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  1. 1. Towards an Integrated System for the Prevention of Chronic Disease in Canada Chronic Disease Prevention Alliance of Canada Nancy Dubois Presentation to the OHHN May, 2003
  2. 2. Presentation Outline <ul><li>Foundation of CDPAC </li></ul><ul><ul><li>Building on previous gains </li></ul></ul><ul><ul><li>Current Context </li></ul></ul><ul><li>Direction </li></ul><ul><ul><li>Vision, provincial/territorial scan and current activities </li></ul></ul><ul><li>Policy Messages </li></ul><ul><li>CDPAC engagement opportunities </li></ul>
  3. 3. CDPAC Foundation <ul><li>Canadian Heart Health Initiative </li></ul><ul><li>Canadian Diabetes Strategy </li></ul><ul><li>Canadian Strategy for Cancer Control </li></ul><ul><li>Risk Factor plans – e.g. tobacco </li></ul><ul><li>WHO Country-wide Integrated Non-Communicable Disease Intervention (CINDI) </li></ul>
  4. 4. Current Canadian Context <ul><li>Government interest and/or investment in risk factors – sustainability of health care </li></ul><ul><li>Advisory Committee on Population Health and Health Security </li></ul><ul><ul><li>Policy papers: public health capacity, chronic disease prevention </li></ul></ul><ul><ul><li>Strategy: development of a research agenda, national consortium for BP in CDP, forum/meeting/summit </li></ul></ul>
  5. 5. Current Canadian Context (cont’d) <ul><ul><li>Health reform - Kirby, Romanow & provincial/territorial reports </li></ul></ul><ul><ul><li>CIHR – health services and population research pillars </li></ul></ul><ul><ul><li>Chronic disease surveillance system development </li></ul></ul><ul><ul><li>National Best Practices Consortium </li></ul></ul>
  6. 6. CDPAC Vision <ul><ul><li>There will be systems change to support health promotion and disease prevention efforts. </li></ul></ul><ul><ul><li>Canadians will have access to a comprehensive, sufficiently resourced, sustainable, and integrated system of research, surveillance, policies and programs that maintain health and prevent chronic disease. </li></ul></ul><ul><ul><li>The systems will link together and build upon existing initiatives in a coordinated and synergistic way. </li></ul></ul><ul><ul><li>The systems will be broader that just the health sector, and will include other relevant sectors such as transportation, education, social services, recreation, and others. </li></ul></ul>
  7. 7. Mission <ul><li>CDPAC will work to foster and help sustain a co-ordinated, countrywide movement for an integrated, population health approach to chronic disease prevention through collaborative leadership, advocacy and capacity building . </li></ul><ul><li>November 2002 </li></ul>
  8. 8. Current Structure National Stakeholders Provincial and Territorial Alliances Alliance members, active participants and s ubscribers Steering Committee Working Groups Secretariat
  9. 9. Stakeholders: Engaged Communities of Practice Nutrition Physical Activity School Health Professional Assoc Tobacco Workplace Canadian Municipalities Public Health Others Prevention Research
  10. 10. Guiding Principles <ul><li>Population-based </li></ul><ul><li>Reduce inequalities </li></ul><ul><li>Leadership </li></ul><ul><li>Integration and coordination </li></ul><ul><li>Comprehensiveness </li></ul><ul><li>Focus on excellence </li></ul>
  11. 11. Guiding Principles (cont’d) <ul><li>Best practices </li></ul><ul><li>Capacity building </li></ul><ul><li>Accountability </li></ul><ul><li>Sustainability </li></ul><ul><li>Linked to and shape developments in Canada’s health system </li></ul>
  12. 12. Steering Committee <ul><li>Canadian Cancer Society </li></ul><ul><ul><li>Cheryl Moyer </li></ul></ul><ul><li>Canadian Council for Tobacco Control </li></ul><ul><ul><li>John Garcia </li></ul></ul><ul><li>Canadian Public Health Association (Apr 03) </li></ul><ul><ul><li>Christine Mills </li></ul></ul><ul><li>Coalition for Active Living </li></ul><ul><ul><li>Nancy Dubois </li></ul></ul><ul><li>Canadian Diabetes Association </li></ul><ul><ul><li>Donna Lillie </li></ul></ul><ul><li>Dietitians of Canada </li></ul><ul><ul><li>Marsha Sharpe </li></ul></ul><ul><li>Federation of Canadian Municipalities (May, 2003) </li></ul><ul><ul><li>John Burett </li></ul></ul><ul><li>Health Canada </li></ul><ul><ul><li>Greg Taylor </li></ul></ul><ul><li>Heart and Stroke Foundation of Canada </li></ul><ul><ul><li>Elinor Wilson </li></ul></ul>
