Toward an Integrated Pan-Canadian Healthy Living Strategy

Special Working Session with Stakeholders

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Ottawa
July 25, 2003

Prepared by The Alder Group

Table of Contents

• Opening Remarks
  • Mary Kardos Burton
  • Scott Broughton
• Participant Comments and Questions
  • Proposed Actions
  • Proposed Action 1
  • Proposed Action 2
  • Proposed Action 3
  • Proposed Action 4
  • Proposed Action 5
  • Proposed Action 6
• Concluding Remarks

Mary Kardos Burton, Co-Chair, Healthy Living Task Group

The special stakeholder meeting is a follow-up to the Symposium; an opportunity to review the results and to have further input into the proposed actions.

The 39 organizations represented were chosen on the basis of their representing a network or large group of stakeholders, as well as their ability to speak on issues around healthy eating, physical activity, healthy weights, health disparities, education and environment.

Much work has gone into the development of the Healthy Living Strategy since the announcement made by the Federal/Provincial/Territorial (F/P/T) Ministers of Health in September 2002. Four pre-consultation meetings were held with stakeholders between January and February 2003, nine roundtables were held across the country between March and April 2003, and the Symposium was held in Toronto on June 16 - 17, 2003.

The participants' continued involvement is essential to the development of the Strategy.

Scott Broughton, Co-Chair, Healthy Living Task Group

Since the September 2002 announcement, the following developments have taken place:

• Formation of the Healthy Living Task Group (as a sub group of ACPHHS), formation of the Consultation Reference Group, formation of the Health Disparities Task Group and support to the Healthy Living Task Group by the Child and Adolescence Development Task Group.
• Four pre-consultation meetings (January - February 2003)
• Nine strategic roundtables (March - April 2003)
• Development of the Healthy Living website and on-line consultation workbook
• Development of the Strategy Framework and discussion document
• Healthy Living Symposium (June 16-17, 2003)

Four themes emerged from the consultation roundtables:

• Integration - broad inter-sectoral involvement, collaboration, integrated approaches
• Sustained action - establish adequate resourcing and infrastructure
• Building on existing knowledge - do not duplicate what exists
• A universal and target approach - flexibility to address the needs of specific populations, regions and communities.

The Symposium included plenary and working sessions that generated feedback from participants, including a sense of urgency around the issues. A number of key recommendations were identified at the Symposium:

• Acceptance and approval of the Strategy Framework by Ministers of Health.
• The creation of a forum for inter-disciplinary, inter-sectoral, and inter-jurisdictional action.
• The development of an enhanced integrated surveillance agenda.
• Options for the utilization of collective resources towards sustained action on healthy living.
• The establishment of one or more focal points for public health action.
• The need for targeted, complementary and coordinated messages.
• The establishment of a process to engage Aboriginal stakeholders at the federal/provincial/territorial (f/p/t) level.
• A separate strategy for Aboriginal Peoples that respects the needs of that population and its diverse sub-populations, and is developed through national consultation.

Based on the outcomes of the Symposium, six proposed actions have been developed:

• Approve the Strategy Framework.
• Establish an Inter-sectoral Committee.
• Create an integrated research agenda, an enhanced and integrated surveillance agenda, and a best practices initiative.
• Establish an Inter-sectoral Community Fund.
• Develop a communications/health information strategy.
• Develop and implement a separate process for consultation with Aboriginal stakeholders.

Key milestones to moving forward include:

• Special working session with stakeholders (July 25, 2003).
• Report to the Conference of Deputy Ministers of Health meeting (August 2002).
• Report to the F/P/T Ministers of Health meeting (September 2003).

A question was posed regarding what will be communicated to the Ministers of Health. The response was that the Ministers will receive more than a general briefing, there will be some specifics including the status of identified short-, medium- and long-term goals.

A question was posed regarding the definition of short-, medium- and long-term goals.

The response was that the Symposium could be considered an accomplished short-term goal, while a long-term goal would be over 20 years, and include identification of the strategies and interventions that should be invested in.

