Skip to content

Increase font size Decrease font size Default font size default color orange color green color
You are here: Home Modules Module 3: Optimize Potential Impact Context - Features of Outer Context
Context - Features of Outer Context Print E-mail
Module 3: Optimize Potential Impact
Article Index
Inner Context
Outer Context
How do complex interventions interact
Examples of context and change
Features of Inner Context
Features of Outer Context
All Pages

Features of outer context

Examples of outer context for public health in Ontario that led to the renewal of public health guidelines

1. Inter-organizational networks & collaboration

  • Three ministries were directly involved in the review and renewal: Health and Long-Term Care, Children and Youth Services and Health Promotion (Nosal & Turner, 2007).
  • Other ministries, including Environment, Transportation and the Aboriginal Affairs Secretariat, were consulted to ensure information exchange  (Nosal & Turner, 2007).

2. Socio-political climate

The socio-political climate was conducive to the changes

Policy issues and priorities

  • Public Health Agency of Canada established in 2005.
  • Escalating health care costs (Nosal & Turner, 2007).
  • A three-year plan, Operation Health Protection, was launched by the Ministry of Health in 2004 to prevent threats to health and promote a healthy Ontario; part of it was to review the public health guidelines.
  • In April 2007 the Ontario Ministry of Health and Long Term Care officially changed its mandate and mission to that of stewardship (Nosal & Turner, 2007).
  • The Ontario Health Protection and Promotion Agency was established in January 2008 (MOHLTC, 2008b).

Influential policy documents
Several policy documents describe the need for strengthening public health capacity:

  • 1994 Lac Tremblant Declaration - need for national strategy to address resurgence of infectious disease (Public Health Agency of Canada, 2007).
  • 1998 Krever Report - response to blood system (Health Canada, 2002a).
  • 2002 Romanow Commission - need for national immunization strategy and commitment to prevention programs (Health Canada, 2002a).
  • 2002 Kirby Report - call for federal government to address PH infrastructure issues (Health Canada, 2002b).
  • 2004 Campbell Report - response to SARS outbreak (Public Health Ontario, 2004).


  • In 2006, the Local Health System Integration Act established 14 Local Health Integration Networks.
  • After the SARS outbreak, there were calls to overhaul the Health Protection & Promotion Act.

3. Prevailing norms

The media has set the stage for needed changes in public health. There is widespread support for an evidence-based approach and accountability in government programming.

  • Public health issues,  including the 9/11 bombings, Walkerton and SARS draw intense media attention.
  • Demand is growing for evidence-based health care standards linked to specific performance measures for increased accountability (Nosal & Turner, 2007).

4. External incentives & mandates

There were external incentives and mandates that contributed to the need for and development of new standards for public health practice.

  • 14 local health integration networks were created, with responsibility for public health services
  • The Ministry of Health’s 10 year vision for stewardship, released in April 2007 required public health to bring its strategic vision, legislation, regulations, policies, standards, monitoring and reporting and funding models into line
  • Renewal of the guidelines was to complement government priorities including the health integration networks, primary care and family health teams, Smoke-Free Ontario and the Healthy Eating and Active Living Strategy

The chart shows that many contextual factors contributed to the need for a renewal of the public health guidelines. Responding to context has helped the renewal be successful and will continue to guide Ontario Public Health in establishing standards.

Go to the Module 3 Activity for help with planning to optimize the impact of your intervention as well as your own activity sheets, you will also find a detailed example of how one group filled in activites 3B and 3C, to give you ideas.

Last Updated on Wednesday, 16 September 2009 18:30