ARCHIVED - Promotion of Population Health Grant and Contribution Programs: Summary of Program Evaluations, 2004-2009

Annex 1: Promotion of Population Health Results-Based Logic Model:

Enlarge Annex 1

Strategic directions:
Prevention and health promotion through concerted actions on the determinants of health to improve health outcomes, reduce health disparities, and improve population health. The determinants of health are the range of social, economic, and environmental factors which determine the health status of individuals and populations.

Description of Logic Model Components

Activities

The activities in the logic model reflect the key elements that define a population health approach. This includes focussing on the health of populations, addressing the determinants of health and their interactions, basing decisions on evidence, applying multiple strategies, employing mechanisms for public involvement, collaborating across sectors and levels, increasing upstream investments and demonstrating accountability for outcomes. These principles are reflected in the design and delivery of PPHGC.

Activity Area 1: Research/Knowledge Development and Integrated Communication and Dissemination Strategies

There is a two-pronged approach to research and knowledge-related activities in the logic model: the first relates to research and knowledge development in support of population health policy and practice; the other concerns integrated communication and dissemination strategies aimed also at supporting population health policy and practice. These activities can be differentiated by the target clients they serve. Both activities lead to increasing awareness and uptake of evidence to enable greater control over the factors that influence health and aim ultimately to affect behaviour change.

Research/Knowledge Development

The focus of these activities is to support research and knowledge development and help shape the policy and practice evidence-base by:

• using a determinants of health approach (looking at one or more determinant, target population, or policy ‘lens’ such as socio-economic status);
• undertaking surveillance-related activities which generate epidemiological data;
• conducting policy research on policies and actions to determine their effectiveness;
• developing social marketing campaigns; and
• developing and testing pilot approaches to projects.

Integrated Communication and Dissemination Strategies

Integrated communication and dissemination strategies aim to engage all sectors of society in order to effectively and efficiently design and disseminate public health messaging to influence behaviour change and improve practice in a given area of population health. The focus of this activity is in developing targeted risk reduction strategies (e. g. nutrition and physical activity) and shaping community-level interventions through the development and dissemination of relevant information, communication, and dissemination strategies. Overcoming barriers (e. g. geographic, cultural) to accessing information in order to improve public awareness on a given health issue is a key thrust of this activity. Population health practitioners are also targeted recipients of health information.

Activity Area 2: Leadership and Policy Development

Provinces, Territories and other stakeholders look to the federal government to articulate a national vision. They also expect the federal government to take the lead in achieving national consensus on policy options for dealing with emerging problems and establishing common approaches to persistent health issues as well as defining roles within the national vision. National leadership is carried out with the recognition that improving health status is an objective that surpasses jurisdictions and requires cooperative action. Participating in joint consultations with federal and provincial governments, developing population health policies, and contributing to policy development in other areas - especially with respect to the determinants of health and risk factors for chronic diseases, are additional ways the Branch leads the way in shaping policy and practice.

Activities in this area include policy analysis, developing policy options aimed at enhancing the responsiveness of health policy and the health system, and creating an enabling environment for cross-sectoral, cross-disciplinary health policies to take shape.

Activity Area 3: Intersectoral Collaboration

Improving the coordination between health and social services, between public and primary health care systems, at local and other policy levels can lead to improved health outcomes, through a systematic and sustained approach. This activity includes:

• joint strategies and initiatives with other health-related policy areas for exercising joint collaboration; and
• collaborating with other orders of government (F/P/T) and with other sectors (private, public, voluntary) to form partnerships to implement common goals and objectives, and to develop and test new programs and projects at regional and national levels.

Intersectoral collaboration can also serve to connect isolated health and social policies, thereby improving the ability of governments and organizations to influence action at all levels of the health system. Examples of intersectoral collaboration underway at Health Canada include working toward a more integrated approach to disease prevention and health promotion. In addition, Canada’s Federal, Provincial, and Territorial Health Ministers have agreed to work together on healthy living strategies.

Activity Area 4: Capacity Building

Provinces, Territories and other stakeholders look to the federal government to participate in the creation of the necessary capacity - or resources, to deal with disease prevention and control issues. Strengthening capacity at the national, regional, and local levels is driven by the objective of enabling the development and implementation of effective multisectoral population health policies and strategies, and it is underpinned by an approach that aims to build sustainable skills, organizational structures, resources, and commitment to health improvement in health and other sectors. Activities in this area are not so much focussed on health service improvement, as they are on improving the delivery of health promotion programs through transferable models and approaches, professional training, and public education.

