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Welcome to HC Link's blog! Our blog will provide you with useful information on healthy community topics, news, and resources, as well as information on HC Link’s events, activities, and resources. Our bloggers include HC Link staff and consultants, as well as our partnering organizations, clients, and experts in the health promotion field.

Please note: opinions in posts are those of the author and are not necessarily the opinions of HC Link or our funder.

We look forward to engaging in thought-provoking conversation with you!

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Fairness in Policy

Last week I had the pleasure of attending the prestigious Hastings Lecture, named for Toronto's first Medical Officer of Health, Dr. Charles Hastings. The event was moderated by the current Medical Officer of Health, Dr. David McKeown, who introduced Sir Michael Marmot as a "health equity rockstar." The title is a fair for the man who is currently Director of the Institute of Health Equity and a Professor in Epidemiology at University College, London, UK. Sir Marmot is best known for his work on the Whitehall II study, as well as leading the World Health Organization's Commission on the Social Determinants of Health. Like the rest of the 350-person crowd I sat captivated, only breaking to laugh at Sir Marmot's well-delivered jokes – or at the panel's comments on local politics.

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Sir Marmot opened with the bold statement that "social injustice is killing on a grand scale." He asserted that a society's success can be judged by the health of its population. Governments, however, tend to focus on only lowest end of the gradient in society, even though health inequality affects all of us. A health system for the poor is a poor health system. Sir Marmot stressed that while inequality exists on a national level, it can also be seen within the same city. In Glasgow, the life expectancy differs by as much as 28 years in different neighbourhoods. In the small town of Lenzie, the average male life expectancy is 82. In the district of Calton, the male life expectancy is only 54 years of age.

To counter this imbalance, Sir Marmot suggested that all ministers operate as ministers of health - as is the practise in Norway, where health performs as a social accountant. Governments should focus on policies which increase the standard of living for all:

  1. Give every child the best start in life.
  2. Enable all children, young people and adults to maximise their capabilities and have control over their lives.
  3. Create fair employment and good work for all. (Marmot shared some disturbing statistics about unemployment and the damaging effects of health – and on economics)
  4. Ensure healthy standard of living for all.
  5. Create and develop healthy and sustainable places and communities.
  6. Strengthen the role and impact of ill health prevention.

Individuals can only be responsible (and be held responsible) when they have the conditions to do so. Fair policies create the necessary conditions. Fairness should sit at the very core of health policies. Ever the evidence-based optimist, Sir Marmot closed his lecture with words of encouragement, "Dream of a world where social justice is taken seriously. Then take the pragmatic steps necessary to achieve it."

Following the inspirational lecture, Sir Marmot was joined in discussion by Dr. Kwame McKenzie and Dr. Charles Pascal. Dr. McKenzie, the director of the Canada Institutes of Health Research Social Aetiology of Mental Illness Training Centre and a senior scientist of Social Equity and Health Research at the Centre for Addiction and Mental Health, used John David Hulchanski's theory of the three Torontos to draw local relevance to Marmots remarks. Dr. Pascal, a professor of Human Development and Applied Psychology at OISE/University of Toronto, bemoaned short term thinking about policy, and advocated for policies with "teeth."

 

Resources:

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Good Ideas for Making Policy Succeed

Last Thursday, I joined roughly 200 policy wonks during a "lunch and learn" event with the Maytree Foundation's Five Good Ideas series. For each session, Maytree invites a different expert to share five practical ideas, and to discuss how these thoughts can be put into action. Sherri Torjman, vice-president of the Caledon Institute, presented the final session in the current series.

Sherri, drawing on her background in poverty eradication and disability issues, shared that the purpose of policy work is to improve the quality of life for all citizens. Policy work aims to effect change, in the public interest. Policy work promotes the inclusion of those who are under-represented in a community.

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Policy development is a critical area for HC Link's clients. Last year, approximately 10% of our consultations concentrated on policy development. Even consultations that do not focus on policy work often have a small policy component.

I was reminded of some of HC Link's recent work as Sherri shared her thoughts. Earlier this year, HC Link worked closely with an elderly-friendly village initiative, which was having difficulty implementing an action plan that was developed several years prior. The village's aim is to improve the quality of life for elderly citizens by providing an inclusive and secure environment that encourages a vibrant and enriching life. HC Link was able to provide training sessions, which addressed motivation of volunteers in the development of community projects, how to recruit volunteers, how to access resources, and how to influence health promotion policies.

