CAPITAL HEALTH REGIONAL LEARNING AND EDUCATIONAL RESOURCES
|
TABLE OF CONTENTS
CHAPTER 1 - BACKGROUND AND CONTEXT
Overview of Project
Project Objectives and Requirements
Initial Definition of Health Education
Research Framework for Developing the Inventory
Methodology
Structure of this Report
CHAPTER 2 - FRAMEWORK FOR HEALTH EDUCATION
AND PROMOTION
Role of Health Education and Health Promotion
Evolution of Health Education and Promotion
Increased Effectiveness for Health Education and Promotion
CHAPTER 3 - INVENTORY OF HEALTH
EDUCATION ACTIVITIES
Organizations Involved in Health Education and Promotion
Health Promotion Inventory Findings
Focus of Activity
Access to Health Promotion Activities
Target Groups
Media Used
Evaluation Methods
Source of Funding
Health Determinant Focus
Areas for Emphasis
CHAPTER 4 - PARTNERSHIPS IN
THE CAPITAL HEALTH REGION
Partners in Health Education and Promotion Services
Roles of Capital Health
Dichotomies in Direction
CHAPTER 5 - SUMMARY AND CONCLUSIONS
Directions for the Future
Action Plan
APPENDIX 1 - SUMMARY OF RECOMMENDATIONS
APPENDIX 2 - FRAMEWORK FOR HEALTH
PROMOTION IN CANADA
Cornerstones of Health Promotion in Canada
Definition of Health (WHO)
Determinants of Health
Ottawa Charter
Implications of the Population Health Promotion Model
APPENDIX 3 - HEALTH-PROMOTING
HOSPITALS NETWORK
APPENDIX 4 - PERSONAL INTERVIEWS
APPENDIX 5 - BIBLIOGRAPHY
CHAPTER
1 - BACKGROUND AND CONTEXT
Overview of Project
The Capital Health Board Education Committee recently developed an education
policy that "recognized the importance of education in promoting the health
and well-being of people living within the Capital Region". This direction
is clearly in line with the overall regional goals and strategies. In the
most recent Capital Health Business Plan Update(1),
one of the values which underlies the Capital Health core businesses and
priorities is:
Personal Responsibility: The right and responsibility of individuals
to make informed choices about wellness and quality of life.
Specific strategies which relate to education and learning opportunities
for the general public and health care consumers are identified as critical
in the opening remarks in the Business Plan:
Illness and injury prevention, health promotion and improving population
health are a significant program focus.
This program focus is part of two of the three core businesses identified
by Capital Health in their business plan:
Core Business 2: Ensure access to core health services
Core Business 3: Ensure integration of health services, education
and research to achieve excellence.
This project supports these themes by identifying the education and learning
opportunities within the region, both by Capital Health, and by other key
partners and by suggesting areas of focus for the Capital Health board
during the next planning cycle.
Project Objectives and Requirements
The objectives that were used for this project allowed the researchers
to appropriately focus the proposed inventory of learning and education
resources. The objectives include:
-
To develop a conceptual framework for examining educational and learning
opportunities available to health care consumers and the general public
in the Capital Health Region
-
To identify the health education and learning activities which are available
to residents of the Capital Health region
-
To identify the organizations, jurisdictions, agencies and other groups
who are involved in public and consumer health education and learning activities
-
To determine the partnership relationships between the various providers
of public and consumer health education
-
To identify the most effective strategies and supportive conditions, based
on a review of the literature, for providing education and learning opportunities
to health care consumers and to the general public
-
To identify areas for effective action by Capital Health in the field of
health education and learning for health care consumers and the general
public who are resident in Capital Health region
-
To recommend the next steps in the development of an action plan for education
and learning activities
Initial Definition of Health Education
The following definition was developed by the project team as the working
definition of health education for methodological purposes:
Health education is defined as: any activity undertaken
by an organization or agency which enables an individual to cope with,
understand and make decisions about issues and circumstances which affect
his/her or another family member's health through the provision of information,
based on which individuals can make positive changes to affect their health.
Activities which would be covered by this definition could include reading,
group discussion, taking a course, attending a seminar or workshop, going
to a resource centre, obtaining individual counselling, attending a self-help
group or activity and/or any other means of obtaining information verbally,
audibly, experientially, electronically or visually.
This definition was augmented by the WHO definition of health promotion
at a later stage in the project. The relationship between health promotion,
as the over-riding concept, and some of its components, including health
education, is shown below:
Research Framework for Developing the Inventory
For each organization , there were a number of key components which were
considered, including: the type of organization, the primary role of the
organization, the focus of the educational activity, the target group served,
the method of access to the activity, the medium used, the mechanism for
determining effectiveness, the frequency of the activity, the funding sources
for the organization, and a listing of other organizations involved in
the provision of the health promotion/health education activity.
These factors were used to develop the conceptual framework which became
the basis for the interviews and contacts with Capital Health and its partners
which in turn formed the basis for the completed inventory of health promotion
and education activities.
Methodology
The critical factor was ensuring that the requested audit of educational
activities obtained the widest possible coverage of organizations involved
in health promotion and health education within the Capital Health region.
A preliminary list was developed based on the consultants' knowledge of
the organizations involved in health education and health promotion within
the Capital Health boundaries. Then, the approach that was taken was one
of widening concentric circles. That is, core organizations that have a
key role in the Capital Health region were interviewed, and from those
interviews, listings of additional organizations involved in health education
were developed. Each organization then received a telephone interview.
Again, additional organizational involvements in health promotion were
solicited. The following graphic illustrates the groups which were sampled
to develop the inventory.
The number of telephone interviews conducted was a function
of the overall time and budget available. Approximately 125 telephone interviews
were completed. In addition, 16 of the larger organizations received a
one hour face-to-face interview. Organizations were selected first that
were anticipated to have a high degree of involvement in health education
and health promotion activities.The key methodology was the development
of an electronic data base. This approach has several advantages to a more
traditional, paper-based, audit approach:
-
printed inventories of health education activities can be produced in a
variety of formats (e.g., by jurisdiction, by type of educational need,
etc.)
-
facilitates the establishment of a searchable data-base for incorporation
into the Capital Health web site
-
technically easy to update in order to keep the information current
Structure of this Report
A companion document to this report, An Inventory of Health
Promotion Activities within the Capital Health Region, provides
summaries of information from the data base based on a variety of search
criteria. The overall data base will also be provided to Capital Health
at the completion of this project. The remaining four chapters of this
report address the project objectives and requirements outlined earlier.
First, a conceptual framework which can be used to address health promotion
activities is briefly described. Then, the health education and health
promotion activities which are available to residents of the Capital Health
region are summarized, based on the findings from an analysis of the organizations
included in the inventory. The most effective strategies and supportive
conditions for providing health education and health promotion activities
are used as a set of criteria for analyzing the activities underway in
the Capital Health region. The next chapter presents a brief discussion
of partnerships within the Capital Health region. The final chapter provides
suggestions for effective action by Capital Health in the field of health
education and health promotion with recommendations for the next steps
in the development of an action plan.
The report also has five appendices: a summary of recommendations; a
more detailed conceptual framework developed by Health Canada; an outline
of the European Health Promoting Hospitals Network; a list of the organizations
and individuals who received personal interviews; and a bibliography of
material consulted in the preparation of this report.
CHAPTER 2
- FRAMEWORK FOR HEALTH EDUCATION AND PROMOTION
Role of Health Education and Health Promotion
In researching and conducting interviews for this report it became evident
that health education is considered a key strategy in a broader health
promotion approach which may include development of healthy public policy.
Health education is a critical component in reorienting health services,
developing personal skills, strengthening community action, and creating
supportive environments. The definition of health education as activities
which enable individuals to cope with, understand and make decisions about
issues and circumstances which affect their health supports the World Health
Organization definition of health promotion:
"... the process of enabling people to increase control over and
to improve their health."
In this report, health education and health promotion are terms which
are linked, and at times, used interchangeably. The following graphic illustrates
the complementary role that such strategies as health education, health
promotion and disease and injury prevention play within the overall health
system.
The success of these strategies buffers the need
for more intensive health services. Health education provides consumers
with the information and skill development to make informed choices about
their health. Simple education strategies such as providing health information
in plain language help decrease the negative impact of other health determinants
such as low literacy. Appendix 2, page 37, presents a fuller discussion
of health determinants. By strengthening the role of health education and
promotion within the overall health system, particularly primary care,
the need for more intense services are reduced by:
-
increasing the resilience and coping skills of the population to enable
them to deal with and respond to the normal changes in life, including
ill-health and disabilities.
