Executive summary

Diabetes is a major public health issue in Canada and around the world. Over 2 million Canadians are estimated to knowingly or unknowingly have diabetes, and 180 million people worldwide have been diagnosed with the condition. Because of the serious potential health consequences and escalating prevalence of diabetes, it is critical that strategies be undertaken to reduce the rates of, and the factors which contribute to, the disease.

In 2000, the Public Health Agency of Canada, Atlantic Regional Office, (PHAC Atlantic), undertook an environmental scan of diabetes prevention programs existing in the Atlantic region to be used as a foundation for planning. Since the environment has changed significantly since then, a second scan was commissioned in 2006 to update the information collected in 2000. This report reflects the results of this review and includes the following:

• an introduction to the concept of a population health approach;
• an examination of the risk factors related to diabetes;
• details of the methodology used to conduct the scan;
• an overview of key strategies undertaken by provincial governments and their partners to address healthy eating and physical activity;
• a description of current programs, services, activities, and initiatives to address healthy eating and active living offered in the Atlantic region, including an inventory of programs by province;
• an analysis of trends occurring since 2000; and
• an assessment of gaps, challenges, lessons learned, and opportunities, as well as recommendations on how stakeholders can work together regionally to prevent diabetes.

In Atlantic Canada, active living and healthy eating form two of the primary pillars of all provincial health promotion strategies. These strategies share common elements and use a population health approach to achieve change. Each province works with strong, broad-based coalitions or alliances which are comprised of community organizations and individuals who share a common vision and interest in promoting healthy eating and physical activity. These active living and healthy eating alliances have been instrumental in influencing the development of strategies and are key partners in their implementation. The formation of these alliances and the development of provincial strategies are significant developments since 2000.

A range of complementary strategies is also under way at the national, Atlantic-wide, provincial, regional, and community levels which contribute to diabetes prevention and the promotion of healthy eating and active living, and these are identified in the report as well.

Unlike the findings of the last scan, most of the activities reported in this scan are based on population-wide approaches (as opposed to interventions with individuals), or have the potential to be with sufficient funding. This is particularly evident in the nutrition/healthy eating area with the introduction of province-wide healthy eating strategies within each province. It appears, compared to the 2000 scan, that greater emphasis has been placed by diabetes-specific organizations on targeting the pre-diabetes population with education and supports to develop healthy lifestyles, in addition to their primary prevention efforts.

In 2000, services and programs in the area of healthy eating and active living fell largely within two separate and distinct groups - public health/health/nutrition and recreation/sport. With the advent of chronic disease prevention frameworks, an increased focus on the prevention of type 2 diabetes and other chronic diseases, and increased emphasis on health promotion, it became apparent that a focused strategy required much more coordination between these two groups, particularly given that obesity (which is influenced by poor nutrition and a sedentary lifestyle) is a significant factor for diabetes and other chronic diseases.

The 2006 report finds much greater coordination and integration of efforts to promote healthy living than existed in 2000. There is evidence of more healthy eating initiatives, government leadership, extensive and structured partnerships, population health approaches, determinants of health addressed, and evaluation, as well as a greater focus on children and seniors. Key approaches are also described in the report; partnership development, public education, and creating supportive environments are the most common.

Respondents, both by survey and telephone interview, were asked to offer their perspective regarding gaps, challenges, lessons learned, and opportunities to move forward to carry out work in the area of diabetes prevention. While there is a much greater sense of optimism among respondents in this scan, long-term sustainable funding at a sufficient level is the most significant constraint affecting the degree of future progress in this area. The greatest opportunities cited by respondents are the commitments of governments to act on physical inactivity and unhealthy eating - the two key risk factors for diabetes - and the solid foundation for intersectoral action provided by the extensive network of partners participating in the active living and healthy eating alliances. Indeed, partnership has proven to be a critical success factor in ensuring organizations achieve their common goals in this area. There appears to be greater coordination and structure among stakeholders and more effort to coordinate activities, policies, programs, and action plans into one coherent, strategic direction.

