Community engagement and policy advocacy approaches to obesity and chronic disease prevention Présentation de Kim Raine au colloque "Recherche interventionnelle contre le cancer : Réunir chercheurs, décideurs et acteurs de terrain » - 17 et 18 novembre 2014, BnF, Paris

1. Centre for Health Promotion Studies
Community engagement and policy
advocacy approaches to obesity and
chronic disease prevention
Kim Raine, PhD, RD, FCAHS
Professor
CIHR/HSFC Applied Public Health Chair (2008-13)

2. Key messages:
• Community engagement represents an approach for
environmental change to promote healthy living.
• case of "Healthy Alberta Communities"
• Designing research and evaluation to create an
evidence base for influencing policy and practice is
challenging:
• how do communities change?
• how does transforming environments influence
Centre for Health Promotion Studies
health?
• Local communities' action can gain support through
policy to address the underlying drivers of unhealthy
eating, physical inactivity, and obesity.

3. Alberta
• Politically conservative
• Oil rich
• Rugged individualism
• Trail blazers
• Leaders in Tobacco
control

4. • Comprehensive 5 year community-based intervention
for obesity and chronic disease prevention (2005-10)
• University-community-government partnership
• 4 unique communities
• Goals:
• Support environmental change within communities to promote
Centre for Health Promotion Studies
and support healthy choices
• prevent obesity, improve health, prevent chronic diseases
• Inform policy, practice, and research decisions
Raine, K.D., et al. Reflections on community-based population health
intervention and evaluation for obesity and chronic disease prevention: the
Healthy Alberta Communities project. International Journal of Public Health.
2010, 55(6)679-686.

5. Baseline Chronic Disease Risk Factors: Community
Reports

6. How to Build Healthy Communities?
• Target community environments
• Leverage resources and rely on the
work of individuals, groups and
organizations already in the
community
• Hire community coordinators
• Invest seed money to help kick-start
activities and maintain momentum
Centre for Health Promotion Studies

7. Workshops for Capacity- Building and
Intervention Development
ANGELO
(Swinburn et al)
Flaman, Plotnikoff, Nykiforuk & Raine. Mechanisms for Understanding the Facilitators and
Barriers to Capacity Building for Chronic Disease Prevention Activities: An Illustration.
Health Promotion Practice. November 2011vol. 12 no. 6 858-866.
Centre for Health Promotion Studies

8. Taking Action in Bonnyville
Priority: Healthy choices available in local restaurants
Restaurant Program
Three restaurants initiated participation –
 Developed to meet the needs of transient workers without
kitchens.
 Developed criteria for participation with AHS Dietitian.
 Promoted program to local restaurants.
 Addressed concerns of restaurant owners (newspaper articles
and radio ads).
 Branded the program.
 Expansion into neighboring community.
Sustainable

9. Taking Action in Norwood/
North Central Edmonton:
The Good Food Project
Priority: Support food security
• Urban social enterprise
project
• Supports local food
production and household
food security
• An alternative to charitable
models to address hunger.
• Sustainable in 2010!

10. Taking Action in Medicine Hat:
Priority: Promote alternative transportation, including walking
and cycling
Coalition for Active &
Alternate Transportation
(CAAT)
Networking and partnering
with KEY stakeholders to
develop and implement
municipal projects such as:
"Leisure Trail Master Plan"
and "Cycling Trail Master
Plan“ to attract more
citizens to active
transportation
Now sustained by the local
Be Fit for Life Centre

11. Key messages:
• Community engagement represents an approach for
environmental change to promote healthy living.
• case of "Healthy Alberta Communities"
• Designing research and evaluation to create an
evidence base for influencing policy and practice is
challenging:
• how do communities change?
• how does transforming environments influence
Centre for Health Promotion Studies
health?
• Local communities' action can gain support through
policy to address the underlying drivers of unhealthy
eating, physical inactivity, and obesity.

