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This is the second in the Canadian Health Network's two-part series on public health in Canada.

Part one gave us an overview of public health and why it's important- no matter where we live.

Part two takes a closer look at a busy, public health unit in southern Ontario- one which is striking a balance between rural and city public health issues.

riving west from Toronto along Highway 401, you may find yourself happening upon a vital, prosperous area known as the Region of Waterloo. Located in southern Ontario at the center of the triangle formed by three Great Lakes -- Ontario, Erie and Huron - the region is made up of three municipalities (Cambridge, Kitchener and Waterloo) as well as four rural townships. In addition to its unique blend of urban and rural, the region has a diverse ethnic population and many new Canadians. With a combined population of 488,400 the region is also one of the fastest growing areas in the province.

On any given day, the Region of Waterloo is like many other places in Canada: populated with people going about the business of earning a living, caring for their families and enjoying a bit of time off whenever they can. And like other communities in Canada, the Region of Waterloo is unique in ways that pose special challenges to the area's public health unit.

			Programs and services available through Region of Waterloo Public Health
			Family and community resources Lifestyle resources Sexuality resources Communicable disease programs Dental health programs Emergency medical services Environmental health To learn about programs where you live, call your local Department of Health. For information on national initiatives in public health, visit the website of the Canadian Public Health Association.

"In public health, we like to say that the community IS the patient," explains Dr. Liana Nolan, Medical Officer of Health for the region. It is Dr. Nolan's responsibility to work with a whole squadron of qualified specialists - registered nurses and public health nurses, public health inspectors, bacteriologists, communicable disease specialists, industrial hygienists, toxicologists, epidemiologists, statisticians and others -- to find ways to be responsive to the health needs of the community.

In the Region of Waterloo, for instance, environmental health issues such as air quality are a concern and clean air strategies that include educating the community on how each person can reduce air pollution are vital. "The ultimate goal is to make this a healthy community," says Dr. Nolan, "so we try to choose the things that have the most impact."

Since the area has a fast-growing immigrant population, the focus of programs must reflect this. "We need to be culturally sensitive and address barriers such as language so that new Canadians can integrate into the community", explains Dr. Nolan. Many new Canadians don't have a family physician, for instance. "We have to step back and think about advocating for others," she adds. "We reach out to them and support them, advocating for people to find meaningful work and social supports." Helping new Canadians find a family physician and providing translation services so they can access the myriad services and clinics available helps them understand that they belong to a community that cares about the health of everyone.

Much of the work done by public health comes out of surveillance and statistical information gathered in a particular community. In the Region of Waterloo, for instance, statistics indicated that a leading cause of death for young people was motor vehicle accidents, so the public health department swung into high gear to encourage parents to use car seats correctly, to implement school programs that educate kids about the dangers of drinking and driving, and to educate the community about the importance of traffic calming measures. "We look at a variety of ways to intervene, including educational strategy and policy strategy," says Dr. Nolan.

			Typical questions at the Region of Waterloo Public Health
			Should I exercise outdoors during smog alerts? My five-year-old child has a toothache and I don't have any dental insurance. Where can I go for help? What is the best way to prevent illness? How can I minimize exposure to potentially rabid animals? How many times a year are public pools inspected? How do I make sure my water is safe? Information on these questions and on many other public health issues can be found on the Region of Waterloo Public Health web site.

While the province sets guidelines and standards for various public health threats such as West Nile virus, it is up to the local public health unit to deliver the program in a way that meets the needs of its own community.

"Your local public health unit is where the rubber meets the road," notes Dr. Nolan. In addition to curriculum support for schools, which might include physical activity and hand-washing promotion, the Waterloo public health unit also carries out water and well inspections, supports local farmers by urging the public to buy local produce on market days, conducts restaurant and long-term care facility inspections, enforces smoking bylaws and provides many more programs and services aimed at keeping the "patient" healthy.

Giving people the facts helps them make decisions. But human nature being what it is, the majority will often choose to move along the path of least resistance. That's why, says Dr. Nolan, part of the policy work is to make the healthy choice the easy choice. "A lot of the real impact of public health is around policy and legislation, how we build communities and run our schools."

Encouraging people to buy food at the local market or supporting schools to ban junk food or local government to build attractive sidewalks and public parks that encourage people to get out and walk usually requires a collaborative effort with resources in that community, including family physicians, school boards, community care facilities, businesses and so on. "We come together around a common issue, coordinate our efforts and help each other," says Dr. Nolan.

One of the paradoxes of public health policy - such as banning smoking in public places - is that what's good for the health of the community may not sit well with some individuals. "Even though we have solid proof that people should be exposed to zero secondhand smoke," notes Dr. Nolan, "some people said we went too far and were infringing on people's individual rights."

Still, she adds, social change has to be brought about through meaningful debate. "When we brought in our non-smoking bylaw in Waterloo in 2000, everyone was talking about it and that discussion was good," says Dr. Nolan. Whatever it takes. Because in the end, when you get everybody talking, they get closer to reaching a goal with health benefits for everyone. And that's what public health is all about.