Sherri's good ideas hold true not only for policy work, but community work in general, and the principles can (and have been) applied to HC Link initiatives.

1. Trust your knowledge. In this case, our consultant Estelle Duchon's expertise in engaging Francophone communities was extremely valuable in revealing the community leaders' needs.

2. Dream big. Big ideas mean big results. As a partner mused "Crazy ideas are ideas that are destabilizing at first, but end up making a difference. They serve as a trigger in the community."

3. Go the extra mile. Implementing an action plan seemed particularly challenging to the involved committees. In order to ensure progress, they contacted HC Link for assistance.

4. Hold that thought. Timing is essential. Sometimes it's worth waiting for a ripe opportunity. In this case, the community was able to implement an action plan after several training sessions which equipped them with the right knowledge and tools for action.

5. Find your Karasima. Find inspiration in your work. In Sherri's case, it was a comment from Karasima, a women on crutches, which validated Sherri's work. In Noëlville and Verner, it meant understanding that addressing seniors concerns also meant addressing the needs of other vulnerable populations, such as children and people with disabilities.

HC Link has delivered webinars and created educational resources involving policy development. We also have a resource bank with a wide variety of relevant readings.

Selected resources include:

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Webinar Recap: Health Promotion Programming for Older Adults: Mental Health, Gambling, Substance and Alcohol Misuse

By Tamar Meyer, CAMH Resource Centre

Older adults (55 years and older) often experience health inequities and for this reason, have been identified as a target population within the Healthy Communities Fund Grant Program. According to a recent Statistics Canada report1, seniors (identified by Statistics Canada as 65+) are the fastest-growing age group in Canada representing 14% of the overall Canadian population in 2009 and expected to grow to between 23-25% in 2036. Between 2015-2021, and for the first time in the history of the Canadian population, a dramatic shift is expected to occur where the number of people aged 65 years of age and over is expected to surpass the number of children (14 and under). This dramatic acceleration combined with the health inequities that older adults often experience make it imperative to apply a health promotion lens to this “silver tsunami”. 

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On March 28th, the CAMH Resource Centre, in collaboration with HC Link, held a two-hour webinar called: “Health Promotion Programming for Older Adults: Mental Health, Gambling, Substance and Alcohol Misuse”.Carolynne Cooper, social worker with CAMH's Problem Gambling Institute of Ontario’s Counseling Services and Marianne Kobus-Matthews, Senior Health Promotion Consultant, provided an overview mental health promotion concepts, and gambling, substance and alcohol misuse prevention strategies and programming directed towards older adults. Webinar participants and facilitators discussed risk and protective factors impacting the health and well-being of older adults.  The importance of social and emotional support to reduce social isolation, financial security, and senior-friendly environments – that is environments that are accessible, provide a sense of community, recreational activities, and a variety of different health promoting and prevention services and supports – were identified by presenters and webinar participants as key protective factors to promote the health of older people. 

Louise Daw, Healthy Communities Consultant with the Physical Activity Resource Centre (PARC), also joined Marianne and Carolynne to share some information and resources highlighting the intersections between physical activity, and the mental health and older adults.  

To access the PowerPoint slides, click hereTo watch a recording of the webinar, click here.

 

Key documents:


Statistics Canada (2010) Population Projections for Canada, Provinces and Territories: 2009-2036.  Minister of Industry: Ottawa. http://www.statcan.gc.ca/pub/91-520-x/91-520-x2010001-eng.pdf  Accessed March 29, 2012.
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Swimming Upstream: A Mental Health (Promotion!) Strategy for Canada

 By Tamar Meyer, CAMH Resource Centre

 

This week, the Mental Health Commission of Canada (MHCC), chaired by CAMH’s Senior Medical Advisor, Dr. David Goldbloom, released Canada’s first National mental health strategy called Changing Directions, Changing Lives. Released during National Mental Health Week, the Strategy is the first of its kind in Canada.  Did you know that prior to the release of this Strategy, Canada was the only G7 country without a national strategy on mental health?

This 6-pronged strategy makes 106 recommendations that cover not only health care but social determinants of health and issues like affordable housing and the justice system; focuses on health equity by underscoring disparities and diversity; addresses the role of poverty and racism; and highlight priority populations like youth, minority official language communities, older adults, immigrants, refugees, ethnocultural and racialized populations, First Nations, Inuit and Métis and northern and remote populations.

