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The National Collaborating Centres for Public Health: Strengthening public health by learning from each other

Contents

I Introduction
II Background to the NCCPH
III National Collaborating Centres
IV What’s next for the NCCPH?
V Get involved
VI Reference

--submitted by Jeannie Mackintosh, Communications Coordinator, National Collaborating Centre for Methods and Tools (NCCMT) and Mylène Maguire, Communications Coordinator, National Collaborating Centre for Public Health (NCCPH)

I Introduction

A recent Canadian Medical Association Journal editorial [1] noted the value of sharing what we know. In particular, the authors acknowledged recent work of the National Collaborating Centres for Public Health (NCCPH) and highlighted examples from specific centres as particularly promising:

“In the public health sector, National Collaborating Centres have begun to offer opportunities for better knowledge transfer. The National Collaborating Centre for Aboriginal Health brought federal, provincial governments and Aboriginal representatives together to exchange knowledge about the social determinants of health. The National Collaborating Centre for Environmental Health drew together water inspectors from across Canada to pool their expertise. A curriculum offered at a Newfoundland regional meeting to train operators working on small drinking water systems is now being replicated in Alberta."

The article continued with “We need more of these opportunities to learn from each other’s experience.”

This article includes a brief history of the NCCPH and includes links in the Resources section to some of the other ways in which the program can help translate knowledge into practice and policy.

II Background to the NCCPH

Canada’s national response to the SARS outbreak of 2003 revealed a gap between what researchers know and what practitioners can do. To address this concern, the Government of Canada established the NCCPH in 2004 to strengthen public health in Canada by making existing and new research evidence available and accessible to public health professionals.

The NCCPH is made up of six individual National Collaborating Centres (NCCs) created specifically to promote and support the use of knowledge and evidence by public health practitioners across Canada. Located in different regions across the country, each centre has a national mandate to focus on a specific area of critical public health importance. The NCCPH draws on the expertise, perspectives and resources of the individual centres, to help get knowledge into practice and policy. The centres work together to promote the synthesis, translation and exchange of knowledge among front-line practitioners, managers, policy-makers and researchers. Activities include conducting national surveys and environmental scans, hosting multisectoral forums, preparing background papers and reports, developing a bilingual website, and coordinating an annual Summer Institute for knowledge sharing.

This year’s Summer Institute, Knowledge for a Change, reflected the goal of the NCCPH: to ensure that the best available knowledge is shared and used to improve public health. The event held in Mont Ste-Anne, Québec, focused on collaboration, networking and evaluation as essential tools for achieving better public health. The event was attended by speakers and participants from around the globe. All presentations from the Summer Institute are available online. See the Resources section for links.

III National Collaborating Centres

The NCC for Aboriginal Health (NCCAH) supports Aboriginal communities across Canada in realizing their health goals and reducing the health inequities that currently exist for Aboriginal people. The centre hosts the First Nations Environmental Health Innovation Network, a virtual network to link First Nations and environmental health researchers. The network builds capacity within First Nations communities to participate in environmental health research and to make use of data and knowledge regarding environmental health issues and concerns for decision making that will lead to health improvements. Successful child-rearing programs and facilitated exchange about best practices are presented in NCCAH’s “Messages from the Heart”: A Showcase on Aboriginal Child Rearing. Five fact sheets on Aboriginal children and child protection services in Canada are available on the NCCAH. See the Resources section for links.

Health is determined by more than just access to doctors or good hospitals. How healthy we are can also depend on a number of non-medical factors including where we live, work and play, our gender, our social status, etc. By encouraging public health practitioners, policy-makers and researchers to consider knowledge about these social determinants of health in their practice and policy decisions, the NCC for Determinants of Health (NCCDH) promotes social justice and health for all. The NCCDH is currently focusing on Early Child Development as a determinant of health and the contribution of public health home visiting to early child development. Other related NCCDH priority areas include women and gender equity, employment conditions, and health literacy. See the Resources section for links.

The NCC for Environmental Health (NCCEH) focuses on the health risks associated with the physical environment and identifies evidence-based interventions to reduce those risks. Working with environmental health practitioners and policy makers, including public health inspectors (PHIs) and medical health officers (MHOs), the NCCEH identifies priority issues, collects information and produces relevant documents that can be used in practice and policy-making. The NCCEH has completed a second overview of environmental health in Canada, including interviews with MHOs and PHIs at the local, regional, and federal levels. The results are helping determine the NCCEH’s action plan for the coming years.

The NCC for Healthy Public Policy (NCCHPP) supports the efforts of the Canadian public health community in promoting healthy public policy through more informed strategies. Its focus is public policy with a potential impact on social, economic and environmental determinants of health, to provide relevant research-based information and tools about the potential health impact of policies and about public-policy processes themselves. The web-based Structural Profile of Public Health in Canada demonstrates how individual jurisdictions address key areas of public health. This tool helps individuals in the public health sector to reach out to other provincial authorities working in similar fields across the country. See the Resources section for links.