12. • Can community-based interventions
reduce obesity and chronic disease risk?
• What is the impact of the interventions
on obesity and chronic disease risk
factors in HAC communities as compared
to secular trends in Alberta?
• How have the interventions contributed
to changes in community capacity and
environments?
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Research Questions

13. Evaluation Activities (2006 - 2009)
• Impact evaluation
– Phone survey
(perceptions &
behaviors)
– Measurement clinics
(health outcomes)
• Community evaluation
– Outcome
– Process

14. Study Design
Raine, K.D., et al., Healthy Alberta Communities: Impact of a three-year community-based obesity and chronic
disease prevention intervention, Prev. Med. Volume 57, Issue 6, December 2013, Pages 955–962.
Centre for Health Promotion Studies

15. Did we make a difference?
• Self-reported well-being outcomes showed
improvement in comparison to secular trends
• Impact on behavior change not evident
• Impact on BMI/ overweight/ obesity not
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evident
• Translating changing environments into
behavior change and health impact is slow
(unable to secure funding for additional 3
years of research, “not novel”)

16. Change in sense of belonging to
community
3.65 %
-2.19 %
5
4
3
2
1
0
-1
-2
-3
-4
←Very weak Very strong→
HAC 2006→2009
Alberta-CCHS 2005-
2006→2007-2008

17. Change in Food Security
2.38 %
0.89 %
2.5
2
1.5
1
0.5
0
-0.5
←Often did not have enough Always have enough of any food wanted→
HAC 2006→2009
Alberta-CCHS 2005-
2006→2007-2008

18. Self-Report Overweight and Obesity
(HAC vs. CCHS)
Healthy Alberta Communities (HAC) Compared to CCHS Alberta,
Adult (18+) Percentage Overweight and Obese with 95%CI,
2003 - 2009
2003 2004 2005 2006 2007 2008 2009
Year
Percentage
40
35
30
25
20
15
10
CCHS Alberta Overweight
CCHS Alberta Obese
CCHS Alberta Trend
HAC Overweight
HAC Obese

19. • Helped to advance understandings of
how communities change
• Demonstrated the value of a
partnerships that value the knowledge
and expertise within the community
• Demonstrated sustainability and
justified expansion to other
communities (AHS)
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Community Evaluation

20. www.healthyalbertacommunities.com
Montemurro, Raine, Nykiforuk & Mayan. Exploring the process of capacity-building among
community-based health promotion workers in Alberta, Canada. Health Promot. Int.
(2014) 29 (3):463-473.doi: 10.1093/heapro/dat008

21. Community Evaluation (2)
• Important to use target of
intervention as key indicators of
impact of community-based
interventions (Role of place) – see
Nykiforuk et al. Community Health and the Built Environment:
examining place in a Canadian chronic disease prevention
project. Health Promot. Int. (2013) 28 (2):257-268.
• Communities need support (policy)
Centre for Health Promotion Studies

22. Key messages:
• Community engagement represents an approach for
environmental change to promote healthy living.
• case of "Healthy Alberta Communities"
• Designing research and evaluation to create an
evidence base for influencing policy and practice is
challenging:
• how do communities change?
• how does transforming environments influence
Centre for Health Promotion Studies
health?
• Local communities' action can gain support through
policy to address the underlying drivers of unhealthy
eating, physical inactivity, and obesity.

23. www.abpolicycoalitionforprevention.ca
• Applying lessons from tobacco control to
physical activity and nutrition
• APCCP – funded 2009-11 by ACPLF. Ongoing
funding from HSF

24. Policy Approaches for Environmental
Change
• Restrict unhealthy food and beverage
advertising targeting children
• Promote policies on urban design and
zoning that promote active living and
healthy eating.
• Encourage financial incentives and
disincentives to promote healthy living
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26. Policy Interventions to Reduce Obesity
(CPAC - 2013-16)
Synthesize evidence: obesity-relevant policies
Broker knowledge for policy development
Build capacity for policy adoption and implementation
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27. Lessons Learned: Future of Population
Health Interventions
Complex system problems
• No “one” solution to social and behavioural determinants of health
• Individual, community and policy interventions alone are not
enough, but in synergy may be points of access to social change
• Need flexible interventions to consider context and capture
complexity
• Need more complex designs, plurality of methodologies and non-traditional
funding mechanisms to study interconnections among
parts of the system
Engaged Scholarship
• Researchers, practitioners and policy-makers are jointly involved in
each step of the process, from initial design to end-stage
implementation
Centre for Health Promotion Studies

28. Merci Beaucoup!
(HAC)
Health and Wellness