-
reducing the proportion of the population behaving in health-affecting
ways (such as alcohol abuse, smoking or consuming a high cholesterol diet),
thus reducing the number of individuals at risk for diseases and conditions
resulting from those behaviours.
-
improving parenting skills in the overall population and providing supports
to disadvantaged families to ensure healthy child development, thus reducing
the long-term need of those children for health, social, remedial education
and other services.
-
increasing the awareness of the causes of accidents and injuries, coupled
with incentives and support to change dangerous behaviours, can result
in lessened disability and death from accidental causes.
Evolution of Health Education and Promotion
Initially, attention in the area of health education and promotion focussed
primarily on individual lifestyle choices (diet, exercise and smoking),
and on healthy public policy (e.g., seat belt legislation). More recently,
because of increased research on the determinants of health, the focus
has started to shift, towards the factors which influence health. Recently,
the National Forum on Health(2) final report
has emphasized the need to broaden the approach to health.
We believe that the social and economic determinants of health
merit particular attention. This is not to diminish in any way the important
contribution made by the promotion of healthy lifestyles or to downplay
the role of other non-medical determinants of health, such as the physical
environment and genetics. Rather, our goal is to raise awareness of the
far reaching implications of social and economic factors and to propose
concrete actions to improve the health prospects of Canadians.
This conclusion supports the research from the Canadian Institute for Advanced
Research directed by Dr. Fraser Mustard. Results from their studies emphasize
the value of early intervention, the negative impact of factors such as
poverty and low education and the importance of people having a sense of
control in their lives and access to safe, healthy living and working conditions.
In support for this type of research the Federal, Provincial and Territorial
Advisory Committee on Population Health agreed upon a number of key health
determinants and a Population Health Promotion Model. This model is described
in Appendix 2, page 41.
Increased Effectiveness for Health Education and Promotion
The literature suggests that effective health promotion activities have
the following characteristics:
-
needs-based
-
community driven and controlled
-
multi-sectoral in involvement
-
multi-disciplinary in delivery
-
targeted to specific populations
-
experiential in nature
-
broadly accessible
-
sustainable projects
The literature highlights the need for the development of evaluation models
and outcome indicators for health promotion initiatives. There has been
significant work done over the last decade to develop mechanisms for evaluating
health promotion activities and identifying outcome indicators. One outstanding
issue in measuring the effectiveness of initiatives is the scope of the
evaluation. Effectiveness can be measured as any or all of the following
examples:
-
meeting the needs of the participants
-
fulfilling the expectations of the program design
-
involving the community in the development and delivery of the program
-
reducing the need for more intensive health and social services at a system-wide
level
It must be kept in mind that the overall effectiveness of health promotion
in a region is more than just the sum of the parts. A series of highly
effective initiatives may have no discernable impact on the overall health
of the population if the impact and coverage of the programs is insignificant
relative to the size of the region. The effectiveness factors noted above
will be used to assess the findings of the analysis of the inventory of
health education and promotion activities in the Capital Health region.
Capital Health's efforts in monitoring the health of the overall population
will be critical as overall evaluation mechanisms are put in place to connect
results from health promotion activities with benchmarks that lead to overall
changes in regional population health.
CHAPTER
3 - INVENTORY OF HEALTH EDUCATION ACTIVITIES
Organizations Involved in Health Education and Promotion
The first section of the companion document to this report, An Inventory
of Health Promotion Activities within the Capital Health Region,
lists the agencies and organizations within the Capital Health Region who
were contacted by telephone to determine the health education, promotion
and prevention activities which they were undertaking. Similarly, Appendix
4, page 47, identifies the individuals and organizations who were received
a face-to-face personal interview. The organizations contacted were selected
as a sample of the categories of partners identified in the partnership
schematic diagram on page 4. Community organizations and agencies received
a total of 45 interviews, 17 of the various branches and organizations
within Capital Health were contacted, including several hospitals and other
organizational entities. 35 federal, provincial and municipal organizations
were contacted, as were 10 professional organizations and 9 provincial
level non-government organizations. Other regions were not contacted, but
a small sampling of 13 other organizations, including large employers,
mass media, businesses, etc., were interviewed.
The Inventory of Health Promotion Activities within the Capital
Health Region has some constraints, identified in the introduction
to the inventory. However the data base offers an excellent overview and
provides a good base for further development. A number of organizations
requested that Capital Health restrict distribution of the inventory of
activities until the organizations who took part in the telephone interviews
have a chance to confirm the accuracy and interpretation of the information.
Health Promotion Inventory Findings
Focus of Activity
Most organizations contacted had more than one focus of activity. Thus,
more than one response to this question was received from most organizations.
Focus of Activity |
Number of Organizations Reporting |
Choosing healthy lifestyles and behaviours |
77 |
General health promotion and protection |
73 |
Understanding health determinants |
44 |
Personal safety and security |
39 |
Dealing with a specific illness, condition or disability |
42 |
Community Support and Development |
32 |
Reproductive and sexual health |
30 |
Use of adaptive techniques and technologies |
26 |
Accessing the health system and services |
20 |
Dealing with another's illness, condition, or disability |
20 |
Consumer rights and responsibilities |
16 |
Understanding health legislation |
9 |
The largest single focus of activities was choosing healthy lifestyles
and behaviours, followed by general health promotion and protection activities,
with nearly half of the contacted organizations or organizational branches
being involved in these activities. Only one quarter of the reporting organizations
or organizational branches felt they were involved in community support
and development.
Access to Health Promotion Activities
Access and availability is a significant issue if health promotion activities
are to be effective. Organizations contacted had a variety of ways in which
individuals became knowledgeable and involved in various health promotion
activities.
Mechanism for Obtaining Access |
Number of Organizations Reporting |
Consumer-driven (individual seeks out material/activity) |
82 |
Provider-driven - voluntary (provider makes available material/activity
or referral as part of service delivery) |
46 |
Provider driven - mandatory (provider requires involvement
as a requirement for obtaining services) |
32 |
Joint development of access between consumer and provider |
17 |
Organization/jurisdiction disseminates (to specific groups,
target audiences, etc.) |
22 |
Given the importance of consumer and community involvement in effective
health promotion activities, it is disappointing to see that only 17 organizations
report that there is joint development of the access mechanisms. For half
of the organizations contacted, the consumer was expected to seek out the
organization and activity to obtain access. In the remaining half of the
organizations, the provider of the health promotion activity took responsibility
for referring or otherwise making available activities and programs to
individuals who were already receiving services from the organization.
Presumably, individuals who wanted to access resources who were not already
receiving services from the organization, would also have to seek out the
information on their own. Speaking as researchers, even when organizations
were contacted directly, it was not always easy to identify either who
to talk to or what health education and promotion activities were sponsored
by that organization. "Broadly accessible" is considered to be a critical
effectiveness factor, and yet there are significant barriers to consumers
in learning about the existence of various health education and promotion
activities and projects.
This finding emphasizes the need to develop some easy mechanism for
consumers to locate information and other support activities of interest
to them. If consumers do not have the knowledge of the availability of
resources, they would benefit from the health promotion activity only if
they were referred or were already involved with the organization. It would
also be difficult to compare similar programs across the region to determine
the most convenient time/place or the content best suited to their needs.
Capital Health has already recognized that information and access is
a significant need for both seniors and service providers through the establishment
of the Senior's Health Line. Monitoring of the usage of the Senior's Health
Line indicates that this information line is used heavily by front line
practitioners as well as by the seniors themselves. Another major source
of information, the Centre for Well Being, is primarily designed for the
use of practitioners. Clearly, the overall effectiveness of activities
in the Capital Health region could be increased by improving consumer and
provider access to information, perhaps through the Capital Health Information
line or through publicizing the "Health Line". There is a wealth of information
already available. The issue is access to the information at the right
time by people who could benefit from the information that already exists
within the Capital Health region.
Recommendation 1: Capital Health should develop an information
network for the use of both consumers and providers by using media, information
processing, communication technologies, and other approaches to improve
access, at anytime and from anywhere, to legitimate and useful information
regarding health promotion. This should include forging closer links with
key educational and social services organizations and agencies.
