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In Canada, Indigenous people experience racism across diverse settings, including within the health sector. This has negatively impacted both the quality of care that Indigenous people receive as well as how research related to Indigenous populations is conducted. Therefore, an Indigenous-led council at a kidney research network, in partnership with other key stakeholders, sought to create a learning pathway that aims to distill the racism that Indigenous people face, and build cultural competence, within the health sector.The learning pathway was designed for researchers, health care providers, patient partners and administrators.Various components of the pathway are established trainings in healthcare and research settings at provincial and national levels. Provincially, some components are implemented in British Columbia, Alberta, Saskatchewan, Manitoba and Ontario.The pathway, called Wabishki Bizhiko Skaanj (meaning "White Horse" in Anishinaabemowin), involves six key steps: a culturally tailored blanket exercise that walks participants through the history of local Indigenous Nations/peoples; a more detailed online training program (San'yas); a series of webinars on Indigenous research ethics and protocols; an educational booklet about engaging Knowledge Keepers in research, as well as sharing details about their traditional knowledge and culture; two certification programs about Indigenous ownership of data; and a "book club," wherein the conversation of racism-and the goal for finding solutions-is continually discussed.Wabishki Bizhiko Skaanj is working to build cultural competence in the Canadian health sector.This learning pathway has the potential to address racial disparities across the country and improve health outcomes for Indigenous peoples.RéSUMé: OBJECTIF: Au Canada, les autochtones font face au racisme dans divers milieux, y compris dans le secteur de la santé. Cela a eu une incidence négative sur la qualité des soins que reçoivent les peuples autochtones, ainsi que sur la façon dont la recherche sur les populations autochtones est menée. Par conséquent, un conseil dirigé par des Autochtones dans un réseau de recherche sur les reins, en partenariat avec d’autres parties prenantes, a cherché à créer une voie d’apprentissage visant à réduire le racisme auquel les peuples autochtones sont confrontés et à renforcer les compétences culturelles au sein du secteur de la santé.La voie d’apprentissage a été conçue pour les chercheurs, les fournisseurs de soins de santé, les patients partenaires et les administrateurs.Cette voie d’apprentissage est composée de formations établies dans le milieu de la santé et de la recherche au niveau provincial et national. À l’échelle provinciale, il y a des programmes ayant lieu en Colombie-Britannique, en Alberta, en Ontario, en Saskatchewan et au Manitoba.La voie d’apprentissage, appelée Wabishki Bizhiko Skaanj (qui signifie « cheval blanc » en Anishinaabemowin), comporte six étapes clés : un exercice culturel sur mesure qui guide les participants à travers l’histoire des nations/peuples autochtones locaux à l’aide de diverses couvertures culturelles; un programme de formation en ligne détaillé (San’yas); une série de webinaires sur l’éthique et les protocoles autochtones en matière de recherche; un livret pédagogique sur l’engagement des gardiens de la connaissance en recherche ainsi que le partage d’informations sur leur connaissance et leur culture traditionnelle; deux programmes de certification sur la propriété autochtone des données; et un « club de lecture » dans lequel nous ne cessons de discuter du racisme tout en cherchant des solutions. RéSULTATS: Wabishki Bizhiko Skaanj s’efforce de renforcer les compétences culturelles dans le secteur de la santé au Canada.Cette voie d’apprentissage a le potentiel de s’attaquer aux disparités raciales à l’échelle nationale et d’améliorer les résultats en matière de santé pour les peuples autochtones.

