Population Health Mobilization: A Regional Strategy - June 1999

III The Strategy

Scope

The strategy is being developed for use by HPPB Regional Offices, rather than as a tool for the whole Branch; although it may well inform a national mobilization strategy. The work being done in the Regions can provide a significant contribution to the emerging understanding of the population health approach by demonstrating how to "do" population health and by generating evidence about its effectiveness. The strategy is a work in progress. It will build upon the work already underway and provide additional coherence to regional planning and priority-setting.

The following sections cover goals, approaches and activities, checkpoints for analyzing health issues and a process for setting congruent regional priorities. The strategy will be updated and amended regularly to reflect emerging priorities, progress and learning.

Desired Goals for the Population Health Approach
Make health a societal goal, resulting in healthy people and communities and reduced disparities. Develop the momentum for change from a focus on issues to a focus on determinants. Increase understanding of the societal role in creating health and changing perceptions of health.	Expand accountability and responsibility for health decisions. Lead to change in how everyone acts and thinks (e.g., business). Foster social cohesion and increase citizen participation, leading to changes to Canadian infrastructure and eventually, to a new health charter.	Increase understanding of the determinants of health and their interconnectedness. Provide a coherent framework for the work of Health Canada and other federal departments, and increase the effective use of resources to improve the health of Canadians. Make population health real and meaningful by generating experience of it, and providing evidence of its effectiveness.

Approaches and Activities

This section outlines broad approaches to mobilize population health and specific activities related to each approach. These are not exhaustive and, over time, approaches and activities will expand and/or be refined as experience provides important feedback about their relative effectiveness. On acceptance of the strategy, examples of specific regional initiatives will be added to the strategy to illustrate the activities described below.

There are five key approaches. The first three, to broaden work on determinants, focus on populations and sub-populations and collaborate across sectors are external in focus. Approaches four and five, knowledge development and documenting the experience of the population health approach, are internally focused.

1. Approach: to Broaden Work on Determinants

Activities:

1. Continue to develop new and support existing initiatives, which expressly address the multiple determinants that contribute to a particular health issue;

2. Support public and professional education about the determinants of health. This is part of the continuum of activities to develop understanding of the approach amongst staff, colleagues in other departments, our partners and the public;

3. Influence research agendas of other decision-makers at the regional level to investigate the determinants of health;

4. Focus on how Regions can have an impact on employment, income and education determinants, those that have been furthest from HPPB direct influence;

5. Examine current programs, projects and initiatives to develop a new understanding of the influences and interactions of the determinants of health underlying key health issues. Where possible, influence or support action on determinants that have not been addressed; and

6. Encourage current partners to consider the importance of the determinants of health and support them to address or influence them.

2. Approach: Focus on Populations and Sub-populations

Activities:

1. Develop experience at influencing programs, policies, services and infrastructure - these are the tools that will have an impact on the health of a population;

2. Work with communities and organizations to enable them to influence policies and programs;

3. Increase involvement in regional/provincial forums and activities that are already organized around health issues in order to influence them to focus on interventions that will have an impact on populations;

4. Develop or participate in multi-faceted initiatives, (one activity or strategy is unlikely to be powerful enough to have an effect on a population); and

5. Be a partner in national strategies. Implement regional sub-strategies to contribute to national population health initiatives.

3. Approach: Collaborate Across Sectors

Activities:

1. Include partners who have an interest in or influence on key determinants. Potential partners are other federal departments, provincial departments and agencies, local governments, community groups, the private sector, representatives of affected populations, labour, education, academic institutions, foundations, voluntary sector, media and others;

2. Use participative processes with partners to ensure joint setting of priorities and directions;

3. Develop expertise at working in partnership with different sectors by seeking out opportunities to work with them. Document and share partnership experiences. In particular, focus on partners that have an influence on determinants such as income, employment and education, areas in which HPPB may wish to develop more expertise;

4. Review current collaborative efforts for opportunities to include new sectors, such as the business sector, in partnerships. This could include review committees and consultations, as well as projects and initiatives;

5. Bring regional strengths to the partnerships, for example, success in working with the community, supporting capacity building and being the enabler;

6. Identify different levels of partnership in intersectoral collaboration, e.g., lead role, funder, catalyst; and

7. Build on opportunities to mobilize population health where regional priorities are of wider societal concern and have currency with the public and decision-makers.

