Chronic Disease Prevention: Looking Back on 2007 and Ahead to 2008

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I Introduction

It is an exciting and fruitful time for health promotion and disease prevention initiatives in Ontario and beyond. In this feature, I have provided several highlights from 2007, a few of my own musings about trends, and some initiatives to look forward to in 2008. I hope this will assist those of us working in this field to take even bigger strides in the prevention of chronic diseases.

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II A Retrospective Look At 2007

Nationally

Chronic Disease Prevention Alliance of Canada (CDPAC)

• The Public Health Agency of Canada (PHAC) funded a project known as "The CUBE: Facilitating Alignment of Primary Prevention Priorities Across Comprehensive Chronic Disease Strategies". It aims to identify ways to better align the primary prevention components of five national disease strategies (Heart, Stroke, Lung, Cancer, and Diabetes). In November 2007 a national consultation meeting took place. The project report is expected by March 31, 2008.  Visit http://www.cdpac.ca/content.php?doc=5.
• Participants at the 2006 CDPAC Conference created a Call to Action that health promoters across the country might find useful to reference or build on. The headline "Help the Worst First" describes the focus on Determinants of Health. Visit http://www.cdpac.ca/media.php?mid=270.

Public Health Agency of Canada (PHAC)

• The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention collects "best practice" interventions. Accepted interventions must show positive effects through a soundly designed outcome evaluation. In addition, systematic review evidence corroborates their results. The collection is by no means exhaustive yet. The portal encourages users to nominate programs for consideration. Visit http://cbpp-pcpe.phac-aspc.gc.ca.
• The Public Health Agency of Canada established The National Collaborating Centre for Methods and Tools (NCCMT).  As one of six National Collaborating Centres, it aims to promote evidence-informed public health decision-making. The NCCMT focuses on the identification, evaluation, development and dissemination of KSTE (knowledge synthesis, translation and exchange) methods and tools. They have recently developed a "Tool for Assessing the Applicability and Transferability of Evidence" to assist public health managers and planners in decision-making about program priorities for their community. This tool highlights a process and criteria for assessing applicability (feasibility) and transferability (generalizability) of evidence to public health practice and policy. It will be available on their web site in early January 2008. Visit http://www.nccmt.ca (English), or http://www.ccnmo.ca (French).
• The Centre for Chronic Disease Prevention and Control's home page (http://www.phac-aspc.gc.ca/ccdpc-cpcmc/index_e.html) features a chronic disease clock, updated daily. It identifies the number of deaths to date this year, and the number as of today, attributable to which diseases.
• With the launch of the Pan-Canadian Public Health Network in 2003 (http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2005/2005_26bk1_e.html), we have seen the creation of expert groups in non-communicable disease and injury prevention and control, and in health promotion. Various issue groups link to each expert group. Most members work within the public health system across the country. The Pan-Canadian Healthy Living Strategy, announced in 2005, became an issue group of the Health Promotion Expert Group. This Healthy Living Strategy, more accountable for progress through this structure, set five priorities for action in 2007. One priority aims to identify/confirm common indicators for physical activity, healthy eating and healthy weights. Their first e-bulletin, distributed in November 2007, (Healthy Living E-Bulletin November 2007, Theme: Children and Youth, "The Right to Be Active," available at http://www.phac-aspc.gc.ca/hl-vs-strat/e-bulletin_e.html) contains the following information:

• Welcome
• Fast Facts: Active Healthy Kids Canada Report Card
• Feature Article: Canadian Parks and Recreation Association: Everybody gets to play
• Healthy Living Best Practices and/or Evidence-based Practices: Best Practices Portal
• Updates from Federal, Provincial and Territorial Governments
• Healthy Living Campaigns
• Key Dates & Events
• Potential Funding Sources: Transport Canada
• Research: Canadian Fitness and Lifestyle Research Institute
• Next Edition: Populations in isolated, remote and rural areas (February 2008)

Provincially

The Ontario Chronic Disease Prevention Alliance (OCDPA) (http://www.ocdpa.on.ca)