Recommendation 2: Capital Health should develop a collaborative
network among citizens who play key roles in health promotion and among
health-focussed citizens groups of diverse types and sizes, to involve
community members in the development of improved information access mechanisms.
Target Groups
The target group breakdown is more subject to difficulty than any other
category. Many organizations specified a large number of target groups,
when what was probably meant was that they served the general public. Thus,
there is more overlap in the following table than in other sections of
this report. Similarly, activities which identify seniors as the target
group are usually only available to seniors, but seniors can also benefit
from activities that are available to the general public. However, not
all target groups can benefit from "general public" programs. For example,
individuals for whom English is a second language or who are challenged
by low literacy often cannot benefit from general programs or information
resources, particularly those which are print based.
Target Group Served |
Number of Organizations Reporting |
General public |
60 |
Health providers |
36 |
All health care consumers |
24 |
Parents and their children |
31 |
Persons with Disabilities |
25 |
Youth and young adults |
23 |
Low-income individuals and families |
16 |
Seniors |
15 |
Individuals with English as a Second Language |
14 |
All families of health care consumers |
11 |
Community Board members |
4 |
The literature indicates that health promotion and education messages
and activities are most effective when they are clearly targeted to a specific
audience. And yet, in the Capital Health region, 84 organizations report
that they are offering programs and activities that are targeted to the
general public or all health care consumers.
Media Used
The following table illustrates the primary medium used by organizations
within the Capital Health region to support the provision of health promotion
programs. In line with the previous comments on low literacy and English
as a second language, the vast majority of health promotion activities
are English-based, and most are supported by print material of some kind.
Medium Used |
Number of Organizations Reporting |
Print material (e.g., brochures, handouts) |
84 |
Group face-to-face (seminars/workshops/courses) |
65 |
Newspaper/magazine or other publications |
58 |
Resource Centres (and other combination activities) |
50 |
Individual face-to-face (counselling, demonstrating, etc.) |
45 |
Telephone (e.g., hotlines, referral lines) |
40 |
Poster/sticker or other campaigns |
34 |
Electronic Dissemination (e.g., Internet) |
28 |
Television (public service announcements, special programs,
paid advertising, community channels, etc.) |
26 |
Libraries |
26 |
Mass or targeted mail-outs to consumers |
16 |
Facilitation of Mutual Aid/Self-help |
11 |
The literature on health promotion effectiveness indicates that print
materials are most suitable for "main-stream", middle class groups who
have the skills and resources to make use of print-based information. Individuals
who are low income, disadvantaged, have low literacy skills, or who have
English as a second language generally have difficulty benefiting from
print based information activities. By far the majority of activities summarized
in the above table are based on print materials and the ability to read.
One attraction for these approaches, particularly brochures, handouts,
or other print materials is the simplicity of production and duplication
as well as the relatively low cost per individual covered and the ease
of duplication. For example, it only costs a few cents to give someone
a brochure on Canada's Food Guide whereas it costs significantly more per
participant to establish a collective kitchen or offer a group counselling
session on nutrition. However, the easy, lower cost approach will not be
at all effective for certain target groups. One of he most effective ways
of changing behaviour is the facilitation of mutual aid or self-help where
the approach provides skills and support rather than being based on print
materials. Only 11 organizations reported that this was the approach that
was being used.
The Centre for Well Being has been funded to act as a resource for providers
using current Internet technology (among other activities). However, many
organizations who have provided information to the Centre cannot access
the information. Of the organizations contacted in this study, only 15
had publicly accessible web sites, and only 26 of the contact people and/or
their organization could be contacted through e-mail. The Centre is considering
a number of options, including the possibility of distributing printed
material in order to increase the access to the information they are collecting.
In many of the personal interviews, a great sense of frustration was
expressed that the technology for quick and easy contact between organizations
was available, but that the organization was not "wired" either because
there were no computers, or there was no Internet/e-mail access. The Internet
was noted as an effective mechanism for consumer and provider health promotion
information as well as virtual support groups and electronic "communities"
for individuals. However, even resource centres had difficult obtaining
access to the necessary computer equipment and Internet access to make
this resource available to the public. The Edmonton Public Library is one
of the limited locations which provides free publically available access
to the Internet and the world of resources it opens up. Capital Health
is in the process of placing an emphasis on this form of information provision.
Recommendation 3: Capital Health should encourage use of electronic
communications technologies, particularly for providers. This could include
promoting e-mail communication between Capital Health and community agencies
and organizations, providing an electronic bulletin board system for posting
of health promotion information of general interest, establishing a mail
list server for practitioners and community agencies on health education
and promotion topics, increasing the number of links on the Capital Health
web-site, hosting electronic discussion groups or increasing the public
access to the Internet.
Recommendation 4: Capital Health should redevelop its own
web site to make it a more effective health education and promotion tool,
including provision of the maximum amount of information regarding resources
and activities available within the Capital Health region, promulgation
of "best practices", sharing of key evaluation and research findings, and
establishment of outcome and other indicators.
Evaluation Methods
Methods of Determining Effectiveness |
Number of Organizations Reporting |
Formal evaluation projects |
64 |
Consumer satisfaction measures (e.g., surveys) |
52 |
Consumer complaints/requests monitoring |
45 |
Demand for service monitoring |
38 |
All of the organizations contacted consistently used some mechanism
to monitor their activities. A full third of the organizations contacted
used formal evaluation projects to determine effectiveness. Several organizations
commented on the positive influence Capital Health has had by facilitating,
encouraging and funding evaluation activities. However, many organizations
commented that they primarily were "demand monitors" and lacked the knowledge
and skills to appropriately evaluate the effectiveness of health promotion
programs. One of the emphases in overall health reform strategy for Capital
Health is to move increasingly toward evidence-based decision making, firmly
grounded in research, evaluation and experiential knowledge. However, some
community agencies partnering with Capital Health continue to lack the
tools and resources with which to fully evaluate their programs.
Recommendation 5: Capital Health would benefit from working
closely with research partners such as the Health Research Consortium,
faculty at the University of Alberta, the Alberta Heritage Foundation for
Medical Research, and the Centre for Well Being, to build a base for excellence
in health education and promotion and would be valuable partners to expand
the research and knowledge base for best practice in the Capital region.
Recommendation 6: Capital Health should work with other key funders
to expand support and build the capacity for community agencies to carry
out program evaluation on health education and promotion initiatives.
Source of Funding
During the course of the interviewing, organizations were very open regarding
the sources of funding that they obtained to support their programs. Most
organizations relied on several sources of funding.
Sources of Funding |
Number of Organizations Reporting |
Federal/provincial and municipal government bodies |
55 |
Fees |
37 |
Donations |
32 |
Wildrose Foundation, United Way (and other grants) |
23 |
Fund-raising |
21 |
Other sources of funding |
17 |
Capital Health |
15 |
Health Canada |
7 |
Alberta Health |
6 |
One fear has been raised publicly by many community agencies over the
last few years: as government budget restrictions occur, community agencies
are forced to rely more heavily on donations, fees, and other fund-raising
mechanisms to support their programs. This is partially the case with "seed"
money or demonstration projects. Often, at the conclusion of the project
(or the funding) even successful projects are left without funding. For
some organizations, the issue of continued funding begs the question of
sustainability of projects, a key factor to ensure continued effectiveness
of health education and promotion activities.
Thirty-seven organizations report that fees (program entrance charges,
purchase of materials, etc.) form part of the funding for their health
promotion and education activities. Fees act as a barrier to many low income
individuals who may benefit most from accessing these programs.
Health Determinant Focus
There is an increasing focus within the health promotion community on the
underlying determinants of health. The following determinants of health
were selected by the Federal, Provincial and Territorial Ministers of Health
at their annual meeting in Halifax, September 14-15, 1994. Each organizational
activity was categorized after the fact according to these determinants.
By far the largest group of organizations involved in health promotion
and health education (nearly three-quarters of the contacted organizations)
deal with personal health practices and coping skills, followed by another
quarter of the organizations who deal with social support networks in one
way or another.
