action, and advocacy; working in partnership with the community to identify and address the determinants of health in our community; and lending resources and/or knowledge to community initiatives.

We acknowledge that there are a variety of perspectives concerning how to define community. In particular, community may refer to a specific geographic area, a population of interest, a process through which people take initiative and act collectively, a goal, vision or outcome (e.g., community cohesion, capacity, leadership), a group of people with a shared identity, history or goals, and something that is always evolving.

We felt the need to articulate a core set of values which support a community development approach to working with communities. This entails a commitment to working in ways that enable meaningful
participation of community representatives from diverse population groups. Inherent in our work is a respect for people, their dignity, self worth, intelligence and capacities, as well as an acknowledgement of systemic inequities, in power and access to resources, in the environments in which we work. We pledge to endeavour to work with communities in ways that honour these values and beliefs.

In addition to regular information sharing meetings with HNSCA members, our activities to date have included presentations to hospital staff and at scholarly conferences, the drafting of a position paper on hospital involvement in community action, a pilot study of hospital involvement in community action in the greater Toronto area, and the development of a detailed qualitative case study research project on hospital involvement in community action in Ontario designed to produce practice guidelines and draft standards for inclusion in accreditation and hospital 'report cards'/'balanced scorecards' (proposal submitted to major funding agency).

The pilot study of the Hospital Network in Support of Community Action, undertaken in the Spring of 1997, suggests, firstly, that a wide range of projects undertaken in the community with hospital participation are guided by community action principles which include a focus on community capacity(ies) and meaningful community-hospital partnership, as well as broader definition and vision of health and it's determinants. Second, respondents sometimes struggle with dual accountability to their institution and to the community. Third, our pilot data indicated that the hospital is viewed by the community as well resourced and powerful. On the one hand, this gives hospitals tremendous clout and 'credibility', and creates interest in the community for closer partnerships. On the other hand, it also gives rise to concerns about implications of this unequal power in community-hospital 'partnerships', and some concern about the motives of hospitals who may be seen as wishing to 'take over", 'expand their turf', or 'shut us out'. Fourth, consequently the issue of developing 'trust' with community participants one of the key challenges (and most crucial tasks) faced by those seeking to do community action from a hospital base. Distrust is seen to arise from

(a) resources and power of the hospital,
(b) narrower biomedical focus, and/or
(c) in some cases, troubled prior history (lack of community outreach, or past mistakes).

Yet when that trust is developed, respondents indicated that it becomes a tremendous supportive base for future work. Fifth, several respondents mentioned using community criticisms of their hospital as a
lever and mechanism for bringing about changes in their institutions (i.e., useful in furthering their work), suggesting that those who take leadership on community action within hospitals face challenges in convincing hospital administrators and management about the importance and potential impact of their work. This suggests a need for organizational change and internal education, since support from top management (and from community agencies) is seen as important.

A variety of community action initiatives were described by participants in the pilot study (see also the vignettes below). In some cases, initiatives focussed on bringing the community more fully into the hospital (e.g., gay lesbian & multicultural awareness among hospital staff). In other cases it meant lending resources (e.g., money, space, expertise, staff time) to community-initiated projects (e.g., a bakery run by immigrant women), or acting as a catalyst for (or participating in) the creation of partnerships that address the determinants of health outside hospital walls (in the community, or at
broader policy level). Significant is the growing participation by hospitals represented in the study in community economic development, given the resources that hospitals command and the well documented links between unemployment and health. Respondents also felt that community action and health promotion will become increasingly important for hospitals in the future.

2. To Join the HNSCA

Founding Members of the HNSCA include: Centenary Health Centre, The Doctors Hospital, Humber River Regional Hospital, Women's College Hospital, St. Michael's Hospital, Scarborough Grace Hospital, St. Joseph's Health Centre, The Centre for Health Promotion, and the Department of Public Health Sciences at the University of Toronto.

HNSCA membership fees are $100 (institutional rate) and $25 (personal/individual rate).

