9.1 How To Mobilize People/Communities/Institutions/ Governments Around The Determinants Of Health

9.1.1 Find the right stuff

The critical importance of the human factor in the regional mobilization of population health cannot be overstated: successful mobilization depends on like-minded people with natural affinities, collaborative skills and shared passion being given the opportunity to work together. These conditions run contrary to the way modern bureaucracies operate: assigning tasks and roles to positions rather than individuals, and establishing relationships between functions rather than people. Yet, over and over again in the conduct of these case studies, participants insisted that their initiative would never have reached the point that it had without the contribution of the individual people involved. In the case where intersectoral collaboration was not maintained, people issues seemed to have been an important contributing factor.

Over and above those conditions, the organizational level of those involved has also been key in their achieving mobilization within their sphere of influence. Involving people with as much decisional authority as possible has been crucial. Several initiatives adopted mobilization processes involving multiple layers of decision makers, fanning out into multiple spheres of influence, and using their successes to stimulate action at other levels.

9.1.2 Develop a critical consciousness around population health

Effective mobilization at all levels depends on the right people in the right places and with the right resources "getting it" - having their consciousness raised about the importance of the broader determinants of health to the point that they are integrated into their thinking and their actions. The initiatives studied here took multiple routes to support this, but they were generally intensive efforts requiring frequent and sustained personal contacts: conferences, workshops, meetings, training programs and/or teleconferences. Mobilizing people/communities/institutions/governments around the determinants of health cannot be done solely with documents (although documents may support it), and it cannot be done without resources to support interactions. As these case studies have shown, these resources do not have to come only from Health Canada. However, Health Canada's support for ongoing interaction among partners has been a critical contribution to some mobilization successes.

Helping people in sectors outside of health "get it" has proven difficult for some of the initiatives. This area remains a challenge, and a potential focus for brainstorming and sharing of insights across settings.

9.1.3 Work from a long-term, developmental perspective

Mobilizing population health is about building the relational infrastructure necessary to support a sustainable intersectoral drive to effect change to the health determinants. The health determinants identified in the population health framework are a product of social and economic history, embedded power structures and vested interests, and cultural outlooks. Altering these is not an overnight affair, and recognizing this, the population health mobilizers have elected to align all their considerable forces and build change slowly but solidly, from the ground up. The work to date has thus been focussed on pouring the foundations and erecting the scaffolding of social change, with an eye to the design of the overall finished structure. Laying this foundation can be expected to take several years, and can also be expected to encounter slower periods during times of change or restructuring involving key sectors or partners. It may be several more years before changes in public policy are seen as a result, and several more years after that before these policies can be expected to have an impact on population health, in terms of the health indicators now in place. As Rachlis has noted, "The cycles of government usually don't have the same time frame as most intersectoral action"⁸: to sustain mobilization efforts will take political will and commitments beyond the usual short-term planning and funding cycles.⁹ In the meantime, it is important for participants in the mobilization process to be able to assess their progress and know if they are making a difference. Frameworks and tools for understanding the impacts of social and economic policy and for measuring social progress are needed, so that smaller advances along the long road to population health improvement can be assessed and strategies adjusted accordingly.

9.1.4 Invest as needed, but for the long term

In general, the resource contributions to population health mobilization, especially of partners' resources, have not been possible to document with precision. Major problems lie in deciding what to count (for example, the entire budgets of the Population Health Branch of Saskatchewan Health and the Prairie Region Health Promotion Research Centre, versus the number of hours the three Partnership members have spent at meetings), and how to include intangibles, for example, use of connections and influence to interest Newfoundland and Labrador's Strategic Social Planners in social and economic inclusion. However, it is clear that a great deal of mobilization can be achieved without a substantial dollar investment from Health Canada or its partners. Naturally, more can be accomplished when more funds are available. However, in terms of Health Canada resources, a key factor in achieving mobilization seems to be the availability and commitment of staff time to the initiatives - backed by their management teams - in which the staff take on roles as active partners rather than as funders.

It is also clear that a long-term perspective on resource availability is helpful to sustain mobilization. When funding is precarious, mobilization will be fragile.

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8. M. Rachlis, op.cit., p. 22.

9. Indeed, the term "mobilization" seems somewhat inapt; perhaps we should speak of "population health incrementalization?"

 

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