THE IMPORTANCE OF INTERSECTORAL
COLLABORATIONS TO PROMOTE
HEALTHY PUBLIC POLICY
Ghazal Fazli, MPH, Phd(c)
Centre for Research Inner City Health
Li Ka Shing Knowledge Institute,
St. Michael’s Hospital
Toronto, Ontario
ACT CANADA SUMMIT DECEMBER 2014
OBJECTIVES
• To share findings from consultations from a
stakeholder engagement event including a variety
of sectors and disciplines across Southern Ontario
• To discuss key findings on knowledge gaps,
challenges and key steps to implementing policy
changes related to the built environment that
would promote physical activity and reduce
obesity.
DIABETES EPIDEMIC
• Ontario is
encountering an
alarming burden of
illness associated
with diabetes
• Rising prevalence of
type 2 diabetes will
require population
based interventions
Lipscombe L and Hux J.
Lancet 2007;369:750-6
Neighbourhood Environments and
Resources for Healthy Living: A Focus
on Diabetes in Toronto
www.ices.on.ca
30 - 50,000
50 - 75,000
75 - 100,000
100- 150,000
150- 375,000
Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto
The built environment as a
potential target for intervention
FEATURES OF WALKABLE NEIGHBOURHOODS
• More compact/dense
• Grid-like street pattern
(shorter blocks)
• Mixed land use
• Destinations within
walking distance
• Sidewalks
More walkable neighbourhoods
more walking
Suburban design discourages walking
and increases reliance on cars
• Large
lot sizes (more
sprawl)
• Less connected
streets (longer blocks)
• Purely residential
zoning
• Few walkable
destinations
• Often no sidewalks
Less walkable neighbourhoods less walking, less
physical activity and more obesity
MORE TIME SPENT IN CARS HIGHER RATES
OF OBESITY
Frank LD et al Am J Prev Med 2004
TORONTO RESIDENTS LIVING IN MOST
WALKABLE AREAS WERE APPROXIMATELY:
 three times more likely to walk to work
 twice as likely to take public transit
 one-half as likely to drive to work
 one-quarter less likely to be obese
As those living in the
least walkable areas
Glazier et al., PLoS One 2014
4-YEAR CIHR PROPOSED RESEARCH PLAN
• Dr. Gillian Booth of St. Michael’s Hospital holds a 4 year CIHR Grant on the
built environment and its impact on health outcomes – obesity and
diabetes
• Multiple studies designed to:
• Examine 10-year trends in the incidence of diabetes in urban settings that differ
on the basis of walkability, access to healthy resources, and exposure to
unhealthy vs. healthy foods (Time series methodology - area level study)
• Evaluate the impact of area walkability, access to resources, and exposure to
unhealthy vs. healthy food on the development of diabetes (propensity-matched
retrospective cohort study – individual level study)
• Model a series of predictive algorithms using hierarchical modeling techniques to
model the impact of built environment interventions - changes in neighbourhood
walkability, access to healthy resources and retail food environment) on diabetes
incidence (using linked CCHS data)
• Critical components of this research program include integrated knowledge
translation events and opportunities to engage important stakeholders,
knowledge users and policymakers to identify policy solutions and
recommendations
RESEARCH PLAN - STUDY AREA
How do we get multiple sectors and agencies involved
in translating evidence into planning and practice?
