A population health approach has been adopted by Health Canada, and the Health Promotion and Programs Branch (HPPB), in particular, as a guiding principle in its major areas of activity; including risk management, aboriginal health, health promotion and disease prevention, and health system support and renewal. "HPPB will play a key role in this broader effort through its leadership in promoting the population health approach and through its role in coordinating national population health strategies" (p.1).

The direction of Newfoundland & Labrador's community health program is guided by "a population health promotion approach, which focuses on factors that enhance the health and well-being of the overall population, [and] is advocated for all core programs" (p.10).

The Strategic Social Plan for Newfoundland and Labrador represents "an overall framework" (p.3) with innovative measures aimed at meaningful change; one of its goal is to foster "collective well-being" (p.iii). It will shift the Government's approach from crisis-driven remedial programs toward proactive approaches that stress the well-being of the whole population. Although the term 'population health' is used, phrases such as 'well-being' are used more frequently to convey the Government's change in philosophy. It states: "Specific emphasis will be placed on the links between social and economic development, on population health and well-being and on economic security" (p.17). Furthermore, the Government recognizes that "an investment in prevention requires more upfront spending" (p.11).

"It is no coincidence that the Ontario Public Health Association has declared that a determinants of health perspective will shape all of its policy recommendations." In its report, Determinants of Health September 1992 - December 1993, the OPHA states that "education policy is health policy; tax policy is health policy; employment policy is health policy."

The population health goals of Saskatchewan "focus on health of the population as a whole, rather than the health of the individual. Working groups have been established to develop measurable objectives for each goal and to identify specific population health initiatives to meet each objective" (p.12).

Since 1994 in British Columbia, the Annual Reports of the Provincial Health Officer have been based on a determinants of health framework. Similarly, the Health Goals of British Columbia, recently adopted by the province, reflect a population health perspective. Support during the development of the health goals, which contain objectives for each goal, included Cabinet endorsement, input and commitment from ministry stakeholders, other ministries and regional authorities.

Closer to Home makes reference to the broader influences upon health that lie outside the health care system.

The North West Territories have created a number of community service boards, amalgamated the Departments of Health and Social Services, and created new Health Intelligence and Health and Wellness units within the Department of Health. These units have been given broad mandates which are expected to contribute to broader political and public awareness of health determinants.

"In the Northwest Territories, a group of deputy ministers has pooled their resources to form a social-economic 'think tank,' called the Social Envelope Committee, to address issues of healthy public policy. In addition, a Deputy Minister's Interdepartmental Steering Committee on Community Wellness and regional interdepartmental committees were established to further develop the community wellness strategy" (p.64).

In July 1996, the Government of Newfoundland and Labrador appointed a Social Policy Advisory Committee of fourteen volunteers from various regions and backgrounds which developed the Province's strategic social plan. A Council on Social Development is planned which will provide advice on provincial directions with specific emphasis on the links between social and economic development, population health and well-being, and economic security.

Newfoundland deliberately separated community service boards from institutional service boards to ensure the former's engagement with population health ideas. A key informant states: "we wanted CHBs to have the same status and clout as the institutional boards, without all of the budgetary distractions of institutional services"(p.50).

In most provinces, a variety of positions have been created by regional /community health boards to engage in a population health approach. For example, coordinators from outside the traditional health system with backgrounds in community development and co-op housing have been hired (NS), a position dedicated to community liaison around determinants of health (PEI), positions in community development have been approved (NF), new positions in population health policy research (SK).

The Calgary Regional Health Authority, "despite being in a deficit position, ...has created a new population health division with a mandate to 'reduce inequities in health status'" (p.35).

The Vancouver-Richmond Health Board has created population health advisory committees for the following groups: aboriginal peoples; children and youth; lesbian, gay, bisexual, and transgender; mental health; multicultural; people with disabilities; seniors; and women.

In British Columbia, the Office of the Provincial Health Officer was established to report annually on the health of British Columbians as measured against population health targets.

To support a population health approach, Health Canada has created a Population Health Fund "designed to support time-limited projects sponsored by voluntary, non-profit, non-governmental organizations which contribute to an increased capacity for action on the determinants of population health... Projects may be local, regional or national in scope..." (p.1-3).