Focus on Health Determinant |
Number of Organizations Reporting |
Personal Health Practices and Coping Skills |
98 |
Social Support Networks |
33 |
Healthy Child Development |
21 |
Health Services |
20 |
Education |
15 |
Working Conditions |
6 |
Physical Environment |
3 |
Income and Social Status |
None |
Biology and Genetics |
1 |
A key role for Capital Health is in mitigating the effects of these
health determinants. Capital Health must respond through the primary care,
acute care and continuing care systems to the poor health which results
from poor or delayed child development and genetically based illnesses,
disabilities and conditions as well as the ill-health which often accompanies
low income and low levels of education. While other sectors have the primary
responsibility for addressing population income and education levels, Capital
Health continues to have the responsibility for the "fall-out" which occurs
in the health system when income and education targets are not reached.
One of the critical understandings about health determinants is that
the health sector, and more particularly, the health promotion and protection
sector within the health sector, is a key partner in addressing the determinants
of health, and must work closely with other sectors, particularly education
and social services to achieve effective results.
Areas for Emphasis
There are three primary areas which were mentioned repeatedly during the
interviewing process which are seen as requiring additional attention.
Children's Mental Health services was a particularly common response to
open-ended questions regarding continued gaps in services.
Recommendation 7: In cooperation with other organizations for
whom children are a primary concern (such as the Provincial Mental Health
Board, the Office of the Commissioner for Children's Services, school districts
and Community Services), Capital Health should increase the emphasis on
children's mental health services
Recommendation 8: Capital Health should broaden access to the
wealth of health education and promotion information and activities to
individuals with low literacy levels. Experiential programs rather than
print-based programs have proved effective. Print resources that are used
should be presented in plain language, or through audio tapes.
Recommendation 9: For consumers who experience language barriers,
continued support for interpreter services and the use of cultural brokers
to provide appropriate information and education opportunities is recommended.
CHAPTER
4 - PARTNERSHIPS IN THE CAPITAL HEALTH REGION
Partners in Health Education and Promotion Services
The literature emphasizes the need for a multi-sectoral, multi-disciplinary
approach which involves the community in order to maximize the effectiveness
of health education and promotions activities. Thus, partnerships are critical
in order to engage the community, and broaden the base of involvement and
sustainability. The graphic on page 4 illustrates the key partners who,
with Capital Health, provide health promotion and education services within
the Capital Health region. These groups include:
-
Local Agencies and Providers - The most extensive partnership
network connects Capital Health with the multitude of local agencies and
organizations which are involved in the provision of health education and
promotion services. This network supports the multi-sectoral, community-based
approach required for effective delivery of services and activities.
-
Provincial Level NGO's (Non-Government Organizations) - Many,
if not most, province-wide NGO's are based within the Capital Health region.
This group would include organizations such as the Alberta Association
for Community Living, the Alberta chapter of the Canadian Mental Health
Association, Action on Smoking and Health, the Alberta Public Health Association,
Centre for Well-Being, Centre for Injury Prevention, etc.. This fact of
physical location differentiates Capital Health from other regions in the
potential and actual roles and relationships which the regional authority
has, or could have, with regard to province-wide NGO's.
-
Municipal and Regional Boards and Governments - This group
includes the municipal boards and administration of the city of Edmonton
and St. Albert as well as the County of Strathcona. Also included in this
category would be other elected or appointed boards (and their administrations)
such as the seven public and separate school boards within the Capital
Health region, library boards, and other regional boards such as the proposed
regional structures for the Office of the Commissioner for Children's Services.
-
Federal and Provincial Government Departments - Capital Health's
board and officials work with officials in both federal and provincial
government departments, particularly Alberta Health and Health Canada,
but also including Alberta Family and Social Services, Alberta Education,
Alberta Community Development, the Workers' Compensation Board and AADAC,
etc.
-
Professional Organizations - Most province-wide professional
organizations are based in the Capital Health region. Partnerships with
organizations such as the Alberta Medical Association, the College of Physicians
and Surgeons, and the Alberta Nurses Association, facilitate a multi-disciplinary
approach to local community development.
-
Other Regions - Capital Health has a variety of relationships
with other regions, through both formal structures (Council of Chairs,
Council of Medical Officers of Health, Council of CEOs, etc.) and other
informal mechanisms. Of particular interest here are the "ring" regions
of Aspen, Lakeland, Westview, Crossroads, and East Central. The residents
of these regions are frequent visitors to the Capital Health region to
obtain health services of various kinds, including taking part in health
promotion activities. In addition, providers from other regions often look
toward Capital Health as a source of information, innovative ideas and
approaches.
-
Other Components within Capital Health - there are many components
to Capital Health which are not directly involved in health promotion.
Effective linkages between the health promotion components of Capital Health
with the remainder of the organization are critical to ensure that goals
and priorities are held in common.
A sampling of organizations and individuals covering all of these groups
(with the exception of elected officials) were interviewed as part of this
project.
Roles of Capital Health
A key focus of the personal interviews which were conducted with some of
the primary partners of Capital Health was the perceived role of Capital
Health in the Edmonton region. Many roles were identified, singly and in
combination, which described the relationship between individual organizations
and agencies and Capital Health. These roles include:
-
Leadership in the Health system
-
Service Provider
-
Source of Funds
-
Advocate
-
Catalyst/Enabler
-
Influencer
-
Coordinator
-
Partner/Collaborator
-
Consultant/Advisor/Evaluator
-
Mediator
It is clear that the many roles played by Capital Health within the region
are complex and multifaceted. The key roles which were most frequently
mentioned include: leader, partner, coordinator and funder. However, the
current business planning documents for Capital Health focus only on the
role of the authority in directly providing health promotion and education
services rather than facilitating and supporting the activities of other
organizations.
Recommendation 10: Capital Health should review its mandate
and role in the provision of health education and promotion services within
the Capital Health region to formalize and emphasize the aspects of leadership,
partnership and coordination. This aspect of Capital Health responsibility
should be built into plannning documents.
It became obvious as the interviews were conducted that the changing role
of Alberta Health over the past few years has influenced both the expectations
and the reality of the partnership roles with Capital Health. There were
certain functions which had historically been the responsibility of Alberta
Health, including overall coordination, provision of a clearinghouse function,
a catalyst for new initiatives, promulgation of best practices, and facilitation
of collaboration, particularly across various regions in the province.
With the role of Alberta Health changing, plus the downsizing which has
significantly affected the number of health promotion specialists in Alberta
Health, many organizations within the Capital Health region are searching
for a replacement organization to undertake these functions. Organizations
which have been suggested as potential replacements include: the Council
of Chairs, the Alberta Public Health Association, the Centre for Well-Being,
and Capital Health itself, none of which have the resources to meet the
demand. Organizations are lamenting the lack of a single source of information
and assistance for consumers searching for health promotion assistance
as well as providers developing and implementing programs, which in turn
raises concerns that scarce resources are possibly being expended on "reinventing
the wheel". Chapter 5 of this report, Summary and Conclusions, on page
27, addresses potential solutions to these issues in more detail.
It became clear that the view of Capital Health by the large organizations
(which are funders in their own right), such as Health Canada, Alberta
Health, AADAC, school boards, municipalities, etc., differed somewhat from
the view of Capital Health by smaller "grass-roots" organizations. Larger
organizations saw themselves in a clear partnership role, with equal authority
on both sides, and with the ability to contribute to Capital Health initiatives
and priorities from their own sector. Similarly, Capital Health was expected
to partner with them to in areas of particular need and on issues of common
priority. Recent initiatives by Capital Health to open up communication
channels with the school boards was extremely well received by the organizations
involved.
Smaller organizations on the other hand tended to differ in whether
they saw the relationship between themselves and Capital Health as a two-way
street or whether the relationship was more one-dimensional. Capital Health
was seen primarily as a source of funding, support and advice.. The most
definite difference was the call by the larger organizations for overall
regional planning processes in the area of health promotion. The smaller
organizations were more concerned with the effectiveness of specific individual
initiatives delivered by that organization rather than the way those initiatives
fit into the overall regional continuum of services.
Recommendation 11: Capital Health should consult with key organizations
in the Capital Health region to develop improved linkages and set priorities
regarding overall regional planning for the continuum of health education
and promotion services.
Some organizations suggested that many of the existing committees seem
to deal with the same issues from slightly differing perspectives, yet
some issues cannot easily find a forum. Historical structures which supported
planning, decision-making and dissemination of ideas and practices no longer
exist, and effective replacement forums have not yet grown into place.