A further comment was made regarding the different terminology being used. At this meeting the terms "short-, medium- and long-term goals" were being used, in the September 2002 communiqué the terms were "short-, medium- and long-term (pan-Canadian) healthy living strategies," and the discussion document for the Symposium refers to "short-, medium-, and long-term priorities, initiatives and actions".

Participants were divided into five working groups and each group was asked to discuss the first five proposed actions (the 6th proposed action deals with a separate process to consult nationally on an Aboriginal-specific holistic wellness strategy and was not discussed.) Background information and questions to consider were provided. The working group sessions lasted most of the day. Each group took detailed notes on flip charts and reported their discussions in plenary at the end of the day. Following is a summary of these discussions, with common themes noted.

Proposed Action 1:

Given that the Integrated Pan-Canadian Healthy Living Strategy Framework constitutes the cornerstone for action on healthy living, it is therefore proposed that the Strategy Framework be accepted and approved as the basis to move forward on healthy living.

Background:
The Strategy Framework is an integrating umbrella framework for sustained action. The purpose of the Framework is to illustrate the relationship between the various conceptual components of the Strategy and to provide overall direction to Strategy development as it rolls out over time. The Framework was approved by ACPHHS in February 2003. Throughout the consultations and the Symposium proceedings there has been overall support for the Framework.

Possible Questions to Consider:
Are there further refinements that could be made to the Framework that would clarify its conceptual components?
- For example, concern was raised at the Symposium in the 'Knowledge Development and Transfer' working group, that the word 'transfer' implies a unidirectional flow of information. The word 'exchange' was considered to be a more encompassing and appropriate term, indicative of multi-directional information sharing.

Summary of Plenary Discussions:
There was general agreement that the Framework was well developed and would be useful for moving forward on healthy living. There were, however, some suggested modifications:

General

• Put more emphasis on the fact that it encompasses ALL Canadians (Note: Several groups made this request).
• Make it clear that healthy living goes beyond the health field.
• Ensure it is universal and targeted.
• Targets and indicators are required.
• All First Ministers must share the responsibility.
• Identify the sectors (e.g. government, private, volunteer and education).
• Create a distinction between "Areas of Emphasis" and the overall framework.
• Articulate the framework has been shaped by consultation.
• Ensure "healthy weights" are not added back in (Note: this was a recurring comment.)
• Make it clear accountability lies with the Minister of Health.
• Clarify target populations.
• Make it clear that to get to the settings, formal and informal systems need to be mobilized.
• Clarify the relationship between health issues (e.g. obesity, body weight, chronic disease, mental health, tobacco use, etc.) Do not lose the focus of healthy eating and physical activity, but keep a phased approach and make it apparent that healthy living is more that physical activity and healthy eating.
• Acceptance is required beyond the Health Ministers who commissioned the work (e.g. Education Ministers etc.)
• Note there is a difference between reducing health disparities and improving health outcomes.

Language

• Ensure the wording matches the wording in the discussion document. It appears that some words have (probably mistakenly) been cut off. (Note: several groups noted this.)
• Replace "Target Populations" with "All Canadians (including priority populations)."
• Replace "Target Populations" with "Universal and Targeted Approaches."
• Change "Knowledge Development and Transfer" to "Knowledge Development, Exchange, Application and Dissemination." (Note: several groups requested specifically to replace "transfer" with "exchange" and to add "application.").
• Use "better" not "best" practices.
• Expand to include "Public Information and Engagement."
• Develop a glossary to clarify terms.
• Develop an explanatory piece to accompany the Framework, and a definition for a population health approach.

Add

• Ensure that food security is included. (Note: this was a recurring theme.)
• Add funding. (Note: this was a recurring theme.) Funding includes pooling, reallocating and additional funds.
• Add evaluation.
• Add the Inter-sectoral "Council" spanning along the entire left side of the diagram.
• Create a separate page mapping how the isolated risk factors (healthy eating, physical activity) would be layered on.
• Add "..." at the end of the "Areas of Emphasis" to signify other areas to be added.
• Add roles and responsibilities.
• Add "Other Critical Health Issues" to "Areas of Emphasis."
• Add "Socio-economics" to "Areas of Emphasis."
• Specify the target (10%) and the short-, medium- and long-term strategies / outcomes.

