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Looking forward / looking back 2009: Reflections on the year that was and the new year – Part II

Contents

I Introduction
II Public Health Agency of Canada – Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention
III Cancer Care Ontario
IV The increased emphasis on evidence-informed planning and decision-making in community health promotion efforts
V Public Health Practice Branch, Public Health Division, Ministry of Health and Long-Term Care

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 part two of the reflections piece (the first part ran on December 11, 2009) and the first OHPE feature for 2010.

II Public Health Agency of Canada – Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention
Submitted by Nina Jetha

The Canadian Best Practices Initiative (CBPI) was developed in response to an identified need to build capacity among those working in the area of chronic disease prevention and health promotion by providing relevant and easily accessed "best practices." These effective and well evaluated interventions are community and population level interventions which can be found on the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention, a central component of the CBPI.

The next version (2.5), of the Portal will be released January 11, 2010, showcasing new content and tools for its users. Practitioners will be able to find community interventions in areas such as asthma/lung disease, hypertension/cardiovascular disease, food security, injury prevention, and seniors’ mental health to name a few. The interventions are rigorously evaluated, proven to be successful and have the potential to be adapted and replicated by other health practitioners working in similar fields. As well, interventions whose effectiveness is supported by less rigorous evaluation methods will also be included.

In addition to the expansion of the content, additional features on the Portal will be added to create a more interactive experience for users. A set of new tools and a collection of well organized resources will be available to assist users with their evidence-based decision making, and the layout of the Portal will be remodelled based on user feedback to make it more friendly to navigate.

Please visit the Portal to see these changes and be on the lookout for Version 3 which will be released in the Fall of 2010 and will include practice based evidence to further expand the body of the knowledge available through the Portal: The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention: http://www.phac.gc.ca/cbpp.

III Cancer Care Ontario (CCO)
Submitted by Amy Blodgett

Last year, the Aboriginal Cancer and Prevention Team at Cancer Care Ontario (CCO) began provincial implementation of Let’s take a stand against…Colorectal Cancer! – an education program and information campaign targeted to First Nations, Inuit and Métis health service provider needs. The initiative has been aimed at helping health care providers and educators improve awareness of colorectal cancer in Aboriginal communities and increase screening participation rates using the Fecal Occult Blood Test (FOBT).

Over the past year, more than 1,500 Let’s take a stand against…Colorectal Cancer! toolkits have been distributed to First Nations, Inuit, Metis, and mainstream organizations, supporting community education efforts. Train-the-trainer education sessions based on the toolkit materials continue to be delivered to health care providers across the province with the intent that health care providers will then transfer knowledge to the community members they serve.

Pilot evaluation has supported the train-the-trainer approach as an effective knowledge transfer mechanism. The long-term sustainability and accessibility of materials has also been noted as a crucial programming element, achieved through online housing. However, the training participation response from health service providers has been lower than expected, possibly due to conflicting health priorities, mode of communication and lapse in phased implementation. This may also underscore the need for further education around cancer as a key health priority for Ontario’s Aboriginal peoples.

IV The increased emphasis on evidence-informed planning and decision-making in community health promotion efforts
Submitted by Nancy Dubois

I see an ever-increasing need for resource allocation (especially time and money) to be informed by some type of evidence and a corresponding need for organizations to tackle the tough questions of “what type of evidence are we willing to accept?” The signals for me on this front include the increased and pervasive reference to situational assessments, evidence-informed decision-making, and balancing need with impact in the new Ontario Public Health Standards. These concepts have also been incorporated into the preliminary information in the new Healthy Communities approach recently released by the Ministry of Health Promotion. Although situational assessments, including a culling of the relevant research findings (“best / promising practices” if you will) is critically important to making good planning decisions, such as setting strategic priorities, specific objectives, and the specific programs and activities to be undertaken, it is not an easy process to manage the data collection, analysis and communication of this information, especially when planning with a team or partnership.

Helpful resources have been developed to aid in this over the last year (the Online Health Program Planner developed jointly by The Health Communications Unit (THCU) and National Collaborating Centres for Methods and Tools (NCCMT), the evidence-informed public health resource from NCCMT, the Towards Evidence-Informed Practice materials, the Canadian Best Practices Portal, and THCU’s Evidence-Informed Practice Resource List to name a few) and I envision that this landscape of tools will grow, making it perhaps even more difficult for the local planner to figure out how to move ahead. Those helping to build the capacity of the community health practitioners will increasingly need to be able to navigate through this maze to find meaningful, yet practical, planning tools. One challenge to the field – allocate sufficient resources (at least 10% of your program budget) to evaluate the impact of programs not yet assessed and disseminate those so colleagues can benefit from your evidence. I would suggest this is especially important in the area of policy change as so little hard evidence seems to exist for this health promotion approach, except in the area of tobacco control, which may not be terribly transferable to other topics.

Increased importance of interpersonal communication as a key communication strategy

Typically there are three health communication approaches from which to choose when planning how best to reach your targeted population: media (both broadcast and narrowcast), events and interpersonal channels. In working with health promotion teams and networks across the province as they develop their strategies, which often include communication activities, I am seeing an increasing understanding of and reliance on the power of interpersonal methods. With the overwhelming amount of media inundating all segments of the population, much of which is not generated from local sources, and can be expensive, I foresee an even greater reliance on interpersonal communication skills. Add to this the increasing emphasis on policy and other system-level change, which often requires direct advocacy efforts with small group or individual decision-making, and these types of skills become even more critical. Inter-personal presentation skills are also part of the Communication section outlined in the Core Competencies for Public Health in Canada. For example:

6.1 Communicate effectively with individuals, families, groups, communities and colleagues.

6.2 Interpret information for professional, non-professional and community audiences.

I would add to this list the need to effectively advocate to “make the case” for resources and supports such as program plans with managers, boards, and funders, as well as argue for or support others in advancing policy options with powerful decision-makers, and continue to talk with anyone who will listen, including the media, regarding the dire straits in which we find ourselves with respect to the need for prevention efforts to offset the tsunami of chronic disease facing us. “They say” that public speaking is the most prevalent fear of people so any training and experience in allaying this will be even more necessary in the future.