Recommendation 12: Capital Health may want to consider "strategic
partnering", ensuring that key partners and forums which address issues
of high priority to Capital Health receive the maximum support in terms
of staff time and resources.
It is well understood that the northern and surrounding regions use Capital
Health services extensively in the area of treatment and diagnosis, and
specialized continuing care. This is taken into account in the new population
funding method for budget allocation. However, there has been little attention
paid to the use of health promotion services, particularly by residents
of neighbouring regions. It is also understood that surrounding and northern
regions tend to see the Capital Health region as demonstrating many best
practices and as a source of provider training. With the change in mandate
for Alberta Health, there is a void in the area of cross-regional coordination.
Recommendation 13: Capital Health should recognize the reality
of its leadership and coordination role with other regions and consider
establishing a forum for multi-regional planning for the northern and surrounding
regions for health education and promotion strategies which are in place
in closely bordering communities around Edmonton.
Dichotomies in Direction
There is more attention, or at least lip service, being paid to population
health, health education and health promotion than ever before. However,
this is coupled with an interesting, and puzzling, fact - at the same time
that significant verbal commitment is given to the concepts and effectiveness
of health promotion as an overall strategy, many organizations are reporting
that organizational supports, such as consultant staff, have been reduced.
In other words, although health promotion activities at the "grass-roots"
level seem to be increasing, health promotion infrastructures have been
weakened or dismantled in the wake of budget cutbacks and organizational
downsizing.
There is an old adage that is certainly true in this case: When you
are up to your knees in alligators, it is hard to remember that you set
out to drain the swamp. In the context of health care in the Capital Health
region, acute care deals with the alligators - health promotion is attempting
to drain the swamp.
The individuals who received face-to-face interviews as part of this
study usually represented the most senior person(s) in each organization
who was responsible for health promotion activities, and each person overwhelmingly
supported the concepts of health education and health promotion, as well
as applauding the fact that Capital Health was even undertaking this study.
It is, therefore, not surprising that these individuals, given their responsibilities,
gave health promotion a high priority. If the overall organization was
examined, however, health promotion may have a somewhat lower priority
compared to the "main" business of the organization, whether that was provision
of educational core curriculum services, treatment of ill-health or provision
of municipal services.
Recommendation 14: Capital Health should consider mechanisms
to raise the profile of health promotion within large organizations to
ensure that the overall infrastructures, including budgets, policy, partnership
incentives and staff resources, are protected as much as possible.
CHAPTER 5 -
SUMMARY AND CONCLUSIONS
Directions for the Future
The health sector has a specific role to play in dealing with health determinants
and population health. As part of the analytic process, every attempt was
made to consider whether any other organization or jurisdiction was more
appropriately responsible for certain areas which seemed to require action.
In particular, the new role of Alberta Health, as well as other provincial
and municipal government departments and agencies, played a large part
in the consultants' deliberations. Recommendations for action by Capital
Health in this section focus on the overall areas within the health sector
which seem to require the most attention.
Many Capital Health board members and officials currently act as stakeholders,
advisors and influencers in the overall development of healthy public policy
at the municipal, regional and provincial level. Although this occurs most
often in the area of health policy, Capital Health representatives also
consult on the development of environmental, social, cultural and other
public policy at the municipal, provincial and federal level.
Capital Health is in an excellent position to provide leadership within
the Capital Health region by using existing public policy forums, such
as the Linkages Committee with the Officer of the Commissioner of Services
to Children. The Canadian Public Health Association(3)
suggests five areas which must be addressed in the development of healthy
public policy:
-
working with others to identify the most important areas where policy can
make a difference;
-
finding partners with whom to develop policy options;
-
encouraging public dialogue on policy options;
-
persuading decision-makers to adopt the healthiest policy option; and
-
following up to make sure that the policy is implemented.
Recommendation 15: Capital Health should consider mechanisms
to encourage input from local health promotion agencies and organizations
regarding issues and options for the further development of healthy public
policy which can be forwarded through the normal channels and forums available
to Capital Health with regional, provincial, federal and municipal organizations.
The primary responsibility for creating supportive environments is shared
between Capital Health and many other regional, provincial and national
organizations. Some of those organizations include Alberta Labour (Occupational
Health and Safety), Alberta Environment and Environment Canada, Alberta
Family and Social Services and Human Resources and Development Canada,
Workers Compensation Board, Alberta Health and Health Canada, and municipalities
within the Capital Health region to name a few. However, there are two
strategies which are directly within the purview of Capital Health.
Recommendation 16: Capital Health should ensure a continued
close working relationship between key branches within the Capital Health
organization, such as Regional Public Health, Community and Acute Care
Services to ensure consistency of approach and complementary focus on creating
supportive environments within the Capital Health region.
Recommendation 17: Capital Health should consider becoming a
champion for the concepts of population health promotion with other organizations,
to assist in the development of congruent goals between Capital Health
and key organizations more directly concerned with supportive environments.
There is a wealth of resources available within the Capital Health region
which address the development of personal skills. Improved access by consumers
to these resources, through an enhanced information network, as suggested
in an earlier recommendation, will result in increased effectiveness of
these health promoting strategies on overall population health.
One key area for partnering for Capital Health which will be developing
over the next few months is the opportunity to work closely with Alberta
Education in the redevelopment of the Health curriculum for the K-to-12
school system. This may be an opportunity to address the concept of "healthy
schools" in addition to an information-based health education process.
The Alberta Health and regional business plans produced over the last
few years demonstrate a marked change in approach to the health system
in Alberta, shifting from a focus on the treatment of disease to a focus
on the promotion of health, emphasizing individual and community responsibility
for individual and population health. Health organizations, particularly
Alberta Health, are reorganizing to place the emphasis on leadership through
specification of health outcomes, rather than administration of health
services delivery. However, until this switch in focus to a population
health approach permeates all sections of the health system, the reorientation
to a wellness based health system will not occur.
There is some concern, expressed during some of the interviews, that
all areas within Capital Health need to embrace the new focus on
population health and health promotion. The literature suggests that one
of the greatest barriers to implementing any reorientation of health services
is the culture of institutions and health professionals who need to pay
attention to the broader health issues (e.g., culture, poverty, literacy,
social isolation) in their own health practices and their own working environments.
Part of the issue relates to the dissemination of information regarding
the effectiveness of health promotion activities vis-a-vis over all costs
of health services. Most evaluation and research activities which are carried
out in the health promotion field are limited to the short to-medium term.
In addition, most evaluation and research work is focussed on best practices
for specific health promotion activities. And yet, the most effective and
comprehensive strategies often only demonstrate their effectiveness in
combination and over the long-term.
Recommendation 18: Although high-level commitment to a health
promotion approach to population health already exists within Capital Health,
continued commitment to research and evaluation in the health promotion
area, and the broad dissemination of results throughout the region, will
assist in reorienting health services to a population health approach.
Action Plan
This report has demonstrated that the issue for Capital Health is not
lack of action in addressing population health and health promotion issues
within the Capital Health region. And, what is needed is not "more
of the same". To increase the effectiveness of the overall health promotion
sector within the Capital Health region, the "action" must be focussed
on reaching more individuals both within the health sector and within the
general population. There are five key strategies which would reorient
activities to meet the highest priority needs:
-
Establishment of a multi-sectoral regional planning process within
the Capital Health region, under the leadership of Capital Health, to ensure
that the major partners in the health promotion field have a coordinated
approach to health promotion and population health. This would ensure that:
-
Overlaps in mandate and services are minimized
-
Public involvement is maximized
-
Gaps are identified and filled
-
Available resources are focussed on the highest priority areas (such as
Children's Mental Health)
-
Services are matched to demand
-
Priorities are mutually established in order to focus activities
-
Establish key strategic partnerships with school boards within the
Capital Health region to strengthen the role of health education and promotion
within the school systems to ensure that effective health education and
promotion strategies are in place at the earliest possible age, including:
-
Strengthening the Health Education curriculum
-
Establishing a more comprehensive approach to issues that require more
than a health education approach, e.g., tobacco use, violence, sexual health.
-
Broadening the health services which are delivered through the school system
-
Partner with community agencies, libraries and resource centres within
the Capital Health region to improve access to information and services
for health care consumers and the general public.
