2005 Integrated Pan-Canadian Healthy Living Strategy - Framework
3.0 A Framework for Action
Action on the Healthy Living Strategy will be undertaken in the following areas:
- Healthy Living Targets;
- Research and Surveillance; and
- Public Information.
3.1 Healthy Living Targets
Why set targets?
The number of Canadians who are overweight or obese has steadily increased over the last 20 years. The current physical activity patterns of most Canadians are not optimal for health, and the proportion of Canadians reporting poor eating habits is increasing. These are disturbing trends that require immediate attention.
A great deal of work is underway to advance healthy living in Canada. Without a clear goal or measure of success, however, there is no way to know whether these initiatives are having their desired effect. Aggressive targets are needed to generate momentum for lasting behaviour change and to stop, and begin to reverse, the alarming trends in overweight and obesity. With the target set by FPT Ministers for Physical Activity, Recreation and Sport in 2003, this process is underway for physical activity, but we need to go further. We need to look beyond 2010, and we need to address healthy eating and healthy weights, as well.
The current situation
For the majority of Canadians, current physical activity patterns are not optimal for health. While less is known about the eating practices of Canadians, we do know that the proportion of Canadians reporting poor eating habits is increasing.
- In 2001, 21% of Canadians reported their eating habits as fair or poor compared to 17% in 1997, and 15% in 1994;Footnote 19
- Almost two-thirds (63%) of Canadians aged 12 and over are not sufficiently active to benefit their health.Footnote 20 The majority of Canadians aged 12 and over (57%) were classified as “inactive” in the 1996/97 National Population Health Survey;Footnote 21 and
- Similarly, three out of five children and youth aged 5 to 17 are not active enough for optimal growth and development.Footnote 22
The number of Canadians who are overweight or obese has steadily increased over the last 25 years.
- Today, approximately 59% of adult Canadians aged 18 or older (65% of men and 53% of women) are either overweight or obese (body mass index greater than 25). Nearly one quarter (23%) of the adult population were obese (BMI greater than 30), which was up significantly from the 1978/79 obesity rate of 13.8%.Footnote 23
- In 2004, among children and youth (aged 2 to 17), 18% were overweight and an additional 8% were obese, compared to 12% and 3% in 1978/79.Footnote 24
Mobilizing for change
Every province and territory in Canada, and the federal government, has adopted the Physical Activity target of increasing regular levels of physical activity by 10 percentage points by 2010 (endorsed by Ministers responsible for Physical Activity, Recreation and Sport in June 2003), and most already have targets on healthy eating and healthy weights which are consistent with those proposed for the Healthy Living Strategy. A list of provincial/territorial targets for healthy eating, physical activity and healthy weights is included as Appendix A.
While the proposed Healthy Living targets have been set to roll out over a 10-year period, to be successful, sustained effort over a much longer period will be required. For this reason, 2015 should be considered as a first marker, with ongoing monitoring and evaluation to be undertaken in order to assess progress and allow for adjustments as appropriate. Measurement tools for the targets will evolve as data become available (e.g. CCHS; measured BMI results, Physical Activity Benchmarks/Monitoring Program, and other), and appropriate tools will be used or developed where possible to measure progress within older adults, Aboriginal Peoples and other cultures, and other target populations.
It is recognized that targets still need to be set for specific populations (including new Canadians, minority cultural communities, and others) as well as indicators to measure reduction of disparities among Canadians by characteristics of gender, race (Aboriginal identity), geographic location, disabilities and socio-economic factors.Footnote 25
Around the world, other countries are striving to address the same issues. For instance, England, Scotland, New Zealand and the United States are only some of the countries that have set targets to increase physical activity, improve healthy eating and healthy weights – consistent with the Canadian healthy living targets. The United States, for example, has set targets to:
- increase to 30% the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day (from 15%);
- increase to 60% the proportion of adults who are at a healthy body weight (from 42%);
- increase the proportion of persons aged 2 years and older who consume at least three daily servings of vegetables, with at least one-third being dark green or orange vegetables from 3% to 50%; and
- increase the proportion of persons aged 2 years and older who consume at least two daily servings of fruit to 75% from 28%.Footnote 26
For Canada, each Healthy Living target seeks to obtain a 20% increase in the proportion of Canadians who eat healthy, are physically active, and are at healthy body weights. These targets are ambitious, but achievable, given the many partners from all sectors in Canada implementing activities related to healthy living. Furthermore, such an increase in the physical activity target level is consistent with the current 2010 Physical Activity target. By extending the timeline to 2015, momentum can be sustained.
