ARCHIVED - Population Health Fund Evaluation 2008 Final Report



Case Studies

Enhancing Project L.I.N.K. for Health
Public Health Agency of Canada, Alberta/NWT region

Projects funded in the Alberta/NWT region in 2002-2004 were asked to support an integrated approach to address physical activity/active living and nutrition, and their underlying determinants of health, for school-aged children and youth in their home, school, and/or community environments. The ultimate goal was to support projects that would contribute to the reduction of the burden of chronic disease.

Project L.I.N.K. for Health aligned with these funding goals and strategic directions, and in addition to that, it used a culturally sensitive approach to address nutritional needs of students and families through education and school policy. Project L.I.N.K. was initiated by the Holy Family Catholic Regional Division in two schools, St. Andrew's School in High Prairie and Good Shepherd School in Peace River. These two communities, located in Northern Alberta, have a significant Métis population, and an aboriginal population that is approximately two times than Alberta as a whole (Peace River) and four times than Alberta’s population (High Prairie). Thus, the need to take a culturally appropriate approach was paramount.

Evidence for the project came from a needs assessment conducted with students in Grades 7 through 12 in 2000 in the Peace Country Health Region. Findings from these needs assessment included:

  • Most adolescents consume less than one glass of milk per day, and consume about one can of pop per day.
  • Only 19% of males and 24% of females eat vegetables more than once per day.

    Project activities directed at teachers included providing in-services to teachers. These in-services addressed broader topics than nutrition and physical activity and included such topics as the stages of change and body image. A Healthy Messages campaign was designed by students, whereby radio and newspaper articles targeting community members to make healthy decisions with respect to the risk factors for chronic disease (nutrition, physical activity and tobacco). Events for families were held at both schools, monthly cooking classes were held at once school, and seasonal nutrition newsletters and calendars were distributed.

This project was successful for a number of reasons. Student leadership was strongly encouraged, and focus groups held at schools gave the students the opportunity to express their views. The project resulted in some unique linkages and partnerships, such as a linkage with the Catholic Church, and partnerships with Ever Active Schools and Schools Come Alive, organizations which provide Alberta school teachers and administrators with the resources and leadership necessary to promote positive physical and social environments in schools and increase physical activity opportunities in schools. The formation of a Steering Committee, with participation from employees from the health region, provided direction and information exchange. The goals of the project were consistent with Peace Country Health Region’s strategic planning, as well as the Alberta Learning curriculum. Communication seminars were held on a monthly basis with staff, to increase teachers’ understanding of the determinants of health and inequities, as well as the barriers to participation in nutrition and physical activity. Overall, the school division was very supportive in providing staff support, meeting space, and time for activity planning. Finally, the project coordinator was a registered dietitian, with a keen understanding of nutrition policy, the determinants of health, and comprehensive school health.

Halfway through the project funding, the project expanded to include all 8 schools in the school division. After PHAC funding terminated, the Holy Family Catholic School Division took over the initiative.

The biggest success of the project was the development of a nutrition policy for all schools in the division. Schools were given two years to phase the guidelines outlined in this policy. Since the program was implemented, soft drinks and sweetened beverages in school vending machines have been replaced with water, milk and 100 per cent fruit juices. Cafeteria and canteens now serve food that follow the Canada Food Guide. Teachers have reported improved behaviour and academic performance among students. Project LINK continues to publish information and tips to support healthy lifestyle choices in local newspapers, and to display nutrition and health information on permanent bulletin boards within the schools. These changes were supported by fundraising events and donations from community members. Bi-Monthly meetings are held for health representatives from all the schools in the divisions, where new project ideas are generated. For instance, every month, there is a new vegetable and fruit theme that is reflected in the meals served in the cafeterias.

Project L.I.N.K. is still running to this day; a new dietitian was recently started and project activities will resume in October 2008. One of the schools affiliated with Project L.I.N.K. (Rosary School) was awarded an a”Extreme School Makeover: Nutrition Edition” award by Alberta Milk in 2006.

