Two Articles from National Collaborating Centres: Advancing Population Mental Health and Telling the Health Equity Story through Population Heath Status Reporting

Advancing Population Mental Health was submitted by Pascale Mantoura of the National Collaborating Centre for Healthy Public Policy.

Telling the Health Equity Story through Population Heath Status Reporting was submitted by Hannah Moffatt, Lesley Dyck, and Pemma Muzumdar of the National Collaborating Centre for Determinants of Health.


One: Advancing Population Mental Health 


Contents

I Introduction
II Putting mental health on the public health agenda
III Advancing population mental health
IV What do you think? – Contact us
V Resources
VI Reference List

I Introduction

Building on the growing recognition that there can be no health without mental health and on the timely release of the Mental Health Strategy for Canada by the Canadian Mental Health Commission, (http://www.mentalhealthcommission.ca/English/Pages/Strategy.aspx) the National Collaborating Centre for Healthy Public Policy (NCCHPP) has initiated a collaborative multi-year project in 2013 – 2014 on population mental health.

II Putting mental health on the public health agenda

In Canada, one in five people experiences a mental health problem or illness each year, with an annual cost to the economy of well in excess of $50 billion (Mental Health Commission of Canada, 2012). It is expected that by 2030, mental health issues will be the leading cause of disability in Canada (Canadian Policy Network and Canadian Institute for Health Information, 2011) and depression will constitute the leading cause of disease burden worldwide (World Health Organization, 2005).

In response to the increasing burden of mental illness, recent years have seen a growing policy acknowledgement in public health for a greater focus on promotion of mental health and prevention of mental illness (Department of Health Melbourne Victoria, 2012; Lavikainen, Lahtinen, & Lehtinen, 2000; Jane-Lopis & Anderson, 2005; Centers for Disease Control and Prevention, 2011). More specifically, this is related to the escalating costs of mental illness, the limited effectiveness and availability of treatment, and the increasing understanding that positive mental health, on its own, is an integral part of health and quality of life. Indeed, impaired mental health for individuals, families, society, and the economy represents a significant burden, with a disproportionate toll upon those who are socially and economically disadvantaged (Friedli, 2009; Fryers, Melzer, Jenkins, & Brugha, 2005; McGibbon, 2012; Mental Health Commission of Canada, 2012). This situation cannot be reduced by the treatment of mental disorders alone or by treating people one at a time (WHO, 2001). It calls rather for a comprehensive population-level mental health strategy, which looks at ways of keeping people from becoming mentally ill in the first place and improving the mental health status of the whole population.

The recognition of the importance of mental health for the overall health and prosperity of populations and nations, in parallel with prevention and treatment of mental illness, is evident both internationally and nationally. The World Health Organization (WHO) has produced many foundational and supporting documents towards promoting positive mental health (WHO, 2002; WHO, 2004; WHO, 2005) since its first definition of mental health in 2001 as, “not merely the absence of disease or infirmity but the presence of a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO, 2001).

This expanded focus on a population-level perspective for positive mental health is also visible in Canada. Already in 1988, a seminal discussion paper “Mental Health for Canadians: Striking a Balance”, released by Canada’s then Minister of National Health and Welfare, indicated the difference between mental health and mental illness. Then, in 2006, the Public Health Agency of Canada (PHAC) published The Human Face of Mental Health and Mental Illness in Canada, (http://www.phac-aspc.gc.ca/publicat/human-humain06/pdf/human_face_e.pdf) which marked an evolution from its 2002 A Report on Mental Illnesses in Canada. The 2006 document also defined mental health broadly as “the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity” (Public Health Agency of Canada, 2006).

In 2006, the Standing Senate Committee on Social Affairs, Science and Technology produced the first national report on mental health, commonly known as the Kirby report. It focused on improving quality of life for people living with a mental illness. This was a catalyst for the 2007 formation of the Mental Health Commission of Canada. In 2012, the Mental Health Commission released its first national strategy, Changing Directions, Changing Lives. It seeks to improve mental health and well-being for all Canadians and to build a mental health system that meets the needs of all individuals living with mental health conditions, and their families.