Modify

• Areas of emphasis is too limited graphically - it does not capture the disease component or all determinants. The "Areas of Emphasis" circles should be replaced by the following three stacked bars:
  • risk conditions
  • risk factors
  • chronic diseases.
• Delete the arrow beside "Population Health" and put key settings and target populations down the side.
• Reverse the order of "Priority Populations" and "Key Settings" boxes.

Proposed Action 2:

Given the clear messages, received through the consultation processes and the Healthy Living Symposium, about the need to facilitate relationship-building and collaboration among the sectors in order to take concerted action, it is proposed that an Inter-sectoral Committee be established.

Background:
The need for government leadership and policy coordination, and, at the same time, broad inter-sectoral involvement in the development and implementation of the Strategy, was considered, by participants in the consultations and at the Symposium, as critical to achieving the goals of improving health outcomes and reducing health disparities, using a population health approach.

Discussion:
The composition of the Inter-sectoral Committee could be as follows:

Option 1 - Limited to representatives from government departments across jurisdictions and sectors: education, environment, health, sports and recreation, transportation, etc.

Option 2 - More comprehensive representation from all relevant sectors across jurisdictions, including health and other government sectors, non-government organizations, health specialists, business and other stakeholders. (Aboriginal groups will be part of a separate process, as outlined in Proposed Action 6.)

An Inter-sectoral Committee would respond to this call for strengthened leadership and a supportive policy framework, and would oversee, among other functions:

• the conducting of environmental scans of policies, programmes, data, and gaps, at the various jurisdictional levels
• options for the utilization of sectoral resources
• the application of a healthy living lens to healthy public policy development in all sectors
• the implementation of the Healthy Living Strategy.

Possible Questions to Consider:
How should the Inter-sectoral Committee operate?

How should the Inter-sectoral Committee be composed? How should the Intersectoral Committee link with other fora?

- e.g., F/P/T DMs Responsible for Physical Activity, Recreation and Sport, whose mandate is to discuss and collaborate on joint policy and programs in the area of physical activity and recreation

- e.g., Council of Ministers of Education, Canada, whose mandate is to be the national voice for education in Canada. It is the mechanism through which Ministers consult and act on matters of mutual interest, and the instrument through which they consult and cooperate with national education organizations and the federal government.

Summary of Plenary Discussions:
Various suggestions were put forward regarding the structure, roles and responsibilities of the Inter-sectoral Committee. Although most groups did not identify a clear preference between the two options (some proposed a combination of the two), several suggested that more than one committee was necessary to steer the healthy living agenda. The options that were put forward are described below by group:

1. The Committee requires:

• concentrated leadership
• ability to capture and mobilize resources
• leadership from the health sector, but it must include membership beyond the health sector
• a Minister to facilitate a Cabinet Committee.

Step one in the process is for the Committee to develop, prioritise and enable the Healthy Living Strategy at the First Ministers meeting. At the same time, existing networks must be mobilized to action on this issue. Other considerations include creating a Committee with representation from CEOs in the private sector, leaders in the NGO and voluntary sectors, and senior F/P/T officials, reporting to the federal F/P/T Committee. Another option would be to create a secretariat model that reports to a parliamentary committee.

2. Create a national-level steering committee of F/P/T Deputy Ministers, from such areas as health, sport and recreation, human resources, and the Council of Ministers of Education of Canada, Federation of Canadian Municipalities and the Rural Secretariat. Its role would be to examine federal jurisdictional policies through a healthy living lens, including identifying enhancing policies and addressing impeding policies, as well as to identify areas of collaboration and coordinated action in each strategic direction area. This committee would oversee a broader operational committee. Health would be the lead ministry and the Prime Minister could be the honourary chair / patron.

The operational committee would develop strategies in the four strategic direction areas and include broad representation from health, education, sport and recreation, professional organizations, research/academia, private sector, NGOs, municipalities and representatives of priority (formerly "target") populations.

