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Looking forward / looking back 2009: Reflections on the year that was and the year coming

Contents

I Introduction
II Ministry of Health Promotion
III 2009: A bad year for health promotion? Will 2010 be better?
IV Health Promotion, Chronic Disease and Injury Prevention at the Ontario Agency for Health Protection and Promotion
V Health Nexus
VI The Health Communications Unit, 6 mandates, 6 observations
VII Chronic Disease Prevention Alliance of Canada (CDPAC) year in review

I Introduction

Each year the OHPE invites organizations and individuals working in health promotion to reflect on the past 12 months and make some predictions about the implications for the coming year. This is the first part of the reflections piece and the final OHPE feature for 2009. The second half of the reflections will run on the January 8, 2010.

II Ministry of Health Promotion
Submitted by Laura Belfie

This year the Ministry of Health Promotion has been active on a number of fronts:

Development of guidance documents for the Ontario Public Health Standards

The Ministry of Health Promotion initiated a process earlier this year to develop Guidance Documents for the Ontario Public Health Standards (OPHS) for which the ministry is responsible. Working collaboratively with public health practitioners and other Ministry partners (Ministry of Health and Long-Term Care, Ministry of Children and Youth Services) through a Steering Committee as well as eight working groups, several documents have been created.

An Oral Health Guidance Document was approved and posted on the OPHS web page in September 2009.

Draft documents have been completed and will be out for review to the field shortly. The documents will address the following:

  • Child Health
  • Comprehensive Tobacco Control
  • Healthy Eating, Physical Activity, Healthy Weights
  • Prevention of Injury
  • Prevention of Substance Misuse
  • Reproductive Health
  • School health

Launch of After School Initiative

In 2009, the Ministry of Health Promotion has partnered with a variety of provincial and community organizations in priority neighbourhoods to deliver after-school programs and services. More than 15,500 children and youth in over 270 sites across the province will benefit from the Ontario’s After-School Initiative. These programs include:

  • healthy eating and nutrition education to help combat childhood obesity
  • physical activity to encourage active lifestyles
  • personal health and wellness education to promote self-esteem
  • other activities to address specific priorities based on local community needs.

The programs align with findings of the Review of the Roots of Youth Violence Report, which recommended that after-school programs be available to promote good nutrition and positive activity, and to help keep youth off the streets.

The after-school initiative is also an important part of Breaking the Cycle: Ontario’s Poverty Reduction Strategy, which aims to reduce the number of children living in poverty by 25 per cent over 5 years — lifting 90,000 kids out of poverty — by boosting benefits for low–income families and enhancing publicly-funded education.

Launch of Healthy Communities Ontario

The growing complexity of health problems requires new ways of working together across disciplines and sectors. The Ministry of Health Promotion launched its new Healthy Communities Approach in June 2009 that applies community development principles and builds on multi-sectoral planning to create the conditions for community health and wellbeing.

Goals of Healthy Communities include: support for Ontarians and their local and provincial leaders to work together to improve community health and well-being; promote greater partnerships at the local, regional and provincial levels to create policies, plans and programs that make it easier for Ontarians to be healthier where they live, work, study or play; further the goals of various Ministry of Health Promotion strategies aimed at keeping people healthy and reducing health care costs of preventable diseases, conditions and injuries; and aligning provincial, regional and local health promotion efforts to achieve common goals.

This year, the ministry rolled out three pillars to support its approach to building Healthy Communities:

Healthy Communities Fund provides one window for groups looking for assistance from the Ministry of Health Promotion to promote physical activity, sport, recreation, healthy eating, injury prevention, tobacco control and mental health promotion projects.

Healthy Community Partnerships provide an infrastructure at the local, regional and provincial levels that brings people together to design and implement community healthy living plans that can create new policies and an environment that promotes health.

Healthy Communities Consortium brings together services of five health promotion resource centres to support communities with partnership and community development, training and best practices. In the coming year, the ministry will continue to develop the three pillars of the approach.