The Canadian Community Health Survey (CCHS) is one of the world's largest ongoing cross-sectional population health surveys, with over 130,000 respondents every two years or over 1.1 million respondents since its inception in 2001. While the survey remains relatively consistent over the years, there are differences between cycles that pose a challenge to analyze the survey over time.A program package called cchsflow was developed to transform and harmonize CCHS variables to consistent formats across multiple survey cycles. An open science approach was used to maintain transparency, reproducibility and collaboration.The cchsflow R package uses CCHS survey data between 2001 and 2014. Worksheets were created that identify variables, their names in previous cycles, their category structure, and their final variable names. These worksheets were then used to recode variables in each CCHS cycle into consistently named and labelled variables. Following, survey cycles can be combined. The package was then added as a GitHub repository to encourage collaboration with other researchers.The cchsflow package has been added to the Comprehensive R Archive Network (CRAN) and contains support for over 160 CCHS variables, generating a combined data set of over 1 million respondents. By implementing open science practices, cchsflow aims to minimize the amount of time needed to clean and prepare data for the many CCHS users across Canada.RéSUMé: CONTEXTE: L’Enquête sur la santé dans les collectivités canadiennes (ESCC) est l’une des plus grandes enquêtes transversales sur la santé de la population, avec plus de 130 000 sondés tous les deux ans et plus de 1,1 million de sondés depuis son début en 2001. Tant que l’enquête reste relativement cohérent, il y a des différences entre des cycles qui posent une challenge majeure pour analyser l’enquête au fil du temps. INTERVENTION: Un paquet de programme appelé cchsflow a été développé pour transformer et harmoniser les variables CCHS aux formats cohérents à travers plusieurs cycles de sondage. Une approche de science ouverte était utilisée pour maintenir la transparence, la reproductibilité et la collaboration. RéSULTATS: Le paquet cchsflow R développé utilisait les données d’enquête de l’ESCC entre 2001 et 2014. Les feuilles de calcul ont été créées pour identifier des variables, leurs noms dans des cycles précédents, leurs structures de catégories et leurs noms de variables finales. Ces feuilles de calcul ont ensuite été utilisées pour recoder les variables dans chaque cycle de l’ESCC pour générer les ensembles de données harmonisés qui peuvent être combiner dans un ensemble de données constamment étiqueté pour l’analyse. Le paquet a ensuite été ajouté comme un entrepôt de GitHub pour encourager la collaboration avec les autres chercheurs. IMPLICATION: Le paquet cchsflow a été ajouté au Comprehensive R Archive Network (CRAN) et contient un appui pour plus de 160 variables de l’ESCC, générant un ensemble de données de plus d’un million de sondés. En exécutant les pratiques de sciences ouvertes, cchsflow vise à minimiser le temps requis pour nettoyer et préparer les données pour les plusieurs utilisateurs du CCHS à travers le Canada.

The communities of Banff, Canmore, Lake Louise, and Kananaskis are home to some of Alberta's most popular tourist attractions. In recent years, the area has seen a significant increase in foreign-born residents. The Bow Valley Immigration Partnership (BVIP) brings together immigrants and stakeholders from multiple sectors to identify and implement strategies to promote integration.In collaboration with community service agencies and local employers, we developed the Bow Valley Workplace Inclusion Charter (WIC), a set of voluntarily adopted policies designed to increase inclusive practices in the workplace and promote integration of newcomers into the community. We then recruited and supported several employers in the area to make and implement specific commitments related to improving social determinants of health such as working conditions, social inclusion, education, and social support networks for immigrant workers.Eight Bow Valley employers, providing work for 38% of workers in the area, were enrolled in the pilot program. Mid-course evaluation identified facilitators and barriers to implementation of the WIC. At the conclusion of the pilot period, we evaluated the commitments implemented by each signatory to the WIC. Six of 8 employers fulfilled at least 5 commitments as articulated in the WIC, and 4 employers fulfilled 10 or more commitments.The WIC is a novel way of partnering with employers, community service agencies and immigrant workers to create inclusive workplace practices and improve integration of immigrants into the community. The WIC also has the potential to be adapted to address the needs of other equity-seeking groups who bring diversity to the workplace.RéSUMé: LIEU: On trouve dans les petites villes de Banff, Canmore, Lake Louise et Kananaskis certains des attraits touristiques les plus populaires de