An interview conducted with Jim Taplin, a school administrator with the Holy Family Catholic School Division, in October 2008. He said that Project L.I.N.K. has lead to the development of new projects, such as a mental health capacity building project. He said that the project lead to other changes in the school environment, such as administrators’ meetings serving fruit rather than coffee and donuts. Initially, there had been some revolt at the changes to the school nutrition policies, but now “It’s part of our daily living,” according to Jim Taplin. He said that unhealthy vending machines look out of place when school staff visit other school divisions. Most of their vendors were able to comply with their nutrition policies, and the school principal who voiced his displeasure the loudest at the onset of the project recently rejected a company’s offer to provide cookie dough for a school fundraiser, as it no longer fit with their healthy school environment. “It’s kind of nice when the Department [Alberta Education] comes out with these guidelines, and we’ve already been doing these things for years,” said Jim.

The mandate of the Chebucto Communities Development Association (CCDA) is to encourage residents of Spryfield to work together to address common community issues, to facilitate participation of marginalized groups and to facilitate community partnerships. The CCDA is located in an area of Halifax that has a significant number of single parent families, individuals and families living in poverty, new immigrants, racial minorities, and large tracts of public housing.

Residents of Spryfield have been concerned for some time about proposals for new housing developments in their community. They felt that the plans would affect their quality of life, the accessibility of affordable housing, and would have a significant environmental impact.

The Healthy Housing, Healthy Community project operates in an urban area with significant variation in income levels and housing choices, and has a significant percentage of low income families, a high crime rate and many transient residents. This project seeks to identify and take action on those Social Determinants of Health that contribute to the health of the community, specifically focusing on determinants such as social cohesion and support, housing availability and access to healthy food. Considering the unique partnerships that have been developed (Halifax Regional Municipality, Chebucto West Community Health Board, Spryfield Residents’ Association, Community Action on Homelessness, Dalhousie University), the potential for additional action is greatly increased. Successful use of the tools and knowledge developed will encourage additional action, as well as activity in other communities and neighbourhoods.

This project has developed a very detailed template identifying Attributes (sociability, nature and resources, access and linkage, etc), Characteristics (way finding, pedestrian activity, walkability, diverse families, mix of densities, local food, etc), and Indicators (noise levels, volunteerism, mixture of housing types, population age structure, etc) for a healthy community, as well as a Healthy Places Toolkit and a comprehensive Healthy Development Evaluation Framework for use by municipal planners, developers, public health officials and citizens to assist in designing and developing healthy communities and healthy housing projects. This tool has been designed with extensive input from community members, city planners, public health officials and private developers, and provides very specific action possibilities for improvement. The interaction of these various partners has also generated considerable learning for all involved. The tools and template developed are generic in nature and can be easily used by any size community or neighbourhood to assess and identify specific action areas for improving the health of the community. They, and the knowledge developed, are easily used and reproduced, resulting in easy access and usability for communities.

The process and tools developed have been adopted by the Halifax Regional Municipality as part of an extensive planning process to set a development framework for the next 20 years in the Municipality. As a result of Spryfield being selected as one of three areas of the Halifax Regional Municipality to undergo an extensive visioning process, an opportunity now exists to provide in-depth use of these tools and to transfer the knowledge gained through the project. The tool is also being shared with municipalities across Nova Scotia and has been presented to international audiences at the 2008 Canadian Public Health Association Conference, held in Halifax in June. Public Health officials in the Capital Health District have been involved in the development of the tools and will use the material in their planning process.

Atatittiniq-Making the links between Inuktitut Language Acquisition & Literacy”
Public Health Agency of Canada, Northern Region

1. Strategic Context

In 2005 the then Northern Secretariat (now Northern Region)’s Nunavut Office sent out a call for PHF proposals. Included in the solicitation letter was the following:
The key determinants that the project addresses are Literacy, Education, Healthy Child Development and Culture. The project addressed the above determinants with a scan of literacy practices in a selection of Inuit communities, compiled best practices, developed recommendations and involved partners throughout the process increasing capacity.

“The goal of the Population Health Fund is to increase community capacity for action on or across the determinants of health.

Objectives of the Population Health Fund are to:

  • develop, implement, evaluate and disseminate community-based models for applying the population health approach;
  • increase the knowledge base for program and policy development on population health;
  • increase partnerships and develop intersectoral collaboration to address specific determinants of health, or combinations of determinants.”