III 2009: A bad year for health promotion? Will 2010 be better?
Submitted by Irv Rootman

From where I am sitting, on the “wet” coast, 2009 looked liked a pretty bad year for health promotion in Canada. Not only did the Canadian Consortium for Health Promotion dissolve, but two of the leading university-based centres for health promotion research, including the one at the University of Toronto, did as well. Perhaps some people would say that this is not a bad thing to happen in that it may mean that such organizations have “outlived their usefulness” or that health promotion has become “mainstream.” While there may be some validity to these arguments, there are valid arguments on the other side as well. For one, the two centres both focused on community-based health promotion research, which may or may not be picked up by other institutions or organizations. They also both have organized summer schools on health promotion for many years which contributed significantly to knowledge exchange and the development of capacity for work in health promotion at various levels. Again, this may or may not be picked up by others. The centres and the Consortium also provided leadership to health promotion across the country and internationally, and facilitated networking and collaboration. This is not to suggest that they were the only organizations providing these functions, but they certainly made a significant contribution which will be missed. So overall, I would argue that 2009 has in fact been a very bad year for health promotion in Canada which may reverberate into the future.

So is 2010 going to be a better year? The good news is that several other organizations and programs focused on health promotion still exist and are active. These include several other university-based centres, training programs, government agencies, a provincial health promotion association, a clearinghouse, and a federal health promotion centre. There are also many people working in health promotion and related fields who have training in health promotion and are fully aware of and committed to its core values. In addition, there are a number of communication vehicles such as the OHPE and Click4hp. The bad news is that as far as I can determine, there does not appear to be any organization or person who is prepared to offer “inspired leadership” to the field equivalent to that provided by people like Ron Draper, Lavada Pinder and Trevor Hancock who put health promotion in Canada on the map here and internationally. So until such people and organizations step forward I find it hard to be optimistic about 2010 in terms of health promotion in Canada. On the other hand, being a “terminal optimist,” I remain hopeful that there will be a renaissance in health promotion in this country and that it will take its rightful place among the key strategies for creating a healthier Canada.

IV Health Promotion, Chronic Disease and Injury Prevention at the Ontario Agency for Health Protection and Promotion
Submitted by Dr. Heather Manson

Health promotion, chronic disease and injury prevention are an important part of the Ontario Agency for Health Protection and Promotion’s (OAHPP) mandate. In keeping with the recommendations of the Agency Implementation Task Force and the priorities identified in OAHPP’s first strategic plan, the Health Promotion, Chronic Disease and Injury Prevention (HPCDIP) Section of OAHPP focused its attention on a number of activities during 2009. Much of this work centred on identifying gaps and opportunities, setting priorities and establishing linkages and collaborations with partner organizations.

In the late fall of 2009, the OAHPP and the Ministry of Health Promotion (MHP) completed negotiations involving the transfer of four Ministry of Health Promotion-funded resource centres: The Alcohol Policy Network, the Health Communications Unit, the Ontario Injury Prevention Resource Centre, and the Program Training and Consultation Centre. Collectively, these centres will give HPCDIP added capacity to provide resources, training, and technical support to public health intermediaries, networks and communities of practice. The official date of transfer is scheduled for April 2010.

Over the past year, HPCDIP has partnered on research and knowledge exchange activities involving a wide range of stakeholders, including government ministries, non-governmental organizations, academics and practitioners. Relevant examples include:

  • The Renewal of Public Health Systems (RePHS), a CIHR-funded initiative focused on a comparative review of core public health standards in Ontario and British Columbia over the next five years.
  • The Canadian Partnership Against Cancer (CPAC) Youth Health Excel Collaborative, which aims to accelerate evidence-informed action on youth health priorities.

