ARCHIVED - Integrated Strategy on Healthy Living and Chronic Diseases - Healthy Living Program Component

Introduction and Context

1.1 Program Description

The Healthy Living Program (HLP) is part of the Government of Canada’s contribution to the Integrated Pan-Canadian Healthy Living Strategy, an inter-sectoral framework for sustained collaborative action to reduce non-communicable disease in Canada. The Program is part of the Integrated Strategy on Healthy Living and Chronic Disease (ISHCD), the federal framework for public health activities, in keeping with the federal role, across the spectrum of health and chronic-disease and through disease-specific strategies on diabetes, cancer and cardiovascular disease.^{Footnote 1} As part of the ISHLCD, the HLP spans the six core public health functions, including:

1. surveillance;
2. knowledge development, exchange and dissemination;
3. community-based programming and community capacity-building;
4. public information;
5. leadership, coordination and strategic policy development; and
6. monitoring and evaluation.

The Healthy Living Program is guided by the following Vision, Mission and Goal:

Vision

A healthy nation in which Canadians experience the conditions that support the attainment of good health, through regular physical activity, healthy eating and maintenance of healthy weights.

Mission

To improve health outcomes and reduce health disparities among Canadians.

Overarching Program Goal

To lead, foster and support action to address the conditions that support healthy eating, physical activity and healthy weights for all Canadians and with a specific focus on sub-populations experiencing health disparities, such as: children and youth; those in isolated, remote and rural areas; and Aboriginal communities.

The operating principles of the Healthy Living Program are depicted as follows:

• the Program will apply and promote integrated health promotion strategies, with a focus on addressing health disparities;
• activities will seek to optimize stakeholder engagement and shared ownership for outcomes;
• priority will be given to activities and investments that support and advance integrated action, including partnerships, networking and capacity-building;
• within the health portfolio, work will be carried out using a matrix management model to optimize integration and partnership in the context of shared responsibility. Partners will be engaged through new and existing collaborative fora; and
• investments will favour activities that are evidence- and best-practice based, clearly rooted in the population health approach and that have national, regional and/or community application;
• communication of knowledge and progress will be an integral element of all Program Components and projects;
• the Program will be adaptive, changing in response to new evidence, emerging priorities and opportunities, and evaluation results;
• activities and investments will focus on areas of greatest impact for achieving goals and objectives;
• supported activities will be subject to competitive processes (where applicable), rigorous assessment and ongoing review; and
• the Program in its entirety will be managed in a way that promotes accountability, transparency and good governance.

Program objectives are:

• to engage and support relevant, inter-sectoral, government and non-government stakeholders to work in an integrated manner to align and advance healthy living across the country;
• to increase the base of healthy living knowledge that will be applied by stakeholders as evidence to support decisions, policies, and program development;
• to provide information to Canadians to help them make informed decisions about healthy living;
• to facilitate the development and enhancement of community capacity through implementation of healthy living policies and programs; and
• to contribute and learn from the advancement of healthy living policy at the international level.

The Healthy Living Program seeks to maximize its impact by:

• engaging key non-governmental stakeholders through formal and informal Program mechanisms to champion and facilitate Intersectoral collaboration;
• engaging federal partners within and outside the health portfolio to foster healthy public policy across the federal system;
• working through Federal-Provincial-Territorial and Intersectoral fora to promote concerted action and align program efforts with those underway in other Canadian jurisdictions; and
• working through international fora, including those in place to advance the Global Strategy on Diet, Physical Activity and Health, to maximize uptake of best practices in the Canadian context and foster knowledge exchange.

1.2 Program Components

The Healthy Living Program is composed of the following four core components: the Healthy Living Fund (HLF); the Intersectoral Healthy Living Network (IHLN); Knowledge Development and Exchange (KD&E); and Social Marketing.

The following section describes each of the four components. The associated logic models are contained in Annex A.

1.2.1 Healthy Living Fund

The Healthy Living Fund  (HLF) (national and regional stream) is a federal contribution program to address effective, sustainable actions at all levels that promote healthy living and provide supportive social and physical environments for health. The key activities associated with the HLF cover three major areas:

• provision of funding to national and regional/community level projects;
• engagement of national/regional stakeholders and provincial/territorial governments; and
• analysis, synthesis and dissemination of research, evaluation results and lessons learned.

The national stream uses contribution agreements with national organizations on national projects to create the knowledge, skills, tools and resources needed to help communities, organizations and individuals act to improve their health. A solicitation guide was developed and an open call for proposals was carried out. Fifty funding submissions were received for consideration. A review panel was established with PHAC representatives as well as evaluators from the sector. Twelve projects were recommended for funding and submitted within the PHAC approval process for approval by the Minister. Given a legacy issue with one of the organizations requesting funding, 11 of the 12 projects were ultimately approved for funding. Funding of $4.359 million over 18 months, was announced in September 2007.