3. Clarify the function/purpose of this committee. The group must be credible and representative with a Commissioner to oversee and facilitate. The Commissioner would facilitate meeting outcomes between governments, NGOs, community groups etc.

Partners must be involved, including:

• those listed in the example
• treasury/finance
• human resource and development
• NGOs
• community groups
• municipalities (community level is where things get done)
• those organizations that can have an impact on removing the barriers to healthy living.

4. A broad inter-sectoral committee (based on option 2) is needed that is both horizontal and vertical. Representatives should include decision-makers and influencers. Develop a national structure as well as parallel provincial committees and parallel regional/municipal groups, allowing each jurisdiction to take their own approach. One advantage of broad involvement is stability/momentum despite changes at the political level. The committee would report to the Health Minister. Its mandate would include: setting priorities, identifying outcomes and indicators, monitoring and evaluation, setting the research agenda, approving the communications strategy, and awarding the Inter-sectoral Community Fund. These tasks would be carried out through work groups.

Sustained funding should be part of the Strategy announcement to ensure the Strategy's success and to influence the commitment of the partners.

A coordinating committee should also be struck to advise the decision-makers. A secretariat function is also needed to support the committees.

5. A combination of options 1 and 2 is needed that is flexible and includes sub-groups and task groups to carry out activities. Build on and involve existing coalitions. Involve all sectors and all levels (federal down to local level). A Healthy Living Council is needed to mobilize and support inter-sectoral, inter-disciplinary and inter-departmental cooperation. The Council will report to the Ministers of Health, but also go beyond them to other sectors. Representation will include F/P/T governments (retain an inter-sectoral governmental "backbone"), local community level, voluntary and private sectors, coalitions, and professions. The functions of the Council will include:

• disseminating tools and information
• developing and setting goals
• monitoring capacity
• defining realistic outcomes and monitoring progress
• identifying options for joint actions, utilization of resources etc.

Proposed Action 3:

Given that participants in the consultation processes and the Symposium proceedings identified the importance of facilitating and supporting the transfer of knowledge at all levels, and in order to ensure a coherent link between research, policy, and practice, the creation of:
- an integrated research agenda, informed by the identification of needs and gaps through the environmental scans. An integrated research agenda would involve a mix of interdisciplinary skills, spanning a full range of quantitative and qualitative research methods, and the full use of applied research and evaluation in community settings.
- an enhanced and integrated surveillance agenda for baseline and ongoing data collection, and for monitoring progress, and
- a best practices initiative

Background:
Consistent with feedback received during the consultation processes and the Symposium, the development of both integrated research and surveillance agendas is central to the development and transfer of knowledge, and co-ordinated and collaborative action. The link between research, policy and practice would further be supported and enhanced by a best practices initiative to facilitate knowledge translation.

Discussion:
An integrated research agenda would:

• Engage key researchers, research funding institutions, and agencies in collaborative decision-making
• Identify gaps in knowledge about integrated approaches to promotion and prevention.

A list of priority research questions could be developed for use by researchers, institutions and agencies to address knowledge gaps related to integrated approaches. The research questions would arise out of the work undertaken by a research subcommittee of the IC to conduct environmental scans to identify needs and gaps.

An integrated surveillance agenda would encompass the collection of baseline and ongoing data in order to establish measurable outcomes, inform Strategy actions, monitor progress, and to evaluate the Strategy.

A best practices initiative would support the design and implementation of integrated approaches by:

• Building on existing efforts to promote healthy living and prevent chronic diseases
• Gathering what has been learned about integrated approaches from previous and existing initiatives
• Synthesizing this knowledge into an analysis of lessons learned and best or promising practices, and developing tools and models from this analysis, and
• Disseminating these tools and models among public health and other health professionals, and within all relevant sectors and jurisdictions.

Possible Questions to Consider:
Who would these researchers and research agencies be? (eg. CIHR, CIHI - Canadian Population Health Initiative, University affiliates)

How do we see the dissemination of knowledge taking place? Might this involve the creation of a data bank?