Funding of federal health research on population health

An annual $4 million Community Action, which supports a range of population health initiatives, such as healthy community and mental health projects, family violence prevention, training for caregivers and early intervention services for children and families, is disbursed through regional boards. It requires "co-investment" from communities which is assessed according to their abilities.

"The Yukon may be unique in writing into its legislation a requirement that, by the year 2000, an equivalent 5% of the treatment budget must be allocated for health promotion" (p.31). Although the term 'population health' is not used ('quality of life' is preferred), issues around the determinants of health are part of the government's agenda.

The Government of Newfoundland & Labrador recognizes that "an investment in prevention requires more upfront spending" (p.11). Accordingly, the Government is "allocating additional resources to family resource programs, child care services (including infant care) and services for youth which will improve the range of available early stage intervention programs" (p.23).

In Saskatchewan, both Health Promotion and Wellness Grants have health determinants as part of their criteria. The 1997/98 Provincial Wellness Grants specifically targets income and social status, social support networks, employment and working conditions and physical environments" (p.39). Since 1994, almost $100 million has been allocated for rural health initiatives, including population health, health promotion and disease prevention programs.

In British Columbia and Saskatchewan, regional health authorities have authority to transfer funds from allocations for institutional health care to community-care or health promotion and prevention programs, but cannot move funds in the reverse direction (p.33,38).

"The Vancouver-Richmond Board...developed a $5 million grants program, $750,000 of which went to health promotion and disease prevention projects and another $750,000 reserved for projects that specifically address poverty, literacy and housing. The remainder of the grants program went to initiatives in mental health, aboriginal health, plans for development of community health centres and home care.... The money for the grants program came from reallocations from the service sector" (p.34)

"In 1993, the British Columbia Health Research Foundation dedicated one of its operational grant funding envelopes to population health research" (p.1).

The National Children's Agenda brings together health and social ministries across levels of government. The National Literacy Secretariat highlights the role of non-health factors as important determinants of health.

A Health Canada sponsored workshop on Employment and Health held in Ottawa in 1996 situated 'employment and health' as a research and policy issue within the population health framework. While identifying policy implications and priorities for policy research it was noted that the CIAR population health framework needs to be enhanced both conceptually and empirically.

Newfoundland having recognized that the challenges facing the Province "cannot be addressed simply by adjusting existing policies and programs," (p.8) recently adopted a Guide to Assess the Health Implications of Public Policy which "acts as a decision enhancement tool that allows for broader thinking on the determinants of health" (p.67). A "Policy Circle Team" involving all senior government policy makers are the primary users.

BC has introduced a similar tool, a Health Impact Assessment, which recommended that all policies be considered for health impacts. In BC, the Population Health Resource Branch of the Ministry of Health assists other ministries in the use of the Health Impact Assessment tool (p.7).

"Using a population health promotion approach, which focuses on the factors that influence health as well as incorporating health promotion and other strategies, the Core Programs document outlines specific goals, objectives, strategies, activities and indicators for four major core programs of Community Health. These include: promotion and support of health and well being; promotion of a healthy environment; prevention and control of communicable diseases; and provision of health services" (p.1)

The British Columbia Health Goals has been incorporated into many policy documents, such as the Ministry of Health's Strategic Plan and Women's Health Planning Project, the Ministry of Children and Families' Performance Management Framework, the Provincial HIV/AIDS Framework for Action, and is used by the Inter-Ministry HIV/AIDS and Aboriginal HIV/AIDS Committees.

In Vancouver's, community members and three levels of government are collaborating to address the HIV epidemic among drug users. They are exploring conditions such as poverty, lack of housing, social isolation, criminalization of drug addiction, lack of supported training/employment and lack of access to appropriate and integrated health and social services.

"The Vancouver-Richmond Board...purchased two rooming-house type hotels to provide secure social housing for a homeless population with mental health problems, or at high risk of HIV transmission through IV drug use.... It has committed another $3 million in this fiscal year units" (p.32).