For further information, please contact: Blake Poland, Department of Public Health Sciences, University of Toronto, tel: 416-978-7542 fax: 416-978-2087, OR Heather Graham, Toronto Hospital, tel: 416-603-5800 x6212,

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3. Examples of Hospital Involvement in Community Action

Vignette 1: The Doctors Hospital brought together service providers working with adolescents in the west end of Toronto and offered support (in the way of staff and seed money) to a project which would endeavour to enhance the health of adolescents in the community. They wanted to explore issues relating to adolescent health and to facilitate a project which would promote community collaboration and increased access to services. Representatives from a group of nine agencies and health care facilities attended the first meeting and agreed to meet regularly to develop the concept further. The group continued to meet monthly and the membership now represents 8 organizations which include: community-based health, social and recreational facilities, and local hospitals and secondary schools.

The group reviewed health indicators provided by the local Public Health Department, and reflected on issues that they were currently addressing in their agencies/organizations. A model for an Adolescent Peer Support Project was developed by the group to address what the group agreed to be the most visible issue affecting adolescent health in their community - school drop-out. It was agreed that the other
identified issues (e.g., housing, employment, etc.) are often the precipitating factors contributing to school drop-out.

The project is designed to increase access to supports for adolescents through an innovative combination of outreach services (at community-based agencies) and on-site services (in local secondary schools). Access to these services will be facilitated by Peer Support Workers who are supervised by project staff. The group is currently in the process of submitting a joint proposal to private and public foundations to secure funding that will sustain the project in the future.

Vignette 2: The Combined Employment and Counselling Program is a community economic development project which involves Central Neighbourhood House, Dixon Hall Neighbourhood Centre and St. Michael's Hospital. All three organizations have been concerned about the impact on health of high levels of unemployment and poverty in the population of the inner city of Toronto which includes many new Canadians, sole support and low income families, a high prevalence of unemployed youth,
large numbers of individuals with psychiatric disorders and Canada's largest concentration of homeless people.

In an attempt to address some of these concerns the three organizations formed an alliance to promote employment and job creation in the community. A proposal was successfully submitted to the Counselling Foundation and Green Shield Canada who provided funding for a job creation and employment counselling project for disadvantaged populations.

A number of businesses have been created and supported through this project including a food catering business run by neighbourhood youth, a bakery established by a group of women from different ethno cultural groups, and a woodworking business run by homeless and psychiatric survivors. The Neighbourhood Centres brought to the project their experience and credibility in working with the community and their know-how in grass roots community development. The hospital's contribution was the preparation of the funding proposal to Green Shield, and credibility in administering grants and program evaluation.

The Hospital also provided very practical assistance by enabling the community businesses to purchase food supplies through the hospital's bulk buying arrangements with suppliers and opening the hospital as a
market for products.

Vignette 3: The World Bakery project evolved from discussions with local women about the ways their skills could be used to develop and operate a business in the local community. They had a thorough business plan developed with assistance from a local college, and had received assistance from various bakeries in the City who provided information, education and mentorship about the operation of a commercial bakery.

The hospital was contacted by Dixon Hall, a local community settlement house providing a range of programs and services for low income people, because this project was looking for a space to operate from. The Wellesley Central Hospital assisted with adaptations to and ongoing use of a commercial kitchen which was no longer in use. The World Bakery provides baked goods to the hospital and other organizations. It also regularly offers baked goods for sale to people at the hospital.

Vignette 4: Confronting Hate Motivated Crime Against Lesbians and Gay Men was a project that evolved from ongoing work of the Wellesley Central Hospital with the local lesbian and gay community to better ensure that their specific health care needs were met by health care providers in the emergency department. The 519 Church Street Community Centre has a history of working in partnership with the hospital, and has a Victim Assistance Program which operates a lesbian and gay
bashing report and information phone line.

The Centre approached the hospital to design mechanisms that would assist staff and physicians to better identify and assist patients in the emergency department who were victims of lesbian or gay bashing. The project was approved and received funding through the Urban Health Initiative of Wellesley Central Hospital. A steering committee, which included people who had been bashed, the 519, hospital representatives from the emergency department and urban health, representatives from the university of Toronto, and a local physician, guided the work of
the project.

The project included educational sessions for emergency staff and physicians, development and implementation of a Gay and Lesbian Bashing Protocol used in the emergency department to assist in identification of people who were bashed, a literature review, an educational manual, and an educational video, which dramatizes an actual gay bashing situation. The educational materials have been made available to people at cost and distributed across Canada.