URBAN PLANNING
• City of Toronto
planning department
• Parks and recreation
• Transit
• Private and public
urban planning
groups
• Canadian Urban
Institute
• LEED-ND
PUBLIC HEALTH
• Public Health Agency
of Canada
• Ministry of Health
Promotion
• Toronto Public Health
• Public health units
• Community health
centers
FOOD SECTOR
• Food policy experts
• City of Toronto,
Food programs and
strategies
• Nutritionists
KNOWLEDGE USERS AS
DISSEMINATORS
INTEGRATED KT EVENT : A COLLABORATIVE
INITIATIVE
• In collaboration with Public Health Ontario (PHO) a
knowledge user and stakeholder engagement
event was organized on October 4th 2013 in Toronto
• Stakeholders were invited from planning,
transportation and public health sectors, plus
government, NGOs representatives from across
Southern Ontario
INTEGRATED KT EVENT: OBJECTIVES
The objectives of this meeting were:
1. Disseminate research findings to key
stakeholders
2. Engage key stakeholders to explore potential
applications
3. Provide a forum for sharing success stories and
barriers to achieving changes in the built
environment
4. Establish partnerships with researchers, planning
and public health
INTEGRATED KT EVENT: PARTICIPANTS
ATTENDED
Public
health =
20
Planning
= 12
Participants
= 55
Transport
ation = 10
CRICH and
PHO Staff
and team
= 13
INTEGRATED KT EVENT: INVOLVING MULTIPLE
SECTORS
Regions/Municipalities
•Toronto
•Ottawa
•London
•Peel
•Hamilton
•Halton
•Durham
•York
Non-governmental
organizations
•Canadian Diabetes
Association
•Canadian Partnership
Against Cancer
•Ontario Professional
Planners Institute
•Ontario Public Health
Association
•Heart & Stroke
Foundation
•Canadian Institute for
Health Research
Government
•Public Health Agency of
Canada
•Ministry of Health and
Long-Term Care
•Ministry of Infrastructure
•Ministry of Municipal
Affairs and Housing
•Public Health Ontario
THEMATIC ANALYSIS
• A preliminary qualitative thematic analysis was
conducted to identify:
• emerging themes related to gaps in knowledge and
barriers that impede evidence-based decision-making and
policy development related to the built environment
• Relevant themes and sub-themes were identified and
validated through post-meeting consultations using online
surveys.
• Survey response rate was 73% (stakeholders further
validated the themes, knowledge gaps and actions
identified)
THEMATIC ANALYSIS RESULTS: THEMES AND
KNOWLEDGE GAPS
Targeted and
Impactful
Messaging
Solutionfocused
implementati
on
Common
Measures and
Tools
Emerging Themes
from Research on
the Built
Importance
Environment
of Public
and Private
Sector
Advocacy
Intersectoral
collaboratio
n
within/betw
een Levels
of
Government
Policy
informed
and
actionable
research
Cross-cutting Themes
Partnership and Collaboration
System Integration
THEMATIC ANALYSES RESULTS:
BARRIERS/ENABLERS AND ACTIONS
• Economic arguments/tools
• Awareness of Political Environment
• Public awareness
• Changing Perceptions
• Communicating across sectors/agencies
• Intersectoral Partnerships
• Identifying champions
RESEARCH AND INFORMATION GAPS
Research and Information Gaps related to the Built Environment
Top Priorities
71% (15)
67% (14)
Lower Priorities
52% (11)
38% (8)
24% (5)
Economic
analyses
Standardized
metrics
Evaluation of
Interventions
Implementation of
Population
Research/Tools
Attributable Risk
Analyses
24% (5)
24% (5)
Research on Built
Environment &
Workplaces
Co-ordination of
Definitions
Research and Information Gaps with respect to evidence that can help promote actions and
policy on the built environment
NEXT STEPS TO SUPPORT POLICY AND
PLANNING
68% (13)
Top Priorities
53% (10)
53% (10)
47% (9)
Lower Priorities
26% (5)
26% (5)
21% (4)
5% (1)
Summary of recommended Next steps to support policy and planning related to the built environment
SUMMARY
• Interventions targeting the built environment that
encourage physical activity may have tangible
health benefits for the population if multiple sectors
are engaged from earlier on
• Challenges in translating research findings into
policy and planning initiatives aimed at promoting
physical activity and curbing the rise in obesity will
require addressing the barriers, enablers and gaps
QUESTIONS
PEEL REGION HEALTHY DEVELOPMENT
EVALUATION TOOL
AIM:
•Tool to rate development submissions
•To encourage future development to proceed in a form
more conducive to healthy living with a focus on
physical activity
INVOLVING MULTIPLE
STAKEHOLDERS
• Consulting re: Ontario
Diabetes Strategy
• Mapping of services
• New partnership,
shared interest in
obesity-prevention
• Toronto Diabetes
Atlas
• Toronto Community
Health Profiles
MOHLTC
Toronto
Public
Health
Public
Health
Ontario
Peel
Region
• Peel Diabetes Atlas
• Healthy
development tool
INTEGRATED KNOWLEDGE TRANSLATION
APPROACH
Policy and
Planning
Research