  13. 13. Provincial / Territorial Consultation ( November 2002) <ul><li>Recommendations for CDPAC </li></ul><ul><ul><li>Assemble the evidence base </li></ul></ul><ul><ul><li>Facilitate transfer of best practices / knowledge </li></ul></ul><ul><ul><li>Champion CDP </li></ul></ul><ul><ul><li>Enable communication </li></ul></ul><ul><ul><li>Enable networking </li></ul></ul><ul><ul><li>Enable resources / capacity building </li></ul></ul>
  14. 14. National Stakeholders Consultation ( April, 2003) <ul><li>Recommendations for CDPAC </li></ul><ul><ul><li>1. Build national stakeholders capacity to work together </li></ul></ul><ul><ul><li>2. Clarify the outcomes for the movement </li></ul></ul><ul><ul><li>3. Exercise leadership and engage others </li></ul></ul>
  15. 15. CDPAC Functions & Activities <ul><li>Collaborative Leadership - work together for integration / alignment of systems through working / reference groups and providing portal for others to lead </li></ul><ul><li>Capacity Building - work for resource and skill acquisition through advocacy and learning opportunities (web, workshops conferences) </li></ul><ul><li>Advocacy – work with decision-makers to ensure implementation of policies </li></ul><ul><li>Cheryl Moyer: </li></ul><ul><li>receied funding from Health Canada to support a start-up phase; </li></ul>
  16. 16. CDPAC Policy Messages for Systems Change (as of March 2003) <ul><li>The framework needs to be comprehensive and built on demonstrated success. </li></ul><ul><li>Public health and municipal capacity needs to be a priority for sustained investment. </li></ul><ul><li>Government coordination and leadership is essential for successful implementation . </li></ul>
  17. 17. Systems Change: Next Steps <ul><li>Engage the leaders for systems change </li></ul><ul><ul><li>public health, primary care, education, recreation, transportation, etc. </li></ul></ul><ul><li>Support Canada’s investment </li></ul><ul><ul><li>invest in provincial/territorial alliances, CDPAC and risk factor alliances for integrated healthy living strategy </li></ul></ul>
  18. 18. What the Alliance is not <ul><li>Does not intend to become a mechanism for coordinating all aspects of chronic disease control -- primary prevention focus </li></ul><ul><li>Does not aspire to become the supra-ordinate alliance that can lead and coordinate all other prevention coalitions in Canada -- not the “mother of all coalitions” </li></ul><ul><li>Does not intend to be “top-down” and directive </li></ul>
  19. 19. Engagement Opportunities <ul><li>Consider becoming an active participant on the CPDAC Web site ( OR ) </li></ul><ul><li>Use the W eb site to share resources, participate in discussion forums & receive regular email newsletter and press releases </li></ul>
  20. 21. Web Site Tools <ul><li>CDPAC Definitions </li></ul><ul><li>NewsBytes </li></ul><ul><li>“ The Case for Change” & other documents </li></ul><ul><li>Updates on each province </li></ul><ul><li>National risk factor strategic papers </li></ul>
  21. 22. Concluding CDPAC Messages <ul><li>The integrated CDP movement is gaining momentum and growing. </li></ul><ul><li>History will be a driver – “Standing on the shoulders of giants” </li></ul><ul><li>Success will be achieved through a systems approach – bring everyone to the table </li></ul><ul><li>The preventive dose needs to be achieved in communities. </li></ul>
  22. 23. Integrated Pan Canadian Healthy Living Strategy
  23. 24. Presentation Outline <ul><li> </li></ul><ul><li>Background </li></ul><ul><li>What is Healthy Living? </li></ul><ul><li>The Goals & Objectives of the strategy </li></ul><ul><li>4 Proposed Strategic Directions </li></ul><ul><li>The process for the development of the strategy </li></ul>
  24. 25. Background <ul><li>Renewed commitment by governments to health promotion, and disease / injury prevention. </li></ul><ul><li>September 2002 agreement among Canada’s Federal/Provincial/Territorial (F/P/T) Ministers of Health to work together on pan-Canadian ‘Healthy Living’ strategies initially emphasizing nutrition, physical activity and healthy weights, and announcement of a national healthy living symposium to take place in 2003. (report on Web site) </li></ul><ul><li>Recent federally- and provincially-commissioned reports indicate that we need to pay more attention to the broader determinants of health and their impacts. (Health Care Renewal Accord on Web site) </li></ul>
