Though we're very forward thinking in public health circles, we haven't quite mastered human cloning. Had we, I'm sure many delegates would have attended multiple concurrent sessions at TOPHC!
So if you were torn between two - or several - sessions, and had to choose just one to attend, fear not: the TOPHC website will soon be populated with most presentations from the convention.
Check in with us over the next couple of weeks for presentations as they become available.
Saturday, 9 April 2011
Social determinants of health: perception, misperception and utter lack of perception
University of Waterloo professor Kelly Anthony has been troubled by her undergraduate students’ lack of awareness of the determinants of health – especially the social determinants of health (SDH) – which she’s observed over a period of years. She’s concerned, too, that students in Waterloo
In terms of the messages about social justice, Anthony concedes that “the public doesn’t get it – because we haven’t done a good job of conveying them to the public.”
Recent literature on the perceptions of the SDH – and there’s not much of it, reports Anthony – indicates that more people believe that we have more agency in our overall health than we actually do. And research suggests that this misperception is getting worse, and that people are increasingly less likely to attribute others’ life circumstances health status to factors other than individual choice and action or inaction.
Presenting with Anthony was undergraduate student Danielle Kofler, who had been completely unaware of the SDH before she took Anthony’s course, and, she says, the course “completely transformed” her thinking. Kofler conducted her own small-sample study of the attitudes of predominantly female subjects within the university community toward agency and choice. The findings supported what Anthony has observed in her students: individuals’ agency and choice were consistently overestimated and the role of outside factors were downplayed or denied.
In terms of what can be done to increase the general awareness of social justice and the SDH, Anthony suggested that the government assume responsibility for promoting human rights and that increased public engagement be encouraged. Students need to be taught about these issues, and much earlier than in university. And the public health community must work harder at better messaging and better strategies for communicating those messages.
In the lively conversation that followed the presentation, the Wellesley Institute’s Bob Gardner recommended the Monopoly-style board game The Last Straw and the work of the Robert Woods Johnson Foundation as useful resources.
To evacuate or shelter-in-place? Emergency management for LTC homes and nursing homes
It 5:30 a.m. on Monday, January 5, 1998. You run a long-term care home in Epiville, a town of 27,000, not far from the Quebec
So what do you do? What are your most immediate concerns and next steps? How do the answers to those questions change when, shortly after 7 a.m., the roof collapses? Or when the hydro shuts off shortly thereafter? What needs to be in place to help with those answers? And with a vulnerable population in your care, do you evacuate the building or do you “shelter-in-place?” In other words, should you stay or should you go?
In an engaging Friday morning session entitled “Should We Stay or Should We Go? – Long-Term Care Homes and Nursing Homes Developing Plans for Sheltering-in-Place or Evacuation,” Richard Bochenek from OAHPP’s emergency management team walked participants through the emergency management cycle of mitigation, preparedness, response and recovery. After detailing the components of an emergency operations plan (EOP), and highlighting the level of thought and foresight such an undertaking requires, he put each working group in the midst of an escalating theoretical crisis, and asked its members to manage their way through the situation.
Bochenek distilled the decision to evacuate or shelter in place to a pair of simple formulas: if the threat faced by staying is greater than the risk posed by leaving, you must evacuate; if the risk (to the patients) posed by leaving is greater than the threat faced by staying, you must shelter-in-place.Bochenek reminded the group that EOPs are living documents that must be reviewed and tested annually, as well as after each emergency.
Assessing progress towards equity
The third plenary of TOPHC 2011 focused on an oft-recurring theme: achieving health equity and reducing health inequalities.
Speakers Bob Gardner, director of health care reform and public policy at the Wellesley Institute, Stephen Whitehead, Saskatoon’s medical health officer, and Penny Sutcliffe medical officer of health for Sudbury and District Health Unit, addressed the road to equity with a shared commitment and unique sets of experiences.
more to come...
Friday, 8 April 2011
A call for rain, while mixed with lightning: a case study of why the perfect political storm can effect health policy change
How do you enact public health policy change? Key informants and perfect political storms, help.
Michael Beeler, a fellow from the CIHR, spoke about Canada's 2001 decision to enter into a pre-purchase agreement to acquire the influenza vaccine for the entire Canadian population. Canada was the first country in the world to do this.
Michael Beeler, a fellow from the CIHR, spoke about Canada's 2001 decision to enter into a pre-purchase agreement to acquire the influenza vaccine for the entire Canadian population. Canada was the first country in the world to do this.
This was an interesting policy decision, as he said, because at the time in Canada there was no demand for this. And yet, the government was willing to spend $35-million for the procurement of vaccines and for the facilities to store them. This decision was not done as a response to an emergency, there was no precedent in the world for this, and yet the government was preparing to vaccinate the entire Canadian population within four months. The procurement, as he said, was based entirely on hypothetical models.
He explained the policy analysis 'problem stream': the policy didn't arise because of a large scale public emergency. In fact, he said, it was a very minor incident in 1997 of avian flu in Hong Kong that caught the attention of decision makers in public health agencies. Further, he noted that the global community was talking about pandemic preparedness at international conferences. Of note, some very senior Canadian officials were key delegates at these conferences.
What was notable, he said, was that these discussions were all amongst the policy community; there was no effort to engage the public. This example shows that it's possible to effect policy change if you lobby / involve key decision makers, even absent of public attention. Health Canada was willing to put together numbers and take them to key decision makers. Evidence did not play a strong role in creating this policy, but precautionary principle did: As it was explained by policy makers, catastrophic costs would be incurred if we didn't have a large scale vaccination program.
