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Figure 1 – Three categories of coordination mechanisms

The first category is labelled “Behind the Handshake”. It refers to the fact that fundamental changes in organizational cultures are necessary to facilitate whole-of-government approaches in planning and executing programs and policies. Without this backdrop, the use of coordination mechanisms is unlikely to lead to success.

The second category, called the “Visible Hand”, emphasizes the fact that strong leadership is a condition for successful intersectoral action.

The third category is called ‘The Invisible Hand”. It emphasizes the fact that whole-of-government initiatives need to be supported with an appropriate level of resources and a sound organizational structure. Whole-of-government initiatives may, for example, benefit from a management culture that relies less on command and control, and more on financial incentives, continual monitoring, and ongoing consultation and engagement.

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Figure 2 – The Business Case

The figure above represents the powerpoint slide that public health officials used to present the business case for ActNowBC. It showed that without any new actions to promote health and prevent disease (i.e. maintaining the status quo), by 2017, the BC Ministry of Health would require 71.3% of the total budget of the government, increased from 41.6% in 2005-2006. The budget projection was based on three assumptions:

1. The Ministry of Health budget would continue to grow at a rate of approximately 8% annually, a rate well above the average gross domestic product (GDP) annual growth rate of 3%.

2.The budget of the second largest ministry, the Ministry of Education, would keep pace with the average GDP annual growth rate, thus steadily accounting for approximately 27% of all government spending.

3.Taxation levels would be constant.

Based on these assumptions the figure shows that other spending (other than for the Ministry of Health and the Ministry of Education) would reach zero by 2017-2018.

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Figure 3 – ActNowBC Logic Model

 

Figure 3: ActNowBC Logic Model

The figure above presents the ActNowBC logic model. On the left side we have the four factors related to improve health and quality of life- physical activity, healthy eating, living tobacco-free and healthy choices in pregnancy.

The next column on the right presents the principles that guide how ActNowBC is addressing these four factors. These principles promote, for example, approaches that are participatory, multisectoral and comprehensive in order to reach the BC population in different settings (community, home, work, school).

The next column on the right presents the expected ActNowBC outputs. It includes both quantitative outputs, like the number of programs implemented, and qualitative outputs, like the participatory processes.

The next column on the right presents the short-term outcomes to be achieved by ActNowBC by 2008. The column presents these outcomes at different levels:

  1. at the individual level (e.g. increased awareness about the four factors);
  2. at the system level (e.g. increased intersectoral action and planning), and
  3. at the environmental level (availability and accessibility to programs, services and infrastructure that supports a healthy lifestyle).

The next column on the right presents the mid-term outcomes to be achieved by ActNowBC by 2015, for example a decrease in obesity rates.

The last column on the right presents what is expected in the long-term from ActNowBC if the intermediate outcomes are sustained, for example improved health and life expectancy and lower preventable health care and social services costs.

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Table 3 – First progress report (January 2008) on ActNowBC- the Target on Tobacco Use

The table above shows the actual and expected smoking rates by 2010 among Canadians 15 years of age and above at the national level and in British Columbia. The data shows that the smoking rate in BC is always the national average and that the province is on course to bring its smoking rate down to 17.6% by 2010, a 10% reduction compared to the smoking rate of 2003.

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