Outputs

Policy research, health knowledge, and information

Using the best available evidence to inform policy and practice is a key function of the Branch. In addition, programs often undertake communications activities that involve targeting population groups and health service providers with information and knowledge that supports health promotion. Such knowledge products can include prevention messaging to a specific target group (e. g., seniors), and practice guidelines for health practitioners. Examples of policy research include best practice research on the effectiveness of health interventions in a variety of settings and target groups, including assessing interventions at the community level.

Strategies, policies, models, guidelines, and practices

Influencing the development and implementation of health promotion and disease prevention strategies, policies, models, guidelines, and practices across sectors and settings is a key federal role and output of population health related activities. Actions are expected to be taken at all levels of government and across sectors (public, private, and voluntary) to maintain momentum around the introduction of strategies about how health promotion should be configured and implemented across jurisdictions and sectors to maintain and improve health. Examples of population health strategies include those related to health education and skills development, health information, and economic, regulatory, and policy initiatives. Actions can include advocacy for creating enabling environments for local action, the mobilization of different actors for the positioning of health promotion as a national priority, and the development and transfer of effective population health models, standards, guidelines, and practices (e. g. research frameworks, training manuals, health practice guidelines).

Opportunities for intersectoral collaboration

Success in promoting the population’s health depends on the collaboration, motivation, and level of advocacy of partners across the voluntary, public, and private sectors. Consolidating efforts within life settings such as work, school or community and engaging partners within and across the systems that impact health, require coordinated intersectoral and inter-jurisdictional interventions, as well as horizontal linkages with other sectors (such as environment, housing, education, and justice). Therefore, the federal role in developing opportunities for intersectoral collaboration is in working with non-governmental organizations, business, educational institutions, professional organizations, and other levels of government to advocate promoting population health. Building on partnership opportunities can enable more integrated health promotion or disease prevention strategies that are based on intersectoral collaboration and encourage such models for community-level action.

Partnerships across sectors and levels of government with a view to citizen engagement would allow opportunities for simultaneously addressing multiple health issues at once, in a more comprehensive, efficient, and inclusive way. A major policy area which serves as good example of the extent and continuity of intersectoral collaboration and the potential for influencing actions relating to improving population health is the proposed Pan-Canadian Healthy Living Strategy.

New Projects, mechanisms, and opportunities for building capacities to address health determinants

Building capacity to address health determinants includes the development of resources (human, financial, and otherwise) at the community level which allow communities opportunities to effectively address risk factors for disease and respond to the determinants of health, in order for individuals to take action to improve their health, the health of their families, and the health of the communities in which they live. Capacity building activities include:

• public education and communication;
• mobilization and advocacy for integrated disease prevention and health promotion strategies (e. g. cross-provincial programs);
• advocacy through strategic partnership building; and
• building capacity to generate evidence for effective actions at the national level and developing the national support infrastructure for sustained action.

The development and dissemination of models, collaboration with other sectors, disciplines, and building capacity for the generation of knowledge on health determinants and vulnerabilities of populations at risk through research, monitoring, and evaluation are also key activity areas.

Immediate Outcomes

Improved capacities for influencing actions on the determinants of health Social and economic determinants play the major role in influencing the health of populations, whether through poverty, employment, education, and housing. Capacity for influencing actions on the determinants of health includes the provision of human and financial resources, as well as those less tangible resources (e. g. social support networks) necessary for enabling communities to take control over the factors that influence their health. Activities in this area take place across the areas of research and development to review, monitor, and disseminate research on the impacts of social and economic determinants on the health of populations.

Improved coordination for intersectoral cooperation among governments, sectors, and Stakeholders

Intersectoral collaboration involves implementing a combination of programmatic, mass media, policy, and partnership arrangements across sectors and jurisdictions to make meaningful population health gains. Improving coordination between governments, sectors, and stakeholders involves having access to meaningful and reliable information, integrating actions for maximal benefits to health, leadership and policy development, and building capacity at all levels. The strategic benefits of intersectoral collaboration are in mobilizing resources and capabilities in support of common population health objectives. Improved coordination for intersectoral cooperation also means addressing population health through an integrated approach - one that is coordinated and nonduplicative, and that has as its general goal the reduction of health disparities and the prevention of many related chronic diseases. An integrated approach is demonstrated by the National Chronic Disease Prevention and Control Strategy.