What was notable, he said, was that these discussions were all amongst the policy community; there was no effort to engage the public. This example shows that it's possible to effect policy change if you lobby / involve key decision makers, even absent of public attention. Health Canada was willing to put together numbers and take them to key decision makers. Evidence did not play a strong role in creating this policy, but precautionary principle did: As it was explained by policy makers, catastrophic costs would be incurred if we didn't have a large scale vaccination program.
To do this, public health agencies and the five largest pharmaceutical companies in Canada came together. There was overwhelming consensus among the agencies about the policy and pharma was willing to finance the huge cost.
He then explained what happened on political scene: there was significant pressure on the federal government to increase health care spending, based on years of budget surplus. Also, there was pressure to give to the 'have not' provinces more, notably Quebec. Policy advocates hired a former minister as a key lobbyist. And, the interests of the governing party - the Liberals - featured prominently.
As Beeler said, we won't really know the behind closed doors conversations as to how this policy was enacted, but we can surmise.
It's full of holes, and needs repair...
...our dental care system in Canada, that is.
TOPHC's Friday luncheon speakers, Dr. Garry Aslanyan of the World Health Organization and Dr. Carlos Quiñonez, of the Faculty of Dentistry, University of Toronto presented findings from the paper: "Putting Our Money Where Our Mouth Is: The Future of Dental Care in Canada," from the Canadian Centre for Policy Alternatives.
They presented some sobering statistics:
- Of an estimated $12.6-billion spent on dental services across Canada in 2009, only 5 per cent was publicly funded.
- That's an incredible contrast in terms of health care spending, which received $182-billion in funding, of which 70 per cent was publicly funded.
- A steady increase in per person spending on oral health care:
- In 1975, the average person spent $135 on oral health care. In 2010: $379.
- And in terms of public dollars invested in oral health care: $11 in 1975, compared to $19.50 in 2010.
- In 2010, 62 per cent of Canadians had private dental insurance, and 6 per cent were covered by publicly funded programs - mostly the poorest people in Canadian communities. That means almost a third of Canadians had neither public nor private insurance to address their oral health care.
- No jurisdiction in Canada has a comprehensive oral health strategy.
Why this report - why now? The authors cited two main reasons: Firstly, the 'signs' of change in Ontario, with $45-million allocated to dental care. Secondly, the timing with the renegotiation of FTP health accord.
The CCPA brought various groups from across Canada together to discuss the issues. Their conclusions are noted in the report. And from the report, Aslanyan and Quiñonez highlighted some points of convergence for policy action:
- Save money and improve health - put money where our mouth is.
- Save money in long term and improve quality of life of those in need
- Re-allocate spending to 'upstream' solutions
- Make better use of all oral health care providers
- A need for oral health policies both on provincial and national levels
Listen. Respond. Engage
Don't be afraid. Just do it.
That was the message a team from Halton Public Health (HPH) left a room full of public health practitioners who are hesitant to use social media to reach out to concerned parents.
That was the message a team from Halton Public Health (HPH) left a room full of public health practitioners who are hesitant to use social media to reach out to concerned parents.
About six months ago, HPH launched Halton Parents – twitter and blogging sites to provide support to parents in the community.
The site came about as HPH realized that social media isn’t just a fad; it is a fundamental shift in the way everyone communicates. The health unit created a parenting strategy that actively reached out to parents and talk about various issues from bullying to fluoridation.
The tweets and blog entries are posted by public health nurses who are listening, talking and engaging an entire community.
HIRA learning: identifying hazards, assessing risk
Simultaneous workshops in separate Dockside rooms on Thursday afternoon gave delegates an opportunity to apply their understanding of Hazard Identification and Risk Assessment to real and hypothetical situations.
In the session entitled Public Health Planning for Mass Gathering Events – Lessons from the G8 and G20, presenters including Brian Schwartz, Jessica Harris and Charles Gardner shared their experiences identifying hazards and assessing risk related to last year’s G8 and G20 Summits. They then introduced a hypothetical international summer sporting event to be held in multiple locations in the Toronto
In the session Don’t Hazard a Guess: Learning How to Develop a Hazard Identification Risk Assessment (HIRA) and a Continuity of Operations Plan (COOP) for Your Organization, Judyth Gulden and Richard Bochenek offered an engaging primer in the development of each document. In the brainstorming sessions that followed, they encouraged participants to expand their understanding of what true emergency preparedness would require in their local health unit or office, and provided practical examples in each case.
Sobering statistics: new facts about alcohol consumption
On Thursday morning, in the first of three sessions presenting the results of new research on alcohol consumption, Robert Mann of the Centre for Addiction and Mental Health made a strong case for Ontario
He began with an informal survey of the alcohol-related “news” that’s disseminated by the media, and the important information that isn’t.
In the news, we hear (once again) about the possible sale of the LCBO to the private sector, about extended hours for sporting events and arts festivals, and about one political figure or another who favours cheap, “buck-a-beer” prices.
What we don’t hear about is the fact that the harmful use of alcohol is the third leading risk factor for premature death and disabilities in the world – and in high-income economies such as ours, it is the second leading risk factor.
- About 25 per cent of students in grades 7 to 12 reported binge drinking (five or more drinks on one occasion) at least once during the past month, in 2009. That’s about 250,000
Ontario
- A full fifty per cent of grade 12 students reported binge drinking in the past year.