How would the 'National Best Practices Consortium for Integrated Chronic Disease Prevention and Health Promotion', currently in development, fit and link with the Strategy's best practices initiative?
- A need was identified for a national forum for knowledge exchange about best practice interventions, as well as the need for coordinating the dissemination and transfer of such knowledge. Currently, a temporary Secretariat has been established for the Consortium, with an Interim Chair appointed.

Summary of Plenary Discussions:

General

• Allocate $5 million or more to healthy living research activities.
• Provide sustained funding to existing programs/networks and ensure core infrastructure (Note: this was a recurring theme).
• Strike a managing research body to coordinate and avoid duplication (Note: better coordination and not duplicating effort was a recurring theme).
• Invest in the information to ensure that messages given are accurate and create urgency in the general public.
• Ensure research is both carried out and used.
• Gathering good data will support sustainability and address inequities.
• Do not just generate information, but ensure contributions to outcomes.
• Use "better" not "best" practices.
• Indicators should address/monitor both goals (increasing health outcomes, reducing health disparities).
• Use the Centres of Excellence model - this would limit repetition of different research projects addressing the same issue.

First steps

• Design a research agenda/plan. (Note: this was a recurring comment.) The coordinating committee should have input into this.
  Identify leadership.
• Identify the type of research that is needed to move the agenda forward.
• Conduct an assets mapping exercise to determine what already exists in Canada, to identify the gaps and to integrate what exists. (Note: this was a recurring theme.)
• Create an Institute on Healthy Living Research using existing research agencies.

Who should be involved

Involve:

• researchers
• end-users
• policy makers
• community
• practitioners
• Canadian Institutes of Health Research (CIHR), Canadian Institute for Health Information (CIHI), Canadian Population Health Initiative (CPHI), Statistics Canada, university affiliates, Canadian Fitness and Lifestyle Research Institute (CFLRI), Sociobehavioural Cancer Research Network (SCRN)
• Link back to Healthy Living Council (or Inter-sectoral Committee) to establish research priorities.
• consumers of research
• F/P/T governments

What needs to be done

• Ensure a balance of all types of research.
• Include evaluation.
• Collect baseline information and then develop activities toward a specified target.
• Go beyond intervention type research and include a policy tracking component.
• Identify criteria/framework for best practices and how to share best practices, successful tools and approaches (Note: best practices research was a recurring theme).
• Identify indicators.
• Develop national standard indicators (existing bodies could fulfill this role).
• Collect baseline data by province/territory and at a regional level.
• Consider data needed to monitor progress of the Strategy. Ensure the outcome indicators are reasonable given the timeframes.
• Do more surveillance and intervention research. Ensure surveillance includes risk factors, risk conditions, and outcomes (including health services utilization).
• Perform strategy-oriented, mission-oriented research.
• Include objective data, surveys, tracking and evaluation in the range of research.
• Develop a national system of training and technical assistance that is linked with the National Best Practices Consortium.
• Examine capacity in communities for delivery.
• CIHR need to take a cross-Institute approach.

Information storage and management

• Create a repository to share experience and findings (including best practices), and allow for discussion and exchange. (Note: this was a recurring comment.)
• Create a central place where research is done, surveillance comes in and then links back to the community. Ensure that the users of the knowledge work with the generators of the knowledge. (Note: this was a recurring theme.)
• Ensure easy, central access to all research (electronic).
• Constantly monitor existing research.
• Build on the Chronic Disease Database, School Health model, and international databases such as those housed at the World Health Organization.
• Affiliate and mandate CHN to track research related to healthy living.
• Delegate the monitoring of the traffic flow of research.
• Link with existing physical activity research strategies.
• Learn from what is being done in existing countries, e.g., Centres for Disease Control in the States.

Dissemination

• Translate the findings.
• Disseminate the findings to those who will use them.

Proposed Action 4:

Given the need for community-based solutions and the need to work inter-sectorally with a range of partners, it is proposed that an Inter-sectoral Community Fund (ICF) be established.