-
Continue to support community agencies by:
-
Involving key partners in joint planning to deal with high priority issues
-
Supporting community leadership and control
-
Emphasizing "best practices"
-
Prioritizing funding to focus on key health determinants
-
Facilitating the establishment of training programs for community members
and providers on needs assessment, planning and evaluation methodologies
-
Support, and supplement where necessary, the activities of the Injury Prevention
Centre, the Tobacco Control Centre, and the Centre for Well-Being in the
establishment of an easily accessible information clearinghouse and
planning network for health providers to:
-
Share information on best practices
-
Demonstrate the impacts of effective health education and promotion strategies
-
Assist in program design, research and evaluation
There are a multitude of health promotion resources and activities available
within the Capital Health region. The responsiveness of local agencies
and organizations to community needs and the growing response to community-based
action is welcomed and supported by all organizations contacted. The action
plan identified above will make it possible to build on current successes
and continue to reorient health services to eventually improve population
health and thereby reduce the burden on the acute care system.
APPENDIX
1 - SUMMARY OF RECOMMENDATIONS
Recommendation 1: Capital Health should develop an information network
for the use of both consumers and providers by using media, information
processing, communication technologies, and other approaches to improve
access, at anytime and from anywhere, to legitimate and useful information
regarding health promotion. This should include forging closer links with
key educational and social services organizations and agencies.
Recommendation 2: Capital Health should develop a collaborative
network among citizens who play key roles in health promotion and among
health-focussed citizens groups of diverse types and sizes, to involve
community members in the development of improved information access mechanisms.
Recommendation 3: Capital Health should encourage use of electronic
communications technologies, particularly for providers. This could include
promoting e-mail communication between Capital Health and community agencies
and organizations, providing an electronic bulletin board system for posting
of health promotion information of general interest, establishing a mail
list server for practitioners and community agencies on health education
and promotion topics, increasing the number of links on the Capital Health
web-site, hosting electronic discussion groups or increasing the public
access to the Internet.
Recommendation 4: Capital Health should redevelop its own web
site to make it a more effective health education and promotion tool, including
provision of the maximum amount of information regarding resources and
activities available within the Capital Health region, promulgation of
"best practices", sharing of key evaluation and research findings, and
establishment of outcome and other indicators.
Recommendation 5: Capital Health would benefit from working closely
with research partners such as the Health Research Consortium, faculty
at the University of Alberta, the Alberta Heritage Foundation for Medical
Research, and the Centre for Well Being, to build a base for excellence
in health education and promotion and would be valuable partners to expand
the research and knowledge base for best practice in the Capital region.
Recommendation 6: Capital Health should work with other key funders
to expand support and build the capacity for community agencies to carry
out program evaluation on health education and promotion initiatives.
Recommendation 7: In cooperation with other organizations for
whom children are a primary concern (such as the Provincial Mental Health
Board, the Office of the Commissioner for Children's Services, school districts
and Community Services), Capital Health should increase the emphasis on
children's mental health services
Recommendation 8: Capital Health should broaden access to the
wealth of health education and promotion information and activities to
individuals with low literacy levels. Experiential programs rather than
print-based programs have proved effective. Print resources that are used
should be presented in plain language, or through audio tapes.
Recommendation 9: For consumers who experience language barriers,
continued support for interpreter services and the use of cultural brokers
to provide appropriate information and education opportunities is recommended.
Recommendation 10: Capital Health should review its mandate and
role in the provision of health education and promotion services within
the Capital Health region to formalize and emphasize the aspects of leadership,
partnership and coordination. This aspect of Capital Health responsibility
should be built into plannning documents.
Recommendation 11: Capital Health should consult with key organizations
in the Capital Health region to develop improved linkages and set priorities
regarding overall regional planning for the continuum of health education
and promotion services.
Recommendation 12: Capital Health may want to consider "strategic
partnering", ensuring that key partners and forums which address issues
of high priority to Capital Health receive the maximum support in terms
of staff time and resources.
Recommendation 13: Capital Health should recognize the reality
of its leadership and coordination role with other regions and consider
establishing a forum for multi-regional planning for the northern and surrounding
regions for health education and promotion strategies which are in place
in closely bordering communities around Edmonton.
Recommendation 14: Capital Health should consider mechanisms
to raise the profile of health promotion within large organizations to
ensure that the overall infrastructures, including budgets, policy, partnership
incentives and staff resources, are protected as much as possible.
Recommendation 15: Capital Health should consider mechanisms
to encourage input from local health promotion agencies and organizations
regarding issues and options for the further development of healthy public
policy which can be forwarded through the normal channels and forums available
to Capital Health with regional, provincial, federal and municipal organizations.
Recommendation 16: Capital Health should ensure a continued close
working relationship between key branches within the Capital Health organization,
such as Regional Public Health, Community and Acute Care Services to ensure
consistency of approach and complementary focus on creating supportive
environments within the Capital Health region.
Recommendation 17: Capital Health should consider becoming a
champion for the concepts of population health promotion with other organizations,
to assist in the development of congruent goals between Capital Health
and key organizations more directly concerned with supportive environments.
Recommendation 18: Although high-level commitment to a health
promotion approach to population health already exists within Capital Health,
continued commitment to research and evaluation in the health promotion
area, and the broad dissemination of results throughout the region, will
assist in reorienting health services to a population health approach.
APPENDIX
2 - FRAMEWORK FOR HEALTH PROMOTION IN CANADA
Cornerstones of Health Promotion in Canada
Definition of Health (WHO)
Over the last few decades, there has been an increasing understanding
of the fact that health is more than just the absence of sickness or ill-health.
Rather, health must be seen as a positive resource for living. This project
is based on the World Health Organization (WHO) definition of health:
Health is a state of complete physical, mental and social well-being
and not just the absence of disease or infirmity.
Determinants of Health
In 1994, the Federal, Provincial and Territorial Advisory Committee on
Population Health prepared a background paper entitled Strategies
for Population Health: Investing in the Health of Canadians. The
population health framework and the strategic directions proposed in this
paper were adopted by the Ministers of Health at their meeting in Halifax,
Nova Scotia, on September 14-15, 1994. The intent of the strategy document
was to identify areas for collaboration between the various levels of government
in Canada by addressing a broad range of health determinants in a comprehensive
and inter-related way. The following nine areas were selected as comprehensively
describing the determinants of health(4):
-
Income and Social Status
-
Social Support Networks
-
Education
-
Employment and Working Conditions
-
Physical Environments
-
Biology and Genetic Endowment
-
Personal Health Practices and Coping Skills
-
Healthy Child Development
-
Health Services
These determinants of health are becoming the key policy focus for the
1990's and beyond.
Ottawa Charter
In 1986, Canada hosted the First International Conference
on Health Promotion, on behalf of the World Health Organization (WHO).
The outcome of this conference was the production and acceptance of The
Ottawa Charter on Health Promotion which defined the fundamental
prerequisites of health as peace, shelter, education, food, income, a stable
eco-system, sustainable resources, social justice and equity. The Ottawa
Charter called for action in five inter-related areas which reflected
the basic premise in the document that access to the prerequisites of health
was a an issue which affected and was affected by many sectors of the population.
The five strategy areas are:
Build Healthy Public Policy - reflects a multi-sectoral approach
to ensure that health-promoting policy is developed and supported within
all sectors.
Health promotion goes beyond health care. It puts
health on the agenda of policy makers in all sectors and at all levels,
directing them to be aware of the health consequences of their decisions
and to accept their responsibilities for health. Health promotion policy
combines diverse but complementary approaches including legislattion, fiscal
measures, taxation, and organizational change. It is coordinated action
that leads to health, income and social policies that foster greater equity.
Joint action contributes to ensuring safer and healthier goods and services,
healthier public services and cleaner, more enjoyable environments. Health
promotion in policy requires the identification of obstacles to the adoption
of healthy public policies in non-health sectors, and ways of removing
them. The aim must be to make the easier choice for policy makers as well.
OTTAWA CHARTER ON HEALTH PROMOTION
|
Create Supportive Environments - targets on the many environments
within which people live, including the physical, social, economic, cultural,
and spiritual, and recognizes the rapidly changing nature of society with
its many influences, including technology and the nature of work.
Our societies are complex and interrelated. Health
cannot be seperated from other goals. The inextricable links between people
and their environment constitutes the basis for a socio-ecological approach
to health. The overall guiding principle for the world, nations, regions,
and communities alike, is the need to encourage reciprocal maintenance
- to take care of each other, our communities, and our natural environment.
