Power, Politics and Public Health: But what about the Evidence?

Rob BoydSandy Hill Community Health Centre

Oasis ProgramUniversities without Walls

Summer Learning Institute July 15, 2009

Overview

• Community mobilization

• How evidence was used at the Ministry Level

• Potential research questions from program level

SIP Partner Agencies• Youth Services

Bureau• Wabano Centre for

Aboriginal Health • Centertown

Community Health Centre (CHC)

• Oasis / Sandy Hill CHC

• Somerset West CHC • AIDS Committee of

Ottawa • Elizabeth Fry Society• Carlington CHC• Pinecrest Queensway

CHC

Ottawa Coalition on HIV/AIDS Mission

• The Ottawa Coalition on HIV/AIDS is a coalition of organizations and associated individuals. We work together to reduce the incidence of HIV and support the wellness of people living with HIV in Ottawa.

meanwhile, in Toronto…

Much community advocacy began, media attention focused on the issue, and it became something that quickly moved to the radar of the minister

As part of the process, Hepatitis C Task Force and Ontario Advisory Committee on HIV/AIDS wrote a joint letter to minister outlining research evidence in support of the harm reduction measures to assist people who smoke crack to avoid infectious disease

How did research inform this process?

The letter is initially written by civil servants and vetted by key stakeholders (experts within our multi-stakeholder advisory committee’s)

We were able to quickly gather supporting research by contacting Lynne Leonard, a researcher for whom we have a pre-existing and ongoing relationship

Had we not had the pre-existing relationship with Lynne, stakeholders on our advisory committee’s would have known key contacts to gather the evidence

Research connected to policy“An evaluation of Ottawa’s Safer Crack Use Initiative in 2006 by Lynne Leonard and her

team at the University of Ottawa indicated the following positive benefits:• A reduction in the sharing of drug use equipment. The proportion of people

sharing pipes ‘every time’ declined from 37% in the six months before the program began to 31% in the first, one-month follow-up post-implementation evaluation, to 12% at six-months and 13% in the twelve month post-implementation assessment.

• A marginal decline in the proportion of participants reporting the presence of oral sores.

• Evidence of change in drug use behaviour, with some people reporting transitioning from injecting to smoking. Prior to implementation, 96% of injection drug users reported injecting in the month prior to the initiative compared with 84% at one-month into implementation and 78% at six months and twelve months into implementation. At the same time, there was a significant increase in the prevalence of crack smoking among people who inject drugs, from 77% of injection drug users reporting crack smoking pre-implementation, to 86% at one-month into the program, 89% at six months, and 93% at twelve months post-implementation.”

What was the outcome? The program was funded by the ministry of health and is being delivered

through a community agency in Ottawa Political advocacy and agitation and media attention brought import to

the issue politically The research evidence was available to the minister as he made his

decision; we (civil service) were able to access relevant, local evidence quickly because of our relationship to researchers and knowledge of their work, and because of an infrastructure that creates a network of key stakeholders, including researchers, to inform the process

People in Ottawa who smoke crack have a means of obtaining materials to assist them in avoiding infectious disease, reducing their likelihood of injecting (an activity with potentially greater health harms) and connecting them to service providers

Media CoverageAn Irrational and Stupid Drug Policy

An Irrational and Stupid Drug Policy Ottawa Citizen May 2008Ottawa Citizen May 2008

City, provincial reps feud over crack pipe program

City, provincial reps feud over crack pipe program

Nepean News January 2008

Nepean News January 2008

Province to fund crack-pipe program in city

Province to fund crack-pipe program in city Ottawa Citizen December 2007

Ottawa Citizen December 2007

Crack Pipe Clash, Ottawa Sun January 2008

Crack Pipe Clash, Ottawa Sun January 2008

Stick it in your pipe, mayor told, Ottawa Sun

Stick it in your pipe, mayor told, Ottawa Sun

January 2008

January 2008

Getting the point, Ottawa Citizen

Getting the point, Ottawa Citizen

What worked ?

• The evidence

• The leadership (Ron)

• Strength of partnerships (at local and provincial levels)

• Opportunity to educate general public through mass media

Program Questions

• Getting the equipment right• Getting the numbers right (reach and building

more evidence)• Getting the resources right (when, where and

how much)• Getting the focus right (a wide lens)• Focus on relationship (slow things down)• Under 18’s

“ The health professional who hands out safe inhalation kits may be the sole contact that this person has with our health care system. It may be the one and only line of communication and if we lose contact with him, we lose him completely. We can’t give up on these people. “

Honourable George Smitherman