Background:

Health and health outcomes are shared responsibilities involving many sectors. Inter-sectoral collaboration in all areas of development, including the investment of resources, is needed to build a Strategy that broadly addresses the determinants of health, is flexible enough to include both universal and targeted approaches, and is sustainable over time. In the past, time-limited funding structures have not, in general, resulted in sustainable initiatives with the capacity to produce the population-level changes needed to affect health outcomes. The sharing of resources from across sectors and jurisdictions has the potential to produce a more effective funding structure in the long-term and is consistent with an integrated approach. Resourcing and sustainability were key concerns expressed by participants at every stage of the healthy living consultation processes.

Key to the success of an ICF is the community-driven approach to community development. Consistent with this thinking is the understanding that the solutions to community issues reside within the community itself. At the heart of successful and sustainable community-driven initiatives is the clear identification of needs and issues, identifying partners and building capacity, addressing solutions at the level of policy change, and enlisting local private sector involvement.

Discussion:
A number of options for the pooling of resources from across jurisdictions and sectors would be explored, in order to fund community-driven healthy living initiatives.

The ICF would represent a mechanism to engage multi-sectoral resources and support, including that of the private sector, to enhance community capacity for people of all ages to access healthy living facilities and programs, through new or existing structures (e.g. schools, community centres, workplaces, etc.). In one possible model for the ICF, all relevant sectors would contribute financial and/or in-kind resources to support community mobilization, demonstration projects, targeted programs, and the development of sustainable community infrastructures.

Under the ICF, community demonstration projects would facilitate the knowledge development and exchange process (Proposed Action 3) and the research-policy-practice link, while contributing to the goals of increasing community capacity, infrastructure development, and sustainability. Using key life settings - community, school, workplace, home - is increasingly recognized as an effective way to reach target populations with integrated promotion and prevention actions. Existing initiatives, such as the 'Healthy Schools' and 'Healthy Communities' movements, serve as evidence-based models of settings-based integrated approaches to promotion/prevention. Such initiatives support healthy living in the context of supportive environments by involving citizens and mobilizing local action.

Possible Questions to Consider:
How might the ICF be structured? How could various sectors pool funds to share the responsibility for community development?

How could actions under the strategic direction of 'Knowledge Development and Transfer' inform and support community-driven initiatives?

Do you know of any successful examples of intersectoral funding mechanisms and if so, how were they structured and why did they work?

Are you aware of any best practices that might inform our thinking for this Fund?

Summary of Plenary Discussions:

General

• Define inter-sectoral in this instance - does it include government, NGOs and others?
• Take both a national and community (local) approach.
• Develop stipulations linked to priorities and strategies.
• Develop a defined process and accountability structure.
• Push the integrated approach and fund multi-pronged initiatives (e.g. kids and tobacco partnering with active living). Ensure funds are not used for just disease focused initiatives, but ensure that several common risk factors are covered.
• It must be accessible to all, inter-sectoral and long-term - this is an investment.
• Ensure time frames are reasonable (at least 3-5 years) and not tied to government year-end. (Note: this was a recurring theme.)
• Place less emphasis on demonstration projects (Note: this was noted by several groups) and more re-allocating of funds to support inter-sectoral collaboration and capacity of systems and communities
• . Those communities that are already resourced may be better at accessing the funds, than those communities that are less resourced, but more in need.
• Ensure there is a feedback loop to share experiences, findings and best practices.
• Choose a target (e.g. after school program) and raise funds to ensure all children have access.

Funding (general)

• Create shared-use policies. (Note: this was a recurring theme).
• Define "funds" in its broadest sense - including dollars, resources, policies etc.
• Funding must not be project-based and should be long-term.
• Funds cannot go back into general operating budgets.
• Ensure there are pooled, reallocated and additional funds.
• Insist on an evaluation component as a requirement for funding.
• Perform an environmental scan of current funding examples and keep an inventory.