- Roughly 34,000
Ontario
- The basic equation for alcohol consumption looks like this:
Increased availability of alcohol = increased consumption = increased morbidity and mortality
- Best practices for reducing the harmful use of alcohol include having a government monopoly on the sale of alcohol (the privatization of alcohol sales in
Alberta
 |
| The subtitle should read: Keep drinking.We'll get you there sooner. |
In his presentation, Ben Rempel of OPHA illustrated the perils of unregulated alcoholic-beverage advertising in Canada Canada
And here, as with virtually every other aspect of modern life, the Internet has a role to play. Ads that could never last on television enjoy a robust cyberlife on YouTube and similar sites.
OAHPP’s Carly Heung presented research on alcohol and community-based violence among young people in the “late-night economy,” which includes bars and nightclubs. She identified the ultimate challenge in reducing this type of violence: “we have to change public attitudes around the acceptability of intoxication.”
Statistics show that Canadians’ consumption of alcohol is on the rise. In the absence of strong, evidence-based alcohol policies – including those aimed at reducing “high-risk drinking” – and strictly enforced regulations on the advertising of alcohol, the harmful individual and societal effects of alcohol can only rise as well. Reason enough, say today’s presenters, for decisive action on both fronts.
Gulf Oil Spill as public health crisis: what the media didn’t tell us… and perhaps didn’t understand
Most everyone in the attendance at TOPHC’s second plenary session on Thursday morning knew of the massive British Petroleum oil spill that took place in the Gulf of Mexico, off of the coast of
LuAnn White, director of the Tulane Center for Applied Environmental Health (CAEPH), in New Orleans
“If you’re not thinking in the long term,” said White, “you won’t be collecting the data you need to assess effects over time.” Establishing baseline data is critical.
White also detailed the environmental, economic and health-related after-effects of the spill – which ran contrary to what those with no direct connection to the region, or who rely on news reports for their information, may have come to believe.
She presented evidence indicating that the Gulf seafood appears safe to eat, the air quality appears not to contain oil-related toxins in harmful concentrations and the impact on marine and bird life was less than devastating. Perhaps most surprisingly, much of the oil either evaporated, or clumped together into relatively easily removable tar balls (not a scientifically accurate description, perhaps, but that’s the gist), and did not decimate the natural environment.
Most media outlets, though, seemed intent on drawing parallels between the Deepwater Horizon spill and that of the not-terribly-similar. Exxon Valdez in 1989. So the general public could only assume the worst, stop eating Gulf-area seafood and cancel trips to the region.
“Communication is critical.” This message was echoed several times throughout the presentation, and was one of its most resounding “takeaways.” The necessity of having a communications “command central” and a tight control on information disseminated to the media and the public during the crisis was not without its drawbacks. And in other respects, the communications efforts came up short.“We didn’t communicate the data well enough to counter the misperceptions,” said White, highlighting an ongoing challenge for scientists and public health professionals, and an uphill battle for Gulf-area interests even today.
Having the evidence or data is one thing. Finding a way to communicate it – so that it’s clear and comprehensible (and dare we say compelling) to a non-scientific audience, including the media, is another thing entirely. But it’s absolutely essential.
Thursday, 7 April 2011
Lessons from Haiti
As relief efforts continue in Haiti, TOPHC – in partnership with Roche Canada – hosted a feature breakfast that highlighted the ongoing public health crisis in Haiti.
Fayola Creft, an emergency management specialist with the OAHPP, showed a video that highlighted a collection of her snapshots and video streams of Haiti just 10 days after the earthquake happened. Creft, who spent 4 days in transit trying to get there, ended up working in the pediatric ward of a hospital, wearing many hats – as she said, “from delivering babies to dressing wounds.”
We spoke with Creft after her video was played.
What should we know about Haiti and the ongoing crisis there?
“Haiti, in general, will always be in a recovery phase. It’s been a struggling country forever. It will take a very long time to recover from the earthquake.”
She noted many of the implications health-wise, notably “a cholera epidemic that continues, indicides of malnutrition, normal third world health conditions that effect the population, no job security and no health education for young mothers and babies.”
What are some of the ‘global lessons’ from Haiti’s crisis, and the Red Cross efforts there?
"We need to consider a Global approach to disaster response and preparedness. The Red Cross has been in Haiti for a long time. They have they have an established relationship with those on the ground - and they connect with all of the Red Cross movement globally. They know how to respond to disasters as a whole. They’ve been implementing programs with established experiences and responses."
What would you say is your main ‘takeaway’ from this?
"Successful responses to emergencies involve preparedness. It can’t be done on the fly. Response mechanisms have to be established before a crisis.
“It’s our human nature to take care of each other, but success comes from being prepared.”
We encourage you to support the Integrated Health Program for Haiti by making a donation to the Canadian Red Cross at www.redcross.ca/TOPHC.
Fayola Creft, an emergency management specialist with the OAHPP, showed a video that highlighted a collection of her snapshots and video streams of Haiti just 10 days after the earthquake happened. Creft, who spent 4 days in transit trying to get there, ended up working in the pediatric ward of a hospital, wearing many hats – as she said, “from delivering babies to dressing wounds.”
We spoke with Creft after her video was played.
What should we know about Haiti and the ongoing crisis there?
“Haiti, in general, will always be in a recovery phase. It’s been a struggling country forever. It will take a very long time to recover from the earthquake.”
She noted many of the implications health-wise, notably “a cholera epidemic that continues, indicides of malnutrition, normal third world health conditions that effect the population, no job security and no health education for young mothers and babies.”
