Intersectoral Collaboration on Non-Medical Determinants of Health: The Role of Health Regions in Canada Dr. James Frankish Institute of Health Promotion Research, College for Interdisciplinary Studies, UBC Every sin is the result of collaboration" (S.. CraneC 1871) Research Team J. Frankish, Institute of Health Promotion Research, UBC G. Moulton, Institute of Health Promotion Research UBC D. Quantz, Vancouver Coastal Health A. Carson, Centre on Aging, University of Victoria A. Casebeer, Community Health Sciences, U of Calgary J. Eyles, Geography & Earth Sciences, McMaster University R. Labonte, Community Medicine, U of Ottawa B. Evoy, Vancouver Coastal Health J. Gerbrandt, Institute of Health Promotion Research, UBC Cathy Pryce, Calgary Health Authority Susan Tirone, Dalhousie University Current & Recent Projects Training-Related Research & Activities Research Training Program in Community Partnership Research Homelessness & Poverty-Related Research Supportive Housing for Persons with Serious Mental Illness Inner-City Inclusivity, Olympics & Health Urban/Rural Migration & Homelessness Health Literacy, & Literacy & Health Research Health Literacy in Canadian School Children & High-Risk (Street) Youth Measuring Health Literacy in Senior Immigrants in Greater Vancouver Research on Health-System Reform & Marginalized Groups Health Promotion in Primary Care Project Children Living with HIV/Aids Adolescents' Concepts of Depression & Related Help-Seeking Research Related to Measuring the Health of Communities Community Coalitions & the 2010 Games Measuring Community Capacity Non-Medical Determinants of Health Income & Social Status Social Support Networks Education Employment & Working Conditions Social Environments Physical Environment Personal Health Practices Healthy Child Development Culture Gender (From Health Canada Excludes Health Services & Biology /Genetics) Rationale - A Continuum of Absurdities Which Health Inequities in Non-Medical Determinants Are Societally Acceptable? There is No Role for Health Regions in Non-Medical Determinants of Health Health Regions are Totally Responsible for Non-Medical Determinants of Health Differences in Health Outcomes What is the Preferred Future for for Health Regions in Addressing Non- Medical Determinants of Health Unavoidable Avoidable Acceptable Unacceptable
Questions for This Morning Research Questions What is your preferred future regarding health regions & How are health regions working with key potential collaborators (i.e., NGOs, private sector, non-health ministries) to address the non-medical determinants of health? What is your capacity' for What is the status of initiatives undertaken by health regions to address the non-medical determinants of health in partnership with other sectors of government and/or society? What are the practical, administrative & policy implications of addressing NMDH through your health region? How do individual-specific, organizational & structural factors limit or facilitate intersectoral collaboration by health regions on the non-medical determinants of health? Project Overview Stratification Survey Instrument Key Informant Interviews Representatives of Regional Health Authorities Representatives of Partners Document Review 107 surveys sent to ten provinces Response rate of 65%. Response rates varied by province lowest - 36.7% (Que) & highest 100% (Alberta). Action within Health Authorities Level Definition No action for this determinant Initial discussion regarding this determinant Outlined action in business and/or strategic plans for this determinant, or we have a stated priority in our annual plan for addressing this determinant Short-term projects (i.e. demonstration projects) and/or dedicated Resources for this determinant Long-term program and/or core funding that address this determinant Action within Health Authorities Seventy-five percent of regions reported at least short-term projects around personal health practices, and 72% of regions reported at least short-term projects around child development. On the lower end, no action was reported for both income/social status and gender by 33% of regions. It is interesting to note coherence between discussion regarding initial awareness & action/advocacy around some determinants, especially health practices & child development.
