Supporting public health practice in healthy growth and development in the Province of Ontario, Canada.

BACKGROUND: As public health services are modernized in Ontario, Canada, there is a need to inform the system-level roles and responsibilities of government agencies. The aim of this study was to identify how Public Health Ontario (PHO) can optimally support evidence-based planning and programming in Healthy Growth and Development (HGD) across Ontario. METHODS AND DESIGN: A situational assessment was conducted with key informants from public health and other HGD fields. SAMPLE: Key informants were identified using purposeful snowball sampling and included public health nurses, health promoters, and medical officers of health. Analytic strategy: Twenty telephone interviews and seven focus groups were used to collect data. A thematic analysis was conducted concurrently with data collection. RESULTS: Five themes were identified: (a) Transition to the new Ontario Public Health Standards (OPHS) included experiences of adopting the new OPHS within local public health units (PHUs). (b) Collaborating and networking referred to the ability to work with community partners. (c) Data, evidence, and research described the presence of data, evidence, and research to support practice. (d) Decision making, planning, and priority setting described resources available that influenced decision making. (e) Current and emerging issues in HGD included high-priority topics. CONCLUSION: Public health practice in HGD is complex with many challenges in data and evidence, and making programming decisions without adequate or measurable indicators. A specialized position at PHO is an opportunity to support some of these system-wide needs.

A Multicomponent Intervention to Encourage Stair Use in Municipal Buildings.

PURPOSE: Evaluate the incremental impact of environmental stairwell enhancements on stair usage in addition to prompts. DESIGN: Phased, nonrandomized, quasi-experimental intervention. SETTING: Two 6-story and one 8-story municipal government office buildings-each with 2 stairwells. PARTICIPANTS: Approximately 2800 municipal employees and 1000 daily visitors. INTERVENTION: All stairwells received door wraps and point-of-decision and wayfinding prompts. Environmental enhancements were installed in 1 stairwell in each of the 2 buildings: wall paint, upgraded stair treads and handrails, artwork, light-emitting diode (LED) lighting, fire-rated glass doors, and removal of security locks on at least the ground floor. MEASURES: Staff surveys and focus groups, electronic and direct measures of stair and elevator use occurred at baseline and over 3 years of phased implementation and follow-up. ANALYSIS: Change in the proportion of vertical movement by stairs using χ2 analysis. RESULTS: The prompts were associated with a significant increase in stair use (odds ratio [OR] = 1.36; 95% confidence interval [CI]: 1.31-1.41), with an average absolute increase of 3.2%. Environmental enhancements were associated with an additional significant increase in stair use (OR = 1.31; 95% CI: 1.25-1.37) beyond prompts alone with an average absolute increase of a further 3.5% that was sustained for 1 year. The initial increases in stair use with prompts alone were not sustained. CONCLUSION: Implementing environmental stairwell enhancements in office buildings increased stair usage in a sustained manner beyond that achieved by prompts alone.

Incorporating consideration of health impacts into land use development approval processes: Development of a Health Background Study Framework.

OBJECTIVES: This project involved development of a Health Background Study (HBS) Framework to support consideration of health impacts within municipalities' approval process for land use development. PARTICIPANTS: Peel Public Health and Toronto Public Health led the project with the participation of planners, urban designers, engineers, public health staff and development industry representatives. SETTING: Historical growth in the Region of Peel and suburban Toronto has resulted in extensive low-density development, creating car-dependent communities with disconnected streets and segregated land uses. INTERVENTION: The inclusion of an HBS in developers' applications to municipalities is one approach by which health-related expectations for the built environment can be established within the approval process. Development of the HBS Framework used the six core elements of the built environment with the strongest evidence for impact on health and was informed by analysis of the provincial and local policy contexts, practices of other municipalities and stakeholder interviews. The Framework's contents were refined according to feedback from multidisciplinary stakeholder workshops. OUTCOMES: The HBS Framework identifies minimum standards for built environment core elements that developers need to address in their applications. The Framework was created to be simple and instructive with applicability to a range of development locations and scales, and to various stages of the development approval process. Peel Public Health is leading several initiatives to support the use of the HBS as a part of the development application process. CONCLUSION: The HBS Framework is a tool that public health and planning can use to support the consideration of health impacts within municipalities' land use development processes.

Public health readiness and role in transformation to a community-based primary healthcare system.

Millar et al. provide a high-level vision for transforming primary care into a community-based primary healthcare system, arguing that public health involvement is critical to the success of this transformation. The authors discuss a number of approaches to mitigate challenges to public health's readiness to participate. In this commentary, the author addresses selected points encouraging the avoidance of high-level conceptual language, a focus on specific value-added linkages and addressing the complex range of critical success factors needed to effect this transformation.

Identifying public health competencies relevant to family medicine.

Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from "post-MD" to "enhanced." Feedback from family medicine and public health educator-practitioners regarding the set of proposed "essential" competencies indicated the need for a more limited, feasible set of "priority" areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Toronto's Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying "teachable moments" during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine-public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations-from common to emergent.

Rethinking schools of public health: a strategic alliance model.

Canada is in the midst of rejuvenation of public health organizations, mandates and infrastructure. Major planning exercises are underway regarding public health human resources, where academic institutions have a key role to play. To what extent could schools of public health be part of the solution? Many universities across Canada are considering or in the process of implementing MPH programs (some 17 programs planned and/or underway) and possible schools of public health. However, concerns are raised about critical mass, quality and standards. We encourage innovation and debate about ways to enhance collaborative and structural arrangements for education programs. A school of public health model might emerge from this, but so too might other models. Also, novel types of organizational structure need consideration. One example is a "strategic alliance" model that is broad-based, integrative and adaptive--building on the interdisciplinary focus needed for addressing public health concerns in the 21st century. From our perspective, the central question is: what (new) types of organizational structures and, equally important, collaborative networks will enable Canada to strengthen its public health workforce so that it may better address local and global challenges to public health?

Developing the public health workforce in Canada: a summary of regional workshops on workforce education and training.

The report of the National Advisory Committee on SARS and Public Health recommended the need for a national public health human resource strategy and the need to identify opportunities for improving training. The recent regional workshops reinforced both these recommendations, and the excellent suggestions made by the participants will be utilized by the many work groups that will endeavour to improve public health system infrastructure in this country.