• The Ontario Chronic Disease Prevention Alliance established six priority areas for action as the next step towards an integrated approach to CDP in Ontario. The priorities, established through a consultative process, are:
• Integration of chronic disease (CDP) prevention into local health systems.
• Common messaging.
• Application of learnings from tobacco control to healthy eating and active living (HEAL).
• Implementation dose of best practices.
• Addressing health disparities.
• Evaluation of HEAL components.
• In March 2007, OCDPA produced "Primer to Action on the Social Determinants of Health". Designed for health professionals, lay workers, volunteers and activists to explore how the social determinants impact chronic disease. It intends to help readers navigate through organizational barriers and offers concrete "primers" to move from inaction to action to ultimately increase access to the social determinants. Visit http://www.ocdpa.on.ca/rpt_PrimertoAction.htm.
• The OCDPA finalized a brochure and bookmark marketing the benefits of  "An Ounce of Prevention". Downloadable versions available at http://www.ocdpa.on.ca/communications.htm.

The Heart and Stroke Foundation of Ontario (HSF) (http://www.heartandstroke.ca)

• As part of their mission to address health promotion and disease prevention, HSF invested in regional Community Mission Specialists (CMS). Some CMS work with the newly launched Community Advocacy Fund. The fund addresses physical activity policy supports through elementary schools. As well, CMS delivered a "Knowledge to Action" workshop in several communities, with support from Queen's University, the Ontario Trillium Foundation and the YMCA. The workshop translates the research presented at the June 2008 International Conference on Physical Activity, Obesity and Children into local action.

The Ontario Collaborative Group on Healthy Eating and Physical Activity (OCGHEPA)

• This group addresses the individual, cultural, social, economic and environmental determinants of healthy eating, physical activity and healthy weights. Translating this evidence to impact the health of all Ontarians requires the coordination of research, surveillance, intervention development, advocacy and public policy. The OCGHEPA provides a forum to advocate for comprehensive approaches to address these issues. The group meets to discuss key issues, provide advice, and supports concerted action. The Canadian Cancer Society, Ontario Division, provides Secretariat support to the OCGHEPA. In 2007, many advocacy statements emerged from this group.

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III Musings On Trends

My impressions about chronic disease prevention in Ontario today follow. I welcome the perspectives of others by way of a letter to the editor. Please write OHPE at editor@ohpe.ca.

1. Emphasis on addressing health disparities continues to increase. Often approached through policy, many find knowing where to start a challenge. Building relationships with other sectors and sorting out leadership roles takes time. The issues are overwhelming and therefore often difficult to break down into manageable action steps.
2. I see heightened interest in how mental health connects with chronic disease prevention. Although no one is questioning the link, defining it remains a challenge. For instance, is mental illness a risk factor for chronic disease? What aspects of mental health are most relevant to address?  The "fishbowl" of the workplace provides a setting in which we can make some important and much needed strides.
3. Struggles continue, at all levels, with operational "integration" of CDP. Many people both within and between organizations address this complex issue. It has programmatic as well as structural implications, and often carries sensitivities regarding "turf". Terms such as "alignment" and "coordination" appear more and more often today--perhaps indicative of a more realistic approach.
4. The emphasis on obesity continues. More and more communities bring stakeholders together to figure out priorities for local action. I would love to see more emphasis on policy approaches and less "parents blaming teachers and teachers blaming parents" dialogue. Windsor-Essex put in place a very strategic approach with policy makers. Keep an eye on it-it may prove interesting and insightful. Across the province, I see focus on children and an increasing dilemma regarding terminology (i.e. discomfort with the term "obesity", as well as discomfort with an emphasis on weight). More and more, community initiatives take the approach of addressing healthy eating and physical activity.
5. To ensure a comprehensive approach to CDP throughout Ontario we require a few missing pieces. A lack of services and programs available when people are ready to make a change appears to exist. Where do people access high quality, credible, affordable, and culturally appropriate supports in the areas of tobacco cessation, nutritional counseling, weight management?  We seem to do better in physical activity where community recreation infrastructure exists and organizations such as the YMCA and Boys and Girls Clubs are available. I worry we spend a lot of time promoting the need for change and some efforts to change policies to make it easier for people to change, but where do they get the actual supports to change?
6. Schools have made great strides in support of CDP. I look forward to seeing similar successes within workplaces, although understand, that accessing workplaces through any type of "system", like what is available with schools presents a challenge. I think we will see exponential action on this front with the advent of the Ontario Healthy Workplaces Coalition (Secretariat contact: Jessica Elgie at THCU at jelgie@thcu.ca) and the Forum on the Advancement of Healthy Workplaces (Contact: Virginia West (co-chair), Deputy Minister, Ontario Ministry of Labour at virginia.west@ontario.ca).
7. In Ontario, we have many resources at our disposal to make a real difference in the prevention of major debilitating and costly chronic disease. However, I often see alarming duplication that does not make best use of these precious resources. We have expensive communication campaigns on physical activity, nutrition, and obesity in most communities across the province. Streamlining the development of these materials could greatly increase media exposure and make effective use of our resources. Good examples of these collaborative campaigns already exist. Perhaps funds are available. The same could be said for toolkits, speakers' packages, displays, programs, contests and the like. Coordinated development is no easy task. However, I see a huge opportunity for provincial leadership, perhaps through the government, OHPRS members and/or the OCDPA, to coordinate our riches.