Employment & Working Conditions Employment & Working Conditions Frequency N=72 25 20 15 10 5 0 1 2 3 4 5 No Action ------------> High Action Regional Workplace Wellness Programs (BC) Tobacco Cessation Programs for Employees of the Health Authority (Manitoba) Intersectoral Collaboration A recognized relationship between part or parts of the health sector with part or parts of another sector which has been formed to take action on an issue to achieve health outcomes in a way that is more effective, efficient or sustainable than could be achieved by the health sector acting alone. WHO International Conference on Intersectoral Action for Health, 1997 Intersectoral Collaboration Ministry of Health Non-Health Ministries Non-Government Organizations within the Health Sector Private Sector Health Non-Government Organizations outside the Health Sector Private Sector Organizations outside the Health Sector Potential Sectors for Collaboration Intersectoral Collaboration Level Definition Currently no involvement at all between our health organization & other agencies/groups for this determinant Some (informal) contact between our health organization & other agencies/groups for this determinant A formal structure for collaboration has been developed between our health organization & other agencies/groups for this determinant Our health organization & other agencies/groups are developing or have completed a plan of action for this determinant Our health organization & other agencies/groups are developing or have implemented programs to address this determinant
Intersectoral Collaboration Both child development and personal health practices were receiving most attention from health regions. Sixty-eight percent of regions reported a high-level of intersectoral activities (i.e., action plan or programs established) around child development, while only 3% reported no intersectoral activities for child development. No intersectoral activities were reported by a larger number of regions around gender (38%), culture (27%), and employment/working conditions (26%). Healthy Child Development Social Support Networks 35 30 25 25 20 Frequency N=72 20 15 10 5 Frequency N=72 15 10 5 0 1 2 3 4 5 No IC ------------> High IC 0 1 2 3 4 5 No IC ------------> High IC Roles for Health Authorities Collaborator/partner Facilitator Communicator/educator Advocate Initiator/leader * the categorization of roles is not mutually exclusive
Factors Influencing Implementation of NMDH Summary of Challenges Individual Factors Defining Nonmedical Determinants of Health (NMDH) Values Underlying NMDH Organizational Factors Complexity of Models of NMDH Time Frames for Addressing NMDH Systems/Environmental Factors Responsibility for Addressing NMDH Impact Assessment of Addressing NMDH Fundamental Nature of the NMDH (Horizontal complexity: NMDH works across sectors (e.g., social, economic); Vertical complexity: NMDH aims for change at individual, community, organizational, and systems levels) Structural Constraints around NMDH Accountability for Addressing NMDH Relations Between Health Sector & NMDH Resources to Strengthen Action on NMDH Sustainability of NMDH Initiatives Facilitators & Barriers Next Steps??? What We Need for Health Regions to Succeed in Addressing NMDH Individual / Community Facilitators, Interpersonal Facilitators, Organizational Facilitators, Structural Facilitators Public support & political will Targeted resources & supportive legislation Policy & practice champions Individual / Community Barriers, Interpersonal Barriers, Organizational Barriers, Structural Barriers In-Depth Case Studies A supportive philosophy A cultural & policy framework Organizational & governance infrastructure Trained staff / Improved education Study of Implementation of Vancouver s Population Health Strategy Enabling skills & accessible resources Remuneration of services/personnel Possible Case Studies of Food Security, Housing, Early Child Development Other Incentives/reinforcements for involvement Evaluation based on practice-based evidence Revisiting the Questions for This Morning Contact Information What is your preferred future regarding health regions & What is your capacity' for What are the practical, administrative & policy implications of addressing NMDH through health regions? Dr. Jim Frankish Senior Scholar, Michael Smith Foundation for Health Research Associate Director, Institute of Health Promotion Research Associate Professor, Graduate Studies & Health Care & Epidemiology (Medicine), Room 425, Library Processing Centre 2206 East Mall Vancouver BC V6T 1Z3 604-822-9205, 822-9210 frankish@interchg.ubc.ca Personal web jimfrankish.com IHPR Web Site - www.ihpr.ubc.ca BC Homelessness & Health Research Network bchhrn.ihpr.ubc.ca BC Homelessness Virtual Library www.hvl.ihpr.ubc.ca Strategic Training Program Partners in Community Health Research www.pchr.net
References Frankish J. Moulton G. Quantz D. Carson A. Casebeer A. Eyles J. Labonte R. Evoy B. 2007. Addressing the nonmedical determinants of health: a survey of Canada's health regions. Canadian Journal of Public Health. 98(1):41-7. G. Moulton et al. 2007, Addressing the Non-Medical Determinants of Health: A Canadian Perspective of Regional Health Authorities & Partners - Part I: Setting Priorities - Developing Strategies Adopting Roles. G. Moulton et al. 2007, Addressing the Non-Medical Determinants of Health: A Canadian Perspective of Regional Health Authorities & Partners Part II: Critical Factors Influencing RHA Actions targeting NMDH.