“It is important that, in promoting mental well-being and reducing risk factors for every­one, we do whatever we can to reduce the gap between those who are thriving and those whose mental health is most at risk.” - p. 21

Mental health promotion figures prominently in the report and is highlighted in the forefront as Strategic Direction 1. The Strategy underscores that mental health promotion needs to occur across the lifespan and in a wide range of settings including schools, community organizations and workplaces. Mental health promotion efforts should include raising awareness on how to promote mental health, prevent mental illness and reduce stigma, and is most effective through initiatives that target specific groups and settings. 

Strategic Direction 1: "Promote mental health across the lifespan in homes, schools, and workplaces, and prevent mental illness and suicide wherever possible.” - p.20

Beyond the first Strategic Direction, it is encouraging to see that mental health promotion is interwoven throughout the entire Strategy resulting in recommendations for action that directly correspond to the main determinants of mental health including: social inclusion and connectedness (see recommendations for action 1.4.2, 3.4.1); violence and discrimination (4.5.3., 5.4.3), and access to economic resources (2.2.1., 2.3.1., 3.5.3).

The CAMH Resource Centre is a great source for additional information and resources. It has hosted a series of mental health promotion webinars to better equip health promotion and public health audiences in Ontario.  These webinars include: 

- Introduction to promoting positive mental health  (slides, resources)

- Mental health promotion in action: reflections from Northern Ontario (slides, recording)

- Introduction à la promotion de la santé mentale positive (slides)

- Promoting positive mental health for immigrants and refugees (slides)

- Promoting mental health in public health (slides, recording)

- Health promotion programming for older adults: mental health, gambling, substance and alcohol misuse (slides, recording)

In addition, there are a number of different mental health promotion tools and resources.  Please visit the mental health promotion resources section of HC Link for more information. 

 

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Austerity and Innovation

 

I just returned from an exciting lunch event at MaRS in downtown Toronto (where incidentally, I had what were quite possibly the best cookies I’ve ever had in my life) that I thought might be of interest to HC Link’s clients. The speaker was Geoff Mulgan, Chief Executive from the National Endowment for Science Technology and the Arts (NESTA) in the U.K. Geoff began his talk with a picture of a painting depicting a beautiful  1800s British wooden sailing ship being towed by a less-than-beautiful tugboat to the shore, where it would be destroyed. Innovation, says Geoff, can be painful as we make way for the new.  But innovation can yield exciting results, particularly in frugal times. Two examples of ‘frugal innovation’ that he used were the Aakash (a $60 tablet computer made in India) and www.couchsurfing.org. Then Geoff challenged us to think: what are the public sector equivalents? How can we mobilize the creativity often seen in the private sector and by imaginative entrepreneurs in the fields in which we work?


In the private sector, 10-15% of budgets are devoted to research and development to foster innovation and new ideas. In the sectors that we – in healthy communities and health promotion – work in, we see far less (if any). To illustrate the effect of this, Geoff showed a graph (which I was not able to find on the internet, so use your imagination) that showed a correlation between health care spending and mortality over time. The more you spend, the more people die. Though slightly tongue-in-cheek, Geoff used this example to show what can happen when we use the same old techniques to cope with ever-changing and complex situations withoutUntitled innovating.
All over the world, countries, governments, organizations and businesses are facing massive cuts in spending/funding. Those of   you working in local communities are no strangers to this reality. But we can – as others have- use this as an opportunity to do things differently. To innovate. And see what happens.


Here are some examples. In Sutton, England the public library faced massive cuts and could no longer purchase new inventory. The solution: Sutton Bookshare – where people list the books on their own bookshelves via the library website that people can pop over and borrow. Now, using the existing infrastructure of the library’s borrowing system, not only has the library solved their problem, but the solution fosters a sense of community. Another example is Big Society Capital – a new bank that lends money to those creating socially innovative projects. The new bank is funded by the millions of pounds sitting in unclaimed bank accounts. Couch Surfing, and similar concepts for car-sharing in Europe also solve the problem of needing a place to stay or a car to drive, but not having the money for a hotel/car rental.


My brain is still spinning from the session. But I think the one take-away for me (other than the cookies!) is that - when you take the ‘problem’ of funding cuts (or the resulting cuts in service due to funding cuts) to the community, the solution can often be found. Many of you are doing just that in your community work – and are finding innovative, community-based solutions that are working for you. I invite you to share those ideas using the comment box below – let’s start a conversation about innovation!

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