Recognizing that healthy weights also require improved nutrition, equally aggressive targets are necessary to generate momentum for healthy eating practices and healthy weights. With recent data from the NPHS and CCHSFootnote 27 suggesting that the proportion of Canadians with healthy body weights is not increasing over time, despite modest increases in physical activity levels, correspondingly aggressive targets have been set to ensure the desired result of these behaviour changes.
Proposed Healthy Living Targets
- By 2015, increase by 20% the proportion of Canadians who make healthy food choices according to the CCHS, SC/CIHI Health Indicators. Footnote 28
According to the baseline data in the 2003 Canadian Community Health Survey (CCHS), the proportion of the adult population consuming fruits and vegetables at least five times per day was 39.0%. A 20% increase would mean that 46.8% of people would be doing so.
- By 2015, increase by 20% the proportion of Canadians who participate in regular physical activity based on 30 minutes/day of moderate to vigorous activity as measured by the CCHS and the Physical Activity Benchmarks/Monitoring Program. Footnote 29
According to the baseline data in the 2003 CCHS, 50.4% reported at least 30 minutes of daily physical activity. A 20% increase would mean that 60.5% of people would be participating in regular physical activity by 2015.
- By 2015, increase by 20% the proportion of Canadians at a “normal”Footnote 30 body weight based on a Body Mass Index of 18.5 – 24.9 as measured by the NPHS, CCHS, SC/CIHI Health Indicators.Footnote 31
According to the baseline data in the 2003 CCHS, 46.7% reported heights and weights that translated to a "normal" body weight. A 20% increase would mean that 56.0% of people would have a "normal" body weight.
Healthy Living targets will need to be aligned with the Public Health Goals (currently in discussion), accompanied by measures of disparities and disparities reduction, and may be adjusted in the future for consistency. It is expected that the Healthy Living targets will complement and support the broader Public Health Goals.
Opportunities for Action
Goals and targets provide a clear focus but, without action, the desired outcomes of improving the overall health of Canadians and reducing disparities are unlikely to be realized. For this reason, the Coordinating Committee and its working groups developed priority areas and specific opportunities for action to support the implementation of the Strategy.
These opportunities for action will be taken up by many stakeholders in healthy living, including:
- Parents and families
- Professionals (health services and beyond)
- Communities and non-profit organizations
- Aboriginal Peoples
- Provincial, territorial and municipal governments and health authorities (including and beyond health sector)
- National networks/alliances/initiatives
- Federal government (including and beyond health sector)
- Private sector (including media)
With the Healthy Living goals and targets as a standard reference point for all sectors to measure the success of their own strategies and interventions, to be successful, coordinated effort is required in a number of areas. For that reason, it is recommended that integrated action be undertaken in activities related to Aboriginal Peoples, as well as policy and program.
Supporting healthy living for Aboriginal Peoples is an important part of the fundamental Strategy goal to reduce health disparities in Canada. F/P/T Ministers of Health (September 2003) requested officials undertake further dialogue with Aboriginal stakeholders under the direction of the Advisory Committee on Population Health and Health Security (ACPHHS). FPT Ministers of Health reconfirmed their commitment in October 2004 and asked that a Healthy Living Strategy be presented to them in September 2005 that is inclusive of an Aboriginal component based on meaningful input with Aboriginal people. National Aboriginal Organizations were engaged in a multi-pronged process. (Please see Appendix B for a summary report of this dialogue.) Efforts will be made to coordinate work of the Healthy Living Strategy with current and future initiatives to improve the health of Aboriginal peoples, such as the Aboriginal Diabetes Initiative and the Blueprint for Aboriginal Health.