What are some of the ‘global lessons’ from Haiti’s crisis, and the Red Cross efforts there?
"We need to consider a Global approach to disaster response and preparedness. The Red Cross has been in Haiti for a long time. They have they have an established relationship with those on the ground - and they connect with all of the Red Cross movement globally. They know how to respond to disasters as a whole. They’ve been implementing programs with established experiences and responses."
What would you say is your main ‘takeaway’ from this?
"Successful responses to emergencies involve preparedness. It can’t be done on the fly. Response mechanisms have to be established before a crisis.
“It’s our human nature to take care of each other, but success comes from being prepared.”
We encourage you to support the Integrated Health Program for Haiti by making a donation to the Canadian Red Cross at www.redcross.ca/TOPHC.
Public health innovation: Are we there yet?
Did you know that approximately two billion people travel each year by air? If you are an infectious disease specialist, you read that statement as: “uh oh... infectious diseases to travel by airplanes globally even faster.”
Dr. Kamran Khan, physician at Mt. Sinai Hospital, enthralled a packed room of public health practitioners with his presentation on Bio.diaspora – an innovative project with a mission to understand global airline transportation network as a conduit for international spread of infectious diseases.
Dr. Kamran Khan, physician at Mt. Sinai Hospital, enthralled a packed room of public health practitioners with his presentation on Bio.diaspora – an innovative project with a mission to understand global airline transportation network as a conduit for international spread of infectious diseases.
Bio.diaspora also works together with Healthmap project (www.healthmap.org) – an exciting project that automates real-time monitoring of online health news currently in seven languages through official and unofficial sources. Early awareness of epidemics could be used to facilitate timely risk analyses for infectious diseases.
He was followed by Niall Wallace, president of Infonaut, who talked about some innovative projects in health in Ontario. Both Kamran and Niall talked about the challenges of being an innovator in the province.
Dr. Arlene King, chief medical officer of health, had earlier set the stage for adopting innovation in public health by calling upon public health practitioners to embrace new ideas, new technologies and new ways of doing things.
Dr. Arlene King, chief medical officer of health, had earlier set the stage for adopting innovation in public health by calling upon public health practitioners to embrace new ideas, new technologies and new ways of doing things.
“We need to set sights on a goal and not be going in circles by figuring out the best process,” said Dr. Vivek Goel, president and CEO of OAHPP, as he summed up the session and urged the provincial leaders to pay special attention to innovators and encourage innovation in the province.
When it comes behaviour change, throw out the rule book!
What’s wrong with rules?
Rules can have the opposite of the desired effect and may reinforce undesired behaviour.
- Anyone with a teenage knows that using “don’t” is an invitation to “do”
- People aren’t motivated by negative consequences. Gyms don’t advertise their services with pictures of unhealthy, unfit individuals. Focus on the positive outcome instead
- People spend their lifetime breaking rules. Think about how many people drive above the speed limit, “because everyone does”
- And there are too many rules to remember
At the end of the day, rules don’t make it easier to change behaviour.
Fear not! You can use social marketing to change behaviour.
Social marketing is a process that blends traditional marketing concepts to motivate behaviour change.
Once you identify a target audience, there are four steps to changing behaviour:
1. Get your audience to believe there is a problem
2. Get your audience to believe it is their problem
3. Get your audience to believe there is a solution
4. Get your audience to believe that they can personally implement the solution.
To fulfill these requirements, you’ll need to spend 95 per cent of your time getting to know your target audience. You’ll need to identify their barriers and understand their beliefs. The more specific the information the better.
You now have the tools you need to change behaviour. So what are you waiting for?
TOP 10 reasons to love ONBOIDS
1. ONBOIDS: It just sounds neat. (Of course, it stands for the Ontario Burden of Infectious Disease Study)
2. Novel: No one in Canada has looked specifically at the burden of infectious diseases.
3. Collaboration: 7 authors, many more contributors.
4. Builds on previous international and Canadian work.
5. Big numbers, huge implications: In Ontario, there are over 7,000,000 infectious disease episodes and nearly 4,900 deaths from infectious diseases.
6. Identification...of the most burdensome infectious agents: hepatitis C virus (HCV), Streptococcus pneumoniae, human papillomavirus (HPV), hepatitis B virus (HBV), Escherichia coli, human immunodeficiency virus (HIV/AIDS), Staphylococcus aureus, influenza, Clostridium difficile and rhinovirus
7. "The Big 5"...most burdensome infectious syndromes, that is: pneumonia, septicaemia, urinary tract infections, acute bronchitis and endocarditis.
8. The study defies public perception. Many of the pathogens ranked among the top 20 receive little recognition as significant contributors to disease burden in the population.
9. Some really great news: Childhood vaccination works, as the the mortality and morbidity associated with illnesses have been largely eliminated as a result of the success of routine childhood vaccination programs.
10. Informs decision-making, identifies areas of future research and action, and highlight gaps in data availability and quality.
For more information about the study, please go to the ICES website at: http://www.ices.on.ca/file/ONBOIDS_FullReport_intra.pdf
Or the OAHPP website at:
2. Novel: No one in Canada has looked specifically at the burden of infectious diseases.
3. Collaboration: 7 authors, many more contributors.
4. Builds on previous international and Canadian work.
5. Big numbers, huge implications: In Ontario, there are over 7,000,000 infectious disease episodes and nearly 4,900 deaths from infectious diseases.
