Vancouver Coastal Health Population Health Strategy Dr. James Frankish, Senior Scholar Director, Institute of Health Promotion Research Associate Professor, Health Care & Epidemiology & College for Interdisciplinary Studies Partners in Community Heath Research-Training Program IHPR Institute of Health Promotion Research

Presenters  Mr. Darryl Quantz (Vancouver Coastal Health) (VCH)  Mr. Ted Bruce (VCH)  Dr. Jim Frankish (University of British Columbia) (UBC)  Mr. Glen Moulton (UBC)

Vancouver Coastal Health (VCH) Geographical Area: 54,165 sq. kms -Population served: (25% of BC's population) Provides full continuum of primary, acute and community care as well as many specialized tertiary and quaternary services

VCH Population Health Framework 1. Leadership  Recognizing the existence of a health issue or health disparity and assuming a responsibility to redress it 2. Partnership Development  Inter-sectoral action to facilitate population health initiatives 3. Advocacy  Assess and advocate for internal and external policies  Mobilize resources and opinions 4. Policy Development  Focus on large-scale changes in policy, programs, and environments

Population Health  An approach to health that aims to improve the health status of the population and to reduce health disparities among population groups.  Action is directed at the health of an entire population, or sub-population, rather than individuals which is typical of most health care service delivery in VCH and elsewhere.

Determinants of Health  Physical environment  Healthy child development  Income/Employment  Educational opportunities  Social support networks  Personal health practices  Culture and language, et cetera.  Gender  Health services  Biology & genetics

VCH’s Population Health Team  Created a team of 5 (executive director (Mr. Ted Bruce), 3 policy consultants (Ms. Claire Gram, Ms. Jennifer Scarr, Mr. Darryl Quantz), and an administrative assistant (Ms. Winnie Price)  Reports to the Chief Medical Health Officer

VCH’s Population Health Framework Four key areas of action  1. Leadership  2. Policy Development  3. Partnership Development  4. Advocacy

Purpose The main purposes of this case study were to identify:  Key milestones and champions in the history and development of the strategy;  Criteria for prioritizing decisions for the use of financial and human resources;  Level of understanding and awareness of the population health framework and team among key internal stakeholders;

Purpose (continued) The main purposes of this case study were to identify:  Opportunities for implementing a population health strategy;  Challenges to the implementation of a population health approach, as well as suggestions for overcoming challenges; and  Indicators of success (outcomes) for population health initiatives, and the capacity to measure outcomes.

Methods  15 semi-structured interviews with key internal stakeholders (30-75 minutes each)  Review of key documents (meeting minutes, conference proceedings, strategic directions, working documents, project descriptions/reports, newsletter articles, etc.)  Participant observation in team meetings (approximately 18 hours over 3 months)

Research Questions  Current work title  Perceived role in the VCH population health strategy?  What is your awareness/understanding of PH team and population health strategy? How can the profile of a PH health agenda be enhanced at VCH?  How would you describe the history & development of the VCH PH strategy? What have been some key milestones and successes in this process?  Who have been the key champions for the VCH PH agenda?  How can senior leadership and other VCH stakeholders be engaged in helping VCH to develop a more significant role in addressing the non-medical determinants of health?

Research Questions  What are potential threats/challenges to implementation & short-term impacts of PH strategy? How can these be overcome?  In the past year, what opportunities have arisen in your work in terms of implementing a PH? Do you see opportunities that can facilitate population health work in VCH?  Identifying outcomes of PH work represents a number of challenges. In your perspective, what are the indicators of success (outcomes) for a PH agenda? How can the capacity to measure these outcomes be developed?  Given the vastness of a PH approach, if there were several promising PH initiatives that the PH team could engage in, what criteria should be used in prioritizing decisions about how to allocate resources (financial and human) to implement a PH strategy?

Potential Implications  Redirection of resources  Need to adopt new or different roles  New stakeholders from diverse sectors  New forms of management  New or refocused functions to address new targets  New foci for evaluation  New partnerships & intersectoral collaboration  May need to develop new capacities & skills

What We Need for Population Health to Work in Vancouver Coastal Health  Public support & political will  Targeted resources & supportive legislation  Policy & practice ‘champions’  A supportive philosophy  A cultural & policy framework  Organizational & governance infrastructure  Trained staff / improved education  Remuneration of health promotion services/personnel  Contextual epistemology & pragmatic accountability

Contact Information Dr. Jim Frankish, Senior Scholar, Michael Smith Foundation Institute of Health Promotion Research Rm 425, Library Processing Centre 2206 East Mall Vancouver BC V6T 1Z , , Personal Website: jimfrankish.com BC Homelessness & Health Research – Network bchhrn.ihpr.ubc.ca BC Homelessness Virtual Library - Partners in Community Health Research