Description of the Project(s)

Literacy influences health in a number of different ways-both directly and indirectly. An individual’s ability to read and understand health information will have a direct impact on his or her health. While many people see the direct links, they often overlook the indirect, yet significant impact that literacy has health. The indirect impacts include the impact of literacy levels on socio-economic status, employment, involvement in the criminal justice system, and preventative health practices.

First language and literacy development are clearly linked to many of the determinants of health including education, healthy child development and culture.


Literacy levels are a key factor influencing population health. Literacy and socio-economic status are strongly linked. Low literacy levels often mean that an individual will either be underemployed or unemployed. Low literacy levels also undermine the health of families in a cycle that continues on from the parents through to their children. These children often perform poorly in school, are less likely to graduate, are more likely later on to become involved in the criminal justice system and to get involved in risky behavior that can affect their health directly.

Healthy Child Development:
Home language use and literacy practice and the ability of parents to support their children’s schooling are significant factors in determining a child’s success. Self-esteem and well-being are also influenced by language.


Language provides a window into cultural beliefs and practices.

The first objective of the project is to increase the knowledge base of the links between language acquisition and literacy development for program and policy development of the NLC, other groups and organizations, and Government of Nunavut departments. Activities included reviewing available literature, community scans, consulting with Elders and language specialists.

The second objective is to use the research to change public attitudes by increasing awareness of the importance of developing strong first language and literacy skills and its impact on children’s school readiness and their ability to succeed. Activities included developing a communication strategy, dissemination of produced reports, face to face meetings and teleconferences.

Interview questions were developed and communities were selected in which studies were carried out. Interviewee’s in the project were based on their suitability as ‘language role models’. A language role model is ‘a parent of any age who works to strengthen their own Inuit language skills and also encourages and assists other people in their community to do the same. A language role model might be someone who works to strengthen language informally and doesn’t necessarily get formal recognition for this work’. A total of 20 language role models – 5 in each of the communities of Cambridge Bay, Taloyoak, Whale Cove and Rankin Inlet participated in the interviews. Information gathered from the interviews was supplemented by interviews with 3Nunavut Literacy Council board members and radio shows hosted in Inuktitut by two NLC staff members. Five call in radio shows took place – one territory wide show as well as one in each community where language role models were interviewed.

A comprehensive evaluation report has compiled results of the project to date. The expected results of the project are that it will increase the capacity of communities to develop solutions to promote increased literacy levels and indirectly positively affecting other related social issues.

targeted clients Children, Parents and caregivers, Literacy & language providers, early childhood educators, adult educators, librarians, community health representatives.

partnership(s) involved in implementation Department of Culture, Language, Elders & Youth; Baffin Regional Agvvik Society; Pulaarvik Kablu Friendship Centre; Department of Health and Social Services; Department of Education; Qikiqtani Inuit Association.

resources other than the PHF funding that were committed to the project(s) The Department of Culture, Language and Youth contributed financially. Efforts were also combined where appropriate with another similar project by the NLC funded by Social Development Canada’s funding called “Strengthening our Communities” to produce more rigorous reports. “Strengthening our Communities” examined best practices in literacy and language acquisition from other jurisdictions.

3. Legacy of the Project(s)

Evaluation of the project to date has indicated that it’s efforts have been well received by all involved from the communities and partners. Many requests have been made of the organization to continue and expand on the projects efforts.

Several recommendations and strategies have been made with the NLC’s partners and government contacts on the importance and how to retain and build Inuit literacy. This body of knowledge will be shared further with policy makers, researchers, and literacy practitioners in the fall of 2008 at face to face meetings. NLC has increased its capacity to work with new partners in Nunavut in the community and with governments.

This project will be funded by the PHF until March 31, 2009. The Office of Literacy and Essential Skills, Department of Human Resources and Skills Development (HRSD) has indicated some interest in working with the NLC in this area next fiscal.

“Garderie bio : manger et grandir” (The organic child care centre: eating and growing), Public Health Agency of Canada - Quebec Region

  • Project still active in 2008, more than 4 years beyond the original project term (demonstrates the durability of the initiative)
  • Partners (health expertise): Institut national de santé publique, Direction de santé publique de Montréal-Centre

The goal of the project was to supply child care centres with organic, locally-grown foods and to sensitize children, parents and workers to the link between agriculture and children’s health. The project addressed the three objectives of the PHF through action on the determinants of health, intersectoral action, and changes in the internal policies of child care centres with respect to nutrition. The project is also consonant with regional priorities that focus on the development of healthy and sustainable communities.