6. Identification...of the most burdensome infectious agents: hepatitis C virus (HCV), Streptococcus pneumoniae, human papillomavirus (HPV), hepatitis B virus (HBV), Escherichia coli, human immunodeficiency virus (HIV/AIDS), Staphylococcus aureus, influenza, Clostridium difficile and rhinovirus
7. "The Big 5"...most burdensome infectious syndromes, that is: pneumonia, septicaemia, urinary tract infections, acute bronchitis and endocarditis.
8. The study defies public perception. Many of the pathogens ranked among the top 20 receive little recognition as significant contributors to disease burden in the population.
9. Some really great news: Childhood vaccination works, as the the mortality and morbidity associated with illnesses have been largely eliminated as a result of the success of routine childhood vaccination programs.
10. Informs decision-making, identifies areas of future research and action, and highlight gaps in data availability and quality.
For more information about the study, please go to the ICES website at: http://www.ices.on.ca/file/ONBOIDS_FullReport_intra.pdf
Or the OAHPP website at:
Capt. Tech to the rescue – how technology is enabling public health
Are you tired of just working at your desk? Do you dream of ways of how technology can help create healthier communities? Are you looking for examples of how technology is enabling healthier communities across the province?
A keen group of participants who answered “yes” to the questions above gathered this morning at the technology session at TOPHC to learn about three concrete examples of how technology is enabling healthier communities.
Amanda Mongeon started the session by giving us a tour of a unique way the Timiskaming Health Unit is engaging the community to create a healthier Timiskaming. Visit http://www.healtytimiskaming.ca/ to see how the community is taking ownership of their health matters.
Eileen de Villa, associate medical officer of health from Peel Public Health gave us a tour of SIMID – tool to enable visualization of the dynamics of infectious disease outbreaks over time and space. The tool provides public health officials and key decision makers with more effective local infectious disease outbreak planning tools. You can see the presentation here.
Ken Hudson from infiteSpaces, at Loyalist College and Jean Terhaar from Hastings and Prince Edward Counties health unit talked about Sloshed – a game to promote the negative impact of binge drinking among students in a fun, humourous, non-judgemental and non-preaching fashion. You can play the game at: http://www.sloshedthegame.com/.
A keen group of participants who answered “yes” to the questions above gathered this morning at the technology session at TOPHC to learn about three concrete examples of how technology is enabling healthier communities.
Amanda Mongeon started the session by giving us a tour of a unique way the Timiskaming Health Unit is engaging the community to create a healthier Timiskaming. Visit http://www.healtytimiskaming.ca/ to see how the community is taking ownership of their health matters.
Eileen de Villa, associate medical officer of health from Peel Public Health gave us a tour of SIMID – tool to enable visualization of the dynamics of infectious disease outbreaks over time and space. The tool provides public health officials and key decision makers with more effective local infectious disease outbreak planning tools. You can see the presentation here.
Ken Hudson from infiteSpaces, at Loyalist College and Jean Terhaar from Hastings and Prince Edward Counties health unit talked about Sloshed – a game to promote the negative impact of binge drinking among students in a fun, humourous, non-judgemental and non-preaching fashion. You can play the game at: http://www.sloshedthegame.com/.
Making Ontario the Healthiest Province
Why should we care about making Ontario the healthiest province? Here's one reason, for the first time, it is a possibility that the generation after us may have a lower life expectancy than us. Another reason, Ontario likes to be the best at everything.
Three panellists presented Ontario based initiatives to inspire and spur dialogue at the session, "Making Ontario the Healthiest Province":
• Tobacco remains the leading cause of preventable disease and death in Ontario. Hence the need for a Comprehensive Tobacco Control program. Heather Manson outlined the program as an example of a complex issue that needed a complex solution to enhance community mobilization. Read the report, Evidence to Guide Action.
• A recent study found that 70 per cent of parents with children in primary school identified physical and health education as very important. For the first time ever, children were included in the review of the revised Health and Physical Education Curriculum and they also identified health as very important. James Mandigo spoke of the new curriculum which aims at developing physical and health literacy by developing comprehension, capacity and commitment to lead healthy active lives and to champion healthy, active living. He also identified resources developed by Ophea to help educators implement the new curriculum. Click here to access them.
• Poor mental health is both a cause and a consequence of experiencing social, economic and environmental inequities. Michelle Gold spoke of mental health promotion and reminded participants that, “There is no health without mental health” (World Health Organization). Gold pointed participants to Vic Health, a leader in mental health promotion. Read their report Evidence Based Mental Health Promotion Resource.
We’re making progress, but there is room for improvement. Panellists championed strong leadership, a whole of government approach and public engagement to move us closer to the vision of a healthier Ontario.
In honour of technology day, some interesting findings from the conference floor.
Between sessions, make sure to check out some of the exhibitor booths on the main floor of the convention centre.
"While I may never care what my lungs look like, I certainly care what my face looks like," said a conference attendee who stopped by the booth showcasing computer imagery that transforms the object of the photo into that of a 65-year-old smoker.
The images are shocking, to say the least.
What this kind of technology might do for smoking cessation projects...
"While I may never care what my lungs look like, I certainly care what my face looks like," said a conference attendee who stopped by the booth showcasing computer imagery that transforms the object of the photo into that of a 65-year-old smoker.
The images are shocking, to say the least.
What this kind of technology might do for smoking cessation projects...
Presidents’ reception: saluting the spirit of collaboration
The first day of the inaugural Ontario Public Health Convention came to a festive end with the Presidents’ Reception in the Frontenac Ballroom.
