Health promotion leadership and practice Intuition or knowledge-based? Ak’ingabe Guyon MSc MD CCFP FRCPC Richard Lessard MD MPH FRCPC Public health and

Health promotion leadership and practiceIntuition or knowledge-based?

Ak’ingabe Guyon MSc MD CCFP FRCPC

Richard Lessard MD MPH FRCPCPublic health and preventive medicine specialistsMontreal Public Health Unit

May 24th 2015, VancouverPublic Health Physicians of Canada symposium

Plan

1. Typologies of health promotion practice

2. Case studies from 30 years of public health

3. Lessons learned

Health promotion leadership & practice Guyon, Lessard, May 2015 2

Health promotion leadership & practice Guyon, Lessard, May 2015

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Health promotion…Ottawa forever!?

Public health

Prevention

Surveillance Protection


1. Build healthy public policy

2. Create supportive environments

3. Strengthen community action

4. Develop personal skills

5. Reorient health services

Ottawa Charter, 1986

Health promotion

See also Rechel & McKee, 2014


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Public health interventions Litvak & al. 2014, Jorm 2009


Advocacy, Strategic influenceMcCubbin 2001

Partnerships, coalitions

Support, expertise

Authority (health protection, emergency response)

Individual services

Health promotion

Disease prevention

Health Protection & emergency response

Surveillance

Collective services

Planning & evaluation, Research


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Healthy public policy instruments Guyon 2012, Bemelmans-Videc 2014


Regulationinstruments

Economicinstruments

Information & persuasioninstruments

…including public relation strategies Smith

2014

Advocacy, strategic influence

Healthy public policy


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• Dr. Richard Lessard : 30 years as regional MHO

• 10 case studies of complex public health interventions– Municipal (Relocation of a casino, …)

– School & early childhood networks (Early childhood summit, …)

– Provincial government (Health inequity mobilisation, … )

– Federal government (Supervised injection site, …)

• Analysis of implemented interventions (see next slide)


Cases from the Montreal public health unit

Information public + médias

Information décideurs

Éducation sanitaire

Développement de programme

Financement activités externes

Sondage opinion publique

Mobilisation des communautés

(Anti-)Marketing social

Support aux regroupements et réseaux

Plan de relations publiques

Projet recherche – évaluation

Promotion de politiques saines

Connaissance – surveillance

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10 case studies, Lessard & Chevalier 2014


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1. Contexthealth issue, challenge, public opinion, scientific evidence, potential and evidence-based interventions…

2. Public policy at stake public policy targeted, improvement requested…

3. Policy environment assessmentwhy target policy to address this issue, pros and cons of influencing policy, other options, stakeholder analysis…

4. Public health unit’s context for decisionlegal, scientific and administrative legitimacy? capacity? priority level for this issue? timeframe? MHO support? internal stakeholder analysis


Framework for public health case study analysis

Lessard R, 2014


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5. Public health unit’s decision processImportance of the health issue vs. capacity vs. chance of success of policy influence vs. timeframe

6. Interventions and strategies usedPublic health functions/ strategies/interventions used to reach objectives

7. Follow-up, aftermathMedia coverage analysis, results, lessons learned, next steps


Framework for public health case study analysis

Lessard R, 2014


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Strengths• Good surveillance data can lead to great media attention

Blind spots?• Reactive vs. proactive interventions : difficult balance • Public relations : do we use these strategies enough?• Public opinion: do we survey enough ?• Meeting members of parliament: too little, too late?• Listening and involving citizens• Community mobilisation, social marketing…anti-marketing

campaigns…

3. Lessons learned

Strengths and blind spots revealed

Lessard & Chevalier, 2014


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Changing social norms takes time 4-50 years?

Acohol, tobacco, seatbelts…

• Change deep-rooted habits salt, sugar, fat, portions, car as the ultimate means of transportation…

• « Mythbusting » and changing mindsets new highways decrease trafic : FALSE

• Influence demand > government policyas demand changes, supply adjusts and governments interventions can be relatively light

• Use coercive policies as the last resort according to evidence and ethics, Nuffield Council on Bioethics

• Status quo = great benefits to some stakeholders…There are no externalities for those who benefit from them…

3. Lessons learned

Our challenge: accelerate shifts in social norms



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• Solid scientific evidence

• Aiming for maximum impact • Key priorities (2-3…not 20)

• Capacity: sufficient staff • Capacity beyond the biomedical: appropriate multidisciplinary

expertise• Flexible but real management & leadership

• Constant re-assessment/ progress evaluation

3. Lessons learned

Conditions for success



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Milestones and next steps

1. Public health case studies Completed cases used for MPH/ MSc classes …publication for 2016?

2. Profesional development Healthy public policy community of practice 2014-2015

Pan Canadian + Quebec health promoter competencies frameworks …PHPC webinar in 2015

3. Organisational development ?…as Quebec’s regional PHUs recover from massive 30% budget cuts


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Conclusions • We can and should analyse our complex public health

interventions

• Reclaiming public health successes: a priority

• Case study: a paramount methodology for public health research and training?

Novick et al. 1997Hunting & Gleason 2012? …imagine a public health case study centre for Canada


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Questions ?Comments ?

Experiences in analysing and supporting health promotion/healthy public policy strategies ?

[email protected]


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Selected referencesBemelmans-Videc et al eds. 2014. Carrots, Sticks and sermons: policy instruments and their evaluation. Transaction

publishers

Guyon A. 2012. Intensifier l’élaboration de politiques publiques favorables à la santé: des approches stratégiques pour les autorités de santé publique. Can J Public health, 103(6) 459-461.

Hunting KL, Gleason BL. 2012. Essential case studies in public health. Essential public health series, Jones and Bartlett learning.

Jorm L, Gruszin S, Churches T. 2009. A multidimensional classification of public health activity in Australia. Australia and New Zealand Health Policy. 6(9) 1-10.

McCubbin M, Labonte R, Dallaire B. 2001. Advocacy for healthy public policy as a health promotion technology. Centre for health promotion, University of Toronto. Document online.

Lessard R, Chevalier S. 2014. 30 ans de communications: un regard sur une pratique de santé publique. Journées annuelles de santé publique, 25 novembre 2014http://jasp.inspq.qc.ca/2014-la-communication-une-fonction-strategique-en-sante-publique.aspx

Lessard R. 2014. Politiques publiques et santé: grille pour la documentation de projets. Document de travail non diffusé.

Litvak E et al. 2014. Typologie des interventions de santé publique. Document de travail non diffusé.

Novick et al. 1997. Public health leaders tell their stories. Aspen publication and Millbank memorial fund.

Nuffield Council on bioethics. The intervention ladder. Website consulted May 18th 2015. http://nuffieldbioethics.org/report/public-health-2/policy-process-practice/

Rechel B, McKee M. 2014. Facets of public health in Europe. Open University Press. Document Online.

Smith R. 2014. Public relations, the basics. Routledge, New York.

http://jasp.inspq.qc.ca/2014-la-communication-une-fonction-strategique-en-sante-publique.aspx

http://nuffieldbioethics.org/report/public-health-2/policy-process-practice/

Documents

Health promotion leadership and practice Intuition or knowledge-based? Ak’ingabe Guyon MSc MD CCFP FRCPC Richard Lessard MD MPH FRCPC Public health and