Population Health Mobilization: A Regional Strategy

I Introduction

This paper outlines the emerging strategy that will be used to steer the regional mobilization of the population health approach, for which the Regional Directors of the Health Promotion and Programs Branch have assumed the role of champion. It provides background information, reviews health promotion activities in the regions in relation to the population health approach, outlines key approaches, activities and entry points, provides suggestions for how to analyze health issues and set priorities, and identifies opportunities, and next steps.

The basic elements of the strategy were developed at a meeting of Regional Directors and regional Population Health Managers in August 1998. Neither they nor the steering group that subsequently worked on the strategy started from "scratch". The paper draws upon work that has been done to articulate the nature and scope of the population health approach and its implementation. A number of documents provided important analysis and recommendations and they are referred to directly in the text, as well as listed in Appendix A.

It is intended that this strategy document will assist regional staff and other Blueprint champions as the implementation of the population health approach continues over the next one to three years.

Population Health

The Health Promotion and Programs Branch adopted a population health approach to guide its work almost two years ago. Since that time, work has been done on a number of fronts to develop and implement this strategic approach. It is being used as a macro framework to analyze health issues and to make decisions about how best to invest resources to improve health status. The definition of the population health approach is evolving and may change with experience.

The population health approach is characterized by:

• Strategies that include policies, programs and services that respond to evidence about the relative effects of multiple determinants of health;

• Actions and outcomes that have an impact on populations and sub-populations, and which therefore address societal, community, structural or system level changes; and

• Collaboration amongst multiple sectors, given that influence over most of the determinants of health lies outside of the health sector.

Taking Action on Population Health describes a set of principles to provide guidance for analyzing health issues and designing interventions. Readers are referred to this document for full descriptions, examples of actions and key questions.

For reference, the guiding principles are listed below:

1. Health is a capacity, a resource for everyday living;

2. The determinants of health are addressed, recognizing they are complex and inter-related;

3. The focus is upstream;

4. Health is everyone's business;

5. Decisions are based on evidence;

6. Accountability for health outcomes is increased;

7. Management of health issues is horizontal; and

8. Multiple strategies, in multiple settings, in multiple systems and sectors are used.

Altogether, these principles make up the population health approach. Acting on just one or two of them would not reflect it, but rather, it is their combined effect that fulfills the approach.

The Blueprint

As the Branch explored the implications of adopting the population health approach, a Blueprint, or plan, was developed to ensure that the necessary thinking and action takes place to implement it effectively. It is comprised of the following components: theory, policy, evidence, marketing, mobilization and institutionalization. Taking Action on Population Health and Moving Ahead on the Theory and Policy Components both offer descriptions of each of these components.

A Branch champion has taken the lead on each component of the Blueprint. Together the champions act as an informal board of directors, providing a sounding board for one another and reviewing progress on each of the components. Individually, they are responsible for developing plans and making sure that progress is made on their component. The Major Projects Directorate acts as a resource to the champions.

The Regional Directors have agreed collectively to take the lead on mobilizing population health in the regions and to participate in the champions' forum. Regional staff will participate in the work of each of the Blueprint components, providing another mechanism to link the mobilization of population health in the regions with the other components. Challenges and opportunities have been identified with respect to the relationships between the mobilization and the other components and will be raised with the champions in the course of working on the various Blueprint components.

Mobilization

The Mobilization component puts the population health approach into action. It refers to intersectoral collaboration on population health initiatives across sectors (e.g., business, labour, social and health) and levels of government (e.g., local, provincial). It is about the doing of the approach - acting on health issues in a way consistent with the guiding principles and characteristics of the population health approach. There is a relationship amongst all the components of the Blueprint, and the experience gathered through mobilization should inform and augment the work of the other components and vice-versa. Mobilization is critically important to the success of the population health approach because it puts theory into practice and will generate evidence about the usefulness of the approach. Regional mobilization will build support for the population health approach "from the ground, up".

Mobilization is about stimulating, developing and implementing population health initiatives across sectors and levels of government in a collaborative way. Expected products are mechanisms, models and tools that enable and support intersectoral planning and decision making, development of program tools and approaches that reflect a population health perspective, sharing of resources and information about best practices, etc. The Mobilization component should generate experience and information that can be fed back to the Theory component in an iterative process to refine the theoretical framework, and to the Policy component to refine policy decision making. It could also generate information to be used in Marketing.

(From Moving Ahead on "Theory" and "Policy" Components of the Population Health Blueprint: A Proposed Strategic Approach, by Diane McAmmond and Associates, June 1998)

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