Appendix E: Integrated Pan-Canadian Healthy Living Strategy 2005 – Integrated research and surveillance agenda

Appendix E: Integrated Research and Surveillance Agenda

Mandate

The mandate of the Research and Surveillance Working Group of the Intersectoral Healthy Living Network Coordinating Committee is to support the development of an integrated research and surveillance agenda on physical activity, healthy eating and their relationship to healthy weights, by building on existing efforts.

Current Context

Since September 2002, the Federal-Provincial/Territorial (F-P/T) Ministers of Health have been working together on an Integrated Pan-Canadian Healthy Living Strategy. The goals of the Strategy are to improve overall health outcomes and to reduce health disparities. The initial areas of emphasis for the Strategy are physical activity, healthy eating and their relationship to healthy weights.

In September 2003, the F-P/T Ministers of Health endorsed the Healthy Living Strategy Framework, involving action in the areas of research and surveillance, including best practices.

A pan-Canadian initiative such as the Healthy Living Strategy must be intimately linked to an integrated research and surveillance agenda to ensure that policy and program interventions are based on the best possible evidence. At all levels (federal/provincial-territorial, regional and local) integrated efforts in knowledge development, synthesis, translation and exchange on physical activity and healthy eating are required to guide population and public health promotion and to support community activities.

Knowledge development (through research and surveillance), knowledge synthesis, knowledge exchange, and the application of knowledge into policies, programs, and practices, are strategic directions of the Healthy Living Strategy Framework.

Background - Development of Research and Surveillance Agenda

In September 2004, the Coordinating Committee of the Intersectoral Healthy Living Network (IHLN) was formed and held its first meeting. Four working groups were established, including the Research and Surveillance Working Group (Working Group). The Working Group is comprised of approximately 25 individuals across diverse sectors, lenses and perspectives.

To achieve its goal, the Working Group identified gaps and recommendations for action in the areas of research, surveillance and best practices through a review of key documents in Canada and internationally. A matrix and synthesis were prepared to identify priority action areas. Strategies and activities to address the priority action statements were subsequently developed, in collaboration with the Intersectoral Healthy Living Network Coordinating Committee.

Rationale for a Primary Focus on Knowledge Development and Exchange

Development of knowledge that can directly guide policy and program decision-making can be informed by research and surveillance activities.

Population-level intervention research is a form of research to understand and address real world concerns in different contexts, recognizing its complexity and attempting to answer such questions as “what are the effects of policies and programs on the health of populations?”

Multiple sectors (e.g. food industry, all levels of government (including departments of recreation, agriculture, finance, etc.)) implement policies and programs that have an impact (beneficial or deleterious) on healthy eating and physical activity. The impact of these interventions is rarely studied: we miss critical opportunities to study these “natural experiments” to learn what works and in what context, in order to inform future policies and programs. The ethical onus is to support fewer but more rigorously evaluated interventions that have been demonstrated to be more effective and safe. For example, some healthy living interventions have in the past been shown to increase rather than reduce health disparities. It is also important to assess the probable impact of a policy or program decision, before a decision is made to implement (and evaluate) it.

With so many social, cultural and environmental factors affecting an individual’s conditions for healthy living, health surveillance is an essential tool in knowledge development. Surveillance helps us understand overall progress, as well as the factors, subpopulations, and trends that require the most attention and also the combined impact of policies and programs at the population-level.

For expenditures on investments in research and surveillance to have impact, the knowledge gained must be synthesized, translated and exchanged with those who make policy and program decisions. Alternately, policy and program decision makers are key drivers of the research and surveillance undertaken. This is central to integrating knowledge use within the health promotion and chronic disease prevention system. Special skills are needed to assemble the available information into useful tools for decision-makers. Under-funding of research, surveillance and knowledge exchange at all levels over the past decade has left Canada with a significant shortage of expertise.

