health promotion: issues, challenges & opportunities · publichealthontario.ca moving forward...

Health Promotion: Issues, Challenges & Opportunities

Dr. Brent Moloughney

November 23, 2017

Health Promotion Ontario Conference

Medical Director

Health Promotion, Chronic Disease and Injury Prevention

PublicHealthOntario.ca

Acknowledgements

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• Several individuals contributed to the conceptualization and content of this presentation:

• Mats Junek – PHPM Resident

• Debra Parry – PHPM Resident

• Heather Manson – Chief, HPCDIP, PHO

• HPCDIP staff

• Colleagues


Issues to Highlight – Selected Colleagues

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Issues to Highlight – Standards’ Topics to Consider…

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PublicHealthOntario.ca 5

• Peace

• Shelter

• Education

• Food

• Income

• Stable eco-system

• Sustainable resources

• Social justice & equity

Prerequisites for Health

Source: Ottawa Charter for Health Promotion, 1986


• Climate change

• Ecotoxicity

• Resource depletion

• Species extinction

• Oceans in trouble

• Unprecedented challenges

Key Areas of Global Change

Global Change and Public Health: Addressing the Ecological Determinants of Health. CPHA, 2015


https://www.cpha.ca/sites/default/files/assets/history/cpha100-poster_e.pdf





A Brief Look at a Few Major Challenges… Potential Responses… & the Health Promoter Competencies

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Early Development Instrument Scores, Ontario, 2004-06 to 2015

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https://edi.offordcentre.com/partners/canada/edi-in-ontario/

Percent of Ontario kindergarteners vulnerable in at least one domain of development increased slightly from 28% to 29.4%









Early Child Development Model

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Siddiqi A, Irwin LG, Hertzman C. Total environment assessment model for early child development.: Evidence report. 2007


Public Health Ontario. Interactive opioid tool. Access: Nov 12, 2017. http://www.publichealthontario.ca/en/DataAndAnalytics/Pages/Opioid.aspx

http://www.publichealthontario.ca/en/DataAndAnalytics/Pages/Opioid.aspx


BC Overdose Deaths – 1991-2017

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https://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/illicit-drug.pdf















Epidemiologic Triangle Applied to Opioid-Related Overdoses

Adapted from: PHO. Risk of sudden increase in opioid-related overdoses in Ontario. Rapid risk assessment. Sept 2017.


Obesity rate projections (ages 15 -74) - OECD

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http://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf


Foresight’s Map of Variables

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Foresight. Tackling obesity: Future choices. UK Dept of Innovation, Universities and Skills. 2007.


Fundamental Premise

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• “The increasing weight of people worldwide is the result of a normal response by normal people to an abnormal environment.”

Urgently needed: a framework convention for obesity control. Lancet 2011; 378(9793):741.


Re-Framing – Creating Supportive Environments

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Peel Public Health. Changing course: Creating supportive environments for healthy living in Peel. 2012.


Contribution of the Built Environment

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The Chief Public Health Officer’s Report on the State of Public Health in Canada 2017 – Designing Healthy Living


Effectiveness of Built Environment Approaches

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• The CPSTF recommends intervention approaches that include one or more components from each of the boxes below:

Community Preventive Services Task Force. Physical activity: Built environment approaches combining transportation system interventions with land use and environmental design. Dec 2016.


Areas for Potential Action: Marketing to Children; SSBs

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Colchero, MA. Beverages Sales in Mexico before and after Implementation of a Sugar Sweetened Beverage Tax. PLoS One. 2016; 11(9): e0163463.

Annual sales of sugar-sweetened beverages and plain water in liters per capita, EMIM 2007–2014.

And… - Product labelling - Daily physical activity - Screen time - etc.


Faced with Big, Complex Problems

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Challenges Responses

• Issues are complex – have many drivers

• Require actions by many actors

• Need long-term, sustained action

• Potential for divided action

• Aim big

• Make friends & act together

• Learn from others

• Use of data & evidence

• Celebrate success along the way


Reasons for Hope

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-Taken on and been successful with big, complex problems before

-If take a step back, can see progress occurring

- Policy shifts are often a decade or more

- Non-linear

- Learn (and leverage experience) from others


NYC – Urgency and a Vision

http://www.nyc.gov/html/planyc/downloads/pdf/publications/planyc_2011_planyc_full_report.pdf

CHALLENGE: 1 Million new people

by the year 2030

http://www.nyc.gov/html/planyc/downloads/pdf/publications/planyc_2011_planyc_full_report.pdf


City Policy + Implementation

NYC Centre for Active Design

Design for Livability

Create or Enhance a Public Plaza in every Community

Making the Nation’s Safest Big City Even Safer

Reimagining the City


Transportation Goals

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Strategic Goals

o Cut annual traffic fatalities by 50% (from 2007 level)

o Implement system of rapid bus lines

o Double bicycle commuting from 2007 to 2012

o Institute complete-street design policy

o Institute programs to treat streets as public space

o Reduce agency energy and vehicle use


NYC – Cycling Infrastructure and Impacts

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http://www.nyc.gov/html/dot/downloads/pdf/cycling-in-the-city.pdf