Short-term results: Through the “Garderie bio” project, Équiterre was able to establish a network linking organic farms, child care centres and citizens in ways that address their respective health, environmental and economic needs. One year after the launch of Garderie Bio : manger et grandir, five child care centres in Montreal and its environs had become drop-off points, as well as providers of information on the relative cost of operating a child care centre on an organic nutrition basis. Most of the children who receive organic foods in these centres are from poor or middle-class backgrounds. This change in their diet creates better health conditions. Specifically, in terms of changes in individual behaviours and attitudes, over 70% of respondents (123) to a survey conducted by Équiterre stated that they had increased their consumption of organic foods, and 57% (70 participants) viewed the project as the primary factor behind this increase. In addition, 10-18% of educators and parents indicated that they now had a greater awareness of and ability to identify organic products.

Medium-term results: Two years later, that is by fall 2007, the number of centres involved in the initiative had risen from five (short-term result) to 55 (medium-term result). It is estimated that an average of 77 children attend each of these centres, bringing to 4,235 the number of children who eat organic foods every day. Additionally, 33% of these child care centres serve as contact points between the farms and neighbourhood residents, enabling parents, employees, as well as residents not involved with the centres to access organic foods. A total of 33 organic farms (providing fruits, vegetables and meat) are associated with 55 “organic child care centres,” thus providing support for and enhancing the sustainability of local agriculture. Furthermore, this project has led to other initiatives in participating centres, including farm visits during which children learn where their food comes from, and gardening and planting sessions using special teaching tools designed to develop children’s interest in these activities. Finally, four child care centres initiated activities involving 91 neighbourhood residents; these activities included managing food basket lists at drop-off points, planting trees, tending to plants, composting and fundraising. In spring 2007, six of the 11 organic farms that had partnered Équiterre for over two years were interviewed by telephone and revealed that their association with the organic child care centres had enabled them to create six jobs (including four full-time positions) and increase their revenues by $72,600 a year (an average of $12,100 per participating farm). Two of the farms were also able to increase the amount of land dedicated to organic crops, with a two-fold increase in one instance (from 2,000 to 4,000 m2) and a 400-fold increase in the other (from 100 to 40,000 m2). “A Portrait of the Food Industry Relating to Residents of the Lower North Shore” Public Health Agency of Canada - Quebec Region

  • Funded by the PHF in 2005 and 2008 for a total PHF contribution of $428,353
  • Partner funding: $131,077 (in-kind contributions)

The goals were to improve the level of knowledge regarding the various components involved in a healthy diet, and to develop solutions to overcome structural problems (cost, transportation, local production) in the provision of quality foods contributing towards a healthier food diet.

To improve the level of knowledge regarding the various components involved in a healthy diet:

  • Create awareness of the cost and benefits of a healthy versus a less-healthy food basket on the Lower North Shore;
  • Create awareness with the businesses, transporters, consumers and partners on the high cost of food transportation to the Lower North Shore;
  • Create awareness on the benefits and the importance of healthy eating.

To develop solutions to overcome structural problems (cost, transportation, local production) in the provision of quality foods contributing towards a healthier food diet.

This project addressed the three objectives of the PHF through action on the determinants of health, intersectoral action, and changes in public policy with respect to nutrition, which includes promoting physical and economic access to fresh produce. The project also addresses regional priorities that focus on the development of healthy and sustainable communities through the three relevant components: the environment, the health and social component, and the economic component.


Establish a profile of the food industry along the Lower North Shore

  • Assessment of needs for consumers and food suppliers through surveys with food retailers (89% participation) and consumers (20% participation)
  • Update of comparative food basket information through a study in five Municipalities on the Lower North Shore, and compared with one in the Québec City region
  • Research supply chain for food delivery to the region, with research data presented to a transportation consultation with stakeholders organized as part of the project.