HPCDIP also initiated the development of a Primary Prevention Framework for Chronic Diseases in Ontario. The proposed framework is based on national and international best practices. By the end of the current (2009–2010) fiscal year, consultation on the framework will be completed with the Ministry of Health Promotion, the Ministry of Health and Long-Term Care (Public Health Division) and other key stakeholders. In addition, HPCDIP established a Scientific Advisory Committee (SAC) to provide scientific and technical advice to guide the renewal of the Smoke-Free Ontario Strategy by the Ministry of Health Promotion. The SAC, which is comprised of experts from the Ontario tobacco control community, is expected to table its report by the end of March 2010.

Since its inception in July 2009, HPCDIP has been pleased to support students from the University of Toronto Community Medicine Residency Program, University of Waterloo’s Masters in Public Health and York University’s Masters in Business Administration. Student projects have included:

  • Role and options for the OAHPP in the Provincial Diabetes Strategy
  • Role and options for the OAHPP in the Provincial Mental Health and Addictions strategy (in progress)
  • Development of a Health Equity framework and lens for the OAHPP (in progress)

HPCDIP looks forward to continuing to engage students in an active academic portfolio.

Over the coming year, HPCDIP will continue to guide the development of an effective chronic disease, health promotion and injury prevention system by building collaborative relationships, providing high quality scientific and technical advice and supporting public health units and health promotion intermediaries. Our plans for 2010 include capacity building activities to support the implementation of the Ministry of Health Promotion’s Ontario Public Health Standards Guidance Documents as well as the provision of technical support for MHP initiatives such as Healthy Communities Ontario.

While we have made considerable progress over our first year of operation, there is still much more to do and the year ahead will be a busy one for us. In the meantime, I wish all of your readers an enjoyable holiday season and a healthy, happy and productive 2010.

V Health Nexus
Submitted by Barb Willet

Like most non-profits in 2009, Health Nexus experienced a lot of change, with a typical range of highs and lows, and much in between. Due to losses in revenue, we said goodbye to several valued colleagues, closed the doors to the secretariat of the Ontario Health Promotion Resource System and reduced our efforts to prevent chronic disease with the wrap up of our Prevent Stroke project. In August, Connie Clement, our executive director for the past eight years, resigned to pursue other opportunities. At the same time, Health Nexus continued to provide a range of services and are proud of our many highlights and successes:

  • We completed a comprehensive evaluation of our highly successful Connecting the Dots (CTD) community engagement strategy, which demonstrated how CTD contributed to increased community capacity through increased connections, greater readiness for collaboration and new and strengthened partnerships.
  • We are excited to be a recipient of a Healthy Communities provincial fund, in partnership with the Health Equity Council. In this 18-month project, we are working to build capacity among frontline staff and senior management in community organizations to address equity and social determinants of health, particularly related to ethnoracial communities affected by poverty.
  • With funding from the Pubic Health Agency of Canada we are conducting a national needs assessment of the Community Action Program for Children / Canada Prenatal Nutrition Program and will develop recommendations to increase the projects' capacity to address issues related to childhood obesity.
  • We are working on the development of a toolkit and corresponding training for Ontario’s service providers around the issue of obesity in Ontario’s First Nations, Inuit, and Métis children.
  • Last, but certainly not least, we are thrilled to be a member of the newly formed Healthy Communities Consortium, providing a range of support to community groups and organizations working on healthy communities initiatives throughout Ontario.

As the new executive director of Health Nexus, it is a privilege to lead the organization into the next decade to continue to provide innovative, effective and responsive health promotion services and to make a significant contribution to the sector.

VI The Health Communications Unit, 6 mandates, 6 observations
Submitted by Larry Hershfield

This year, I decided to look at the last year through the lens of THCU Mandate Areas, and some of our achievements:

In terms of planning, we released the Online Health Promotion Planner in April 2009, and we now have over 1000 user accounts (available at http://www.thcu.ca/ohpp/) exceeding our initial target. This tool provides a variety of planning support including program planning, logic model, outcome objectives and assessment data. Registration for our orientation webinars is through the roof. We have had requests and inquiries from across Canada and across the oceans. We are overwhelmed by the reception, and tantalized with all the possibilities for expansion, enhancements and adaptations. In short, we never planned on this.

