Request for Proposals (RFP 010) for Synthesis Research: Integrated Approaches to Chronic Disease Prevention: A Focus on Promoting Healthy Weights and Preventing Overweight/Obesity

Funding and General Information

Deadline for applications: November 26, 2002 (must be courier stamped November 25th for next day delivery).
Up to $300,000 has been set aside in this competition for up to five synthesis research projects.
Project final reports must be completed by December 15, 2003.

Synthesis research is the identification, review, analysis and appraisal of the best available existing knowledge. The synthesis research should be as comprehensive as possible and should:

• align with population health concepts (Health Canada, 2001);
• include published literature, "grey" (unpublished) literature, the practical experience of policy/decision makers and/or the knowledge of multi-disciplinary practitioners and experts in the field;
• at global, international, national, provincial/territorial levels;
• in all languages (that is, not necessarily just English or French, for example); and
• from a variety of discipline-specific perspectives (for example, databases such as Psychlit, CINAHL, ERIC, Soc Sci Cit Index and MEDLINE should be searched).

The synthesis proposals should provide critical assessment of the present knowledge about theory and practice, identify future knowledge needs, and discuss the policy implications for decision-makers.

Research to pilot, demonstrate or evaluate interventions is ineligible.

Scope of Competition

Context and Background

Integration

Health Canada is working towards a more integrated approach to health promotion and disease prevention. Also, Canada's federal, provincial and territorial health ministers have agreed to work together on healthy living strategies that emphasize nutrition, physical activity and healthy weights.

Chronic Disease Prevention

Chronic diseases are the leading cause of death and disability worldwide. In Canada, over two-thirds of deaths result from four clusters of chronic disease: cardiovascular disease, cancer, respiratory illness and diabetes. Over half of Canadians live with chronic illness. Because many chronic conditions share common modifiable risk factors, Canadians are often at risk for several major diseases at once. Two thirds of Canadians have multiple risk factors (for example, poor diet and lack of regular physical activity). Social, cultural and environmental influences and genetic factors also contribute to risk for chronic disease.

Chronic disease represents a significant burden on individuals, families, workplaces and communities. The total direct and indirect cost of illness, disability and death in Canada due to chronic disease is over $80 billion each year.

There have been some successes in prevention nationally, within provinces and territories, and at the local community level. Until now, prevention initiatives have typically been unifactorial in focus, that is, addressing a single issue, either specific risk factors (for example, tobacco use, physical inactivity, or unhealthy eating) or specific diseases (for example, cardiovascular disease, diabetes, or cancer). But the chronic disease epidemic persists. This suggests the need for integrated action - a coordinated, systematic and comprehensive approach involving different stakeholders, using a combination of methods to address the common risk factors for a number of major chronic diseases.

Promoting Healthy Weights and Preventing Overweight/Obesity

Addressing healthy weights lends itself to an integrated approach. There are multiple risk factors (such as unhealthy eating, physical inactivity, or poor mental health) plus important social, economic, physical and cultural influences and genetic factors. There is widespread global, international, federal, provincial/territorial, and community-based interest in promoting healthy weights. There are also many initiatives and investments at these levels to build upon.

Overweight and obesity are growing health issues in Canada. About half of adult Canadians are overweight and one in six is obese (Macdonald et al 1997). Obesity during childhood increases the risk of adult obesity. The prevalence of childhood obesity tripled from 1981 to 1996 (Tremblay and Willms, 2000). Excess weight is associated with a number of chronic diseases including Type 2 diabetes, heart disease, some cancers, poor mental health, respiratory problems and arthritis-related disability. Total direct costs of obesity in Canada have been estimated at $1.8 billion or 2.4% of total health care expenditures for all diseases (Birmingham et al 1999).

Objective

To support Health Canada's move towards a more integrated approach to health promotion and chronic disease prevention, the Health Policy Research Program is requesting proposals for synthesis research.

Research Questions

1. Strategy - What is meant by "integration" in chronic disease prevention, with a focus on preventing overweight and obesity?

