Introduction

"Health care is vital to all of us some of the time, but public health is vital to all of us all of the time." - C. Everett Koop, Former Surgeon General, U.S.A.

The purpose of this discussion paper is to assist the Public Health Agency of Canada, Atlantic Region (PHAC Atlantic) and other stakeholders to better understand the regional public health environment. The work was carried out in February and March 2005 and is seen as an important step towards strengthening public health partnerships in the region.

THE PUBLIC HEALTH AGENCY OF CANADA

In order to strengthen its ability to protect the health and safety of Canadians, the Government of Canada delivered on its commitment to establish a new Public Health Agency of Canada (PHAC) in September 2004. The mission of the PHAC is to promote and protect the health of Canadians through leadership, partnership, innovation, and action in public health. With pillars in Winnipeg and Ottawa and regional offices across the country, the PHAC is well placed to collaborate with Canada's provinces and territories on matters of public health.

The creation of the PHAC came as the result of wide consultation with the provinces, territories, non-government stakeholders, and Canadians in general. A national public health agency was also recommended in Dr. David Naylor's report, Learning from SARS: Renewal of Public Health in Canada, as well as in other Canadian and international reports.

The PHAC's focus areas

The PHAC identifies promotion, prevention, and protection as the three main activities for public health practice. These three areas focus on communicable disease, non-communicable disease and injury, and healthy human development.

Communicable disease encompasses diseases that are transmitted through various forms of contact. It includes zoonotic diseases such as the West Nile virus and avian influenza. It also includes sexually transmitted diseases such as syphilis, HIV/AIDS, and hepatitis C and respiratory diseases such as SARS. Chicken pox, measles, and mumps are common childhood communicable diseases. Some communicable diseases have effective vaccines that limit the spread of the disease, and others do not. There are currently 52 communicable diseases reported nationally.

Non-communicable disease and injury can be broken down into several areas. Non-communicable disease includes a broad range of diseases - many sharing common risk factors - such as arthritis, cancer, stroke, diabetes, cardiovascular disease, and respiratory disease. Injury encompasses a wide range of activities related to motor vehicles, recreational vehicles (such as ATVs), bicycles, and pedestrian safety. It also includes home-setting and age-specific safety issues such as falls prevention in seniors. Suicide (self-injury), fetal alcohol spectrum disorder, occupational health and safety, and shaken baby syndrome are other diverse areas related to injury control and prevention.

Healthy human development focusses on the life-course context of the health of citizens and includes a focus on addressing the upstream causes of many of the diseases listed above. Often, the "determinants of health," defined by Health Canada,¹ are used as a lens for action. They include

• Income and social status
• Social support networks
• Education and literacy
• Employment/working conditions
• Social environments
• Physical environments
• Personal health practices and coping skills
• Healthy child development
• Biology and genetic endowment
• Health services
• Gender
• Culture

Healthy human development includes actions in all of the above areas, with a special focus on health promotion, health policy development, and protection. Supporting healthy human development acknowledges the complexities and interactions of all of the social, economic, and emotional factors that influence our health.

The PHAC's enabling functions

The PHAC also identifies five enabling functions related to building the capacity to carry out work in the areas listed above. These five enabling functions are

• public health surveillance
• research, evaluation, and knowledge translation
• policy, legislation, regulation, and planning
• health human resource planning, development, and training
• community capacity building

Public health surveillance is defined as the "systematic collection, analysis, interpretation, and dissemination of health data on an ongoing basis, to gain knowledge of the pattern of disease occurrence and potential in a community, in order to control and prevent disease in the community."² Having access to community-level data and information to perform a regular community health assessment is a critical step in moving forward to enhance population health.

Research in public health helps answer community questions, facilitate the understanding of population health issues, and inform and support policy development. The evaluation of public health activities provides an opportunity to explore the relationship between interventions and defined health outcomes. Knowledge translation focusses on the opportunity to share information in a way that can be easily understood and used for influencing practice by the parties involved. From researchers to public health practitioners, and from community members to government decision-makers, knowledge translation ensures that information flows in a meaningful way.

The role of public policy, legislation, regulation, and planning is a crucial part of public health. Policies that set standards for seat-belt or helmet use have obvious public health implications through reducing injury. Child-benefit clawbacks and poorly planned public transportation routes may also have real and direct implications for community health. A municipal commitment to green spaces may mean more accessible recreation activities for families, while regulations related to pollution emissions protect the air we breathe.

The health human resource planning, development, and training enabling function recognizes the need to have a well-trained, supported, and resourced body of individuals with diverse training and cross-training to work in all aspects of public health. This may include service delivery by public health nurses, dental hygienists, and nutritionists; research capacity in all areas of public health; diagnostic capacity; and knowledge of how to work effectively with diverse communities.

Community capacity building for public health refers to the opportunity to build upon the inherent knowledge and questions of a community with regard to the health of citizens and the population. Resources, information (including data and statistics, best practices, and research outcomes), and funding at the community level can support the work of community-based organizations and informal groups in making positive, effective, culturally sensitive, and context-specific changes to enhance their own health.

National Collaborating Centres for Public Health

Announced at the same time as the creation of the PHAC, National Collaborating Centres for Public Health are also being developed.

"As a primary goal, the centres will build on existing strengths and create and foster linkages among researchers, the public health community, and other stakeholders to ensure the efficiency and effectiveness of Canada's public health system. The National Collaborating Centres will facilitate the sharing of knowledge and help put it into practice at all levels of the public health system across Canada."³

British Columbia will host the National Collaborating Centres for Environmental Health and Aboriginal Health. The National Collaborating Centre for Public Policy and Risk Assessment will be based in Quebec, and Ontario will be home to the National Collaborating Centre for Infrastructure, Info-Structure and New Tools Development. The National Collaborating Centre for Infectious Diseases will be based in the Prairies, and the Atlantic region will be home to the National Collaborating Centre for Determinants of Health.

The PHAC Atlantic

While the roles of the regional offices as part of the new PHAC are not yet well-defined, it is clear that these will be built upon the strong foundations of the work done in the past by the Population and Public Health Branch, Health Canada. Throughout the transition, existing partnerships will continue to be strengthened, new partnerships and opportunities forged, and consultation with stakeholders expanded.

The PHAC Atlantic expects to continue to support collaboration and other initiatives that promote understanding, acceptance, and implementation of a population health approach, with a focus on vulnerable communities (including Francophone and Acadian communities), healthy public policy development, and promoting social and economic inclusion. The PHAC Atlantic identifies three key areas of work: community capacity building, knowledge development, and inter-sectoral collaboration.

The PHAC Atlantic strives to help volunteer, non-profit, and non-government organizations increase their capacity to act on the determinants of health through various funding programs. Funding programs include Aboriginal Head Start; the AIDS Community Action Program; the Canada Prenatal Nutrition Program; the Community Action Program for Children; the Diabetes Prevention and Promotion Contribution Program; the Hepatitis C Disease Prevention, Community-based Support and Research Program; and the Population Health Fund. Each of these programs, in turn, sponsors local or province-wide community projects.

Knowledge development is another broad area of activity for the PHAC Atlantic. The publication of research findings and discussion papers helps community partners and other stakeholders increase their understanding of key health issues and how best to address them.

The PHAC Atlantic is committed to promoting inter-sectoral collaboration to address the determinants of health. Such collaboration occurs on many levels and requires a commitment to creating and supporting ongoing inter-sectoral working groups. Key partners include various levels of government, universities, research centres, and community organizations as well as linguistic and cultural communities throughout the region.

 

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