Making new research and evidence accessible and relevant to front-line public health practitioners and policy makers is the goal of the NCC for Infectious Diseases (NCCID). Among its initiatives, the NCCID established knowledge exchange networks for members to discuss issues, share documents and links, and learn about upcoming events. The KENs are supported by the Canadian Network for Public Health Intelligence. Work is continuing in Edmonton to develop the NCCID’s first regional Learning Site for HIV and sexually transmitted and blood-borne infections (STBBI prevention). Program enhancement and evaluation at this site will facilitate the development of knowledge for improving HIV and STBBI prevention programs across Canada.

The NCC for Methods and Tools (NCCMT) aims to enhance evidence-informed public health (EIPH) practice and policy by providing leadership and expertise in sharing what works in public health. The NCCMT’s network – DialoguePH – provides a forum for professionals working in public health to share their experiences and challenges, and to discuss the methods and tools they use to find, interpret and use evidence in public health. Members of DialoguePH include decision makers in public health as well as others with formal or informal roles and responsibilities related to knowledge translation. The NCCMT’s activities include an EIPH wheel that illustrates the seven steps of evidence-informed decision-making, a fact sheet that provides greater explanation and context, and a dedicated website section. See the Resources section for links.

IV What’s next for the NCCPH?

In addition to working on their specific areas of specialization, the NCCs collaborate on projects of public health importance. For example, NCCDH and NCCAH hosted Early Child Development Forum: Exploring the Contribution of Public Health Home Visiting to explore effective strategies for public health home visits. The forum held in Saskatoon in October, 2008, was the first of its kind and was attended by 120 participants from across Canada. See the Resources section for links.

National public health priorities continue to inform the work of the NCCPH. Water systems serving small and remote communities are of particular concern. Currently, all six NCCs have joined forces to address drinking water safety in order to prevent future outbreaks of waterborne disease events such as the one that occurred in Walkerton, Ontario, in 2000. A study commissioned by NCCEH – Retrospective Investigation of Drinking Water-Related Illnesses in Canada (Novometrix Research Inc.) – thoroughly investigated waterborne disease events that occurred between 1993 and 2008 and identified risk factors. One of the main findings of this investigation is that these events have been linked to small water systems. See the resources section for links.

The NCCPH Small Drinking Water Systems Project is a large-scale initiative aimed at improving those systems by providing the necessary evidence to inform practice and policy. Appropriately, the NCCEH will take a lead role on the project, but all NCCs will contribute their expertise.

The project will benefit from the foundational research on small drinking water systems in Canada recently done by the NCCEH. The following were among the issues identified by that research:

  • Outbreaks of waterborne diseases provide opportunities to identify sources, health impacts and other contributing factors to waterborne illnesses.
  • Canada currently has no national surveillance system for waterborne disease outbreaks and no standardized approach to collection of information on outbreaks.
  • Information collected on waterborne disease outbreaks is often not published, distributed or adequate.

To guide the project’s direction, the NCCEH consulted public health inspectors responsible for small drinking water systems in May 2009, at the Canadian Institute of Public Health Inspectors Conference. Since then, the NCCPH has sought direct input from water systems experts, front-line professionals and policy-makers at the following events: a session June 9th at the CPHA Conference in Winnipeg; a one-day forum on June 23rd in Toronto; and a session on July 14th at the International Congress on Circumpolar Health in Yellowknife.

Each session was a great opportunity to exchange knowledge and expertise. NCCEH presented results of its investigation and participants identified the needs of small drinking water systems that are not currently being addressed in Canada. These productive sessions are helping to identify research priorities and opportunities for future collaboration regarding the safety of small drinking water systems in Canada’s northern and remote communities. A number of gaps were identified and prioritized within each of these six areas:

  • testing
  • treatment
  • surveillance
  • interventions
  • policy
  • education and training.

A session planned for September 2009, in Quebec will explore areas less well covered in previous consultations.

A survey is now being conducted to prioritize the activities in each of the six given areas. Priorities being rated include the effectiveness of chemical or physical tests for drinking water safety, the costs of test procedures, the evaluation of the evidence related to the success/failure of recent water systems upgrades and if these lessons can be applied in different contexts, etc. The survey’s results will help the NCCs develop a comprehensive approach to best provide public health oversight of small water systems.

V Get involved

For more information about the NCCs and about our collaborative Small Drinking Water Systems Project please watch for regular updates on the NCCPH common website at http://www.nccph.ca/. If you would like to participate in the project, please contact Philip Girvan at 1-866-272-2704 or at [email protected]. A new version of the website is under development and will be available within the next few months. It will feature publications from all NCCs; information on past and upcoming forums, sessions and workshops; and the latest about NCCs’ projects.

The collective work of the NCCPH and the individual NCCs can be a model of sharing and cooperation. The NCCPH continues to strengthen public health in Canada by creating and embracing opportunities to learn from each other.

VI Reference

1. CMAJ • June 9, 2009; 180 (12). doi:10.1503/cmaj.090808. Editorial A country of perpetual pilot projects. Hon. Monique Bégin, PhD, Laura Eggertson, BA and Noni Macdonald, MD MSc