Explore different avenues to supply healthy food

  • Community kitchens – five were established
  • Community gardens – five were established
  • Implemented nutrition courses and cooking classes in three secondary high schools, at four community kitchens, along with two nutrition contests

Development (long-term)

  • Project submissions and a business plan were developed for local food-related businesses (greenhouse, Wildberry harvesting and processing)
  • Numerous partnerships were established for the duration of the project as well as having partners assume responsibility for on-going (post-project) activities

Partnership : The project was carried out in partnership with a number of other regional and external organizations, including the Centre de santé et des services sociaux de la Basse-Côte-Nord, Commission Scolaire du Littoral, Council of Mayors, Québec-Labrador Foundation, and the Local Development Center (CLD). Since the beginning of the project, numerous other partners have become engaged such as the Coopérative de développement regional du Bas-Saint-Laurent/Côte-Nord (CDR), Société d’aide au développement des collectivités de la Côte-Nord (SADC), Institut de technologie agroalimentaire de la Pocatière, and the Food Mail Program, Indian & Northern Affairs. Many of these partners attended the Forum of Partners in March 2007 to contribute to a long-term Action Plan for continuing the work on developing and maintaining healthy lifestyles along the Coast.

Action on health determinants

The issue of a healthy diet crosses over a number of the primary health determinants that have an impact on an individual’s well-being. The project addressed, in the first instance, the following health determinants within its activities:

  • Education – a significant portion of the project’s activities transferred information and knowledge to the general population and to targeted sub-groups;
  • Personal Health Practices & Coping Skills – a segment of the project activities emphasized the demonstration of ‘best practices’ for eating and the acquisition of skills that enhance the individual’s capacity to follow a healthier diet;
  • Healthy Child Development – a significant portion of activities were carried out through the schools with the direct participation of children in a learning framework;
  • Physical Environment: planning to develop local food-related businesses (greenhouse, Wildberry harvesting and processing)
  • Economy/Revenue: to meet the food needs of low income at a lower price (action on food security).

The project has also touched upon, in the second instance, the following health determinants:

  • Social Support Networks – the establishment of community-based and collective activities has contributed towards the enhancement of social support networks regarding nutrition and healthier eating habits;
  • Social Environment – the project’s activities have added a new dimension of social participation related to food and nutrition that was not previously present in all communities;
  • Culture – the project engaged the different constituencies of the community and attempted to change cultural behaviour that, at the start of the project, was too accepting of a less healthy lifestyle with regard to food, and less willing to seek out the necessary capacity (information, change in attitudes) to challenge the various aspects of the problem that required change.

Post-project activities

A number of the activities initiated through the project have continued past the termination date of the project (March 2008):

  • Community kitchens;
  • Community gardens;
  • Nutrition and cooking courses will be offered to the adult and high school populations.
  • Continued development of local food resources (Wildberry sector);
  • Continued development of at least one new business in the food supply sector (greenhouse in Gros Mecatina);
  • Sourcing adequate funding to maintain a continual education, awareness and participation campaign on leading a healthy lifestyle (Québec en forme).

Continued involvement

A number of the partners involved in the project have indicated that they will continue to work with the Coasters Association to support on-going activities:

  • Centre de santé et des services sociaux de la Basse-Côte-Nord: Services of the nutritionist for community kitchens and school activities (Quebec en forme project);
  • Commission scolaire du Littoral: School-based activities (cooking courses, contests) – (Quebec en forme project);
  • ITA La Pocatiere: Wildberry project;
  • Council of Mayors: Funding for community gardens;
  • Local businesses: Funding for community kitchens and gardens.

“We Can Act”: A Health Promotion Strategy for Quebec’s English-speaking Communities. Public Health Agency of Canada- National Project


“We Can Act: A Health Promotion Strategy for English-speaking Communities” is a project of the Community Health and Social Services Network (CHSSN), a network of community organizations, public institutions and other stakeholders promoting projects and partnerships to improve the health status of English-speaking communities. “We Can Act” has been supported by the Population Health Fund since 2004.

The project reflects the goals of the Population Health Fund. “We Can Act” increases community capacity to take action on determinants of health by mapping health determinants and mobilizing communities to participate as fully recognized stakeholders in Quebec’s health and social services system. “We Can Act” is creating new knowledge on the health status of English-speaking communities that is influencing the actions of service providers and policy makers that aim to adapt services to meet newly identified community needs. “We Can Act” has contributed to the development of a successful population health model of formal partnerships between community networks and the public system.