The conservation of natural resources throughout the world should be emphasized
as a global responsibility. Changing patterns of life, work, and leisure
have a significant impact on health. Work and leisure should be a source
of health for people. The way society organizes work should help create
a healthy society. Health promotion generates living and working conditions
that are safe, stimulating, satisfying and enjoyable. Systematic assessment
of the health impact of a rapidly changing environment - particularly in
areas of technology, work, energy, production and urbanization is essential
and must be followed by action to ensure positive benefit to the health
of the public. The protection of natural and built environments and the
conservation of natural resources must be addressed in any health promotion
strategy.
OTTAWA CHARTER ON HEALTH PROMOTION
|
Strengthen Community Action - enables communities to become
empowered in setting priorities and making decisions on health issues.
Health promotion works through concrete and effective
community action in setting priorities, making decisions, planning strategies
and implementing them to achieve better health. At the heart of this process
is the emmpowerment of communities, their ownership and control of their
own endeavours and destinies. Community development draws on existing human
and material resources in the community to enhance self-help and social
support, and to develop flexible systems for strengthening public participation
and direction of health matters. This requires full and continuous access
to informtion, earning opportunities for health, as well as funding support.
OTTAWA CHARTER ON HEALTH PROMOTION
|
Develop Personal Skills - enables individuals to gain the
knowledge and skills to maintain and improve their health and well-being,
including strengthening their long-term contributions to society.
Health promotion supports personal and social development
through providing information, education for health and enhancing life
skills. By doing so, it increases the options available to people to exercise
more control over their own health and over their environments, and to
make choices conducive to health. Enabling people to learn throughout life,
to prepare themselves for all of its stages and to cope with chronic illness
and injuries is essential. This has to be facilitated in school, home,
work and community settings. Action is required through educational, professional,
commercial, and voluntary bodies, and within the institutions themselves.
OTTAWA CHARTER ON HEALTH PROMOTION
|
Reorient Health Services - redirects health services to focus
on the needs of the whole person and rethinks the roles of the providers
and the users of health services.
The responsibility for health promotion is health
services is shared among individuals, community groups, health professionals,
health service institutions, and governments. They must work together towards
a health care system which contributes to the pursuit of health. The role
of the health service sector must move increasingly in a health promotion
direction, beyond its responsibility for providing clinicl and curative
services. Health services need to embrace an expanded mandate which is
sensitive and respects cultural needs. This mandate should support the
needs of individuals and communities for a healthier life, and open channels
between the health sector and broader social, political, economic and physical
environmental components. Reorienting health services requires stronger
attention to health research as well as changes in professional education
and training. This must lead to a change of attitude and organization of
health services, which refocuses on the total needs of the individual as
a whole person.
OTTAWA CHARTER ON HEALTH PROMOTION
|
In addition, the 212 participants from 38 countries
who attended the conference pledged the following:
-
To move into the arena of healthy public policy, and to advocate a clear
political commitment to health and equity in all sectors;
-
To counteract the pressures towards harmful products, resource depletion,
unhealthy living conditions and environments, and bad nutrition; and to
focus attention on public health issues such as pollution, occupational
hazards, housing and settlements;
-
To respond to the health gap within and between societies, and to tackle
the inequities in health produced by the rules and practices of these societies;
-
To acknowledge people as the main health resource, to support and enable
them to keep themselves, their families and friends healthy through financial
and other means, and to accept the community as the essential voice in
matters of its health, living conditions and well-being;
-
To reorient health services and their resources towards the promotion of
health; and to share power with other sectors, other disciplines, and most
importantly, with people themselves.
-
To recognize health and its maintenance as a major social investment and
challenge; and to address the overall ecological issue of our ways of living.
The Ottawa Charter has been translated into 40 languages
and serves as a guidepost for health promotion around the world.
Implications of the Population Health Promotion Model
Health Canada has combined the definition of health, the determinants
of health and the strategies for health promotion into an overall model
for planning and analysis of health promotion activities. By examining
a jurisdiction's practices from the perspective of health determinants
and health promotion strategies, as well as by the type of target group,
gaps and overlaps in activity can be identified. The model can then be
used to assist in developing future plans, either for as an overall system
wide planning model, or at a local level for helping in needs assessment.
The following graphic illustrates this model.
This project used this model(5) to assist
in the analysis of the activities in the area of health education and health
promotion in the Capital Health region.
APPENDIX
3 - HEALTH-PROMOTING HOSPITALS NETWORK
The Health Promoting Hospitals Movement:
Working for Health
Announcement of Vienna Conference
The concept: a health promoting hospital tries to incorporate the concepts,
values and standards of health promotion into the organizational structure
and culture of the hospital. The goal is to improve the quality of health
care, and the conditions for and satisfaction of the staff, patients and
relatives. The method is to apply the principles of the Ottawa Charter
for Health Promotion to
develop the hospital in the ways expressed in the Budapest Declaration
on Health Promoting Hospitals.
The WHO European Project
The objective of the WHO European Health Promoting Hospitals project
is to promote a movement of hospitals throughout the WHO European Region:
-
to facilitate and encourage cooperation and the exchange of experience
and programmes between the participating hospitals;
-
to introduce health promotion into the culture of the hospitals;
-
to broaden the focus of hospital management and structures to include health
care, not just curative care;
-
to develop documented and evaluated examples of good practice for the use
of other institutions; and
-
to identify areas of common interest in which to develop programmes and
evaluation procedures.
Approaches for Development
Four approaches have been identified for developing health promoting
hospitals in the European Region.
-
The Health Promoting Hospitals European Network is a wide network of hospitals
implementing health promoting activities and other institutions interested
in the subject. Some 400 hospitals belong to this Network.
-
The Health Promoting Hospitals Pilot Project includes 20 European hospitals
committed to changing and adjusting their structure and culture to become
healthier institutions for patients, staff and the community.
-
The thematic networks intend to bring together hospitals that are carrying
out specific health promoting activities, such as creating a smoke-free
environment, improving the quality of life of patients or reducing stress
in personnel. A project on health promotion for elderly cardiovascular
patients is being developed in collaboration with the European Union.
-
The regional/national networks aim at facilitating and encouraging the
cooperation and exchange of experience between the hospitals of a region
or country, including identification of areas of common interest, sharing
of resources and development of common evaluation systems. To date, some
270 hospitals from 11 European countries participate in the regional/national
networks.
Main Areas for Programme Development
-
The well being of staff and patients
-
The quality of services
-
Disease prevention, health education and rehabilitation
-
Sanitation and the protection of the environment
-
Relations between the hospital and the community
-
Coordination between primary health care and hospitals.
Health Promoting Hospitals European and thematic networks
Full membership is open to hospitals that: endorse the principles of
the Ottawa Charter for Health Promotion (LINK) and the Budapest Declaration
on Health Promoting Hospitals as guidelines for action; and develop programmes
or activities for health promotion based on the Budapest Declaration to
introduce comprehensive organizational change.
Affiliated members or observers include hospitals, other institutions
and people that: endorse the principles of the Ottawa Charter for Health
Promotion and the Budapest Declaration; and are interested in the development
of the project, or in collaborating with hospitals in the project.
Regional/National Networks Recognized by WHO
Individual members must fulfil the requirements for full members of
the Health Promoting Hospitals European Network. Each network defines its
own requirements and conditions for membership. To secure membership or
for more information, please contact the Ludwig Boltzmann Institute or
the Hospitals Unit of the WHO Regional Office for Europe.
Background
The Health Promoting Hospitals Movement of the WHO Regional Office for
Europe is a project of the Hospitals Unit of the Department of Health Policy
and Services. The project started officially at a workshop on hospitals
and health that was held in Vienna in 1990. It was established as a multi-city
action plan of the WHO Healthy Cities project. The Ludwig Boltzmann Institute
for the Sociology of Health and Medicine was appointed coordinating centre
for the project. On the basis of the Ottawa Charter for Health Promotion
and the experiences of the Healthy Cities project, the Budapest Declaration
on Health Promoting Hospitals was developed at the first business meeting
of the Health Promoting Hospitals Network, which was held in Budapest in
1991. The Declaration focuses on the content and aims of the member hospitals.
Since then, other networks have been established to facilitate and encourage
the development of the project.
Business meetings and annual conferences are held to exchange information
and experiences and to decide on the future developments of the project.
A newsletter is published twice a year as well as various leaflets and
information booklets.