  25. 26. What Is Healthy Living? <ul><li>Through a population health lens, healthy living encompasses a number of levels: </li></ul><ul><li>At a population level, healthy living refers to the practices of population and sub-population groups, that are consistent with improving, maintaining, and/or enhancing health. </li></ul><ul><li>As it applies to individuals, healthy living is the practice of health enhancing behaviours, or put simply, living in healthy ways. It implies the physical and mental capacity to make healthy choices. </li></ul><ul><li>At all levels the social, economic, political, cultural, and environmental conditions which support health must be in place for healthy living to become a reality. </li></ul>
  26. 27. An Integrated Pan-Canadian Healthy Living Strategy <ul><li>What? </li></ul><ul><ul><li>The Integrated Pan-Canadian Healthy Living Strategy is an umbrella framework under which links will be created among existing strategies around healthy living, those currently under development, and new strategies to be developed, in the short-, medium-, and long-term. </li></ul></ul><ul><ul><li>For example, through its overall integrative approach, the Strategy will link ongoing strategies on tobacco use and control, diabetes, heart health, and chronic disease prevention, with a new strategy for Healthy Eating and Physical Activity. </li></ul></ul>
  27. 28. <ul><li>What? ( cont’d) </li></ul><ul><ul><li>Action in this area reflects an initial priority and emphasis on partnership (inter - jurisdictional, inter - sectoral, stakeholder) and collaborative action around physical activity, healthy eating, and their relationship to healthy weights. </li></ul></ul><ul><ul><li>Agenda will broaden to include other health issues over the medium- and long-term. </li></ul></ul><ul><ul><li>Overall Strategy is characterized by a collaborative effort for health promotion, and disease and injury prevention, based on a population health foundation. </li></ul></ul>
  28. 30. <ul><li>Why? </li></ul><ul><ul><li>Many successful health promotion and disease prevention efforts are underway. However, a more concerted Pan-Canadian and integrated approach is necessary to make substantive gains in health outcomes and to reduce health disparities, thereby improving the quality of life of Canadians. </li></ul></ul>Glossary of terms on the Web site
  29. 31. Goals of the Strategy <ul><li>T he Goals of the Strategy are: </li></ul><ul><ul><li>To improve overall health outcomes </li></ul></ul><ul><ul><li>To reduce health disparities </li></ul></ul>
  30. 32. Objectives of the Strategy <ul><ul><li>To build partnerships among health jurisdictions and sectors, others that impact health, and key stakeholders, to take action on the determinants of health </li></ul></ul><ul><ul><li>To develop an integrated and collaborative Healthy Living Strategy consisting of short-, medium-, and long-term actions addressing the common risk factors for a range of health issues, working through the determinants of health and a population health approach </li></ul></ul><ul><ul><li>To draw upon and build on existing capacity, consolidating health promotion, and disease and injury prevention efforts targeting populations and sub-populations within life settings </li></ul></ul>
  31. 33. 4 Proposed Strategic Directions as a Focus for Action <ul><li>Leadership and Policy Development </li></ul><ul><ul><li>E.g. Building relationships/partnerships among governments to develop healthy public policy </li></ul></ul><ul><li>Knowledge Development and Transfer </li></ul><ul><ul><li>E.g. Concerted initiatives in research and surveillance </li></ul></ul><ul><li>Community Development and Infrastructure </li></ul><ul><ul><li>E.g. Development of community-based demonstration projects </li></ul></ul><ul><li>Public Information </li></ul><ul><ul><li>E.g. Public Awareness and Education/Social Marketing </li></ul></ul>
  32. 34. The Process:Building A Strategy <ul><li>1. Pre-consultation (January-February): to share information with key stakeholders on the Healthy Living Initiative and engage them as partners in building the Healthy Living interactive consultation process </li></ul><ul><ul><li>Consultation Reference Group meeting with key stakeholders and P/Ts on 30 January, 2003 </li></ul></ul><ul><ul><li>CAL Workshop on 07 – 08 February, 2003 (update and seek advice on the Healthy Living agenda and consultation process) </li></ul></ul>