• What definitions and models of integrated approaches exist for prevention? In chronic disease prevention? In overweight/obesity prevention?
• What integrated global, international, provincial/territorial, regional/local strategies and/or initiatives (for example, alliances, coalitions, task forces, etc.) exist for prevention of chronic diseases, generally? Prevention of overweight/obesity, specifically?
• What are the characteristics and common elements of successfully integrated approaches to prevention (from a macro system-level perspective, population - level and individual level)? Chronic disease prevention? Overweight/obesity prevention?
• What evidence exists to support integrated approaches to chronic disease prevention? Prevention of overweight/obesity in particular? What are the direct and indirect costs and benefits of developing and implementing an integrated national chronic disease prevention strategy? For overweight/obesity prevention?
• Based on the experiences of other countries, what are the best practices in planning and implementing an integrated prevention strategy? In chronic disease prevention? In overweight/obesity prevention?
• What are the policy and funding implications of integration within and across the federal, provincial/territorial, regional/community levels? What incentives need to be in place to encourage integration?

2. Interventions
a) Addressing the determinants of health
What are the best practices for addressing the determinants of health for promoting healthy weights and preventing overweight/obesity?

b) Targeting particular populations or settings
What are the best practices in integrated interventions for promoting healthy weights and preventing overweight/obesity in particular populations (for example, children and youth, seniors, Aboriginal Canadians, low income Canadians, people living in northern, rural or remote areas) in particular settings (for example, schools or workplaces)?

c) Reducing risk among individuals
What are the best practices in health promotion and risk reduction programs for overweight/obesity? What are the costs and benefits of addressing a single risk factor in isolation (healthy eating or physical activity)? What are the costs and benefits of addressing multiple risk factors?

3. Evaluation
What are the best practices in the evaluation of integrated policies, programs and initiatives (for example, alliances, coalitions or task forces) for prevention, especially in the area of chronic diseases with a focus on preventing overweight and obesity? There should be consideration of the best practices in all aspects of the evaluation process, including:

• Tools for describing integrated approaches (for example, logic models)
• Evaluation questions
• Methods (for example, indicators, data collection tools, etc.)

Policy Contact

Applicants must get in touch with the policy contact at least once during the development of the proposal. The policy contact is responsible for ongoing interaction with researchers on the policy issues and context. Policy inquiries should be directed to Nancy Porteous, Senior Policy Analyst, Prevention and Clinical Practice Division, Centre for Chronic Disease Prevention and Control, Health Canada, (tel: 613-954-8651, e-mail: nancy_porteous@hc-sc.gc.ca). Do not forward a proposal, draft or otherwise, to the policy contact for review as such preliminary review will be deemed a conflict of interest and may result in disqualification of the application.

How to Apply

Applicants are required to register in order to obtain an application form and a registration number. Inquiries regarding registration, eligibility/ineligibility, administrative questions about timeframes and budgets, application formatting and content, the review process, and terms and conditions of the Health Policy Research Program should be directed to Sherrill MacDonald (tel: 613-954-0830, e-mail: sherrill_macdonald@hc-sc.gc.ca). Deadline for applications is November 26, 2002 (must be courier stamped November 25th for next day delivery). Address for courier:
Sherrill MacDonald (tel: 613-954-0830)
Health Canada
Room 1528B, Jeanne Mance Building, Tunney's Pasture
Postal Locator 1915A
Ottawa ON K1A 0K9

References

Birmingham CL, Muller JL, Palepu A, Spinelli JJ, Anis AH. The cost of obesity in Canada. CMAJ 1999; 160: 483-8.

Health Canada. The Population Health Template: Key Elements and Actions that Define a Population Health Approach. 2001.

Macdonald SM, Reeder BA, Chen Y, Despres JP, and the Canadian Heart Health Survey Research Group. Obesity in Canada: a descriptive analysis. CMAJ 1997; 157 (1 Suppl): S3-S9.

Tremblay MS, Willms JD. Secular trends in the body mass index of Canadian children. CMAJ 2000;163:1429-33.