Funding recipients are required to complete the standardized PHAC Project Evaluation and Reporting Tool (PERT). The PERT is a form that has been developed to monitor and document the effectiveness of all participating PHAC programs, and to assess the impact these community-based programs are making on the health of Canadians and Canadian communities. PERT enables all programs to collect the same categories of information, using the same methods.  The information gathered by the PERT is used to measure and assess the implementation, impact, and effectiveness of PHAC-funded programs. Project staff received training on PERT and program staff review PERT questionnaires from the funding recipients for accuracy. The PERT is comprised of the following sections:

• Monitoring;
• Resources and Sustainability (Financial, Human, and Other);
• Partnerships;
• Target Population Involvement;
• Education/Awareness/Outreach Activities;
• Training For Paid Staff and Volunteers;
• Media Coverage;
• Action On Policy;
• Project Outcomes;
• Evaluation Reporting and Dissemination; and
• PHAC Project Support.

Through the regional stream of the HLF, PHAC created a bilateral agreement process that focused on joint priorities and matched funding by P/Ts for physical activity and healthy eating projects. PHAC program personnel and P/T representatives established individual Bilateral Agreements to meet their objectives. The level of sign-off at the P/T level varied. All Bilateral Agreements have recently been signed and projects are being initiated. A joint coordinating committee was established with participants from both levels of government to administer  the agreements and oversee the implementation and reporting.  The regional stream will also be using PERT for project monitoring and reporting.

1.2.2 Intersectoral Healthy Living Network

The Intersectoral Healthy Living Network (IHLN) is a virtual pan-Canadian network dedicated to fostering partnerships and improving collaboration and information exchange among sectors and across jurisdictions in support of healthy living. The Network brings together a number of existing virtual networks, acting as a central mechanism to facilitate communication among members in order to advance the vision and goals of the Integrated Pan-Canadian Healthy Living Strategy. The objectives of the IHLN are implemented through the Health Living Issue Group (HLIG).

1.2.3 Social Marketing

The Healthy Living Social Marketing efforts, managed by the PHAC Communications Directorate, seek to foster positive societal behaviour change through the aligned efforts of a federal social marketing and public education campaign and a pan-Canadian communication strategy. Budget 2005 allocated $14 million over five years and $3 million ongoing for social marketing activities.

1.2.4 Knowledge Development and Exchange

The Knowledge Development and Exchange (KD&E) component is a central health promotion function that creates a platform for evidence-based action on healthy living. It bridges the continuum from creating and collecting knowledge to making informed policy and program decisions. Knowledge development combines evidence from a variety of sources, including surveillance, scientific studies, the PERT, opinion and policy research to derive options and solutions to guide public health decision-making by individuals, organizations and governments. Knowledge exchange seeks to bring experts and end-users together to share information about needs, gaps, priorities and products.

The KD&E function of the Healthy Living Program focuses on informing policy and program decision-making through knowledge capacity development, new knowledge development, knowledge synthesis, and ongoing national and international dissemination and exchange. The KD&E functions rely on statistical and research skills, as well as knowledge of key data sets and players in the field, including academia, NGOs and other levels of government, both domestic and international.

1.3 Program Resources

The following table includes a breakdown of the planned resources for the Healthy Living Program. The table is broken down by the four components and shown with the categories of human resources i.e., full-time equivalents (FTEs), Operations and Maintenance (O&M) and Grants and Contributions (G&Cs) budgets.

The following financial figures have been provided to the evaluators summarizing actual expenditures as of January 23, 2009. Detailed analysis was not undertaken due to time constraints. However, the table indicates significant variances from the planned resources figures outlined above.

1.4 Structure of the Report

The remainder of this report is divided into four sections:

• Section 2 - Methodology/Design – describes how the evaluation framework was developed and outlines the objectives, issues, limitations and methodologies.
• Section 3 - Findings – provides the analysis and conclusions regarding program relevance, the success of the Program in terms of outputs and outcomes, the design and delivery effectiveness of the Program and assessment and usage of lessons learned.
• Section 4 - Conclusions – provides the overall conclusions.
• Section 5 - Recommendations – outlines overall and component specific recommendations.

It should be noted that the findings information, contained in section 3, are sequenced and presented according to the evaluation framework. As such, the evaluation question is introduced and then the related findings are presented across the four components. For efficiency, this format has been adopted for all evaluation questions.

The Annexes contain the following information

• Annex A - Logic Models (for the program overall and each of its components);
• Annex B - Evaluation Framework;
• Annex C - Documents List;
• Annex D - Interview Guides