In terms of evaluation, as Dewey taught us, success is achievement relative to expectations. So in addition to the obvious challenge of measuring achievement, we must be ever diligent in defining expectations. We have had the pleasure of seeing our teaching of Outcome Objectives migrate from flipchart, to PowerPoint, to laminates, and now onto an online Objective Builder (worksheet 3.1 within the Online Health Promotion Planner). However, beyond this, we are now exploring Intervention Mapping (http://interventionmapping.com/) as a planning, implementation, and evaluation methodology, and can plainly see how much we all have to do and learn.

As for policy development, we all wrestle with the question of how much influence does evidence really have? War on crime, minimum sentencing,…. how about Safe Injection Sites: just to mention a few test cases. I find the National Collaborating Centres for Public Health (NCCHP)’s summary paper very illuminating (find it at http://www.healthypublicpolicy.ca/docs/FafardEvidence08June.pdf)

Could health communication get more complicated? I cannot wait to see the debriefing of this year’s H1N1 communication. We give high marks for the coordinated and planned communication strategies, but while we were all busy making and implementing plans, a single death reverberated through the offices and homes of Ontario. Not to mention the overwhelming amount of information in the blogosphere, and conflicting points of view by assorted experts.

For workplace, what is the answer to the turbulent times, the massive job losses? A few years ago, I developed a paper on the importance of work for Goodwill Ontario. Find it at http://www.goodwill.on.ca/2006_Community_Works_Report.html. If I worried then about the loss of our community-binding social contract, which stops the unemployed from taking to the streets and/or slaughtering the aristocracy as in centuries past, what am I thinking now? Yet at the same time, Tiger’s dalliances, a winning hockey team, and Adam Lambert seem to distract us (or, at the least, good parts of our media) from issues of political economy.

And sustainability? THCU’s model talks about sustaining issues, behaviors, programs and partnerships. THCU’s world in terms of structures is rapidly changing: as announced elsewhere in these pages, we are going to be managed by the Ontario Agency for Health Protection and Promotion; the Ontario Health Promotion Resource System and its Secretariat have disappeared, and the Centre for Health Promotion does not exist as a separate entity. Notwithstanding, we fully expect to pursue the same important health promotion issues, sustain skills-based and other community behaviour, offer more programs, and adapt our many partnerships, even as our structures do change.

VII Chronic Disease Prevention Alliance of Canada (CDPAC) year in review
Submitted by Nicholas Watters and Craig Larsen

2009 will be remembered by many as a year of challenges, from a global recession, to the H1N1 flu pandemic, we were never short of moments that tested our ability to adapt and persevere. Yet during these difficult times, many Canadians embrace challenges, and see them as an opportunity to collaborate together on new creative initiatives, policies, and research that enable a healthier, more sustainable Canada for future generations. With that thought in mind let’s reflect upon the year that was for CDPAC in 2009.

Strategic Priorities

In February the Alliance which includes, the Heart and Stroke Foundation of Canada, Canadian Cancer Society, Canadian Diabetes Association, Canadian Public Health Association, Dieticians of Canada, Canadian Council for Tobacco Control, Coalition for Active Living, YMCA Canada, the Kidney Foundation of Canada, the Canadian Association for Mental Health and Illness, and two provincial/territorial representatives, determined CDPAC should focus on the following two strategic priorities:

  • Obesity, with a particular focus on marketing and advertising of unhealthy foods and beverages to children.
  • Advancing CDPAC’s Primary Prevention for Chronic Diseases in Canada: A Framework for Action Report (2008).