Policy and Program
To have maximum impact, community-wide policies and programs designed to address healthy eating and physical activity must be:
“accompanied by broader environmental changes in areas like urban design, transportation, and food pricing and advertising. For community-wide policies and programs to succeed local governments need to work with all sectors including businesses, non-governmental organizations and citizens, and with senior levels of government.” (CPHI, 2004)
In particular, the Healthy Living Strategy identifies the need for action in order to:
- Improve physical activity and healthy eating patterns, behaviours and choices among Canadians; and
- Improve access to, and affordability of, healthy food choices and physical activity opportunities.
Significant effort is already underway, but more can be done. For example, the federal government is currently taking steps to meet the action areas highlighted above – as evidenced, for instance, by the revisions underway to Canada’s Food Guide to Healthy EatingFootnote 32 ; the support given to healthy eating and physical activity programs (e.g. the Combined Guide to Healthy Eating and Physical Activity); and the new nutrition labeling legislation. Provincial and territorial governments also have important healthy living initiatives underway.
Each of these pieces is important, but insufficient, if not enhanced through partnerships with other sectors. For instance, the new nutrition labeling will enable private sector companies to provide consumers with understandable nutrition information about their products. Couple these initiatives with improved training for community service providers and there will be strengthened awareness of healthy eating and physical activity choices among Canadians. These efforts would be further reinforced if/when combined with municipal and local authorities’ decisions to ensure grocery stores with affordable healthy food choices are accessible in low income areas, and where community food-security strategies (such as community gardens, co-op kitchens, etc.) are supported.
Action is also needed to reduce the gap in physical activity levels that exists at different age, sex, education and income levels.
Leadership on disparities reduction within the health sector is needed to facilitate the roles of the health sector and to support growing awareness and policy action in other sectors to achieve health gains.Footnote 33
Much is underway to support and encourage physical activity among CanadiansFootnote 34 but often the initiatives are disparate and ad hoc. The Healthy Living Strategy offers a valuable means of integrating and aligning those efforts. Programs already exist. For example, Go for Green’s Walking School Bus is designed to provide children with safe, active, sustainable transportation to and from school. It is a component of the national Active & Safe Routes to School program, a joint venture of Go for Green, Green Communities Association; the Way to Go! School Program of British Columbia; Recreation Parks Association of the Yukon; Ecology Action Centre (Nova Scotia); Resource Conservation Manitoba; SHAPE Alberta; and the Public Health Agency of Canada. The potential for success is even greater if these types of efforts were aligned and supplemented by municipal, provincial and federal governmental initiatives to improve infrastructure and neighbourhood design in such a way as to facilitate and encourage healthy eating and physical activity through, for example, the establishment of parks, play structures, healthy workplaces, and community gardens.
The Healthy Living Strategy also fosters:
- Enhanced collaboration and planning across health and “non-health” sectors.
Health promotion and chronic disease prevention extend beyond the scope of the health sector alone. The health of Canadians is impacted by the environment, transportation, infrastructure, agriculture, and many other areas. Bringing these different areas together will be critical to the success of assuring the health of Canadians and more needs to be done. A good example of a current initiative bringing together members across the health and education sectors is the newly formed Joint Consortium for School Health, which aims to:
- act as a catalyst for strengthening intersectoral collaboration;
- enhance the capacity of stakeholders to work together to promote the healthy development of children and youth through school-based and school-linked policies, programs, and activities;
- develop mechanisms and activities that align efforts at all levels (for example: the establishment of P/T School Health Coordinators); and
- assess the case for local-level School Health Coordinators to act on behalf of local school boards and public health authorities, in partnership with other stakeholders in community.
Summary of Policy and Program Priorities
- Improve healthy eating patterns, behaviours, and choices among Canadians; and
- Improve access to, and affordability of, healthy food choices
- Support and facilitate affordable, appropriate and accessible physical activity facilities and opportunities; and
- Reduce the gap in physical activity levels that exists at different age, sex, education, abilities, and income levels
- Enhance collaboration, understanding and planning across health and “non-health” sectors
(Please see Appendix D for more detail on policy and program options, including examples of potential strategies to address these priorities.)
