2. Largest impact Smallest impact Reducing societal harms (Adapted from Frieden, T.R., AJPH. 2010; 100:590-595) COMPREHENSIVE APPROACH Systems (municipal, provincial, federal legislation) Environment (community Collaboration) Individual

3. Advocacy Advocacy is an effective strategy for addressing the social determinants of health. – visible leader or spokesperson – raise awareness and represent the need (public, media and political bodies). – Social, political and economic factors are all potential areas of advocacy

4. Advocacy Process Process is key – Provide education to Decision Makers/targets first – Once you have educated the targets and no action, go to the opposition – Takes time, expect setbacks Examples of Advocacy - Lobbying - Coalitions - Campaigning - Media

6. 6

7. - May 2011 The Gould Report Was Released.The Gould Report - August 2011 The Nova Scotia Health’s Working Groups Recommendations On Prescription Drug Overdoses is releasedWorking Groups Recommendations On Prescription Drug Overdoses - August 2011 N.S. Government makes Prescription Monitoring Program 24/7N.S. Government makes Prescription Monitoring Program 24/7 - October 2011 N.S. Government gives Annapolis Valley Health funding for methadone treatment.N.S. Government gives Annapolis Valley Health funding for methadone treatment. Community Advocacy – Amy Graves

8. Cigarette smoking Past year smoking 1996-2012 NSSDUS 2012

9. 190,986

10. battery, atomizer, cartridge battery + cartomizer

11. Health Canada’s Position

12. OpponentsProponents E-cigarettes are unproven cessation devices; should be required to undergo same rigorous testing for safety/efficacy as other NRTs E-cigarettes have potential to undermine major tobacco control gains E-cigarettes are clean drug delivery device that can satisfy smokers’ addiction to nicotine and to smoking behaviours Even if untested, health risks of e-cigarettes could not come close to those of cigarettes

13. How do we motivate communities? When can we coordinate our efforts? What happens when community energy is not reflected in DHA mandates or management? When do we (as staff) lead and when do we follow How do we best facilitate community-based advocacy? Discussion