Program and public policy

There is no shortage of reasons for public health actors to want to form ties with municipal governments, given the major role played by municipalities in shaping the living environments of their residents and the effects of these living environments on health. The reasons for forming ties with municipal actors can be more or less clearly defined and more or less ambitious: to learn from each other, to better coordinate respective actions, to propose a collaborative project that takes advantage of respective areas of expertise and capacities, or to try to make municipal policies healthier.

This practical guide, produced by the National Collaborating Centre for Healthy Public Policy (NCCHPP), is intended to support your efforts to establish and maintain relationships with municipalities. The advice presented here is based on interviews with public servants in Canadian municipalities (Morestin, 2019) and on a variety of other resources that explore the municipal world. This gu…

The intent of this briefing note is to introduce some tools developed in recent years to facilitate the integration of health issues into the decision-making processes of sectors whose primary concern is not population health. It is not the product of a comprehensive review of the various support instruments for health-related decision making, but rather a review of tools associated with the HiAP approach that have been the subject of publications. Most of them are aimed at the municipal decision-making level and are mainly intended for use in urban areas.

The scope of the health determinants considered by each of these tools varies. Some, such as rapid HIA, the Health Matrix and the health lens approach, are more holistic and apply to all types of policies. Thus, they are perfectly aligned with the spirit of HiAP insofar as they make it possible to examine the structural determinants of health affecting health equity. Others were designed to support a particular focus, such…

Increasingly, the concept of solidarity is being brought into discussion as one of the principles and values that should guide the ethical practices of public health actors.¹ Reflecting on ethical issues specific to solidarity as it relates to public health practice appears worthwhile because solidarity is a concept that first and foremost concerns groups or communities of people. Viewed from this perspective, solidarity is a value that, for some authors, seems more suited to playing a central role in public health ethics than do the more individualistic values, such as autonomy, which are usually regarded as central to biomedical or clinical ethics (Baylis, Kenny, & Sherwin, 2008; Dawson, 2011a; Prainsack & Buyx, 2011). This is why solidarity is frequently mentioned in frameworks that rely on values or principles to help guide ethical deliberations specific to the more community- and population-oriented public health issues…

A public health ethics must begin with recognition of the values at the core of public health, not a modification of values used to guide other kinds of health care interactions (Baylis, Kenny, & Sherwin, 2008, p. 199).

Public health practitioners have long grappled with ethical issues in their practice but, until recently, there have been few relevant ethics frameworks that take into account the values base of public health.¹ Historically, those involved in health care ethics and bioethics more generally have failed to provide public health practitioners with guidance geared to their unique ethical concerns. Until relatively recently, a rights-based deontological approach (Zahner, 2000), or the health care ethics principles of autonomy, beneficence, non-maleficence, and justice (Beauchamp & Childress, 1979), were invoked as the appropriate framework to support ethical public health p…

Health in All Policies (HiAP) is an increasingly important approach for systematically addressing the social determinants of health at all levels of government. HiAP refers to “an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity”.¹

In Canada, HiAP is on the radar of several governments, organizations and networks. Advocacy for and the momentum of a HiAP approach has been building, drawing attention to the potential impacts of this approach. Yet challenges to implementation exist across jurisdictions, including the use of a shared language, conflict of interest between sectors, and the need to ensure sustainability. Despite a clear interest, there are few spaces to share and learn from various Canadian and international initiatives and thus accelerate the dissemination and adaptat…

Health inequalities have been a preoccupation of public health for many years. They occur when some population groups enjoy better health, longer life expectancy, and a host of other health-related advantages compared to other population groups. Health inequalities are often seen among different income groups but also occur between groups defined by gender, race, or age, for example. Different policy approaches have been proposed over the years to reduce health inequalities. In the briefing note, Policy Approaches to Reducing Health Inequalities, we distinguish between approaches that act predominantly on the social determinants of health and those that act predominantly on the social determinants of health inequalities. The former include approaches that target living conditions, communities and settings, as well as individuals, while the latter consist of approaches that focus on the social, political, cultural, economic and environmental contexts, as well as the social p…

In 2019, the National Collaborating Centre for Healthy Public Policy (NCCHPP) reached out to Dr. Trevor Hancock to discuss ways to introduce the core ideas of ecological economics to public health practitioners and decision makers. Some of those ideas were previously exposed in a 2015 report on the ecological determinants that Dr. Hancock led for the Canadian Public Health Association (CPHA) (Hancock, Spady, & Soskolne, 2015).

Those discussions eventually took shape in the form of the interview published here. As governments around the world, including the Canadian federal government, are thinking about ways to move beyond a narrow focus on economic growth toward the implementation of “well-being budgets” or “sustainable budgets” the ideas contained in this interview are timely to inform those reflections.

In what follows, Dr. Hancock addresses seven main areas:

1. Ecological determinants of health
2. The Anthropocene
…

The purpose of this document is to equip public health actors to conduct an ethical analysis of policies that are said to be paternalistic. It aims to provide the conceptual tools needed to identify paternalistic policies and assess the ethical burden with which they may be associated. The document also offers practitioners a clear and structured approach intended to guide ethical deliberation about paternalistic policies.

• Paternalism in a nutshell
• Some examples of policies called paternalistic
• An approach and tools for the ethical analysis of paternalistic policies

This document is designed to provide an explicit and reasoned approach to conducting an ethical analysis of paternalistic public health policies. In choosing to frame the debate in terms of paternalism one risks assigning disproportionate weight to certain values within the deliberative process. The third step in our approach aims, among other things, to compensate for th…

The NCCHPP produced a Scan of Mental Health Strategies to show what is being developed in the field of population mental health across Canada. This Scan provides an overview of mental health and wellness and related strategies through comparative tables and summaries, with a particular emphasis on work related to the promotion of mental health and the prevention of mental illnesses.

This document presents the information contained in the online comparative table that lists the most recent Indigenous-specific mental health and/or wellness strategies in Canada. In developing this section of the Scan, a search of the grey literature was carried out, and completed by reaching out to key informants in certain provinces/territories. Briefly, we searched for Indigenous-specific mental health strategies and suicide prevention strategies in each province and territory, as well as pan-Canadian strategies. In addition, Indigenous-specific wellness strategies were also identified and in…

The NCCHPP produced a Scan of Mental Health Strategies1 to show what is being developed in the field of population mental health across Canada. This scan provides an overview of mental health and wellness and related strategies through comparative tables and summaries, with a particular emphasis on work related to the promotion of mental health and the prevention of mental illnesses.

This document presents the information contained in the online comparative table that lists the most recent Canadian provincial and territorial strategies in mental health. In developing this section of the Scan, a search of the grey literature was carried out, and completed by reaching out to key informants in certain provinces/territories. Briefly, we searched for mental health strategies in each province and territory. We did not, however, search for provincial or territorial wellness strategies though these may include dimensions of mental health. The content is therefore not necessarily a c…