Health promotion leadership and practice
Intuition or knowledge-based?
Ak’ingabe Guyon MSc MD CCFP FRCPC
Richard Lessard MD MPH FRCPC
Public health and preventive medicine specialists
Montreal Public Health Unit
May 24th 2015, Vancouver
Public Health Physicians of Canada symposium
Plan
1. Typologies of health promotion practice
2. Case studies from 30 years of public health
3. Lessons learned
Health promotion leadership & practice
Guyon, Lessard, May 2015
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1. Typologies of health promotion practice
Health promotion…Ottawa forever!?
Public health
Surveillance
Protection
Health promotion
Prevention
1. Build healthy public
policy
2. Create supportive
environments
3. Strengthen
community action
4. Develop personal
skills
5. Reorient health
services
Ottawa Charter, 1986
See also Rechel & McKee, 2014
Health promotion leadership & practice
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1. Typologies of health promotion practice
Public health interventions
Advocacy, Partnerships, Support,
Strategic
coalitions
expertise
influence
McCubbin 2001
Litvak & al. 2014, Jorm 2009
Authority
(health
protection,
emergency
response)
Individual
services
Collective
services
Health promotion
Disease prevention
Health Protection & emergency response
Surveillance
Planning & evaluation, Research
Health promotion leadership & practice
Guyon, Lessard, May 2015
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1. Typologies of health promotion practice
Healthy public policy instruments Guyon 2012, Bemelmans-Videc 2014
Advocacy, strategic influence
Regulation
instruments
Economic
instruments
Information & persuasion
instruments
…including
public
relation
strategies
Smith 2014
Healthy public policy
Health promotion leadership & practice
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2. Case studies from 30 years of public health
Cases from the Montreal public health unit
• Dr. Richard Lessard : 30 years as regional MHO
• 10 case studies of complex public health interventions
–
–
–
–
Municipal (Relocation of a casino, …)
School & early childhood networks (Early childhood summit, …)
Provincial government (Health inequity mobilisation, … )
Federal government (Supervised injection site, …)
• Analysis of implemented interventions (see next slide)
Health promotion leadership & practice
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Moisissures école
Inégalités sociales
Jardins communautaires
Injection supervisée
Maturité scolaire
Casino – déménagement
Pont Jacques-Cartier
2. Case studies from 30 years of public health
Herbe à poux
Casino – alcool
Blue Bonnets
10 case studies, Lessard & Chevalier 2014
9
9
Information public + médias
Public health interventions
Information décideurs
Développement de programme
3
4
Financement activités externes
3
Sondage opinion publique
3
Mobilisation des communautés
(Anti-)Marketing social
2
1
Support aux regroupements et réseaux
8
Plan de relations publiques
2
Projet recherche – évaluation
3
Éducation sanitaire
10
Promotion de politiques saines
Connaissance – surveillance
4
6
2 6 3 8
8 5 9 8
6
2. Case studies from 30 years of public health
Framework for public health case study analysis
1. Context
health issue, challenge, public opinion, scientific evidence, potential and
evidence-based interventions…
2. Public policy at stake
public policy targeted, improvement requested…
3. Policy environment assessment
why target policy to address this issue, pros and cons of influencing
policy, other options, stakeholder analysis…
4. Public health unit’s context for decision
legal, scientific and administrative legitimacy? capacity? priority level for
this issue? timeframe? MHO support? internal stakeholder analysis
Lessard R, 2014
Health promotion leadership & practice
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2. Case studies from 30 years of public health
Framework for public health case study analysis
5. Public health unit’s decision process
Importance of the health issue vs. capacity vs.
chance of success of policy influence vs. timeframe
6. Interventions and strategies used
Public health functions/ strategies/interventions used to
reach objectives
7. Follow-up, aftermath
Media coverage analysis, results, lessons learned,
next steps
Lessard R, 2014
Health promotion leadership & practice
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3. Lessons learned
Strengths and blind spots revealed
Strengths
• Good surveillance data can lead to great media attention
Blind spots?
• Reactive vs. proactive interventions : difficult balance
• Public relations : do we use these strategies enough?
• Public opinion: do we survey enough ?
• Meeting members of parliament: too little, too late?
• Listening and involving citizens
• Community mobilisation, social marketing…anti-marketing
campaigns…
Lessard & Chevalier, 2014
Health promotion leadership & practice
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3. Lessons learned
Our challenge: accelerate shifts in social norms
Changing social norms takes time 4-50 years?
Acohol, tobacco, seatbelts…
• Change deep-rooted habits
salt, sugar, fat, portions, car as the ultimate means of transportation…
• « Mythbusting » and changing mindsets
new highways decrease trafic : FALSE
• Influence demand > government policy
as demand changes, supply adjusts and governments interventions can be relatively light
• Use coercive policies as the last resort
according to evidence and ethics, Nuffield Council on Bioethics
• Status quo = great benefits to some stakeholders…
There are no externalities for those who benefit from them…
Lessard & Chevalier, 2014
Health promotion leadership & practice
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3. Lessons learned
Conditions for success
• Solid scientific evidence
• Aiming for maximum impact
• Key priorities (2-3…not 20)
• Capacity: sufficient staff
• Capacity beyond the biomedical: appropriate multidisciplinary
expertise
• Flexible but real management & leadership
• Constant re-assessment/ progress evaluation
Lessard & Chevalier, 2014
Health promotion leadership & practice
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Milestones and next steps
1. Public health case studies