Management
The Hospitals unit of the WHO Regional Office for Europe and the Ludwig
Boltzmann Institute for the Sociology of Health and Medicine coordinate
the project. The four networks are interrelated to maximize the benefits
of exchanging experience with selected programmes and structures.
Contacts
For further information, contact:
Hospitals Unit
WHO Regional Office for Europe
8 Scherfigsvej
DK-2100 Copenhagen OE
Denmark
Tel: (45) 39 17 12 70
Fax: (45) 39 17 18 65
E-mail: mgb@who.dk or kja@who.dk
Ludwig Boltzmann Institute for the Sociology of Health and Medicine
WHO Collaborating Centre for Hospitals and Health Promotion
Universitätsstrasse 7/2
A-1010 Vienna
Austria
Tel: (43) 1 402 93 60 25
Fax: (43) 1 403 93 63
E-mail: hph.soc-gruwi@univie.ac.at
© WHO Regional Office for Europe
URL:http://www.who.dk/tech/hs/hphbroc.htm
Updated 31 January 1997 - jfr@who.dk
APPENDIX 4 -
PERSONAL INTERVIEWS
Alberta Health
Ron Dyke, Senior Team Leader, Health Policy
Dennis Ostercamp, Barb Hanson
Health Canada
Penny Mosmann, Provincial Manager, Health Protection and Promotions
Branch
Alberta Education
Gina Vivone-Vernon, Assistant Director, Humanities Unit, Health, CALM,
Physical Education, and ECS
Alberta Public Health Association
Phyllis Hodges, Executive Director
Alberta Centre for Well-Being
Cynthia Smith, Director
Alberta Injury Prevention Centre
Kathy Belton, Project Coordinator
Alberta Alcohol and Drug Abuse Commission
Brian Cairns, Executive Director
Centre for Health Promotion Studies, University of Alberta
Dr. Douglas R Wilson, Acting Chair
Office of the Commissioner of Services for Children
Hugh Nicholson, Regional Director, Edmonton, Planning and Development
City of Edmonton, Community Services
Wally Subczak, Innovative Services
Pat Power, Public Education
Caritas Group, Health Resources Centre
Cheryl Barabash-Pope, Coordinator, Community Development and Health
Promotion
Strathcona County Health Centre
Darlene Smith, Community Care and Public Health
St Albert Public Health Centre
Janet Thorpe, Manager
Edmonton Catholic School Board
Richard St. Arnaud, Director, School Operations Services
Edmonton Public School Board
Bruce McIntosh, Department Head, Program Operations, Monitoring and
Planning
Public Health Library, Capital Health
Ann Vanden Born, Library Coordinator
APPENDIX
5 - BIBLIOGRAPHY
Bruner, C., L. G. Kunesh and R. A. Knuth. What Does Research Say
about Inter-agency
Collaboration? North Central Regional Educational Laboratory,
Oak Brook, 1992.
Canadian Public Health Association. Action Statement for Health
Promotion in Canada. July, 1996.
Capital Health. Action for Health Annual Report. August
19, 1996.
Capital Health. Action for Health Proposal Document. December
17, 1996.
Capital Health. Highlights: Directions for Health - Directional
Plan Update 1996 - 1999. January, 1996.
Capital Health. Capital Health Authority Business Plan 1997/98
- 1999/2000. March, 1997.
Edelman, Peter B. and Beryl A. Radin. Effective Services for
Children and Families: Lessons from the Past and Strategies for the Future.
Background Paper presented at the National Forum on the Future of Children
and Families. 1991.
Frank, John W. and J. Fraser Mustard. The Determinants of Health
from a Historical Perspective. Daedalus, Journal of the American
Academy of Arts and Sciences, Fall, 1995. Vol 123, No.4.
Glass, Gene V. Primary, Secondary and Meta-Analysis of Research.
Educational Researcher, November, 1976, pp.3-8.
Golden, Olivia. Collaboration as a Means, Not an End: Serving
Disadvantaged Families and Children. Background Paper presented
at the National Forum on the Future of Children and Families. 1991.
Gomby, Deanna S. et al. Long-Term Outcomes of Early Childhood
Programs: Analysis and Recommendations. The Future of Children,
Vol 5. No. 3, Winter, 1995.
Halpern, Robert and Robert Myers. Effects of Early Childhood Intervention
on Primary School Progress and Performance in the Developing Countries.
Prepared for the Bureau for Program and Policy Coordination, United States
Agency for International Development. April, 1985.
Hamilton, Nancy and Tariq Bhatti. Health Promotion Development Division.
Health Canada. Population Health Promotion: An Integrated Model of
Population Health and Health Promotion. February, 1996.
Hayward, Sarah, RN et.al. Public Health Nursing and Health Promotion:
Background Paper. Prepared for the Ontario Health Evaluation Network,
1996.
Hazel, Jane. Technological Advances and Their Uses for Social
Marketing. Prepared for the Health Promotion Directorate, Health
Canada. April, 1994.
Health Canada. Building a Stronger Foundation: A Framework for
Planning and Evaluating Community-Based Health Services in Canada.
Background paper prepared for the Federal/Provincial/Territorial Deputy
Ministers of Health by Margaret I. Wankel, L. Duncan Saunders, Raymond
W. Pong, and W. John Church. 1995.
Health Canada. Federal, Provincial and Territorial Advisory Committee
on Population Health. Strategies for Population Health: Investing
in the Health of Canadians. Prepared for the Meeting of the Ministers
of Health, Halifax, Nova Scotia, September 14-15, 1994.
Health Canada. Program Promotion Division, Health Promotion Directorate.
Health Programs and Services Branch. Social Marketing in Health Promotion.
Compilation of key articles on Social Marketing. January, 1994.
Horne, Tammy, Ph.D. A Comprehensive Approach to Promoting Healthy
Early Childhood Development: Supporting Children, Parents and Communities.
Background paper prepared for Capital Health. 1996.
Michels, Katie, MHSc. Creating A Capacity for Change in Health
Promotion and the Non-Profit Sector: A Discussion Paper on Healthy Organizational
Change. Prepared for the Ontario Prevention Clearinghouse. July,
1996.
National Forum on Health. Advancing the Dialogue on Health and
Health Care: A Consultation Document. Internet source http://wwwnfh.hwc.ca/publicat/advancin/idxadva.htm.
National Forum on Health. Canada Health Action: Building the
Legacy. Final Report - Volume 1. February, 1997.
National Forum on Health. Health and Health Care Issues - Summaries
of Background Areas. Supplement to Canada Health Action:
Building the Legacy. February, 1997.
National Forum on Health. Report on Dialogue with Canadians: Health
and Health Care. Internet source http://wwwnfh.hwc.ca/publicat/dialogue/idxdial.htm
National Forum on Health. What Determines Health? Summaries
of 26 papers on health determinates prepared for the National Forum on
Health. Internet source http://wwwnfh.hwc.ca/publicat/execsumm/.
National Forum on the Future of Children and Families. Schorr, Lisbeth
B., Deborah Both, and Carol Copple, Editors. Effective Services for
Young Children: Report of a Workshop. National Academy Press, Washington,
DC, 1991.
Nelson, Douglas W. The Role of Training and Technical Assistance
in the Promotion of More Effective Services for Children. Background
Paper presented at the National Forum on the Future of Children and Families.
1991
Schorr, Lisbeth B. with Deborah Both. Attributes of Effective
Services for Young Children: a Brief Survey of Current Knowledge and its
Implications for Program and Policy Development. Background paper
presented at the National Forum on the Future of Children and Families.
1991.
1. Capital Health. Capital Health Authority
Business Plan 1997/98 - 1999/2000. March, 1997.
2. National Forum on Health. Canada Health
Action: Building the Legacy. Final Report - Volume 1. February,
1997.
3. Canadian Public Health Association. Action
Statement for Health Promotion in Canada. July, 1996.
4. Health Canada. Federal, Provincial and Territorial
Advisory Committee on Population Health. Strategies for Population
Health: Investing in the Health of Canadians. Prepared for the
Meeting of the Ministers of Health, Halifax, Nova Scotia, September 14-15,
1994.
5. Hamilton, Nancy and Tariq Bhatti. Health Promotion
Development Division. Health Canada. Population Health Promotion:
An Integrated Model of Population Health and Health Promotion.
February, 1996.