The unique needs and concerns of Aboriginal Peoples will be considered as new policies and programs are developed.
3.3 Research and Surveillance
Research includes knowledge development, synthesis, translation and exchange, with an ultimate goal of informing policy and program decision-making. Best practices are addressed through the inclusion of such concepts as intervention research and the review and development of resources for communities.
A Healthy Living Integrated Research and Surveillance Agenda, including best practices, will be used to support and help with the implementation of actions, and to measure progress in achieving goals. This agenda seeks to address current gaps, which include:
- lack of implementation and costing data, which are crucial for informed decision-making;
- little coordination among and within sectors, especially in integrating research with policy and practice;
- limited capacity for research and surveillance related to health promotion and prevention; and
- little understanding of what interventions (for example, in the built environment) will best support healthy living.
Canada on the Move, led by the Institute of Nutrition, Metabolism and Diabetes, CIHR is a national platform which will be used for data collection, research and evaluation of programs that support increased physical activity and healthy eating. It engages individual Canadians representing a wide range of demographics to provide information on their physical activity; helps organizations from various sectors to track the success of their programs; and is intended to be a source of data for researchers to evaluate health promotion activities.
In order to address some of these gaps, the following objectives have been specified for the research and surveillance agenda:
- Policy and program decisions based on timely, regular and meaningful data;
- Coordination and integration of investments in research, policy and practice;
- Easy, efficient and timely access by communities to knowledge (in a useable form) needed to inform decisions;
- Improved ability of researchers in conducting research to address policy and practice;
- Synthesis and translation of existing research for use by population and public health organizations;
- Collaboration of key intersectoral stakeholders at all levels in various phases of knowledge development and exchange; and
- Integration of research, surveillance and evaluation with policy and program development.
In particular, the agenda will focus on three priority areas:
- Increased capacity for knowledge development and exchange to promote healthy eating, physical activity and their relationship to healthy weights;
- Increased population-level intervention research to understand and address the determinants of healthy eating, physical activity and their relationship to healthy weights; and
- Implementation of an integrated system for knowledge development and exchange regarding policies and programs in the health and “non-health” sectors.
It is understood that research, surveillance and best practices must consider the specific needs of various Aboriginal communities and support knowledge development in the area of disparities reduction.
(Please see Appendix E for more detail on the integrated research and surveillance agenda.)
3.4 Information publique
Social marketing is an important mechanism to communicate messages arising from policy, program, research and surveillance initiatives. The Healthy Living social marketing plan was conceived in collaboration with partners from federal and provincial/territorial governments, together with members from the private and voluntary sectors. This plan will contribute to, and deliver key messages, regarding each of the targets. For instance, the Healthy Living Strategy currently envisions:
Long Live Kids is an NGO-led initiative led by Concerned Children’s Advertisers and involving the collaboration of industry, issue experts and government with the goal of providing Canadian children with tools for healthy eating, active living and improved media literacy. There is a series of child-directed public service messages and an education program for educators, parents and community leaders.
- Forging strategic alliances - Canadians are faced with an enormous amount of information, including conflicting messages, on how to make healthy choices. Forging strategic alliances between the private sector, NGOs, and F/P/T governments, will assist by offering consistent information from a variety of trusted sources;
- Healthy Living Strategic Alliance Toolkit – to assist collaborating organizations in creating common ties between initiatives and programs or messages. In particular, it would address the need for common tools to be used for individual self-assessment and to facilitate behaviour and broader social change;
- National advertising campaign - to motivate Canadians to be healthier, be more physically active and to participate in sport, in addition to communicating the importance of integrating these activities into their daily lives
- An Aboriginal-specific social marketing campaign which is tailored to the diversity of Aboriginal Peoples; and
- Website and 1 800 O Canada - for Canadians to learn more and access tools for informed healthy living choices.
(Please see Appendix F for more detail on the social marketing strategic plan.)
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