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Intersectoral
Collaboration for the
Control of Non
Communicable Diseases
National Health Forum,Vilnius, November 29-30, 2012
Canadian experience
Sylvie Stachenko,
University of Alberta
Road Map
1. Building blocks for
intersectoral action
2. Example of national
and provincial
approaches
3. Key challenges and
lessons
3
The Burden of Non
Communicable Diseases in
Canada
High risk groups • Increased prevalence in vulnerable communities (e.g.
Aboriginals) and in socio-economically disadvantaged groups
Economy • Direct health care costs: 71 billion dollars
• Indirect costs: 85 billion dollars
All these numbers will increase as a result of • Aging
• Increased prevalence of some risk factors, e.g. obesity
Some alarming trends
• 4 out of 5 Canadian adults have at least one risk major factor for chronic disease
• High blood pressure and Type 2 diabetes occurring at younger ages
• 1 out of 4 Canadian children are overweight or obese
Increasing Health Disparities
Aboriginal Status vs non aboriginal
• Life expectancy:
males: 68.9 years vs 76.3 years
females: 76.6 years vs 81.8 years
• Infant mortality: 16% higher
• Smoking: 59% vs 17%
• Type 2 diabetes: 3 – 5 times higher
• Years of life lost to injury: 3.5 times higher
• Rates of tuberculosis: 8 – 10 times higher
What has been the response
in Canada?
Canadian Investments
in Health Promotion to address NCD
Prevention
Single risk factors – tobacco
Single diseases-cardiovascular
Specific population groups – children
Towards an intersectoral approach to
NCD prevention
Commonality of risk factors for major NCD’s
Systems approach to planning and delivery
Major participation of civil society
Strategic partnerships for intersectoral action
Multiple Entry Points Incremental
Building on a long
history in health
promotion
Canadian Strategy for
Tobacco Control
Governance
- Multisectoral Partnerships
Multi-pronged Strategy
- Access
- Advertising and Promotion
- Packaging and Labelling
- Product Regulations
- Taxes
- Smuggling
- Enforcement and Education
Sustained over time
9
Community-Based Programming
Community Action
Program for Children
Canada Prenatal
Nutrition Program
10
Health and Education
School Settings Initiatives
healthier foods and nutrition policy
in cafeterias, vending machines
11
The Canadian Heart Health Initiative
Building the evidence base for
intersectoral action on NCD
Demonstration programs in all 10 provinces
Observatory of community-based comprehensive programs- a focus on vulnerable populations
311 projects in 10 provinces,
35 community level programs
Development of tools and methodologies
Risk factor surveillance
Process evaluation
Implementation research
The Canadian Heart Health
Initiative Catalyst for the
development of NCD supportive
infrastructure
• The Heart Health Risk Factor Survey ,precursor
to the current Health Measures Survey.
• Precursor to the Population Health Intervention
Research Initiative for Canada
• Coalitions for heart health at all levels expanded to chronic disease alliances that have been influential in advancing the healthy living and chronic disease strategy
13
The Federal Chronic
Disease and Healthy
Living Strategy
• Balance between broad population-based
intersectoral action eg Healthy Living
Strategy
and
• Disease specific strategies,including
Cardiovascular disease, Diabetes,Cancer
Obesity:the case for intersectoral action
Source: see Kumanyika Ann Rev Pub Health 2001; 22:293-308
INDIVIDUA
L
Energy
Expenditure
POPULATION
%
OBESE
OR
UNDERWT
Food
intake :
Nutrient
density
FACTORS
INTERNATIONAL
School
Food &
Activity
WORK
/ SCHOOL/HOME
Infections
Labour
Worksite
Food &
Activity
Leisure
Activity/
Facilities
Agriculture/
Gardens/
Local
markets
COMMUNITY
LOCALITY
Health
Care
Syste
m
Public
Safety
Public
Transport
Manufactured/
Imported Food
Sanitation
NATIONAL/
REGIONAL
Food &
Nutrition
Urbanization
Education
Health
Social Security
Transport
Family &
Home
Media &
Culture Media
programs
&
advertising
Developmen
t
Globalization
of
markets
National
perspective
Action on Diet, Physical
Activity and Health
- Strong focus on intersectoral
approaches
-Comprehensive, collaborative and
in partnership with national,
P/T, and NGO stakeholders
including CDPAC
- Initial focus on diet and physical
activity and healthy weights
A declaration from Canada’s
ministers of health
• Commitment for
upstream action
• A focus on
intersectoral
action
Multilevel networks to
advance
the NCD Prevention
Agenda
• Public Health Network (cross jurisdictional)
Expert group on chronic disease prevention and promotion
• Chronic disease prevention alliance
• Pan Canadian intersectoral healthy living network
• …
18
Knowledge Synthesis
and Development
• Comprehensive learning system
National Best Practice portal for Health Promotion and Chronic Disease Prevention
www.phac.gc.ca/cbpp
PAHO-PHAC Observatory of Chronic Disease Policy
www.phac-aspc.gc.ca/ccdpc-cpcmc
• Supportive knowledge translation platforms-National
Collaborating Centres – Healthy Public Policy
– Social determinants of health
– Aboriginal Health…..
19
Provincial Intersectoral
Actions
Act Now BC
Act Now BC is an integrated, partnership-based, multi-
sectoral, health promotion and chronic disease
prevention strategy designed to improve the health of
British Columbians by focusing on the risk factors and
underlying determinants associated with chronic
diseases:
Physical inactivity
Poor nutrition
Tobacco use
Alcohol use
Act Now BC Goals
Make British Columbia the healthiest jurisdiction to
host the Olympic and Paralympic Winter Games.
Specific targets related to 4 modifiable risk factors
Build community capacity to
create healthier, more
sustainable, and economically
viable communities, and
Reduce demand on the health care system.
Political leadership that seizes the opportunity intersectoral vision and direction obtained through leadership
and a strong mandate
Funding support
Diverse horizontal and vertical strategies and mechanisms Breaking down the silos in government – the horizontal
dimension
Engaging the many civil society organizations and different layers of government– the vertical dimension
Targets and accountability Publicly stated Act Now BC goals and targets
Clear understanding about who is responsible for what
Annual departmental service plan describing their contribution to the achievement of the targets
Success Elements
Act Now BC legacy
• Progress in achieving targets
• Tobacco target was achieved
• The concept of healthy public policy
accepted
• CIHR funded study to explore the
lessons learned from the Act Now BC
and its impact on the action planning
for health promotion in BC and in
Canada
The Quebec approach to Health in All
policies
• Mainly horizontal governance .No vertical dimension
• No HD targeted a priori (defined on the basis of MoH
directions)
• Legal act mandating:- intra-governmental mechanism
for evaluation of public policies and knowledge production
system to shed light on the decision-making
• Internal HIA of the laws and regulations of other departments
(with support from the MoH),and external HIA of the impact of
• certain laws and regulations on public health (MoH - INSPQ).
What kind of governance
works best?
• No one-size-fits-all
• Very context dependent eg culture and history
• Different time limits, breadth of involvement, level of involvement
• Strong mandate,sustained leadership
•
• Integrated policy development mandate,informed by info and research knowledge
• Adequate resource base
•
Challenges
• Capacity gaps to assess, identify, and
communicate impacts of gov’t policies on
health & health inequalities
• Developing effective supports for horizontal
work: accountability structures, rewards,
shared leadership protocols
• Willingness to invest sufficient time and
resources
• Meaningful involvement of other sectors
• Working with industry
Aciu
Thank You