ARCHIVED - Executive Summary

In 2003, the Canadian province of British Columbia (BC) won the bid to host the 2010 Winter Olympics. The government of the day made the achievement a window of opportunity to establish a health promotion legacy for the people in BC, pledging to make the province the healthiest jurisdiction to ever host the Games. To this end, the government launched ActNowBC in 2005, a bold intersectoral health promotion initiative that integrates the actions of the whole-of-government with those of civil society. ActNowBC has five targets set for 2010:

1. Increase by 20% the proportion of the BC population (aged 12+ years) that is physically active or moderately active during leisure time from the 2003 prevalence of 58.1% to 69.7%.
2. Increase by 20% the proportion of the BC population (aged 12+ years) that eats the daily recommended level of fruits and vegetables from the 2003 prevalence of 40.1% to 48.1%.
3. Reduce by 10% the proportion of the BC population (aged 15+ years) that uses tobacco, from the 2003 prevalence of 16% to 14.4%.
4. Reduce by 20% the proportion of the BC population (aged 18+ years) that is currently classified as overweight or obese from the 2003 prevalence of 42.3% to 33.8%.
5. Increase by 50% the number of women counselled regarding alcohol use during pregnancy and have focused strategies for the prevention of fetal alcohol spectrum disorder (FASD) in all regional health authorities.

Between October 2007 and September 2008, we conducted 49 interviews in BC with key senior public servants, politicians, academics and NGO officials involved with ActNowBC. From their perspectives we examined the different elements of the ActNowBC “story”, and more specifically the factors and mechanisms that are facilitating 1) the whole-of-government contribution to ActNowBC and 2) the partnerships between the BC government and the civil society sector.

At the close of our study, ActNowBC has not yet matured to the point where definitive lessons can be drawn. Nevertheless, we believe that there is a transcendent approach in the performance story we have documented thus far – that the BC government has demonstrated an ability to “sail the ship while you build it”, moving ahead with a whole-of-government initiative even though not all the elements nor ideal conditions are in place. For example, the cross-ministerial accountability framework is only now emerging. And other ActNowBC actors, within and outside of government, are forging ahead while simultaneously balancing planning and action. We believe that the integrating mechanisms and strategies initiated and adopted thus far as part of the ActNowBC initiative are “promising best practices” that can inform other jurisdictions in the development of similar whole-of-government initiatives.

 

 

ActNowBC: Promising Practices and Key Challenges: As this report was being written, a number of health promoting initiatives are said to have been aided by ActNowBC, directly or by virtue of its momentum. Already, targets three and five have been achieved. ActNowBC has also expanded and enhanced training and grant opportunities in a holistic healthy lifestyles strategy aiming to improve health equity within Aboriginal communities. In addition, BC has adopted stronger tobacco control legislation, restrictions in using industrially produced trans fat, new guidelines for healthy foods in vending machines in BC public buildings and school health guidelines related to vending machines and to physical activity levels.

We discovered that there were several factors that explain the outcomes and process-related achievements and contributions of ActNowBC that have been observed thus far. These factors fall into two broad categories: leadership, in different forms and at different levels; and the adoption of horizontal and vertical strategies and mechanisms to foster intersectoral action. The ActNowBC platform explicitly calls for all government sectors to work together-both at the horizontal (different ministries) and vertical (involvement of health authorities and municipalities) levels. It also encourages greater vertical coordination and collaboration between government and civil society organizations.

Leadership: The Premier’s steady commitment towards the principles of an integrated health promotion initiative is one of the key success factors behind the launch of ActNowBC, and the main reason why ActNowBC has been able to evolve and mature since its inception in 2005. His continuous support enhances the profile of ActNowBC and ensures that ActNowBC remains high on the agendas of all Ministers, Deputies and Assistant Deputy Ministers. The background work of senior civil servants also clearly emerged as a critical success factor. They seized the opportunity to harness the momentum of the Winter Olympics to advance health promotion as a long-term investment and gain a province-wide health legacy with potential cross-sector benefits.

Increasing collaborative action among government sectors with diverse strategies and mechanisms: This report highlights how the following mechanisms and strategies contribute to enhancing cross-sector collaboration:

• A compelling business case positioned chronic diseases as an economic drain on all Ministry budgets, not just that of the Ministry of Health.
• Some of ActNowBC targets are boldly ambitious and as such can only hope to be achieved through cross-sector coordinated and collaborative action.
• An incentive fund of $15 million supported pilot health promotion projects by ministries other than the Ministry of Health during the early days of ActNowBC.
• A new inter-departmental committee of Assistant Deputy Ministers distributes accountability for ActNowBC across ministries.
• Government level leadership was extended outside the health sector by having at one point a Minister of State for ActNowBC attached to the Ministry of Sports, Tourism and the Arts.

The involvement of civil society organizations: A coalition of nine civil society organizations – the British Columbia Healthy Living Alliance – received a $25.2 million one-time grant to implement and enhance community-based health promotion programs across the province oriented to the ActNowBC targets. 2010 Legacies Now, a not-for-profit society, also received a one-time grant of $4.8 million. The leaders involved have forged ahead with several programs, having overcome the challenges associated with simultaneously developing new partnerships among their respective organizations and with the ministries overseeing the implementation of ActNowBC.

Challenges: Rolling out such a multifaceted initiative, despite the best efforts of people committed to ActNowBC, is fraught with complex challenges and differences of opinion persist. While most respondents applauded the political decision to set ambitious targets to rally multisector action, some expressed concerns about the risks to sustainability of ActNowBC if targets are not met by 2010. Some respondents believe that there is an overemphasis on social marketing campaigns and not enough action on social determinants of health to secure a lasting legacy for BC. Others suggest that a stages approach is needed in that not all components of such a complex integrated strategy can be undertaken at once. Shifting governance structures may have slowed the stabilization of ActNowBC but with all departments embedding ActNowBC into their logic models and service plans, a high level accountability framework is anchoring ActNowBC.

Conclusion: In 2010, the BC government will report on whether the ActNowBC targets have been reached. In the meantime, this case study contributes to the performance story of ActNowBC, describing and discussing the effort of individuals and organizations connected to the implementation of the initiative. The quote below concisely summarizes the general tone within the government sector as it relates to ActNowBC, suggests that intersectoral action may be taking root and that ActNowBC may be changing the way that the government within the province does business:

“I give this government full points for setting targets and trying to get us all thinking about service plans [commitment to ActNowBC]. It really is a discipline that wasn’t particularly well-embedded in government prior to this administration…” (Gov)