Implementation of strategies and policies to support health promotion

It is a federal responsibility to protect and promote the health of the people of Canada. Legislation and policy are used to encourage practices that promote population health. Planning and implementing population health policies and strategies in consultation with communities reflects and reinforces the needs of communities and community-identified priorities. This includes identifying, implementing, and reviewing appropriate legislation, policies, standards, guidelines, and protocols in consultation with communities and stakeholders.

Increased awareness and use of reliable population health evidence

The purpose of increasing awareness and use of reliable evidence is to enable individuals and groups to take greater responsibility for, and control over, their own health and build problem solving and decision making capacity. The federal role in enabling increased awareness and information uptake is in developing communication tools and messages that can be disseminated at local levels, and easily accessed by a variety of population health practitioners.

Intermediate Outcomes

Evidence base to shape promotion of population health policy and practice

Given the complex array and interaction of the factors related to the health of the population, continued expansion of the evidence-base and exchange of this knowledge is essential to inform future policy development and action. A range of approaches can define the state of practice in influencing a single health issue. An integrated evidencebase, one which draws together the best available evidence on a given health issue, can enable more effective and efficient use of knowledge and its application in policy and practice. Examples of knowledge development initiatives include the use of national-level surveys in policy and practice, (e. g. National Population Health and Canada Community Health surveys) and developing knowledge through collaborative relationships with research agencies (e. g. Canadian Institutes of Health Research and Canadian Population Health Initiative), the voluntary sector, and academia. From a program management perspective, an integrated evidence base can also aid in decision-making around program planning, program management, and policy development.

Strengthened health promotion policies and actions within the health system

Leadership and policy development activities at the federal level aim to find ways of improving the performance of the overall population health policy-making system, ensuring that the policy capacity exists at all levels to deal with population health issues in a coordinated fashion. This includes ongoing efforts to reform Canada’s health system and effectively position population health within the broader social, economic, and health development agendas, particularly since the determinants affecting the health of individuals and populations often lie outside the health care system (environment, biology, genetic endowment etc.). Improving the link between national population health leadership and community needs through partnerships, enhancing population health human resources, and improving the implementation of policies aimed at improving the population’s health are all goals of this intermediate outcome.

Improved access to health and social services for target populations

The implementation of policies that protect the health and well-being of the most vulnerable people in society (children, the elderly, Aboriginals) is a key driver for improving access to health and social services. Improved access to health and social services involves overcoming geographic and physical accessibility issues (e. g. rural populations) and ensuring the provision of culturally appropriate health and social services.

Long-Term Outcomes

Improved health outcomes

It is recognized that an effective approach to improving health and reducing health inequalities requires a long-term plan. Improving health outcomes at the population level is contingent on investing in sound policies, programs, strategies, practices, and collaborative actions at the community, regional, and national levels which are established with an ultimate goal of producing better health outcomes. The broad activities outlined in the logic model provide a framework for engaging in activities designed to influence outcomes in the population’s health. A strong commitment to accountability including monitoring and evaluation to assess the effectiveness of interventions and establish priorities for future investments underpins all activities in the logic model.

Improved personal health practices and skills

Encourage the adoption of positive health practices, at the same time focusing attention on the broader social and economic factors that influence healthy choices impacts on the improved personal health practices of Canadians. The development of personal skills is an important area of promoting population health, with an approach that emphasizes improving personal resources for change (e. g., increasing self-esteem and social supports). The range of personal skills supported goes beyond those connected to health behaviours and includes programs and projects addressing literacy, mutual support, and advocacy skills. These skills are seen to provide the foundation upon which individual and community capacity to take action on the determinants of health is built.

Ultimate Outcome

Improved population health and reduced health disparities

Through the achievement of these immediate and intermediate outcomes, it is expected that progress can be made toward the achievement of longer-term outcomes of improved personal health skills and practices, improved health outcomes, and improved population health and reduced health disparities. Ultimately, this leads to achievement of the health outcomes identified by the individual programs based on the health issues they are addressing. These theoretical assumptions are in keeping with recommended approaches to improving population health and rest on accumulated body of health promotion and disease prevention knowledge, which posits that sustained and concerted actions in these areas of intervention will lead ultimately to the reduction of disease and reduced health disparities, and improvements in overall health. Strategies for reducing health disparities can include regulatory strategies aimed at reducing hazards to health, research strategies designed to help discover and apply knowledge needed to solve health problems, and intervention strategies which aim to inform, influence, and assist both individuals and organizations to take action on matters affecting their health and the health of their communities.