-- submitted by Blake Poland, Department of Public Health Sciences, University of Toronto, tel: 416-978-7542 fax: 416-978-2087,


A. Hospital Health Promotion Network

The World Health Organization would like every hospital to be a Health Promoting Hospital. What do they mean?

The Health Promoting Hospital concept was precipitated by Marc Lalonde's 1974 Report titled "A New Perspective on the Health of Canadians". In 1986, the WHO initiated the Ottawa Charter of Health Promotion, and later coupled with the 1991 Budapest Declaration, and the Healthy Cities program gave rise to the Health Promoting Hospital project.

Hospitals were seen as having enormous potential to influence the public in relation to health matters. They can have a particular influence on the health and well being of patients and their relatives, their staff and the immediate community in which they are located.

In 1993, the WHO launched the Health Promoting Hospital Concept, with support of the European Union and Federal Governments, to develop a movement of hospitals to incorporate health into the hospital culture. This involved 20 European hospitals in 12 countries. Now this international network has more than 1000 participants, representing 30 countries. The WHO web site for the International Network of Health Promoting Hospitals is at

The Ottawa Charter was particularly important in the evaluation of health promotion in Canada. The Canadian Council on Health Service Accreditation, in 1986, requested that goals and objectives for health promotion be included in mission statements of hospitals. In 1989, the Canadian Hospital Association issued a report on hospital-based health promotion which stated that hospitals should improve health, not just provide sick care. Hospitals slowly became involved in health promotion strategies.

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B. The [Canadian] Hospital Health Promotion Network

Recognizing the need to further develop and raise the profile of health promotion in hospitals, a group of health promotion practitioners joined together in May 1993. This was done in affiliation with the University of Toronto, Centre for Health Promotion. This group of 10 Southern Ontario health promotion practitioners, from a range of health care institutions, formed the Hospital Health Promotion Interest Group. The Interest Group evolved into a network whereby providing supportive links with other hospitals in which ideas, problems and solutions are shared.

In 1996, the Hospital Health Promotion Network, linked with the international network, was established across Canada with 47 hospitals participating.

The Network serves as a resource for developing and advancing health promotion in health care facilities; a repository for information about health promotion; and a forum for working on issues central to health promotion. It identifies opportunities for collaboration and resource sharing; conducts conferences and seminars on issues in health promotion; and conducts research and evaluation relevant to critical health promotion issues. This Network provides a support structure for health promotion within hospitals, and provides links to educational institutions to encourage learning opportunities.

Current Activities: * A semi-annual newsletter [see below]; * Setting up a listserv for the group so the HHPN members can talk with each other, pass along minutes and eventually speak with people involved in hospital health promotion in others parts of Canada and the world; * 3 key projects - 1. How to get started doing Health Promotion in hospitals - 2. Inventory of Health Promotion activities at each partner site - 3. Developing a mailing list of people involved in health promotion in hospitals. For these projects, the HHPN is seeking student assistance.

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C. Health Promotion Exchange Newsletter

The twice-yearly Health Promotion Exchange newsletter serves as a recognized source of information about health promotion in hospitals. Now, the WHO Health Promoting Hospital newsletter [] is linked with the Canadian newsletter, and each will share information and articles from each Network.

For further information about the Network or for a copy of the Health Promotion Exchange newsletter, please contact: Ted Mavor, Coordinator of Health Promotion, Grand River Hospital, Kitchener, Ontario Telephone: (519) 749-4300, ext. 2375, e-mail:

Slowly the Canadian grassroots development is gaining stature and acceptance, particularly in light of the Health Care Reform process taking place across our nation.

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D. Joining the Hospital Health Promotion Network

If you are interested in joining the Hospital Health Promotion Network, please contact any of the following: Nancy Mulroney, Assistant Coordinator Education Services, Queen Street Mental Health Centre, Toronto, Ontario, Telephone: (416) 535-8501, ext. 2183

Lorraine Farrow, Coordinator of Health Promotion, Oakville-Trafalgar Memorial Hospital
Oakville, Ontario, Telephone: (905) 339-4147, e-mail:

Debbie Bang, Coordinator Consumer Health Information Services, St. Joseph's Community Health Centre, Hamilton, Ontario, Telephone: (905) 573-7777, ext. 8054, e-mail:

-submitted by Ted Mavor