While determining CDPAC’s strategic focus three key needs were identified for advancing the Framework for Action:

  • CDPAC needs to tell the story of chronic disease prevention in Canada.
  • CDPAC needs to understand how the prevention goals and activities of the current Canadian chronic disease related frameworks and strategies relate to the Framework for Action.
  • CDPAC needs to understand how our member activities align with the Framework for Action.

To help achieve the second of these needs, CPDAC is currently hosting a graduate student for a practicum project that will result in a report (due March 2010) which will:

  • Analyze and compare the: Canadian Diabetes Strategy; Canadian Heart Health Initiative; Canadian Healthy Living Strategy; Canadian Cardiovascular Disease Action Plan; Canadian Strategy for Cancer Control; The Federal Tobacco Control Strategy; and the Canadian Mental Health Strategy Framework using CDPAC’s Framework for Action as an analytical platform.
  • Make recommendations for integration based on the findings.

New Initiatives

CDPAC was thrilled to learn that our application for funding from the Canadian Partnership Against Cancer’s ‘Coalitions for Linking Action and Science’ (CLASP) initiative was successful. A program of activities titled ‘Collaborative Action on Childhood Obesity’ will be carried out from October 2009 through March 2012. Our CLASP consists of six national, provincial, and territorial partners with expertise in policy, research, prevention/promotion and clinical practise. Our coalition includes:

  • Childhood Obesity Foundation
  • University of Ottawa
  • Heart and Stroke Foundation of Quebec
  • Coalition québécoise sur la problématique du poids
  • Government of Northwest Territories
  • Chronic Disease Prevention Alliance of Canada

Our CLASP coalition aims to leverage some existing evidence-based activities underway in Canada in order to create a comprehensive obesity prevention strategy, similar to those used to reduce tobacco use. Our goal is to contribute to a reversal in the escalating trend in child and youth obesity, and we have identified four specific aims to achieve this goal. The four aims include:

  1. To increase the adoption and implementation of school-based education and behaviour change strategies that address the consumption of sugar-sweetened beverages and screen time in each jurisdiction including identified aboriginal communities.
  2. To increase access to positive local and culturally relevant alternatives for healthy eating and restrict access to ‘unhealthy’ options by supporting the implementation of policies, regulations and guidelines in schools and their surrounding communities including local stores and community kitchens. (And increased local production and distribution of healthy and culturally relevant foods --- with a particular, but not exclusive, focus on First Nations groups).
  3. To decrease the appeal of ‘unhealthy options’ by supporting the implementation of policies that restrict advertising to children and provide disincentives for purchase of unhealthy foods (choose least and not recommended foods) through taxation thus increasing the appeal of locally harvested and produced food, particularly in the case of the Aboriginal communities involved.
  4. To build the capacity of national and provincial stakeholders to implement evidence-based obesity and chronic disease prevention initiatives by developing mechanisms for inter-jurisdictional networking, evaluation and knowledge exchange.

Significant Meetings

On October 1, 2009, CDPAC met with the Honourable Minister Leona Aglukkaq. The topics highlighted were, an overview of CDPAC’s work, including the graduate work CDPAC is overseeing, the marketing of unhealthy foods and beverages to children, food security, and childhood obesity. Minister Aglukkaq commented that she'd be very interested in hearing from CDPAC with regard to "3, 5 or 6 areas where integrated action on chronic disease prevention could be focused."

On October 22, 2009, CDPAC met with Stephanie Yates, Policy Advisor, Office of the Leader of the Official Opposition. Our main messages included an overview of CDPAC; its members and current priorities, followed by discussions related to obesity, marketing to children and food security. Ms Yates indicated that she had already highlighted obesity as a potential platform issue, and that CDPAC's current and future messages could be of assistance.

Upcoming Events

CDPAC is in the initial planning phase for our next conference, which will be held in April of 2011. All three of CDPAC’s previous conferences were very well received and we are excited to be moving towards our fourth.

Finally, CDPAC would like to wish everyone a safe and happy holiday season, as well as a productive and fruitful 2010.