In 5 years, expanded or enhanced on-street bike network ~300 miles










Change in Times Square

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http://www.earthpowernews.com/humans-make-comeback-battle-cars/











Public Plazas in Communities

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Provide multiple entries and appropriate transparency along the street to help enliven the pedestrian environment

Maximize variety, detail, texture and continuity on the lower 1-2 floors of the building facade

Building Exteriors: Contributing to the Pedestrian Environment


Cheonggyecheon Area – Seoul, KR

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http://www.metro.seoul.kr/kor2000/chungaehome/en/seoul/2sub.htm




San Francisco Waterfront

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https://www.bizjournals.com/sanfrancisco/blog/2014/10/loma-prieta-quake-san-francisco-waterfront-photo.html















(Previous) San Francisco Freeway

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Importance of Framing

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• Overall traffic collisions stable

• BUT, traffic-related fatalities for:

• Pedestrians

• Cyclists

• Older adults


Risk of Pedestrian Fatality with Vehicle Speeds

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UK Department for Transport. Relationship between speed and risk of fatal injury: pedestrians and car occupants. 2010.


Build on Success (and reframing)

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Tobacco-freekids.org


Evidence, Uncertainty and the Need for Action

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• Evidence-based public health action is often inhibited by a mismatch between the magnitude and importance of a public health problem, and the adequacy of evidence on potential interventions to address the problem.

Rychetnik et al. A glossary for evidence based public health. J Epidemiol Community Health 2004; 58(7):538-545.


Moving Forward Thoughtfully

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• Beware analysis paralysis (maybe if we just do one more SR…)

• Actions should be based on the best available evidence – as opposed to waiting for the best possible evidence

• Learn by doing… Evidence base needs to develop alongside the delivery of novel interventions informed by available evidence and strengthened by expert advice

Peel Public Health. Changing course: : Creating supportive environments for healthy living in Peel. 2012.


Using Data & Evidence to Make the Argument

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https://www.peelregion.ca/health/resources/healthbydesign/pdf/moh-report.pdf






Importance of Collective Action

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The Mexican soda tax: How to win a campaign. 8th EPHA Annual Conference. Brussels. Sept 2017.


The Potential for Common Messaging and Branding

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Run, Jump. Play. Every Day

Choose to Boost Veggies and Fruit

Power Off and Play!

Water Does Wonders


Summary

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• Faced with big, complex problems

• We’ve succeeded in the past

• Aim big

• Framing

• Make friends & act together

• Learn from others

• Use of data & evidence

• Celebrate success along the way


Health Promotion

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• The policies and processes that enable people to increase control over and improve their health:

• These address the needs of the population as a whole in the context of their daily lives, rather than focusing on people at risk for specific diseases; and,

• Are directed toward action on the determinants of health.

• Action oriented and based on public policies to enable, support and protect health.

Last J, ed. A dictionary of public health. 2007.


The Health Impact Pyramid

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Frieden TR. A framework for public health action: The health impact pyramid. Am J Public Health 2010; 100(4):590-595


Why Develop Set of Health Promoter Competencies

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Pan-Canadian Health Promoter Competencies Project


Overview

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Health Promoter Competencies

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Accompanying Toolkit

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Health Promoter Position Profile

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• Provides a fuller description of context to supplement the competencies

• Rationale for health promoter positions

• Role summary

• Proficiency level examples for each competency statement


Domain 2 – Situational Assessments

A health promoter is able to: Level 1 Level 2

2.2. Access and critically appraise

evidence (i.e. published and grey

literature, systematic reviews, and

promising practices) for potential health

promotion action.

Appraise an existing study or systematic

review for the promotion of healthy eating

and physical activity in childcare facilities

and identify implications for practice

Contribute to/lead conduct of a systematic

review of existing evidence for effective

interventions for promoting active

transportation to/from school


Toolkit – Position Profile: Role Summary

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• Health promoters analyze the nature of a health issue or problem and provide specialized analysis and advice based on theory, evidence and experience on how to address it through the appropriate mix of health promotion strategies.



Toolkit – Position Profile: Values & Principles

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• Practice is based on several values/principles:

• equity and social justice

• a holistic definition of health

• covers the full range of health determinants

• recognizes the influence of the environment on health

• empowers people and builds individual and collective capacity

• seeks to enhance people's social participation

• involves intersectoral collaboration.



Caution : A Competency Set is a Tool Not a Magic Solution

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• Impact may be limited if significant potential gaps in system design:

• Defined the mandate? (comprehensive legislation; core program standards)

• Establish appropriate structures, positions, resources, info systems; accountability mechanisms; etc.

• Leadership; strategy; priority setting & planning; etc.

• Mechanisms to consult and undertake collaborative planning



Final Comments

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• A lot has been accomplished in 30 years

• Much left to do – faced with big, complex issues

• Health promoters bring critical knowledge and skills

• Aim big!

Public Health Ontario keeps Ontarians safe and healthy. Find out more at PublicHealthOntario.ca

For More Information About This Presentation, Contact:

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health promotion: issues, challenges & opportunities · publichealthontario.ca moving forward...

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