Implementation Strategies
Measuring Results
Policy Development
Examples/Case Studies
Tools
Implementing the Population Health Approach
Putting population health theory and policy into practice means acting on health
issues in a way that is consistent with the
key elements of a population health approach.
.
Implementation Strategies
A population health approach plans and executes programs, policies, and interventions
along the entire spectrum of health action, including:
- health promotion
- disease (and injury) prevention
- risk management
- policy coordination
- medical treatment
- rehabilitation
- palliative care
The population health approach is a unifying force for the entire spectrum
of health system interventions - from prevention and promotion to health protection,
diagnosis, treatment and care - which integrates and balances action between
them.
Health
Promotion
Health promotion is one of the ways to take action on population health. It
has long been recognized as a way of taking action on the social, physical,
economic and political factors that affect health. It also emphasizes the need
to work with other sectors to ensure that the collective policy environment
becomes one that supports health. Health promotion is a concept that has been
endorsed within Health Canada's Health Promotion and Programs Branch (now the
Population and Public Health Branch) to assist in the development of programs
and policies that support healthy living. more...
Risk Management
An upcoming Health Canada guidance document, Integrating Population Health
and Risk Management Decision-Making, describes the general concepts of population
health and risk management, explains the linkage between the two, and provides
an example illustrating how a population health approach may be integrated into
the risk management decision-making process. more...
Prevention
Prevention of health problems (e.g., disease, injury) occurs at three levels:
- Primary prevention involves activities aimed at reducing factors leading
to health problems.
- Secondary prevention activities involve early detection of and intervention
in the potential development or occurrence of a health problem.
- Tertiary prevention is focused on treatment of a health problem to lessen
its effects and to prevent further deterioration and recurrence. more...
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Measuring Results
Politicians, public servants and organizations at all levels are increasingly
called upon to be transparent, open to comment and scrutiny, and accountable
for the short- and long-term impact of their decisions. The desired outcome
of our work depends on the role that we are fulfilling, how we are working,
with whom we are working and what we are working on. If we are the intermediary
or the facilitator and catalyst, then our desired outcomes are different than
if we are the program deliverer.
The population health approach calls for an increased focus on health outcomes
(as opposed to inputs, processes and products) and on determining the degree
of change that can actually be attributed to our work. This emphasis will have
an impact on planning and goal-setting processes as well as on the choice of
interventions or strategies employed. In making decisions on the best investment
of resources, strategies that have the potential to produce the greatest health
gains will be given priority.
Outcome evaluation is essential in a population health approach. It examines
long-term changes in both health and the determinants of health. These include
changes in knowledge, awareness and behavior, shifts in social, economic and
environmental conditions, as well as changes to public policy and health infrastructure.
Outcome evaluation also seeks to measure reduction in health status inequities
between population sub-groups. Longer-term outcome evaluation is essential to
a comprehensive evaluation program, which also includes process evaluation (to
determine whether a policy or program is meeting its goal and reaching its target
population) and impact evaluation (to measure immediate results of a program
or policy). The importance of both process evaluation and outcome evaluation
can be seen in Health Canada's Community Action Program for Children
Defining Accountability & Evaluation
Accountability is the obligation to answer for responsibilities conferred.
It involves providing detailed information about how responsibilities have been
carried out and what outcomes have or have not been achieved. A key element
of accountability is transparency, which results from conducting one's activities
in a manner that can be easily observed and understood by the public. This includes
responding appropriately to requests for information and reporting to the public.
For example, Toward
a Healthy Future: Second Report on the Health of Canadians by the Federal,
Provincial and Territorial Advisory Committee on Population Health (ACPH) reports
and comments on the state of the nation's health. It alerts policy makers, practitioners
and the public to current and future challenges in health. more...
Accountability at Health Canada
Increasingly, the federal government is emphasizing and taking measures to
inform Canadians about the achievements and results of public spending. To provide
Canadians with relevant information and report on program investments and results,
the federal government is developing and implementing practices for accountability.
These practices require that all policy documents to Cabinet and submissions
to Treasury Board Ministers feature, first of all, a performance measurement
and reporting strategy and, secondly, a performance and accountability framework.
more..
Actions and Considerations
Health Impact Assessment
Assessing the health and social impact of programs and policies is an important
aspect of population health. Health impact assessment can be defined as any
combination of procedures or methods by which a proposed policy or program may
be judged as to the effect(s) it may have on the health of a population. Policies
or programs of any nature may directly affect the health of a population, or
may indirectly affect their health by altering, influencing, or affecting the
determinants of health. more...