What has not been yet explored in the Canadian context is how to align the objective of improving well being for all Canadians with a population wide approach to mental health. Central to this concept of population mental health is not only the prevention and treatment of mental illness when it occurs but perhaps more importantly the promotion of positive mental health, both for the general population and for those with mental disorders, the integration of mental health into the broader public health framework, and the recognition that mental health and physical health are thoroughly intertwined and inseparable. In short, it expresses that mental health has to be everyone’s business (Canadian Population Health Initiative – Canadian Institute for Health Information, 2008; Huppert, 2009a; Huppert, 2009b).

III Advancing population mental health

It is within this context that the National Collaborating Centre for Healthy Public Policy (NCCHPP), in collaboration with the other National Collaborating Centres (NCCs), has conducted a scan to identify stakeholders, networks, researchers, and foundational documents in Canada concerning upstream mental health. The results of this scan will be made available soon to inform public health actors about what is happening across Canada. Arising from the needs identified by stakeholders, we will produce information documents outlining recent provincial, territorial and federal mental health strategies up to the present day, as well as a collection of foundational documents. The need to draw the ensemble of Canadian strategies and documents together in one place emanates from practitioners, managers and decision makers with whom we met throughout the scan. Another need that was identified was to share a common definition of mental health, a concept which in both the literature as well as in strategic documents, is variously defined and understood, especially when it relates to positive mental health. In order to respond to this, we are preparing two fact sheets in which we will attempt to clarify the concepts of positive mental health and population mental health.

During the coming months, accompanied by the other NCCs, we will also focus on identifying the most pressing needs for frontline practitioners and decision makers in relation to a population mental health framework. This process will be informed by existing work including the interesting study Connecting the Dots, (http://www.camh.ca/en/hospital/about_camh/provincial_systems_support_pro...) recently published by the Centre for Addiction and Mental Health (CAMH), Public Health Ontario, and Toronto Public Health, on the work from Ontario public health units in addressing child and youth mental health. What we learn from these enquiries will inform additional work to come.

IV What do you think? Contact us

We would be very pleased to hear from you about your interest in, and questions about population mental health, including areas where you think there are needs for public health practitioners and policy makers. This will add to the conversation as well as to networking around the subject in Canada. Your input will also increase the NCCHPP’s ability to respond, along with the other NCCs, to missing resources in the area to the benefit of local and regional public health actors.
Please contact pascale.mantoura@inspq.qc.ca

V Resources


Mental Health Commission of Canada (MHCC)
http://www.mentalhealthcommission.ca/

Changing Directions, Changing Lives: The mental health strategy for Canada
http://www.mentalhealthcommission.ca/English/Pages/Strategy.aspx

Canadian Institute for Health Information (CIHI)

 “Improving the Health of Canadians: Exploring Positive Mental Health”
https://secure.cihi.ca/estore/productSeries.htm?pc=PCC367

Canadian Population Health Initiative

“Mentally Healthy Communities: A collection of papers”
https://secure.cihi.ca/estore/productSeries.htm?pc=PCC441

Public Health Agency of Canada.
The Human Face of Mental Health and Mental Illness in Canada (2006).
http://www.phac-aspc.gc.ca/publicat/human-humain06/pdf/human_face_e.pdf

WHO
Promoting Mental Health. Concepts. Emerging Evidence. Practice. (2005)
http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf

CAMH, Public Health Ontario, and Toronto Public Health
Connecting the Dots. How Ontario Public Health Units are Addressing Child and Youth Mental Health (2013)
http://www.camh.ca/en/hospital/about_camh/provincial_systems_support_pro...

VI Reference List

Canadian Policy Network and Canadian Institute for Health Information. (2011). Return on Investment. Mental Health Promotion and Mental Illness Prevention. Retrieved from: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1658

Canadian Population Health Initiative-Canadian Institute for Health Information. (2008). Mentally Healthy Communities: A collection of Papers. Retrieved from: https://secure.cihi.ca/free_products/mentally_healthy_communities_en.pdf

Centers for Disease Control and Prevention. (2011). Public Health Action Plan to integrate Mental Health Promotion and Mental Illness Prevention with Chronic Disease Prevention 2011-2015. Atlanta: U.S. Department of Health and Human Services. Retrieved from: http://www.cdc.gov/mentalhealth/docs/11_220990_Sturgis_MHMIActionPlan_FI...

