Mapping the Role and Functions of Public Health in Chronic Disease Prevention and Control

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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

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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.

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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

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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

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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).

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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.

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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.

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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?

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Thank you!

For follow-up comments and/or questions:

Kerry Robinson, Ph.D.

[email protected]