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Introduction to the modules
Ontario Public Health Practioners

Multiple intervention programs can be applied to a range of public health issues. They can run long-term, such as immunization programs, which are mandated by legislation, and continue even when regulations or guidelines change, as they did with the introduction of Ontario’s Public Health Standards in November 2008. Please refer to: Ontario Ministry of Health - Public Health Standards. Or they may be a response to social, environmental or political changes, or arise from new ideas from research or practice. Here are some ways that public health practitioners become aware of issues that might respond to a multiple intervention program:

  • At a community health conference, a women's group suggested immigrant women seem to be at higher risk for breast and cervical cancer.
  • Data from a national health survey showed 18-24 year-olds had the highest overall smoking rates.
  • A community group mentioned a lack of home support for downtown seniors who injured themselves falling down icy stairways.
  • The provincial government promised to improve neonatal care in remote and isolated communities.
  • An outbreak of salmonella was linked by the media to the popularity of ‘raw food diets' among high-school girls trying to lose weight. iStock_000008542224XSmall

Four principles: Ontario Public Health Standards

Public health units in Ontario need to consider the following principles in identifying health issues for Multiple Intervention Programming. Many from other health jurisdictions may also find these principles to be helpful.

1. Need: Public health programs and services must consider the health needs of the local population. Data and information on need should be used to guide decisions at the local level. Need is established by assessing the distribution of determinants of health, health status and incidence of disease. The determinants of health will often inform what interventions are needed most, and influence how public health practitioners run those interventions to meet provincially set outcomes.

2. Impact: Making broad social changes involves action by many parties, including public health. Because comprehensive strategies that operate at multiple levels are likely to have greater impact, public health should co-ordinate and align its programs and services with others in the community. To help assess the impact of public-health programs, boards of health should consider:

    • whether there is reasonable evidence the intervention was effective;
    • whether it was compatible with public health programming;
    • the breadth of a program’s impact on the population;
    • the barriers to achieving health and narrowing inequities;
    • how able planners are to develop measures of effectiveness and impact;
    • unintended consequences of interventions.

    3. Capacity: Effective management requires understanding, and measuring, local public health capacity and resources required to achieve outcomes. Boards of health must assess their capacity (including organizational structures and processes, workforce planning, development and maintenance, information and knowledge systems and financial resources) when they are planning programs and services. Other important considerations are the skill level of staff, the accessibility of information and the cost of achieving the desired outcome.

    4. Partnership and collaboration: Public health planning should promote the ability of the community to improve population health by fostering partnerships and collaboration among community partners. These include voluntary sector, non-governmental organizations and community groups to education, health and social services and other government bodies to the private sector. Building community and citizen engagement will improve local involvement in meeting public health needs.

    Need: How big is the problem?

    According to the 1996/97 National Health Survey, smoking rates were highest among young adults, 35.5 per cent of whom smoked compared to 28.9 per cent of the total population.

    Because little was known about effective anti-tobacco interventions for young adults, planners looked at factors related to their developmental stage. People from 18 to 25 are in transition from adolescence to adulthood. They are likely to start smoking and resistant to attempts to get them to stop. Risk factors — such as the high stress of university and college and joining the work force, moving, changing peer groups and becoming more independent all contribute to the pressure to smoke. The smoking that begins as an adolescent experiment can become entrenched in young adulthood, leading to lifelong addiction.

    Environmental factors were also considered. Exposure to environmental tobacco smoke in university residences, social settings and typical workplaces was highlighted as a particularly significant contributing factor in the lives of young adults.

    Potential impact: How much can we fix it?

    The risks of smoking can be modified. Smoking rates have dropped enormously over recent decades, as public health interventions discouraged smoking uptake and encouraged quitting.

    There is a proven track record of effective public health interventions to prevent drug and alcohol use by this age group.

    Appropriateness: Are we the best people to do it?

    Public health had a clear mandate to address the issue of smoking, including direction from the provincial government to reduce the proportion of daily adult smokers to 15 per cent by 2005. Health units are particularly well-positioned to address the multiple factors that contribute to smoking among this age group. Health education, support for healthy public policy and supportive environments are the framework for public health practice.

    There was a well-resourced program to prevent tobacco use, prevention and cessation initiatives established at the health unit with strong support from all levels of management. Through the work of this program, the health unit knew one local university was planning to work toward smoke-free residences, because it had asked for help on that initiative.

    The health unit had existing partnerships that would give it access to young adults and help establish its credibility.

    Capacity: Are we able to do it?

    At the time there was an interest in exploring how health programs could collaborate to deliver more comprehensive programming, so resources for the project were made available through cross program co-operation.

    The local school of nursing and a university-based research unit helped provide direction and expertise to assist in assessing needs and evaluating the early implementation.

    The health unit staff participated in tobacco-use prevention networks across the province and country and internationally and used them to get information on promising intervention strategies and assessment processes.

    Allies and partners: Who will help us?

    There was a broad range of partners to provide assistance and support, particularly in the university community, where researchers, students, health professionals and residence managers could all contribute. So could community partners, such as the YM-YWCA, and other health professionals working in preventing tobacco use.

    Last Updated on Sunday, 31 May 2009 17:49