Delegates, presenters and exhibitors joined the presidents of the convention’s three partner organizations – Vivek Goel, president of the Ontario Agency for Health Protection and Promotion (OAHPP), Liz Haugh, president of the Ontario Public Health Association (OPHA) and Valerie Sterling, president of the Association of Local Public Health Agencies (alPHa) – and Paul Lucas, president of the convention’s platinum sponsor, GlaxoSmithKline, for refreshments and remarks.
Vivek Goel thanked OAHPP’s Ian Johnson for his tireless efforts at TOPHC’s helm, and acknowledged the chair of agency’s board of directors, Terry Sullivan, who was in attendance. He also TOPHC's esteemed guests: A sense of the importance of this public health event was echoed by most every speaker at the reception. Liz Haugh spoke of the “strong, vibrant partnership” that is beginning with this event; Valerie Sterling mentioned the spirit of collaboration and partnership that characterizes the public health sector and the common thread that ran through the diversity of topics presented during the first day's sessions.
Building on this sense of potential and spirit of collaboration, Arlene King issued a challenge to TOPHC organizers and the public health community at large: she wants to see TOPHC double its attendance within five years!
Assessing equity: There is no “general population”
Delegates attending the afternoon Regatta Room session entitled “A Health Equity Assessment Framework for Ontario’s Public Health Units,” were offered a sneak peek at a new model for assessing planned and existing policies and programs. They also had a chance to put the framework through its paces with two case studies: a strategy to prevent childhood obesity and a harm-reduction strategy for users of illicit drugs.
The trio of presenters – Brian Hyndman, Ingrid Tyler, and Daniela Seskar-Hencic – introduced the new framework and contextualized it within the World Health Organization definitions of “health equity” and “health inequalities,” the Ontario Public Health Standards (OPHS) Foundational Standards (2008), and the commitment to equity contained in the Ontario Agency for Health Protection and Promotion’s founding legislation.
The equity assessment framework comprises four steps, each with its own series of questions and issues for consideration. Public health professionals can employ a variety of recommended processes – including a literature review, environmental scan, analysis of existing data and consultation with stakeholders – to determine the scope of their assessments and answer the questions posed within the framework.
The delegates conducted small-group discussions, using the framework to assess the strategies outlined in the case studies. A lively follow-up discussion with the group as a whole yielded positive feedback and constructive criticism on the framework itself and the means by which it might be field-tested in the future.
“Public health units need to be fully aware of the composition of the communities they serve, including those groups at greatest risk of poor health outcomes,” noted a handout distributed at the session. The new equity assessment framework is a work-in-progress that should prove useful in maintaining an awareness of equity-related concerns at all stages of the policy and/or program development and review process.
Wednesday, 6 April 2011
Smoking: an epidemic
Smoking is the number one cause of death and disease in Ontario. It kills 13,000 people every year.
We know that and yet a smoke-free Ontario is still far from being a reality. To discuss why that is the case, participants gathered for an interactive panel session on “Tobacco Endgame: Evidence, Knowledge Exchange and Politics (So Close and Yet so Far).”
Robert Schultz, associate professor in the Department of Public Health Sciences, and director of evaluation and monitoring, principal investigator, and research scientist at the Ontario Tobacco Research Unit, laid the foundation for the discussion by explaining why we haven’t yet won the tobacco endgame.
Robert Schultz, associate professor in the Department of Public Health Sciences, and director of evaluation and monitoring, principal investigator, and research scientist at the Ontario Tobacco Research Unit, laid the foundation for the discussion by explaining why we haven’t yet won the tobacco endgame.
He was followed by Michael Perley, director, Ontario Campaign for Action on Tobacco, who spoke about arguments against the “B” word a.k.a banning!
Dr. Hazel Lynn, medical officer of health for Grey Bruce, followed next with local perspective on the end game. Her presentation drove home that point that smoking is an adult problem and we need to take action.
The presentations were followed by three excellent case studies:
- Ending exposure to second-hand and third-hand smoke by Roberta Ferrence and Jaclyn Kaye – Ontario Tobacco Research Unit, University of Toronto
- Branding of cigarette packs – David Hammond, Dept of Health Studies & Gerontology, University of Waterloo
- Reducing retail availability: is the endgame hindering progress by Michael Chaiton, a professor in Tobacco and Public Health at U of T and a scientist at the Ontario Tobacco Research Unit.
I came out of the session with a better understanding of the politics involved in the tobacco endgame; why advocacy and lobbying are critical in implementing smoke-free environments and how together by working at local, provincial and federal levels can help us achieve our goal of Smoke-Free Ontario!
“Food and water are life”
Delegates convened in Pier 3 to take part in an interactive panel session entitled, “What About Food Skills?”
Colleen Kiel from the Ministry of Health Promotion and Sport (MHPS), opened the session by framing food skills as outlined in the Ontario Public Health Standards, which requires Food Skills as part of Chronic Disease Prevention standards.
Kiel suggests that there are different meanings of food skills and that health units should consider defining food skills in a way that considers the needs of the local community and the health unit capacity. At a minimum the definition should include: food selection, healthy food preparation and food storage. A more fulsome definition would also include: knowledge, planning, conceptualizing food, mechanical techniques and food perception.
Next Ruth Sanderson an epidemiologist at OAHPP reviewed approaches to monitoring food skills. Currently no standard measurement tool, commonly used indicator, or approach to systematically monitor the population’s food skills exist. She explored four assessment tools, two of which took place in Ontario. This work has approached the monitoring of food skills as a set of knowledge, behaviours and skills linked to the individual. Sanderson challenged the participants to consider food skills, as not solely related to the individual, but to also consider the environmental context.