“We Can Act” is multi-level initiative securely anchored in the blueprint to promote a population health approach in Canada. Its strategic goal is to address health status inequalities and increase the participation of English-speaking communities in the new context of Quebec’s health and social services system. This new context promotes a population-based approach to providing services by engaging multiple partners. “We Can Act” brings target English-speaking communities directly into the development of population health models in the newly created local services networks. The result is a strengthening of collaboration within communities and with planning authorities and service providers.

In 2007-2008, “We Can Act” implemented a three point health promotion strategy. A mobilization strategy built the foundation for multi-level community-public partnerships in the context of Quebec’s 10 year Public Health Plan. Strategies for joint action were developed within this new strategic framework. A community capacity building strategy focused on the community’s ability to elaborate health promotion approaches through communication, education and sharing of tools with other language minority communities A strategic information strategy supported community and health planning authorities and services providers in the use of determinants of health analysis of census data, development of community profiles and analysis and the use of this information to raise awareness in influencing policy and partnership development at various levels of government.

Building on the successful actions since 2004, the CHSSN received $375,000 from the Public Health Agency of Canada in 2007-2008 to achieve seven results. These results included:

  • Shared information and held exchanges between the CHSSN, the Ministère de la santé et des services sociaux (MSSS) and the Institut national de la santé publique (INSP). This is leading to the drafting of a community collaboration agreement with INSP extending to 2013;
  • Hosted a provincial public health conference involving approximately 125 health officials and community leaders. Conference organizers included the CHSSN, the Ministère de la santé et des services sociaux and the Institut national de la santé publique;
  • Organized exchanges between minority language health and social service networks in the provinces of Alberta and Prince Edward Island;
  • Added Statistics Canada 2006 census data to a comprehensive data model describing English-speaking communities. The data model takes into account the new administrative territories at the heart of Quebec’s new population-based approach to services in public system; Developed and disseminated report of health determinant profiles (vitality profiles) of Quebec’s English-speaking Communities. This report links Quebec social and health survey information with demographic data on English-speaking persons; Delivered training workshops for community leaders participating on regional health networks working with public partners on the use of this statistical information in building more specific regional vitality profiles;
  • Supported selected minority English-speaking communities in the development of partnerships with public health authorities that informed public health professionals on the need for health promotion approaches using communication strategies and education to reach underserved English-speaking communities.

To enhance sustainability of project results and to maximize the participatory involvement of the population group, the CHSSN worked in partnership with nine health and social services networks and five other regional community organizations. These networks and organizations consisted of paid staff and volunteers, and are representative bodies of the target communities. Government and non-government organizations participated as network members acting as the link between community and those ensuring coordination and delivery of services.

This network model further served as the process through which the population group (community) was consulted and solicited to participate in project activities. The model allows for regional networks to contribute both financial and in-kind support, and take ownership in the sustaining of local and regional initiatives. In the case of Quebec-wide initiatives, the CHSSN serves as the network responsible for the integration and sustaining of these activities. The illustration below highlights the CHSSN network model for community engagement and participation.

Illustration I: CHSSN network model for community engagement and participation (based on the World Health Organization model of stakeholder collaboration)

Due to a long-term commitment by project partners, the activities accomplished in 2007-2008 are being sustained by the following actions:

  • A strategic partnership has been established between the CHSSN, the Ministère de la santé et des services sociaux and the Institut national de la santé publique, resulting in formal and long-commitments in the elaboration of population health activities targeting the English-speaking minority community. This partnership will further strengthen communities’ role in Quebec’s health and social services system by influencing policy and programs that address the determinants of health including those of English-speaking communities;
  • A community action model consistent with the model of the World Health Organization and theoretical framework for governance and stakeholder accountability has been developed as a way to identify a common and comprehensive approach for all actors to address the improvement of health and well-being of English-speaking people across Quebec;
  • The CHSSN has incorporated this model and framework within its five year action plan 2009- 2013 to improve health outcomes in English-speaking communities. This has resulted in a commitment of new federal investments that will support Quebec’s public health actions with English-speaking communities;
  • Communities have successfully mapped health determinants, created vitality profiles and engaged other sectors in the piloting of over fourteen public health projects in eleven different regions in the province of Quebec. Regional networks and public health authorities have assumed ownership and sustainability of initiatives;
  • CHSSN and regional networks have begun sharing population health tools and information with other official language minority communities across Canada such as approaches to building vitality profiles and delivering health promotion programs from a distance.
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