Health Goals
Health
goals provide a framework to better understand the relationship between
the health outcomes we want and our efforts to achieve them. When health
goals are expressed in measurable objectives and quantified targets, they
provide the yardstick to measure population health improvements (or lack
thereof). Without specific targets to guide health actions, expectations
for health gains remain vague. Targets specify the amount and timing of
desired change expected on a health
status indicator and set forth the parameters of success in a population
health approach. more...
Policy Development
Policy development in population health has built on the shoulders of a series
of prior policy initiatives with a similar purpose, namely to maintain and improve
the health of Canadians. While various characterizations of the population health
policy can be made, it is most fruitful to see population health as a framework
for thinking about the social and economic forces that shape the health of citizens.
As such, it builds on a long tradition of public health and health promotion,
and goes beyond the more traditional focus on the individual as the medical,
biological or lifestyle problem. ![large group portrait](/web/20061211063211im_/http://www.phac-aspc.gc.ca/ph-sp/phdd/images/9.gif)
The Canadian Institute for Advanced Research
has played a leadership role in building this framework, starting with a series
of seminars led by Fraser Mustard at McMaster University in 1983.
The population health framework is a work in progress. While many elements
are clear, others are yet to be fully developed. It is not yet a fully detailed
model that identifies the specific causes of good health, nor does it enable
us yet to predict the effects on health of specific social and economic conditions.
Nevertheless the population health policy provides, at the most general level,
an approach which can increasingly set out the elements that are key to maintaining
and improving the health of Canadians.
Examples/Case Studies
Health Canada supports initiatives that incorporate a population health approach
in many areas, such as activities in the Population
Health Regional Mobilization Strategy and the Population
Health Fund. However, it will take time before these efforts yield meaningful
results. As outcomes of current population health activities are compiled, Health
Canada will develop case studies to fully examine and document applications
of a population health approach to policy, research and practice.
Meanwhile, the Department is aware that there are projects not just in health
but in other sectors, which (deliberately or otherwise) are using at least some
elements of a population health approach. We are gathering information on these
initiatives, which we believe will provide useful interim success stories and
examples of population health in action. These examples will help stimulate
discussion and increase knowledge of critical concepts in the population health
approach. Keep in mind that examples of initiatives to date do not illustrate
or even contain every element of a population health approach.
The Role of Evidence in the
Development of National Policies to Enhance Children's Well-Being: A Canadian
Case Story (1990-2001) was presented to the XVIIth World Conference on Health
Promotion and Health Education in Paris, France in July 2001 by Dr. Wendy Watson-Wright
of Health Canada.
To view these files you will need PowerPoint
Presentation Viewer.
Backgrounder to Children's
Case Story PDF
Format 38KB
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The Dufferin Mall Story is recognized
internationally as a successful experiment in community development achieved
by a unique partnership between business and government.
Tools
The Population Health Template
Working Tool organizes and consolidates current understandings of population
health. Health Canada has identified population health as a key concept and
approach for program and policy development aimed at improving the health of
Canadians. The working tool outlines the procedures and processes required to
implement a population health approach and provides guideposts that help to
assess preparedness and capacity to implement population health initiatives.
The tool draws on the detailed and comprehensive discussion paper, The
Population HealthTemplate: Key Elements and Actions that Define a Population
Health Approach.
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Considering Issues in a Population Health
Approach
The linked table highlights
the elements and issues that need to be considered in a population health approach.
Entry Points to Health
Health can be approached from many different perspectives and health concerns
can manifest themselves in a wide variety of ways. None of these "entry points"
is unique to the population health approach and all are valid places to begin
in considering health and interventions to improve health. An essential feature
of the population health approach is understanding health in terms of its broad
determinants. Because determinants interact, pursuing a population health approach
beginning with any given entry point will typically lead to consideration of
an array of inter related perspectives and concerns, many of which could equally
well have served as the entry point.
Entry points include:
- demographic groups (e.g., children, women, Aboriginal peoples, persons
with low income);
- diseases or causes of death (e.g., AIDS, cancer, influenza, heart disease,
diabetes);
- hazards to health (e.g., radiation, contaminated water, unsafe products,
environmental tobacco smoke, violence);
- settings (e.g., homes, schools, workplaces, municipalities, recreational
facilities);
- behaviours/lifestyle (e.g., tobacco use, alcohol or drug abuse, nutrition,
exercise);
- and determinants of health (e.g., income and social status, education,
employment and working conditions, social support). more..
Checkpoints for Applying the Population Health Approach
As part of a 1998 pilot session to involve Health Canada staff in developing
a population health approach, the BC Regional Office of the Health Promotion
and Programs Branch produced a tool entitled Checkpoints
for Applying the Population Health Approach.
Linked
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