Department of Health Melbourne Victoria. (2012). Using Policy to Promote Mental Health and Wellbeing- A Guide for Policy Makers. Prevention and Population Branch,Victorian Government. Retrieved from: http://docs.health.vic.gov.au/docs/doc/CF6408DF588418D3CA257A5A0015241A/$FILE/Using%20policy%20to%20promote%20mental%20health%20and%20wellbeing%20-%20A%20guide%20for%20policy%20makers.pdf

Friedli, L. (2009). Mental Health, Resilience and Inequalities. WHO Europe. Retrieved from: http://www.euro.who.int/document/e92227.pdf

Fryers, T., Melzer, D., Jenkins, R., & Brugha, T. (2005). The distribution of the common mental disorders: social inequalities in Europe. Clinical Practice and Epidemiology in Mental Health, 1(1), 14. doi: 10.1186/1745-0179-1-14

Huppert, F. A. (2009a). A New Approach to Reducing Disorder and Improving Well-Being. Perspectives on Psychological Science, 4(1), 108-111.

Huppert, F. A. (2009b). Psychological Well-being: Evidence Regarding its Causes and Consequences. Applied Psychology: Health and Well-Being, 1(2), 137-164.

Jane-Lopis, E. & Anderson, P. (2005). Mental health promotion and mental disorder prevention. A policy for Europe. Nijmegen: Radboud University Nijmegen.

Lavikainen, J., Lahtinen, E., & Lehtinen, V. (2000). Public Health Approach on Mental Health in Europe. National Research and Development Centre for Welfare and Health (STAKES), 
Ministry of Social Affairs and Health. Retrieved from: http://ec.europa.eu/health/ph_projects/1998/promotion/fp_promotion_1998_...

McGibbon, E. (2012). Oppression and Mental Health. Pathologizing the Outcomes of Injustice. In Oppression. A Social Determinant of Health. (pp. 123-137). Nova Scotia, Manitoba: Fernwood Publishing.

Mental Health Commission of Canada. (2012). Making the Case for Investing in Mental Health in Canada. Retrieved from: http://www.mentalhealthcommission.ca/English/node/5020?terminitial=41

Public Health Agency of Canada. (2006). The Human Face of Mental Health and Mental Illness in Canada. Retrieved from: http://www.phac-aspc.gc.ca/publicat/human-humain06/pdf/human_face_e.pdf

WHO. (2001). World Health Report 2001. Mental Health: new understanding, new hope. Retrieved from: http://www.who.int/whr/2001/en/

WHO. (2002). Prevention and promotion in mental health. Geneva, WHO. Retrieved from: http://www.who.int/mental_health/media/en/545.pdf

WHO. (2004). Prevention of mental disorders. Effective Interventions and Policy Options. Geneva, WHO. Retrieved from: http://www.who.int/mental_health/evidence/en/prevention_of_mental_disord...

WHO. (2005). Promoting Mental Health. Concepts. Emerging Evidence. Practice. Retrieved from: http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf
 


Two: Telling the Health Equity Story through Population Heath Status Reporting

Contents

I Why integrate health equity into reporting practices?
II Learning together
III What does this mean for health promotion practice?
IV More resources on the social determinants of health, health equity, and public health practice
V Questions or comments?   

I Why integrate health equity into reporting practices?

Many OHPE Bulletin readers will have heard Jason’s story (http://www.phac-aspc.gc.ca/ph-sp/determinants/). His experience reveals the importance of asking “why” and identifying the causes of the causes. The National Collaborating Centre for Determinants of Health (NCCDH) has been supporting Canadian public health organizations to improve the process they use to create population health status reports.

Integrating health equity into population health status reporting means always asking why some community members are healthier than others. This, of course, helps orient programs and services to meet the community health needs.