Pat Vanderkooy from the Region of Waterloo Public Health gave the audience a glimpse into food skill competencies in the Waterloo Region. A few interesting findings from the Cross-sectional Waterloo Region Area Survey were:
To read more on Food Skills in Waterloo, click here.
Vanderkooy highlighted some of the key successes from the Waterloo peer program, which included: increased/better food skills, the adoption of healthier eating behaviours, illness/disease prevention, empowerment and community food security.
She noted that it is of the utmost importance to understand your audience. “We can talk about the Canada Food Guide forever,” said one participant, “but if they don’t see how this can be part of the meal or you don’t understand the social situation, you’ve lost a big part of the picture.” Without making the content relevant, food skills lose the traction they need to encourage long-term behavioural changes.
A lively discussion took place about the role of food skill competencies could play in the primary education curriculum. While we have yet to see our own celebrity chef champion the cause as Jaime Kennedy did, panellists agreed that linkages are needed across the spectrum of society. As Vanderkooy said, “Food is no longer the cause of a few passionate nutritionists and chefs. Food and water are life.”
Marian Yusuf from Toronto Public Health had many successes to share with the group as well. She talked about the Toronto Food Strategy, which acknowledges that equitable food access requires a health-focused sustainable food system. “The strategy looks at the whole system from farm to food disposal. The overarching goal is health. The strategy is about social justice, food literacy for everyone, environmental protection, strengthening communities, supporting local, green equitable food access,” said Yusuf. The strategy was informed by Cultivating Food Connections: Toward a Healthy and Sustainable Food System for Toronto.
Elizabeth Smith from the Nutrition Resource Centre concluded the session by examining food skills in provincial programs. The Centre has been working on food skills for nearly 20 years with 15 sites in Ontario and 250 Community Food Advisor volunteers. Smith also talked about the ready to use Colour It Up program, which addresses barriers to healthy eating and has seen uptake in Toronto and other local municipalities.
Participants came away from the session with a lot of great examples of how food skills can become part of public health strategies that aim to prevent chronic disease ... a lot of food for thought.
Colleen Kiel from the Ministry of Health Promotion and Sport (MHPS), opened the session by framing food skills as outlined in the Ontario Public Health Standards, which requires Food Skills as part of Chronic Disease Prevention standards.
Kiel suggests that there are different meanings of food skills and that health units should consider defining food skills in a way that considers the needs of the local community and the health unit capacity. At a minimum the definition should include: food selection, healthy food preparation and food storage. A more fulsome definition would also include: knowledge, planning, conceptualizing food, mechanical techniques and food perception.
Next Ruth Sanderson an epidemiologist at OAHPP reviewed approaches to monitoring food skills. Currently no standard measurement tool, commonly used indicator, or approach to systematically monitor the population’s food skills exist. She explored four assessment tools, two of which took place in Ontario. This work has approached the monitoring of food skills as a set of knowledge, behaviours and skills linked to the individual. Sanderson challenged the participants to consider food skills, as not solely related to the individual, but to also consider the environmental context.
Pat Vanderkooy from the Region of Waterloo Public Health gave the audience a glimpse into food skill competencies in the Waterloo Region. A few interesting findings from the Cross-sectional Waterloo Region Area Survey were:
- Women are more skilled in food preparation and food-related activities than men
- Adults in households with higher incomes are less likely to have “good” food skills than those with lower incomes
- Most households still take more than 30 minutes to cook their main meal, but not many meals are cooked from scratch.
Vanderkooy highlighted some of the key successes from the Waterloo peer program, which included: increased/better food skills, the adoption of healthier eating behaviours, illness/disease prevention, empowerment and community food security.
She noted that it is of the utmost importance to understand your audience. “We can talk about the Canada Food Guide forever,” said one participant, “but if they don’t see how this can be part of the meal or you don’t understand the social situation, you’ve lost a big part of the picture.” Without making the content relevant, food skills lose the traction they need to encourage long-term behavioural changes.
A lively discussion took place about the role of food skill competencies could play in the primary education curriculum. While we have yet to see our own celebrity chef champion the cause as Jaime Kennedy did, panellists agreed that linkages are needed across the spectrum of society. As Vanderkooy said, “Food is no longer the cause of a few passionate nutritionists and chefs. Food and water are life.”
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| Marian Yusuf |
Elizabeth Smith from the Nutrition Resource Centre concluded the session by examining food skills in provincial programs. The Centre has been working on food skills for nearly 20 years with 15 sites in Ontario and 250 Community Food Advisor volunteers. Smith also talked about the ready to use Colour It Up program, which addresses barriers to healthy eating and has seen uptake in Toronto and other local municipalities.
Participants came away from the session with a lot of great examples of how food skills can become part of public health strategies that aim to prevent chronic disease ... a lot of food for thought.
The Incident Management System in Ontario
While the session was entitled, "From SARS to H1N1: What Have We Learned – A Discussion on How the Ontario Health Care and Public Health Systems can Benefit from the Continued Development of the Incident-Management System (IMS)," it might have been more appropriately renamed: "IMS and Ontario: a happy, well-considered marriage for emergency management."
To read about the Incident Management System in Ontario, please click here.
And why do Ontarians need IMS? Because we've learned from past public health events, from the ice storm in '98, to the 2003 SARS outbreaks, to the H1N1 flu virus. In Ontario, we've had very high profile public concerns, balanced with a low tolerance for failure and no province wide IMS.