Funding sources/models

• Funding must come from both federal and provincial governments.
• The federal government must commit to significant, long-term funding levels to get this done.
• GST
• taxes from unhealthy areas such as fatty foods, tobacco etc.
• lotteries
• sports equipment taxes
• matching funds programs (Note: this was a recurring theme)
• resource sharing/ pooling (including resources and funding)
• Use the Alberta Community HIV fund model. The federal government creates an initial, sustained fund that groups can access if they also put up funding and resources.
• private sector
• different disbursement models (e.g. National Crime Prevention Council (NCPC) model, In Motion model that requires inter-sectoral, multi-year commitment, models that involve private sector contributions)
• United Way model is problematic as it dictates what organizations can and cannot do
• New Brunswick Sport funding model
• ALACD Funding Model
• Funding could be administered by arms length bodies (e.g. Trillium Foundation in Ontario).
• Heart Health - a good federal/provincial leveraging model.

Proposed Action 5:

Given that it is recognized that Canadians need to adopt healthy eating and physical activity practices, the development of a communications/health information strategy is proposed.

Background:
Increasing the consistency of promotion and prevention messaging to Canadians is a priority that has been identified through the healthy living consultations and the Symposium working sessions.

A roundtable discussion to explore the issues related to social marketing and healthy living will take place in mid-September. The meeting will bring together an intersectoral group including Health Canada communications/social marketing staff; Health Canada program officials; Ministerial staff; communications/social marketing representatives from the provinces and territories; non-governmental organizations interested in healthy living; industry representatives; and national and international social marketing and healthy living experts.

Health Canada is currently undertaking secondary research exploring the variables related to Healthy Living practices (i.e. physical activity, eating, and related factors) of Canadians that will increase understanding of, and help to segment, the target audience to ensure that future campaigns and messages are appropriate and effective. In addition, Health Canada is conducting an analysis of secondary research to identify gaps.

Discussion:
In the short-term, this could include coordinated and complementary healthy living messaging, targeted to reach home, school, workplace, and community.
Healthy Living 'branding' - developing a healthy living logo/tagline to be linked with HL messaging and promotion.

The importance, at the outset, of messaging to children and families. Coordination, cooperation and consistent (yet culturally, regionally, and socio-economically sensitive) messaging is needed within and across sectors. Education, media, and health are key partners.

In the medium- and long-term, a comprehensive communications strategy could roll out, including: public research to gather more information on social marketing practices, and values related to healthy eating and physical activity that are important to Canadians; pilot projects; and, multi-sectoral involvement.

September's social marketing roundtable will provide a forum for stakeholders and experts to: share and discuss trends, "best practices" and "lessons learned" from healthy living-related initiatives in Canada and internationally; discuss how best to combine the themes of physical activity and healthy eating under the overall Strategy; hear the results of the Health Canada-led secondary Healthy Living research; place in context social marketing as part of the overall Healthy Living Strategy; and discuss next steps.

Possible Questions to Consider:
What is the key audience for the initiative (Healthy Living social marketing piece of it)?

What is the segment of that key audience & why?

After identification of research gaps - what types of research could be undertaken by governments and by NGOs?

How do we define the brand (i.e. what is the "promise" that healthy living will make)?

Summary of Plenary Discussions:

Target audiences

• The key audience is all Canadians
• Ensure all target audiences are identified and their needs are met.
• Children need a prevention message, others need a crisis message.
• Specific priority audiences could include:
  • youth
  • children at different ages
  • seniors
  • parents
  • educators
  • policy makers
  • workplace
  • disabled Canadians
  • Aboriginal Canadians
  • at-risk populations.

Messages

• Make them targeted, sector-specific and settings-specific.
• Messages must be constant, consistent and simple (Note: this was a recurring theme). A good example is the 0 tobacco, 5 fruits and vegetables, 30 minutes of physical activity campaign in Quebec.
• Ensure a clear understanding of the basic message as a first step (e.g., required amount of physical activity).
• Include a call to action. (Note: this was a recurring theme).
• Use language that is understood by the public.
• Consider the breadth of lifestyles of the different audiences.
• "Make time for health today so you have your health tomorrow."