Given the importance of improved risk-factor surveillance systems, some levels of government have already made expenditures in this area. In addition, through an F-P/T process, the Surveillance Systems for the Chronic Disease Risk Factors Task Group of the Advisory Committee on Population Health and Health Security (ACPHHS) developed a detailed strategy for surveillance relevant to healthy living including physical activity and healthy eating. Since the surveillance Task Group also reports to the ACPHHS, their efforts have been incorporated in the development of this Integrated Research and Surveillance Agenda. To reduce duplication (a principle of the Healthy Living Strategy), the Research and Surveillance Working Group of the Healthy Living Strategy did not develop a detailed action plan for surveillance, but highlighted surveillance as a necessary tool where appropriate.

Summary of Gaps

• Factors like the built environment (e.g. road and transportation systems) are known to have an impact on the physical activity and body weight of the population. But little is known about which specific interventionswill best support healthy living.
• Determining and analyzing causal relationships that drive positive change will facilitate effective decision-making and funding decisions.
• Implementation and costing data are often not collected and/or disseminated with research results. Such data are crucial for informing decisions. Implementation, cost-benefit and cost-effectiveness analyses must become central components of prevention research to guide policy-makers on the best use of limited resources.
• Multiple sectors and systems (e.g., those responsible for public policy, public health programs, and research funding) often do not coordinate their efforts. A culture shift, incentives, and enabling mechanisms are needed to integrate research, policy, and practice.
• Qualified researchers and program evaluators must be directed to and provided with the resources necessary to tackle the problems of greatest importance to decision-makers.
• It is difficult to obtain funding to build the public assets (e.g., local data collection systems to support planning, evaluation and knowledge generation; linked databases; and technology based interventions for non-profit public health intervention) required to integrate research, policy and practice, and to use resources to best advantage.
• Research funding agencies have limited capacity to fund strategic research, and a culture that tends to value curiosity driven research ahead of strategic research.
• Chronic under-funding of prevention research and public health systems for surveillance, knowledge synthesis and exchange mean that there is limited capacity for this work in Canada. New capacity must be developed to implement a successful healthy living strategy.

Integrated Research and Surveillance Agenda

Vision

Canadians have improved overall health outcomes and reduced health disparities as a result of implementing effective policies and programs based on synthesis, translation and exchange of knowledge based on research and surveillance.

Goal

To implement an integrated system that has seamless linkages between research, surveillance, policy and practice for physical activity and healthy eating.

Objectives

The objectives of the overall Healthy Living Strategy are the following:

• Increased prevalence of healthy weights – achieved through healthy means – among Canadians
• Increased levels of regular physical activity among Canadians
• Improved healthy eating practices and activity levels among Canadians, particularly infants, children and youth
• Increased number of at-risk/vulnerable communities with access to affordable healthy food choices and appropriate physical activity facilities and opportunities
• Improved infrastructure and neighbourhood design that support opportunities for healthy eating and physical activity
• Reduced health disparities.

The objectives of the Integrated Research and Surveillance Agenda are consistent with those of the Healthy Living Strategy (above) and include the following:

• Policy and program decisions are based on timely, regular, and meaningful data.
• There is coordination and integration of investments in research, policy and practice.
• Communities have easy, efficient, timely access to knowledge they need, in useable form, to inform decisions.
• Researchers are better able to conduct research to address policy and practice.
• The existing research is synthesized and translated for use by population and public health organizations.
• Key intersectoral stakeholders at all levels collaborate in the various phases of the knowledge development and exchange cycle, to create the ability to “learn as we go” - what works, and in what context.
• Research, surveillance and evaluation are integrated with policy and program development.

Strategies

The following priorities are proposed to further develop an integrated research and surveillance agenda:

Strategy # 1
Increase capacity for knowledge development and exchange to promote healthy eating,
physical activity and their relationship to healthy weights.

Strategy # 2
Increase population-level intervention research to understand and address the determinants of healthy eating, physical activity and their relationship to healthy weights.

Strategy # 3
Implement an integrated system for knowledge development and exchange regarding
policies and programs in the health and “non-health” sectors.

