1 Mapping the Role and Functions of Public Health in Chronic Disease Prevention and Control Kerry Robinson, Marie DesMeules, Mae Johnson Evidence & Risk Assessment Division CPHA June 2008

2 Context Understanding current public health roles and activities in chronic disease prevention and control (CDP) in Canada is an important foundation for public health policy development. –Can inform multi-level, pan-Canadian coordination of strategies and policies to reduce health inequalities.

3 Purpose To undertake a ‘mapping analysis’ to describe the current landscape of provincial/territorial (P/T) health systems and assess pan-Canadian public health functions and related strategies addressing chronic disease.

4 Methods Information sources: –National Collaborating Centre for Public Health- Public Health Structural Profile (2007) –Internal PHAC reports/files –Provincial/Territorial government reports/policy documents and websites –Chronic Disease Prevention Alliance of Canada- website resources and reports from P/T alliances Descriptive content analysis & comparison Next step: complete review of findings by Provincial/Territorial government representatives.

5 Scope of Analysis Limited to the government health sector-led strategies –Joint NGO-government strategies included. Includes range of public health activities across three pillars of stages of healthy living and chronic disease: –Health promotion, disease prevention, secondary prevention/management Analysis across: –Systems, structures and public health functions related to chronic disease –Conceptual models and frameworks relevant to chronic disease/healthy living –Nature of strategies/policies and related implementation activities –Available competencies and capacity for action on chronic disease.

6 Results: Public Health Systems & Structures for Chronic Disease Provincial leadership by 1-2 health ministries for policy development, standards, legislation, and several core public health functions. –Exception: NL, QC, NU, NT, YK have integrated health & social services ministries Health is no longer the only Provincial Dept./ Ministry that is concerned with chronic disease/healthy living: –Recent trend to creation of new wellness/healthy living P/T ministries: NB, ON, NS, MB

7 Results: Public Health System Structures Regional level authorities responsible for planning and management of health service provision including delivery of public health programs/activities. –Exceptions: ON-regional level public health units AB, PEI health care planning/responsibility at provincial level YK, NU deliver public health at local/community level via health centres. Local/community level delivery of health care services. –Many provinces (8) (have community health centres that provide integrated primary care and community health promotion.

8 Public Health Functions for Chronic Disease: Similarities Commonality: P/T leadership on surveillance, health promotion and disease prevention (policy development) and health protection. Consistency: P/T lead on health protection management/planning and legislation and regulation. Regional enforcement of health protection/environmental health. Disease screening/management has some involvement from all levels, implementation is primarily at local level.

9 Public Health Functions for Chronic Disease: Differences Variation in degree of P/T level mandate/ guidance, funding and program development support for health promotion and disease prevention activities. Lack of clarity on what level of system if any is responsible for population health assessment in some jurisdictions. Some emerging provincial responsibility for capacity building and knowledge exchange support to regional level.

10 Prov./ Terr. Conceptual Model for Chronic Disease Chronic Disease/ Healthy Living Strategy Strategies & Policies Include Knowledge Exchange & Capacity Building Initiative Healthy Eating Physical Activity Tobacco NL PE NS NB QC ON MB SK AB BC YK NT NU

11 Results: Related P/T Strategies Nearly all P/Ts have policy statements / strategies that address integrated Healthy Living and/or Chronic Disease under different names, all include reference to traditional lifestyle factors. –Healthy Living: PE, AB –Wellness: NL, NB, NT –Population health: SK –Healthy eating & physical activity: QC, ON –Healthy living/health promotion & chronic disease prevention: MB, BC –Chronic disease: NS Nature of guiding conceptual models of outcomes (health/disease), behaviours/risk factors, determinants and related action strategies vary based on focus of P/T strategy. –Ottawa Charter strategies prominent in all PT models

12 Results: Nature of Related P/T Strategies Several strategies mention Aboriginal people as a target population, very few have an Aboriginal-focused Strategy (e.g., BC-tobacco). P/T trend favouring development of integrated healthy living/disease strategies vs. disease specific strategies. –Disease specific organization are still active in all P/Ts and as key partners in the various strategies All strategies were developed in collaboration with community groups and NGOs. Three provinces have policies/initiatives that specifically address knowledge exchange/capacity building (Gov’t led: NS, ON, NGO/alliance led: MB).

13 Results: Focus on Social Determinants of Health Over 2/3 of P/Ts mention the importance of addressing some or all of the social determinants of health in their guiding models and policy strategies. Approx. 1/3 of P/Ts discuss the importance of addressing health status inequities between different populations related to cultural and social factors. Most focus on disparities (differences). Few P/T strategies include upstream strategies to address root causes.

14 Discussion Next steps: complete analysis of nature of actions/ activities implemented and available competencies/ capacities for chronic disease. –Identify assets & needs Opportunities: –Enhanced communication between public health system levels to ensure key public health functions are addressed. –Demonstrate success with practical efforts / interventions addressing social determinants within public health’s scope of action. –Learn from several P/T initiatives in capacity building as models for other jurisdictions to evidence-based public health practice. –Need for pan-Canadian knowledge exchange to share innovations and enhance coordination of efforts.

15 Questions: Thoughts Welcome… What is missing from the mapping analysis? What are the trends in public health roles and activities for chronic disease across the country? What are the unique or key contributions of various players? What is optimal balance of pan-Canadian policy/strategy coordination and allowing for flexibility/differences in chronic disease efforts? What models of multi-level collaborations can be used to strengthen efforts for chronic disease prevention?

16 Thank you! For follow-up comments and/or questions: Kerry Robinson, Ph.D.