Completed cases used for MPH/ MSc classes
…publication for 2016?
2. Profesional development



Healthy public policy community of practice 2014-2015
Pan Canadian + Quebec health promoter competencies frameworks
…PHPC webinar in 2015
3. Organisational development

?…as Quebec’s regional PHUs recover from massive 30% budget cuts
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Conclusions
•
We can and should analyse our complex public health
interventions
•
Reclaiming public health successes: a priority
•
Case study: a paramount methodology
for public health research and training?
Novick et al. 1997
Hunting & Gleason 2012
? …imagine a public health case study centre for Canada
Health promotion leadership & practice
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Questions ?
Comments ?
Experiences in analysing and supporting
health promotion/healthy public policy strategies ?
akingabe.guyon@mail.mcgill.ca
Health promotion leadership & practice
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Selected references
Bemelmans-Videc et al eds. 2014. Carrots, Sticks and sermons: policy instruments and their evaluation. Transaction
publishers
Guyon A. 2012. Intensifier l’élaboration de politiques publiques favorables à la santé: des approches stratégiques pour
les autorités de santé publique. Can J Public health, 103(6) 459-461.
Hunting KL, Gleason BL. 2012. Essential case studies in public health. Essential public health series, Jones and Bartlett
learning.
Jorm L, Gruszin S, Churches T. 2009. A multidimensional classification of public health activity in Australia. Australia and
New Zealand Health Policy. 6(9) 1-10.
McCubbin M, Labonte R, Dallaire B. 2001. Advocacy for healthy public policy as a health promotion technology. Centre
for health promotion, University of Toronto. Document online.
Lessard R, Chevalier S. 2014. 30 ans de communications: un regard sur une pratique de santé publique. Journées
annuelles de santé publique, 25 novembre 2014
http://jasp.inspq.qc.ca/2014-la-communication-une-fonction-strategique-en-sante-publique.aspx
Lessard R. 2014. Politiques publiques et santé: grille pour la documentation de projets. Document de travail non
diffusé.
Litvak E et al. 2014. Typologie des interventions de santé publique. Document de travail non diffusé.
Novick et al. 1997. Public health leaders tell their stories. Aspen publication and Millbank memorial fund.
Nuffield Council on bioethics. The intervention ladder. Website consulted May 18th 2015.
http://nuffieldbioethics.org/report/public-health-2/policy-process-practice/
Rechel B, McKee M. 2014. Facets of public health in Europe. Open University Press. Document Online.
Smith R. 2014. Public relations, the basics. Routledge, New York.
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