General

• This cannot be just a media campaign.
• Clarify whether this is marketing of the Strategy or the areas of emphasis (Note: one group identified the goal as being to sell the Strategy).
• Ensure the campaign covers awareness, action, monitoring and evaluation, and that social support is built in. (Note: the idea of ensuring social support and services, and enabling programs was a recurring theme.)
• Reach kids through mediums they are connected to (e.g. computers), and have TV personalities deliver the message directly: "You have been watching too much TV today, get outside and play." (Note: the use of TV was a recurring theme.)
• Link to the broader Strategy. (Note: this was a recurring theme.)
• Use the Canadian Health Network.
• Be sensitive to at-risk groups and those facing inequities (Note: special consideration of target or priority populations was a recurring theme).
• Make use of opportunities for private sector involvement, including in-kind contributions and expertise.
• Tie into 2010 Olympics hype (but be careful how this is done, as using the Olympics and elite athletes will not necessarily encourage the average Canadian.)
• Learn from previous campaigns (e.g. ParticipAction, Vitality!)
• The campaign must be enabling and empowering, that does not use scare tactics or blame people.
• Partnerships are essential. Involve all stakeholders (Note: this was a recurring theme) including the Chronic Disease Prevention Alliance of Canada, private sector etc. Identify the roles of everyone involved (including at the different levels, e.g. local, national etc.)
• Gain approval for the communications strategy through the Inter-sectoral Committee.
• Create champions.
• Ensure a nationally spearheaded campaign that is flexible and collaborative. Develop a core strategy and messages that others can use. (Note: this was a recurring theme.)
• Branding healthy eating and physical activity together could be a problem, and healthy living encompasses more than these two issues.

Proposed Action 6:

Given that more consultation is needed to develop a strategy under the IPCHLS framework, which addresses the needs of Aboriginal peoples, it is proposed that:
a process be developed to engage Aboriginal stakeholders in F/P/T activities, and
further processes be developed to consult nationally on an Aboriginal-specific holistic wellness strategy.

Background:
Over the course of the pre-consultation meeting, the Roundtables, and the Symposium proceedings, Aboriginal stakeholders indicated that more consultations would be required. It became clear at the Symposium that a separate process, linked to the development of the overarching IPCHLS, would be needed to take Aboriginal considerations into account in the creation of a healthy living action plan for Aboriginal peoples. It is recognized that the specific considerations of Aboriginal Peoples need to be addressed and the First Nations and Inuit Health Branch will be undertaking a separate consultation process.

Summary of Plenary Discussions:
There were no discussions regarding this proposed action.

Other

Participants were invited to add any items they felt were important or had been overlooked. They were also encouraged to submit any further ideas to the Healthy Living Task Group after the meeting.

• Proposed Action #7 - Develop regulatory policies to encourage and facilitate healthy eating and physical activity. Strike a task force to examine taxation, education, labelling, advertising, urban zoning/planning, transportation, minimum income, food subsidies etc.
• Education is an important sector as it involves all children, cuts through most barriers. Involving education is critical for short-, medium- and long-term prevention.
• Ensure sustained support for national agencies that are providing critical contributions to health living.
• Elevate the sense of urgency around the issue and make the argument for investment, e.g., physical activity is linked to increased alertness, literacy etc.
• Identify the role of physical education.
• Identify the F/P/T roles and responsibilities.

Participants were invited to make any concluding remarks. These included:

• The discussions that have already taken place between Ministers and between ministries are encouraging and it is hoped they will continue.
• It is essential that there is capacity to deliver on activities around healthy eating and physical activity.
• Existing groups and coalitions have an active role to play (e.g. CDPAC, Coalition for Active Living etc.) and they should receive funding to ensure their continuation.

Scott Broughton and Mary Kardos Burton offered their reflections regarding the day's discussions. They identified the challenge of convincingly communicating the big story of public health and effectively selling the value of healthy living. The results of the discussions will be taken by the Healthy Living Task Group and reflected back to the Ministers and Deputy Ministers.

The participants were thanked for their hard work and valuable contributions.