A series of recommendations were generated for this document addressing sustainable funding, access to and promotion of programs, strategic leadership and coordination, partnership, targeted areas for action, supportive policy and programs, and evidence-based decision making/knowledge development and exchange. They can be summarized as follows:

1. Sustainable Funding

• Increase efforts to provide sustainable funding in sufficient levels to those involved in the implementation and delivery of healthy eating and physical activity strategies/programs on a population-wide basis in order achieve the intended outcomes.
• Support building of the basic infrastructure to implement physical activity and healthy eating strategies, both in terms of human resources and financial and physical plant/facilities, as necessary. Particular needs include building sufficient infrastructure (equipment, spaces, and facilities) and increasing capacity (positions at the provincial and community levels) to support an increased focus on health promotion and wellness.

2. Access To And Promotion Of Programs

• Encourage steps to improve the availability of programs so that all members of the population can access services regardless of geographic location, or other barriers. Provide assistance with promotion of the programs so that the population is aware of the services available.

3. Strategic Leadership And Coordination

• Provide leadership, direction, and support at multiple levels to ensure an integrated, coordinated approach. Alignment of efforts and strategic planning within the region will help identify areas for action best suited to PHAC Atlantic and to each key stakeholder. Some activities are costly and/or apply equally to all jurisdictions (e.g., social marketing campaigns) and perhaps provinces/healthy living alliances could benefit by working together with PHAC Atlantic to coordinate efforts in these areas. A vast number of initiatives are under way at the national, Atlantic-wide, provincial, regional and local levels, and it is difficult to ensure stakeholders within the region are informed of developments in order to coordinate efforts, provide complementary services, and avoid duplication.

4. Partnership

• Continue to support/enhance the partnership networks of the healthy eating and active living alliances in recognition of the potential impact of collaboration and the need for intersectoral approaches. Partnerships between the government, community groups and alliances are critical to moving the agenda forward.
• Build partnerships with other key sectors, particularly the food/agricultural industry, which have a contribution to make in promoting healthy eating and active living and which appear underrepresented in this scan. Seek out ways to address barriers and more fully engage existing partners where necessary.
• Strengthen the level of collaboration between diabetes initiatives and healthy eating/physical activity groups, as well as with initiatives related to other diseases with the same risk factors. Ensure funding allocation mechanisms support this approach.

5. Targeted Areas For Action

• Children and youth: Continue to focus on school-aged children and youth to help ensure the adoption of life-long healthy eating and active living practices.
• Food Security: Enhance efforts to ensure the availability of nutritious affordable food for low-income groups. The degree to which the reach of other programs extends to low-income and rural groups is also not clear, given the uneven accessibility of programs generally, and more work may be necessary to explore this sub-population, given the socio-economic status of the region as a whole.
• African-Canadian, ethno-cultural, and other communities: Examine need and opportunities for working with African-Canadian and other ethno-cultural communities in the promotion of healthy eating and physical activity. Build on initiatives such as the diversity and social inclusion initiative in primary health care as a model for action. Explore gaps in services targeted to particular sub-populations in various jurisdictions.
• Seniors: While more programs have targeted seniors, this is a population that will continue to need sustained focus, given the aging demographics of the region's population.
• The family: The family unit as a whole also merits attention since healthy eating and physical activity patterns are also influenced and shaped within the family context.

6. Supportive Policy And Programs

• Continue efforts to address the risk factors of obesity, unhealthy eating and physical inactivity with the creation of supportive policy and program environments across multiple sectors. Continue to use a broad range of approaches to achieve outcomes.

7. Evidence-Based Decision Making, Knowledge Development And Exchange

• Ensure programs and initiatives have an evaluative component built into their work so as to provide the evidence needed for what works and what does not.
• Establish mechanisms for sharing information about programs offered in the region, research and evaluation results (in easy-to-use form), and best practices. Also explore other mechanisms to share information, network, and build partnerships on an Atlantic-wide basis so as to avoid duplication of effort. Consider establishment of a clearinghouse to maintain a body of literature - evaluation, research, programs, environmental scans, and the like that are relevant to the region.
• Assist in the development of links with the research community.

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