4. Approach: Knowledge Development

Activities:

1. Provide opportunities for staff to develop knowledge and understanding of the determinants of health and the key concepts and principles of the population health approach, through ongoing discussion of learnings and best practices. Organize think tanks and seminars, and contribute to national knowledge development initiatives. This is part of the continuum of activities to develop understanding of the approach amongst staff, colleagues in other departments, our partners and the public;

2. Provide opportunities for staff to enhance skills: analysis, relationship building (with external partners), influencing, etc.;

3. Conduct research regionally which provides knowledge about our programming with respect to the implementation of population health;

4. Build upon national research by applying findings to regional situations and by identifying national implications of regional research; and

5. Identify intersections between work on population health and work in other fields, from the points of view of both action and theory.

5. Documenting the Experience of the Population Health Approach

Activities:

1. Develop a common evaluation framework in collaboration with other Blueprint champions;

2. Demonstrate the population health approach by example. Develop, implement and evaluate models. Contribute results to Branch population health marketing efforts;

3. Track, analyze and document activities. Ensure that experience and learnings are shared with other components of the Blueprint as appropriate; and

4. Study national and regional examples of other intersectoral federal initiatives such as Crime Prevention, Health and Environment and Rural Health.

Planning and Priority-Setting

Checkpoints

A methodology for analyzing health issues was developed by the BC regional office and then modified during the pilot project on knowledge development. Regions may want to use this analysis to ensure a consistent approach to understanding and taking action on health issues.

Entry Points

Entry points are places to start the analysis of a health issue or a set of issues. They can include demographic groups, diseases or causes of death, hazards to health, settings, behaviors or lifestyle actions and determinants of health. Entry points are just that: places to begin to consider particular health issues, contributing factors and their respective effects on the health of a population. Regions use them as starting points as they analyze health issues and to lay the groundwork for setting strategic priorities.

Priority-setting

Regional Population Health Managers were tasked with identifying how regions have and will identify priorities for mobilization. They have agreed that in general terms, priorities will be based on work at a multi-sectoral level, and in particular, work which draws in non-traditional health care sectors to:

• Increase the focus on the broader determinants of health such as income and social status, employment, social environment and health services;

• Involve a range of sectors in developing healthy public policy; and

• Generate a variety of evidence which can inform our processes and strategies for influencing healthy public policy and the development of future programs and initiatives.

These priorities reflect HPPB regional offices strengths and capacities developed over the past 20 years in the field of health promotion. Regional offices are well placed to:

• Bring together varied and multiple partners and sectors, and in particular, populations living in conditions of risk;

• Ensure that a broad perspective to issues (multi-determinants) is used in the development of health strategies;

• Promote the health promotion value system in the development of health initiatives, based on holistic and community development values and assumptions; and

• Integrate a variety of information in planning and evaluating initiatives, including knowledge, experience and data ranging from formal research to experiential learnings, i.e. evidence-based decision-making.

Inputs for the determination of regional priorities will come from several sources:

• The annual Departmental and Branch priority setting exercises will provide general directions and goals;

• Regional priorities will be informed by consultations with provinces, territories, the community and other partners, and by emerging priorities from other spheres within each region; and

• The analysis of existing activities and initiatives will identify both strengths, gaps and opportunities for action, and assist in refining regional priorities.

Priorities for the mobilization will be established through inter-regional consultations and decision-making, based on the strengths of individual regions and on opportunities presented across the country. While priorities may vary between regions as a result of unique features, the entire range of activities and actions supported will form the basis for the analysis of the mobilization function.

The Regional Population Health Managers' Forum has taken on the task of coordinating this approach. They have identified a process to review existing and planned regional examples of mobilization, identify common outcomes, characteristics and benchmarks, and to develop a framework for documenting and analyzing population health approaches and activities. This will build upon the Approaches and Activities analysis described in this paper. Part of this analysis will be a description of the value added inputs which regional offices bring to Taking Action on Population Health and which aid in the establishment of priorities. The Forum will also develop outcomes, benchmarks, time lines and accountability references to describe and measure the effectiveness of this process for setting of priorities.

During the initial implementation period, a portion of regional resources will be set aside for specific mobilization activities to protect them from the pressures other funding programs and issues put upon Branch resources. At the same time, work will continue to shift the delivery of all programs and resources so they increasingly reflect the population health approach.

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