The challenges, and benefits, related to workplace health

The physical and mental effects of stress are predicted to be the number one health issue facing workplaces in the near future. Although knowing this is on the horizon is better than being caught unawares, and there are a lot of conceptual models that help to explain what is necessary to prevent and combat this situation, there are precious few workplaces well equipped to address this. In my opinion, this could be a crippling phenomenon unless more and more employers address things like work/life balance, project and time management, child and elder care, effective knowledge management and discrimination and bullying in the workplace. These are not easy issues to tackle – many are sensitive, personal topics, some bringing into play the management practices of the organization, and others requiring the examination of overall policies within the workplace. It is my opinion that we will need to identify innovative approaches to these issues, with the corresponding evaluation efforts to assess impact, and the dissemination means to share these learnings, as well as finding effective means of recruiting more and more workplaces to address workplace health in the first place.

As we approach a future of health care that we can’t afford now because of all the pending chronic disease problems with our aging population, we have to do whatever possible to prevent these types of stress-related problems. I would predict that we, as health promoters writ large, are ill-equipped to meet this challenge, much less those working directly in workplaces. Occupational health and safety efforts have been well addressed, there has been plenty of headway on lifestyle issues, but the challenge remains for the organizational culture aspect of workplace health. Stress affects all three of these topics so will require a very comprehensive approach. Add to this the fact that workplaces do not have an organized system, such as is the case with schools, making it a one-by-one exercise in many cases. I am hopeful that 2010 brings an enhanced effort towards workplace health, a key setting to reach a large proportion of the Ontario population, and that one important aspect of this would be attention at the provincial and federal government levels to initiatives that can be applied in a workplace setting.

V Public Health Practice Branch, Public Health Division, Ministry of Health and Long-Term Care
Submitted by Paulina Salamo

With respect to the most significant developments over the past year, a couple of thoughts or “buckets” come to mind:

  • Public health system strengthening from multiple levels – a number of events and accomplishments. From the provincial perspective, Ontario welcomed its new Chief Medical Officer of Health (CMOH), Dr. Arlene King, on June 15. The Ontario Public Health Association celebrated a major milestone with 60 solid years of being a catalyst and voice of and for public health in the province. The Ontario Agency for Health Protection and Promotion released its 2010–2013 Strategic Plan (http://www.oahpp.ca/Documents/FINAL%20Strat%20Plan%20web.pdf). There was continued work on discipline-specific competencies for public health by various professional associations (e.g., Health Promotion Ontario, Canadian Institute of Public Health Inspectors, Dietitians of Canada). From an international perspective, a link back to Alma Ata, the 2008 World Health Report from the World Health Organization focuses on primary care and identifies key action statements on healthy public policies and strengthening public health at national and transnational levels (http://www.who.int/whr/2008/08_overview_en.pdf).
  • Focus on the social determinants of health and health equity – from a provincial perspective, a number of initiatives come to mind that underscore the importance of addressing health equity through the efforts of public health and the active engagement of other sectors. The Poverty Reduction Act and two initiatives under Poverty Reduction Strategy – The Dental Program for Low-Income Families (through Ministry of Health and Long-Term Care (MOHLTC)) and the After School Initiative (through the Ministry of Health Promotion (MHP)). The release of the Mental Health and Addictions discussion paper by the MOHLTC, which identifies the determinants of health and well-being as one of the foundations and key strategic directions focusing on healthy communities and community resilience has been another important initiative. Also of note is MHP’s Healthy Communities approach. From the federal government, the 2009 report on the State of Public Health in Canada, by the Chief Public Health Officer, addresses the health of Canada’s children and the influence that childhood experiences, health and well-being can have over a life course (http://www.phac-aspc.gc.ca/publicat/2009/cphorsphc-respcacsp/index-eng.php). And last but not least, from a research perspective, Canadian Institutes of Health Research, Institute of Population and Public Health has put health equity up front in its 2009–2014 Strategic Plan “Health Equity Matters” (http://www.cihr-irsc.gc.ca/e/40524.html)
  • Accountability – the year was also marked by greater scrutiny, need for improved transparency and focus on accountability. The release of the Initial Report on Public Health by MOHLTC, not only provides a snapshot of the current state of public health across the province, but also represents another step towards performance management and further commitment to strengthening of the system (http://www.health.gov.on.ca/english/public/pub/pubhealth/init_report/ind...). Public health has certainly been in the spotlight with pandemic H1N1 – again highlighting the key role that public health plays in the lives of Ontarians – the media slant with pH1N1 however, was one of accountability to the public.

The above developments represent only a grain of sand in the “public health sand box.” Implications for the many stakeholders involved in the planning and delivery of public health programs and services for the coming year are many and varied – some of which include:

  • The need for better alignment between applied public health research and policy-makers, particularly on issues related to public health syste (health human resources, performance measurement, capacity, funding, etc.).
  • The need for better alignment of functions between “public health organizations” (including research agencies, non-governmental organizations, community health centres) to respond to increased demand, multiple converging strategies (i.e., chronic disease prevention and management, diabetes), limited resources, as well as increased scrutiny to demonstrate value for money.
  • The Canadian Public Health Association will be celebrating its centenary in 2010 at its June conference – an event not to be missed and an opportunity to resurface the roots of public health as we forge ahead to address the public health priorities of the 21st century.