Ontario's IMS respects existing structures in Ontario, Ontario’s stakeholder groups and takes advantage of the strengths of existing emergency management systems in Ontario.
According to presenter Dr. Brian Schwartz, the basics of IMS outline the following:
1. Who is in charge 2. How do you communicate and 3. How do you scale up and down?
Looking forward, Schwartz said, "We are building an evidenciary-based model for emergency management. We continue to improve the model. We need to be in partnership with local public health units, and we have to adopt the IMS structure to our own areas of public health."
To read about the Incident Management System in Ontario, please click here.
And why do Ontarians need IMS? Because we've learned from past public health events, from the ice storm in '98, to the 2003 SARS outbreaks, to the H1N1 flu virus. In Ontario, we've had very high profile public concerns, balanced with a low tolerance for failure and no province wide IMS.
Ontario's IMS respects existing structures in Ontario, Ontario’s stakeholder groups and takes advantage of the strengths of existing emergency management systems in Ontario.
According to presenter Dr. Brian Schwartz, the basics of IMS outline the following:
1. Who is in charge 2. How do you communicate and 3. How do you scale up and down?
Looking forward, Schwartz said, "We are building an evidenciary-based model for emergency management. We continue to improve the model. We need to be in partnership with local public health units, and we have to adopt the IMS structure to our own areas of public health."
Evidence, with Nancy Edwards.
Consider the structural determinants of health.
That was one of the many takeaways received by the audience who attended Nancy Edwards' plenary on Evidence.
In “Evidence for public health action: perspectives of a research funder,” Edwards, Scientific Director of the CIHR-IPPH, outlined her thoughts on using evidence to move forward the public health agenda. As she said, “we can’t keep doing things the way they have been done.”
Edwards started her talk with a brief summary of some past successes in the province; she said we'd come a long way over the past 25 years in Ontario, including: teaching health units, PHRED systematic reviews, health-evidence.ca, PHAC - National Collaborating Centres, CHNET-Works! and applied health research networks.
She said that the challenge for those of us in public health is: “How do we take this evidence that's produced and use it so that it’s not left on shelves?"
She noted new research generated in the last 25 years, including:
· socioeconomic gradients of health,
· effectiveness of behavioural interventions,
· organizational interventions that support practice changes,
· randomized controlled trials of multi-strategy and multi-level complex interventions,
· multiple intervention trials that have yielded unexpected results,
· lack of community engagement in design of intervention,
· and relatively short time frames for studies reduced intervention potency study.
Edwards then challenged the audience to consider how health problems or phenomena are recurrently produced by the system. She said the science is shifting from:· · understanding determinants to examining the impact of coherent, multi-level interventions and policy
· describing socioeconomic gradients to interrogating health inequities
· describing socioeconomic gradients to interrogating health inequities
· · controlling context to understanding the influence of context on interventions.
She outlined some future challenges, including addressing health inequities. She said where many calls for action exist in Canada, and, despite research and some successes, "we need to understand the pathways to health equity."
And what about those structural determinants of health? She said we don't ask about them because they are so a part of who we are, so we often overlook them. She provided the example of First Nations communities, and what was most overlooked was the structural determinant of their health: the-residential schools in which they grew up. Edwards said, “if we're serious about working upstream, we have to get at these structural determinants of health."
Some of her further conclusions:
· We need intersectoral action, including interprovincial and intercountry research initiatives.
· We need to consider implementation systems. Ask the questions: “what is it that makes these interventions happen? What makes it work? and what produces failures?
· She also touched on population and public health ethics. She said that ethics helps us to bring equity to the forefront of research and policy making.
Going forward, Edwards noted some critical issues, including:
· linking evaluation and research
· addressing research funding realities
· extending research designs and methods
· bringing together strengths of evaluation and research
· developing priorities for data harmonization
· determining if we are closing the equity gap and
· shifting the structural determinants of health
"Health for All"
The symposium featured guest speakers Irving Rootman and John Garcia, and a panel discussion focused on critical reflection of the Charter and its impacts with moderator, Vivek Goel, and panelists Sandra Laclé, Angela Mashford-Pringle, Ruth Grier and John Garcia.
Irving Rootman engaged over 550 attendees with an overview of the Ottawa Charter. Rootman brought us back to 1974 with the publication of the Lalonde Report entitled, A New Perspective on the Health of Canadians, which put health promotion in the spotlight. Since then, many achievements have been made to build capacity and develop the field of health promotion.
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| Irving Rootman |
Despite advances, there is much more to be done. Rootman urged the audience to keep the goal of health for all “front and centre,” to find better ways to address environmental issues, and asserted his opinion that even though we have yet to engage the public, Ontario remains a leader in health promotion.
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| John Garcia |
The panel had a lively discussion. The audience erupted in applause when a participant asked, “How to get a meeting with a minister?”, and Grier responded, “Elect ministers who like talking about these things.” The discussion focused on issues related to social determinants of health and the importance of public engagement. Panellists encouraged those who are new to the public health field to believe that you can affect change.
The symposium set the tone for the inaugural Convention and inspired us all to move forward with the goal of health for all.
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| Panel discussion |
To view the presentations from the Sheela Basrur Centre Symposium, click the links below:
- Overview of Ottawa Charter
Presented by: Irving Rootman - The Ottawa Charter and Health Promotion in Ontario
Presented by: Dr. John Garcia
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