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IV Coming Attractions

Nationally

The Canadian Best Practices Initiative

• The Canadian Best Practices Initiative will reveal the next version of the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention at the CDPAC conference in November 2008. This includes an expanded collection of annotated interventions in "best" and "promising" categories, among others, as well as several knowledge exchange supports to assist people with adapting these interventions to their own context. Visit http://cbpp-pcpe.phac-aspc.gc.ca.

Chronic Disease Prevention Alliance of Canada

• Development of a searchable database of primary prevention investments in Canada will occur as part of "The CUBE" project. Scheduled for completion and available on CDPAC's website by March 31, 2008.
• CDPAC received funding to launch Enhancing Capacity for Knowledge Development and Exchange (KDE) for Health Promotion and Chronic Disease Prevention which will develop and pilot web-based tools to enable CDPAC members to interact, collaborate and exchange knowledge and best practices in chronic disease prevention. Key activities include conducting a membership survey and establishing an expert advisory group to identify which types of tools are most relevant and have the greatest potential impact for CDPAC members. Expect tool development and pilots over the coming year. Visit http://www.cdpac.ca/content.php?doc=5.
• CDPAC holds its 3rd National Conference November 24-26, 2008 at the Westin Hotel in Ottawa. Check http://www.cdpac.ca/content.php?doc=98 for regular updates.
• The Canadian Centre for Chronic Disease Control and Prevention at PHAC established a Demonstration Program, to which Dr. Barb Riley provides strategic leadership. The two goals of the program are to strengthen evidence-informed practice in partnership with provinces and territories, and to build capacity to generate and use best available evidence to continuously improve population health interventions. Two components are underway: Provincial/territorial projects which will test models to develop, implement and continuously improve population interventions and developing a Pan-Canadian enabling system to support knowledge exchange efforts within provinces/territories. These plans include a common evaluation framework and a knowledge exchange system.
• The International Society For Behavioral Nutrition and Physical Activity holds its annual meeting May 21st - 24th, 2008 in Banff, Alberta.
• The Chief Public Health Office for Canada, Dr. David Butler-Jones will be releasing his first report, with a focus on Social Determinants of Health.

Provincially

• The Association of Ontario Health Centres undertakes work to build capacity with staff of the Ontario CHCs to deliver integrated chronic disease prevention and management programs. This may entail an expanded or different role for these community health workers.
• The Ministry of Health Promotion asked Ontario's Heart Health Program: Taking Action on Healthy Living, which operates in all 36 public health regions of the province, to address strategic planning in 2008. At this time the focus--whether on another term of renewed funding or planning for a future without dedicated resources—is unknown.
• As the 14 Local Health Integration Networks continue to develop their strategic direction, most identified a role in the area of chronic disease prevention. Although each is unique, I find it encouraging that yet another "traditional" healthcare group recognizes the merit of prevention work.
• The Ontario Health Promotion Resource System (http://www.ohprs.ca) will undertake a strategic planning process to identify opportunities for the future. This is the largest capacity building network for health promotion in the world and through the on-going evaluation initiatives of the OHPRS, it will strive to provide necessary, collaborative, coordinated and efficient services.
• The members of the OHPRS who have a role in supporting work in the area of obesity have formed an ad hoc group to connect on what each other is doing and to look at any potential for collaborative work based on gaps. Watch for products and/or processes related to this in 2008.
• The Health Communication Unit (http://www.thcu.ca) will offer multiple webinars on effective obesity messaging in 2008.