Related NCCDH resource
What is a population health status report and why is it important? http://nccdh.ca/images/uploads/Learning_Circle_3.pdf

II Learning together

In 2011, the NCCDH began a two-year project that brought together health sector stakeholders from across Canada. This “Learning Circle” met through a series of discussions, demonstrations, and presentations. Throughout the process, the group offered advice and skills to support Capital Health in Halifax, the practice hub, as they worked on their first population health status report (to be released in later this year).
The Learning Circle covered a range of different topics over several discussions. To share their exchange with a wider community of public health peers, the NCCDH published a series of videos and brief reports:

The October 2012 Learning Circle discussion and related literature review is especially worth highlighting; the following practices were identified as being key to telling the health equity story in a population health status report:

  • Use of social and regional data that stratifies the population
  • Use of both absolute and relative measures, including those that summarize the magnitude of inequities
  • Combination of simple measures with more complex measures
  • Inclusion of qualitative data that describe the experience at the community level
  • Use of pictures and maps to communicate information
  • Discussion of community assets as well as deficits.

In a video on the importance of local data, Dr. Gaynor Watson-Creed, a Medical Heath Officer in Halifax, recalls a story from her sister, a family doctor. After speaking with a patient about healthy food choices, and hearing that fruits and vegetables were simply not available at the dollar store, Dr. Watson-Creed’s sister experienced a moment of clarity. She began to question why some neighbourhoods had access to affordable, healthy food in grocery stores, while others did not (to watch this video, visit http://www.youtube.com/watch?v=-hUwIoiYmeA&list=PLFvgvG0dOW24LdkeL4r78tD...).

A population health status report that effectively integrates health equity has the potential to be instrumental. Dr. Watson-Creed’s sister heard one person’s story, and it helped her to reframe her thinking. The local data in a population health status report reflects many peoples’ stories, and can similarly reframe conversations – shifting the focus towards interventions that are likely to narrow the gap between the most and the least healthy.

Learning Circle members identified that using local data to start local conversations was a useful way to ensure that inequities stayed on the public agenda. In making a population health status report, data is stratified by social, economic and geographic characteristics to identify differences in health status across the population. Once a health difference is identified, conversations with community members and stakeholders can help to provide context, and shed light on why those differences may exist. If a health difference is determined to be systematic, avoidable, and unfair, then it is considered a health inequity (to learn more about this concept, download Let’s talk: health equity from the NCCDH resource library http://nccdh.ca/resources/entry/health-equity).

Related NCCDH resource
Representing the data and telling the health equity story in population health status reporting
http://nccdh.ca/images/uploads/Telling_the_Story_EN_Final.pdf

III What does this mean for health promotion practice?

Knowledge translation is an important part of health promotion, particularly when engaging intersectoral actors to influence the social determinants of health.

Health promoters may not have direct responsibility for generating a health unit’s population health status report, however the importance of their involvement cannot be overstated. Public health practitioners who work in the area of health promotion play a key role in engaging communities to collect and interpret local data, and by extension, in telling the health equity story and driving local action. What’s more, the data contained in health status reports informs the way that Health promoters tailor and orient interventions to meet the needs of their communities.

A number of examples and resources can be found in this summary of the November 2012 Learning Circle discussion: Knowledge Translation Methods and Tools for Population Health Status Reporting, http://nccdh.ca/images/uploads/KT_EN_Final_(2).pdf.

IV More resources on the social determinants of health, health equity, and public health practice

Throughout this text, we have linked to a number of resources relevant to population health status reporting.

Visit http://www.nccdh.ca to access other resources on the social determinants of health, health equity, and public health practice, and to learn about organizations addressing the social determinants of health across Canada.

You can also collaborate with over 1000 public health colleagues from across Canada in our online network, Health Equity Clicks: Community (http://www.nccdh.ca/community). Members can start their own conversation, participate in a featured conversation, or read through the online exchange.

Here are some past discussions that may be of interest:

V Questions or comments?    

We love hearing your practice stories and your questions. If you have a story to share, or have any questions about our projects or resources, please contact Pemma Muzumdar, Knowledge Broker at pmuzumd@stfx.ca