(N.9) Healthy Public Policy/Public Health Policy

Question 1

Healthy public policy

Answer 1

public policies (government) outside of the health sector
- characterized by an explicit concern for health and equity in all areas of policy and by an accountability for health impact
- created for purpose of health, NOT by health ministry
- ex. Ministry of Education

Question 2

T or F: healthy public policy is more of a concrete thing, less of a matter of degree

Answer 2

F: Less of a concrete thing, more of a matter of degree

Question 3

Creates debate with federal government - will they object, do they have the jurisdiction to do so?

Answer 3

Comes down to Constitution Act
○ Most responsibility for health = provinces
○ Not the case for non-health sectors, federal government sectors may affect health (ex. Agriculture)

Question 4

debate with healthy public policy = expanding alcohol sales in Ontario

Answer 4

• Debate over alcohol and its availability and accessibility = more alcohol related issues
• As a consumer, why can’t I get alcohol whenever I want?
• Convenience reasons to expand scope of alcohol, yet health reasons to create constraints

Question 5

Declaration of Alma Ata (1978)

Answer 5

Declaration adopting at the International Conference of Primary Healthcare

• Called for urgent action to develop and implement primary healthcare throughout the world (particularly in developing countries)
• Primary healthcare = access to physicians/nurses

In addition to advocating for primary healthcare, said:
○ Conference strongly reaffirms that health is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector
○ Realization that health can’t just be dependent on health sectors - try to instruct others on making health affirming actions

Question 6

Main target of alma ata (failed)

Answer 6

attainment of health for all by 2000 = = failed

• Everyone achieve a level of health that permits them to lead a socially and economically productive life

Question 7

Ottawa Charter for Health Promotion (1986)

Answer 7

• alma ata lead to Ottawa Charter for HP
• intersectoral harmony to promote health
• focus so much on medicine, what about other ‘fundamental conditions’/prerequisites for health
  ○ Peace
  ○ Shelter
  ○ Education
  ○ Food
  ○ Income
  ○ Stable eco-system
  ○ Sustainable resources
  ○ Social justice and equity
• Stating other ministries have responsibilities for health too

Question 8

aim of Ottawa Charter for Health Promotion (1986)

Answer 8

must make the healthier choice the easier choice (for policymakers too)

Question 9

Outside circle in logo of Ottawa charter for HP

Answer 9

= build healthy public policy

Question 10

Adelaide Recommendations on Healthy Public Policy (1988)

Answer 10

• Build on momentum of Ottawa charter
• Healthy public policy is characterized by an explicit concern for health and health equity in all areas of policy and by an accountability for health impact
  ○ If policy in a non-health area impacts health, you have a responsibility for it
  ○ Can hold you to account for harming people (waste management, education etc.)
• In pursuit of healthy public policy, government sectors concerned with agriculture, trade, education, industry, and communications need to take into account health as an essential factor when formulating policy
• Healthy public policy:
  ○ makes health choices possible or easier for people
  ○ makes social and physical environments health-enhancing
  ○ assigns high priority to underprivileged and vulnerable groups
  ○ recognizes the unique culture of Indigenous peoples, ethnic minorities, and immigrants
• Not just in an interest in health, but equity
  ○ Also responsible for contributing to health inequities
  Governments must measure and report the health impact of their policies

Question 11

Health impact assessment

Answer 11

• Common tool used by governments to examine health impacts of a given policy
• Doesn’t try to kill a policy, just assess in a way to promote health as much as possible
• Responsive to evidence on the social determinants of health
• A method for making health a concern for all policy sectors, as proposed in the WHO’s Adelaide Recommendations on Healthy Public Policy

Question 12

what did the health impact assessment emerge from

Answer 12

Emerged from Environmental Impact Assessment

Question 13

what is this: a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population

Answer 13

HIA = Concern about health impacts and equitable distribution

Question 14

2 aims of HIA

Answer 14

1. Evaluate the POTENTIAL HEALTH IMPACTS of policies
   - positive/negative, short/long-term
2. ENHANCE the QUALITY OF DECISION MAKING through recommendations to improve predicted positive health impacts and minimize negative impacts

Question 15

HIA can be done in … (3)

Answer 15

1. Prospective
   –Gov. planning on bus transit - think of impacts
   – Might still have an opportunity to make changes/policy more healthy
2. Concurrent
   – While policies are being developed
   – Ministry of education reaches out to work with ministry of health to evaluate both sectors
3. Retrospective
   – Look back at policies that were implemented, and realize certain sectors were not incorporated

Question 16

when doing a HIA, ask

Answer 16

• What are the policy’s potential BENEFITS to the population’s health?
• What are the policy’s potential HARMS to the population’s health?
• Might certain populations be DISPROPORTIONATELY advantaged or disadvantaged by the policy?
• Consider: both INTENDED and UNINTENDED benefits and harms, short-term and long-term benefits and harms
  ○ (Unintended = common environmentally)
• How might the policy be modified to better promote or mitigate harms to the population’s health?
  Can be challenging as health people are not experts in given ministry

Question 17

What is the only example in Canada where HIA are systematically done

Answer 17

Quebec - Mandated that every sector needs to do HIA

Section 54 of Quebec’s Public Health Act (2001):
“The Minister shall give the other ministers any advice he or she considers advisable for health promotion and the adoption of policies capable of fostering the enhancement of the health and welfare of the population. In the Minister’s capacity as government advisor, the Minister shall be consulted in relation to the development of the measures provided for in an Act or regulation that could have significant impact on the health of the population.”

Question 18

Public health policy

Answer 18

1. Focuses on the health of POPULATIONS instead of individuals
   - ex. health of Indigenous populations
   - In a way cares about healthy public policy
   - How to shift the curve from less healthy to more - cares about SDH
2. Focuses on PREVENTION instead of treatment
   - Ex. Vaccination
   - Much more difficult to create policies people will accept, raises questions on justification
   - Difficult = no evidence need to play out to see
3. Focuses on COLLECTIVE ACTION instead of individual intervention - often means at the policy level
   -ex. fluoride in municipal water supply
   - Will always have some segment of the population that does not want to comply

Question 19

Public health

Answer 19

collective activities that aim to protect and promote the health of populations

Question 20

Public health care

Answer 20

health care that is publicly financed

(e.g., Canada’s ‘public’ health care system)

Question 21

Public Health Agency of Canada (PHAC)

Answer 21

PHAC focuses on PREVENTING CHRONIC DISEASES, like cancer and heart disease, preventing injuries, and responding to PUBLIC HEALTH EMERGENCIES and infectious disease outbreaks

Question 22

Public Health Ontario (PHO)

Answer 22

PHO provides SCIENTIFIC EVIDENCE and expert guidance to shape policies and practices for a healthier Ontario

Question 23

Of Canada’s total expenditures on health, what percentage makes up spending on ‘public health’?

Answer 23

= 5%

• Prevention (rest is treatment)
• COVID-19, restaurants on food safety, STD prevention