  33. 36. The Process: Building A Strategy <ul><li>2. Strategic Roundtables (February – March): to build partnership with a broader range of stakeholders in healthy living </li></ul><ul><ul><li>9 Pan-Canadian Roundtables (including First Nations, Inuit, and Métis)– February/March 2003 </li></ul></ul><ul><ul><li>Roundtables Objectives: </li></ul></ul><ul><ul><ul><li>Share expectations of the Federal/Provincial/Territorial Ministers of Health on the development of the Integrated Pan-Canadian Healthy Living Strategy </li></ul></ul></ul><ul><ul><ul><li>Invite participants to inform the development of the Healthy Living Strategy </li></ul></ul></ul><ul><ul><ul><li>Identify key initiatives/actions/strategies for consideration as part of the development of the Healthy Living Strategy that can occur immediately or in the longer term </li></ul></ul></ul><ul><ul><ul><li>Begin to build partnerships </li></ul></ul></ul><ul><ul><li>Web site has agenda, report, participants, evaluations by site </li></ul></ul>
  34. 37. The Process: Building A Strategy <ul><li>3. Consultation Workbook: The workbook was designed to: </li></ul><ul><li>Help inform the reader about the Healthy Living Strategy and some specific issues and challenges related to healthy eating, healthy weights and physical activity. </li></ul><ul><li>Enable interested Canadians to express their opinions and ideas on the Healthy Living Strategy and these issues. </li></ul><ul><li>Enable Canadians to identify initiatives and actions that they would like to see included in Phase I of the Healthy Living Strategy. </li></ul>
  35. 38. The Process: Building A Strategy <ul><li>4. The Symposium (28-29 April, 2003 now June 16 & 17 ): Specific objectives of the Symposium are to present and invite input on: </li></ul><ul><ul><li>the context in which the Strategy is being developed </li></ul></ul><ul><ul><li>the proposed framework, including the vision, goals, foundational approach, guiding principles, strategic directions, and areas of emphasis of the Strategy </li></ul></ul><ul><ul><li>an overview and key findings of the consultation processe s </li></ul></ul><ul><ul><li>proposed elements of an action plan addressing physical activity, healthy eating, and their relationship to healthy weights, as the initial area of emphasis of the Strategy. </li></ul></ul>
  36. 39. <ul><li>5. Post-symposium: </li></ul><ul><ul><li>Conference of Deputy Ministers of Health Meeting – June 2003 </li></ul></ul><ul><ul><li>Ministers of Health Meeting – September 2003 </li></ul></ul>The Process: Building A Strategy
  37. 40. For more information, contact … <ul><li>For specific information relating to the content on th e website, including information on the roundtables, symposium or workbook, please contact Tina Lalande at Health Canada (613.957.0898), or use one of the following co-ordinates: </li></ul><ul><li>Email: </li></ul><ul><li>Fax: 613.241.8847 </li></ul><ul><li>Mail: Healthy Living Strategy c/o The Alder Group 1306 rue Wellington Street, Suite 200 Ottawa, ON Canada, K1Y 3B2 </li></ul>
  38. 41. Health and Wellness, MOHLTC: &quot;Exploring Chronic Disease Prevention in Ontario: How to Build Health Promotion P ractice&quot; Focus Group s
  39. 42. Purpose of the Focus Groups <ul><li>To explore the value, feasibility and interest of Ontario organizations in connecting in some way regarding chronic disease prevention. </li></ul><ul><li>To explore the related opportunities, challenges, expectations and conditions within which a partnership of some kind might work. </li></ul><ul><li>To explore the details of a partnership in terms of preferred type / structure including a leadership model, necessary supports and priority functions. </li></ul><ul><li>To recommend next steps in this process to move towards coordinated chronic disease prevention for Ontario. </li></ul>
  40. 43. Results of the Process <ul><li>8 groups planned (7 held) </li></ul><ul><ul><li>Voluntary non-government organizations </li></ul></ul><ul><ul><li>Researchers </li></ul></ul><ul><ul><li>OHPRS members </li></ul></ul><ul><ul><li>Local practitioners </li></ul></ul><ul><ul><li>Regional groups </li></ul></ul><ul><ul><li>HPW, MOHLTC </li></ul></ul><ul><ul><li>Provincial organizations </li></ul></ul><ul><ul><li>MOHLTC (beyond HPW) & Education / Recreation ministry reps </li></ul></ul><ul><li>Approximately 60 people attended </li></ul>
  41. 44. Results of the Process <ul><li>6 themes of the discussion emerging </li></ul><ul><ul><li>Opportunities </li></ul></ul><ul><ul><li>Challenges </li></ul></ul><ul><ul><li>Needs </li></ul></ul><ul><ul><li>The Model </li></ul></ul><ul><ul><li>Potential functions in Ontario </li></ul></ul><ul><ul><li>Recommendations </li></ul></ul>
  42. 45. Next Steps in the Process <ul><li>Report to be received by HP&W </li></ul><ul><li>Circulation to the participants </li></ul><ul><li>Discussion / decision regarding content </li></ul>