Intersectoral

Collaboration for the

Control of Non

Communicable Diseases

National Health Forum,Vilnius, November 29-30, 2012

Canadian experience

Sylvie Stachenko,

University of Alberta

Road Map

1. Building blocks for

intersectoral action

2. Example of national

and provincial

approaches

3. Key challenges and

lessons

3

The Burden of Non

Communicable Diseases in

Canada

High risk groups • Increased prevalence in vulnerable communities (e.g.

Aboriginals) and in socio-economically disadvantaged groups

Economy • Direct health care costs: 71 billion dollars

• Indirect costs: 85 billion dollars

All these numbers will increase as a result of • Aging

• Increased prevalence of some risk factors, e.g. obesity

Some alarming trends

• 4 out of 5 Canadian adults have at least one risk major factor for chronic disease

• High blood pressure and Type 2 diabetes occurring at younger ages

• 1 out of 4 Canadian children are overweight or obese

Increasing Health Disparities

Aboriginal Status vs non aboriginal

• Life expectancy:

males: 68.9 years vs 76.3 years

females: 76.6 years vs 81.8 years

• Infant mortality: 16% higher

• Smoking: 59% vs 17%

• Type 2 diabetes: 3 – 5 times higher

• Years of life lost to injury: 3.5 times higher

• Rates of tuberculosis: 8 – 10 times higher

What has been the response

in Canada?

Canadian Investments

in Health Promotion to address NCD

Prevention

Single risk factors – tobacco

Single diseases-cardiovascular

Specific population groups – children

Towards an intersectoral approach to

NCD prevention

Commonality of risk factors for major NCD’s

Systems approach to planning and delivery

Major participation of civil society

Strategic partnerships for intersectoral action

Multiple Entry Points Incremental

Building on a long

history in health

promotion

Canadian Strategy for

Tobacco Control

Governance

- Multisectoral Partnerships

Multi-pronged Strategy

- Access

- Advertising and Promotion

- Packaging and Labelling

- Product Regulations

- Taxes

- Smuggling

- Enforcement and Education

Sustained over time

9

Community-Based Programming

Community Action

Program for Children

Canada Prenatal

Nutrition Program

10

Health and Education

School Settings Initiatives

healthier foods and nutrition policy

in cafeterias, vending machines

11

The Canadian Heart Health Initiative

Building the evidence base for

intersectoral action on NCD

Demonstration programs in all 10 provinces

Observatory of community-based comprehensive programs- a focus on vulnerable populations

311 projects in 10 provinces,

35 community level programs

Development of tools and methodologies

Risk factor surveillance

Process evaluation

Implementation research

The Canadian Heart Health

Initiative Catalyst for the

development of NCD supportive

infrastructure

• The Heart Health Risk Factor Survey ,precursor

to the current Health Measures Survey.

• Precursor to the Population Health Intervention

Research Initiative for Canada

• Coalitions for heart health at all levels expanded to chronic disease alliances that have been influential in advancing the healthy living and chronic disease strategy

13

The Federal Chronic

Disease and Healthy

Living Strategy

• Balance between broad population-based

intersectoral action eg Healthy Living

Strategy

and

• Disease specific strategies,including

Cardiovascular disease, Diabetes,Cancer

Obesity:the case for intersectoral action

Source: see Kumanyika Ann Rev Pub Health 2001; 22:293-308

INDIVIDUA

L

Energy

Expenditure

POPULATION

%

OBESE

OR

UNDERWT

Food

intake :

Nutrient

density

FACTORS

INTERNATIONAL

School

Food &

Activity

WORK

/ SCHOOL/HOME

Infections

Labour

Worksite

Food &

Activity

Leisure

Activity/

Facilities

Agriculture/

Gardens/

Local

markets

COMMUNITY

LOCALITY

Health

Care

Syste

m

Public

Safety

Public

Transport

Manufactured/

Imported Food

Sanitation

NATIONAL/

REGIONAL

Food &

Nutrition

Urbanization

Education

Health

Social Security

Transport

Family &

Home

Media &

Culture Media

programs

&

advertising

Developmen

t

Globalization

of

markets

National

perspective

Action on Diet, Physical

Activity and Health

- Strong focus on intersectoral

approaches

-Comprehensive, collaborative and

in partnership with national,

P/T, and NGO stakeholders

including CDPAC

- Initial focus on diet and physical

activity and healthy weights

A declaration from Canada’s

ministers of health

• Commitment for

upstream action

• A focus on

intersectoral

action

Multilevel networks to

advance

the NCD Prevention

Agenda

• Public Health Network (cross jurisdictional)

Expert group on chronic disease prevention and promotion

• Chronic disease prevention alliance

• Pan Canadian intersectoral healthy living network

• …

18

Knowledge Synthesis

and Development

• Comprehensive learning system

National Best Practice portal for Health Promotion and Chronic Disease Prevention

www.phac.gc.ca/cbpp

PAHO-PHAC Observatory of Chronic Disease Policy

www.phac-aspc.gc.ca/ccdpc-cpcmc

• Supportive knowledge translation platforms-National

Collaborating Centres – Healthy Public Policy

– Social determinants of health

– Aboriginal Health…..

19

Provincial Intersectoral

Actions

Act Now BC

Act Now BC is an integrated, partnership-based, multi-

sectoral, health promotion and chronic disease

prevention strategy designed to improve the health of

British Columbians by focusing on the risk factors and

underlying determinants associated with chronic

diseases:

Physical inactivity

Poor nutrition

Tobacco use

Alcohol use

Act Now BC Goals

Make British Columbia the healthiest jurisdiction to

host the Olympic and Paralympic Winter Games.

Specific targets related to 4 modifiable risk factors

Build community capacity to

create healthier, more

sustainable, and economically

viable communities, and

Reduce demand on the health care system.

Political leadership that seizes the opportunity intersectoral vision and direction obtained through leadership

and a strong mandate

Funding support

Diverse horizontal and vertical strategies and mechanisms Breaking down the silos in government – the horizontal

dimension

Engaging the many civil society organizations and different layers of government– the vertical dimension

Targets and accountability Publicly stated Act Now BC goals and targets

Clear understanding about who is responsible for what

Annual departmental service plan describing their contribution to the achievement of the targets

Success Elements

Act Now BC legacy

• Progress in achieving targets

• Tobacco target was achieved

• The concept of healthy public policy

accepted

• CIHR funded study to explore the

lessons learned from the Act Now BC

and its impact on the action planning

for health promotion in BC and in

Canada

The Quebec approach to Health in All

policies

• Mainly horizontal governance .No vertical dimension

• No HD targeted a priori (defined on the basis of MoH

directions)

• Legal act mandating:- intra-governmental mechanism

for evaluation of public policies and knowledge production

system to shed light on the decision-making

• Internal HIA of the laws and regulations of other departments

(with support from the MoH),and external HIA of the impact of

• certain laws and regulations on public health (MoH - INSPQ).

What kind of governance

works best?

• No one-size-fits-all

• Very context dependent eg culture and history

• Different time limits, breadth of involvement, level of involvement

• Strong mandate,sustained leadership

•

• Integrated policy development mandate,informed by info and research knowledge

• Adequate resource base

•

Challenges

• Capacity gaps to assess, identify, and

communicate impacts of gov’t policies on

health & health inequalities

• Developing effective supports for horizontal

work: accountability structures, rewards,

shared leadership protocols

• Willingness to invest sufficient time and

resources

• Meaningful involvement of other sectors

• Working with industry

Aciu

Thank You