Population Health in Canada: A Working Paper

Commentary on the "Snapshot"

In the recent literature, some questions arise as to whether anything is actually happening with population health. Regionalization of the health care system and a focus on delivery of health services has dominated many discussions, thereby masking population health initiatives. The issue is exacerbated by language: some refer to "population health" while others prefer "quality of life," "well-being," "health promotion" and/or "community development." Our snapshot suggests, however, that there is plenty of population health activity in Canada for conference participants to discuss and to learn from. Population health is taking place in many forms, in many places, with many partners across Canada.

There do appear to be important differences between urban centres and rural areas with respect to their approach to population health. Among regional health authorities, for example, Calgary-Edmonton (Capital Health Authority), Vancouver-Richmond Health Board, and Saskatoon Health District appear engaged in addressing the determinants of health. Many other boards appear more preoccupied with financial pressures in the health care sector. Some board members have little community development experience. They are or have been located in hospital settings and may feel, then, that population health is taking money away from what they view to be essential services. Accordingly, there may be few champions for the population health perspective in some regions. Program planners and policy makers must consider opportunities for working with partners across regions and different levels of government.

Differences in involvement in population health to date (across sectors of government and between urban and rural areas) serve to highlight the need for shared responsibility for action on the determinants of health. They also suggest that there is a need for capacity-building and technical assistance. Similar issues will pertain to involvement of the private sector and nonprofit or nongovernmental organizations in population health initiatives.

An additional challenge to the adoption of a population health perspective may be a paucity of specific, concrete outcome indicators and measures. A lack of organized health data and difficulty doing systematic evaluations is frequently cited by national, provincial and regional representatives as a reason for scant political will. Similarly, resources and technical assistance, such as workshops and guidebooks, are needed, and data must be usable by decision-makers. There is an oft-cited need to conduct longitudinal and qualitative research to fully understand the complexities of a population health approach.

These challenges highlight the need for ongoing development of tools and measures for conducting health and social impact assessments. Some of this work is already being undertaken by different groups across Canada (e.g., Canadian Institute for Health Information, Statistics Canada, Health Services Utilization & Resources Commission (Sask.), Centre for Health Services & Policy Research (UBC). Manitoba Centre For Health Policy and Evaluation). Additional help with these issues may be forthcoming from some non-governmental and university-based organizations. For example, a partnership between two universities, the Saskatchewan health ministry, and the Medical Research Council of Canada has created the Saskatchewan Population Health Evaluation Research Unit (Labonte, Jackson and Chirrey, 1998). Similarly, "over the next few years the Health Network of CPRN will be undertaking projects that connect evidence about population health with policies for health gain across the public and private sectors" (Hayes and Dunn, 1998: v). Networks such as the Canadian Consortium of Health Promotion Research Centres also offer an important source of expertise and an existing infrastructure for conducting population health research.

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