Guiding Principles

The development and implementation of the Integrated Research and Surveillance Agenda are guided by the following principles:

• The Integrated Research and Surveillance Agenda should be consistent with the Integrated Pan-Canadian Healthy Living Strategy.
• Given the intersectoral nature of the Healthy Living Strategy, key stakeholders should be involved in various roles and multiple activities throughout the continued development and implementation of the Integrated Research and Surveillance Agenda.
• The Integrated Research and Surveillance Agenda should be based on a Population Health Approach and take into account the broader public health context (e.g. development of a pan-Canadian public health strategy).
• The Integrated Research and Surveillance Agenda is being recommended to the F-P/T Deputy Ministers of Health and the F-P/T Ministers of Health. This Integrated Research and Surveillance Agenda has been developed as a proposed plan and is evolving.
• Diversity (of people and environments in Canada) must be recognized and reflected in the development and implementation of the Integrated Research and Surveillance Agenda.
• The ‘integrated’ (research, surveillance, policy, practice) nature of this Integrated Research and Surveillance Agenda is an inherent part of its added value to ensure continuous generation and use of timely, pertinent data that contribute to ongoing improvement in policies and programs.

Integrated = adj.combined into a whole; united; undivided.
(Canadian Oxford Dictionary: 2001)

Key Related Stakeholders [List Appears in Alphabetical Order]

A list of stakeholders has been prepared to provide an overview of the current landscape of the research, surveillance and best practices field related to physical activity and healthy eating. This list is not meant to be exclusive, and is open to further modification.

Government of Canada Example(s):

• Canadian Institutes of Health Research
• Canadian Heritage
• Health Canada
• Indian and Northern Affairs Canada
• Social Development Canada
• Statistics Canada
• Transport Canada

National Non-Governmental Organizations Example(s):

• Canadian Fitness and Lifestyle Research Institute
• Canadian Institute for Health Information
• Canadian Population Health Initiative
• Canadian Society for Exercise Physiology
• Chronic Disease Prevention Alliance of Canada
• National Cancer Institute of Canada
• Regional health authorities and public health units

Private Sector

Provincial / Territorial Governments

Universities

Strategy #1: Increase capacity for knowledge development and exchange to promote healthy eating, physical activity and their relationship to healthy weights

Activities:

Short Term (6-18 months)

• Identify and align strategic directions, investments, knowledge generation and exchange activities.
  • identify appropriate and relevant course of action or mechanisms; determine key stakeholders to involve in order to accomplish particular activities; review plans and priorities.
  • develop, implement and integrate activities of various partners across sectors.

Medium Term (18-60 months)

• Create a sustainable, intersectoral knowledge development and exchange system through national and/or regional centres for continuously improving policy and program in the health and non-health sectors.
  • Leadership by the federal government for developing and maintaining the infrastructure, in collaboration with an intersectoral advisory group (note: this could involve building on existing and/or developing infrastructure)
• Increase and promote institutionalized opportunities for cross-sectoral collaborations and exchanges for researchers, policy-makers and practitioners across various environments and sectors.
  • Leadership by the Public Health Agency of Canada, supported by an intersectoral advisory group

Strategy #2: Increase population-level intervention research to understand and address the determinants of healthy eating, physical activity and their relationship to healthy weights

Activities:

Medium / Long Term (18-60 months, +)

• Establish a group of leaders who are currently building foundational capacity in this field to align investments and plans across organizations.
• Support the development of common tools, measures, and mechanisms (eg. data collection, analysis and translation) that can be used by multiple communities and sectors to facilitate synthesis and exchange of knowledge and for surveillance.
• Develop a longitudinal study on healthy living which will examine various population level indicators.
• Conduct cost-benefit analyses of the impact of health and non-health sector policies and programs at all levels
  • Leadership by the Public Health Agency of Canada, supported by an intersectoral advisory group

Strategy #3 Implement an integrated system for knowledge development and exchange regarding policies and programs in the health and “non-health” sectors

Activities:

Medium / Long Term (18-60 months, +)

• Examine and expand upon successful models of integrated decision-making systems to facilitate intersectoral planning.
• Support the development and exchange of practical and relevant resources for communities.
  • Leadership by the Public Health Agency of Canada, supported by an intersectoral advisory group