l’Alberta. Ces dernières années, le nombre de résidents nés à l’étranger a sensiblement augmenté dans la région. L’association Bow Valley Immigration Partnership (BVIP) réunit des immigrants et des acteurs de nombreux secteurs afin de trouver et d’appliquer des stratégies pour favoriser l’intégration des nouveaux arrivants. INTERVENTION: En collaboration avec des organismes de services communautaires et des employeurs locaux, nous avons créé une charte d’intégration en milieu de travail, la Bow Valley Workplace Inclusion Charter : un ensemble de politiques adoptées volontairement pour faire augmenter les pratiques rassembleuses sur le lieu de travail et favoriser ainsi l’intégration des nouveaux arrivants dans la communauté. Nous avons ensuite recruté plusieurs employeurs de la région et nous les avons aidés à prendre et à concrétiser des engagements spécifiques pour améliorer les déterminants sociaux de la santé, comme les conditions de travail, l’inclusion sociale, l’éducation et les réseaux de soutien social des travailleurs immigrants. RéSULTATS: Huit employeurs de la vallée de Bow, qui emploient 38 % des travailleurs de la région, se sont inscrits au programme pilote. L’évaluation à mi-parcours a fait ressortir les éléments qui favorisent ou qui entravent l’application de la Charte. À la fin de la période d’essai, nous avons évalué la concrétisation des engagements pris par chaque signataire. Six des huit employeurs ont respecté au moins cinq engagements énoncés dans la Charte, et quatre sur huit en ont respecté dix ou plus. CONSéQUENCES: La Charte est un nouveau moyen de créer des partenariats avec des employeurs, des organismes de services communautaires et des travailleurs immigrants pour créer des pratiques rassembleuses en milieu de travail et améliorer l’intégration des immigrants dans la communauté. On peut aussi l’adapter aux besoins d’autres groupes en quête d’équité qui apportent de la diversité sur le lieu de travail.

People in Alberta are more likely to seek information about cancer prevention online than they are to have this conversation with their primary care provider. As people turn to the internet to support health decision-making, it is critical that we improve the supportiveness of the virtual health setting for cancer prevention.In 2014, the Alberta Cancer Prevention Legacy Fund launched an online HPV Decision Aid Tool to support evidence-informed decision-making in response to suboptimal uptake of the HPV (human papillomavirus) vaccine. Google Analytics data from approximately 2000 recent interactions with this tool have yielded insights into the concerns that impact people's decision-making about the vaccine.Most users of this tool are adults interested in the vaccine for themselves (69%), rather than parents considering immunizing their children (31%). No differences were found in the information-seeking behaviour of parents of girls compared with parents of boys, suggesting that mental models among those who are considering the HPV vaccine may have shifted in recent years. Concerns differed by respondent; cost was the most important concern among adults (62.0%), while parents were most concerned about vaccine safety (61.5%). Only 23% of users asked "what is HPV", suggesting that many people in Alberta now have basic knowledge about the virus.Results provide a real-time "pulse" on knowledge and attitudes towards HPV immunization, which informs our approach to tailoring messaging with the aim of increasing vaccine uptake in Alberta. Outcomes will provide evidence needed to inform new interventions aimed at increasing HPV immunization rates.RéSUMé: LIEU: Les gens de l’Alberta ont plus tendance à chercher des informations sur la prévention du cancer en ligne que d’en parler avec leur fournisseur de soins de premier recours. Comme les gens se tournent de plus en plus vers Internet pour éclairer leurs décisions en matière de santé, il est essentiel d’améliorer notre soutien aux milieux de soins virtuels de prévention du cancer. INTERVENTION: En 2014, le fonds spécial de l’Alberta pour la prévention du cancer (Alberta Cancer Prevention Legacy Fund) lançait un outil en ligne d’aide à la décision axé sur le VPH (virus du papillome humain) pour favoriser la prise de décisions éclairées par les données probantes, vu le recours sous-optimal au vaccin anti-VPH. Les données sur environ 2 000 interactions récentes avec cet outil, extraites au moyen de Google Analytics, ont offert un aperçu des préoccupations qui comptent dans les décisions des gens au sujet du vaccin. RéSULTATS: La plupart des utilisateurs de l’outil sont des adultes que le vaccin intéresse pour eux-mêmes (69 %) plutôt que des parents qui songent à faire vacciner leurs enfants (31 %). Aucune différence n’a été constatée dans le comportement de recherche d’informations des parents de filles et des parents de garçons, ce qui indique que les modèles mentaux des personnes qui envisagent le vaccin anti-VPH pourraient avoir changé ces dernières années. Les préoccupations différaient selon les répondants; le coût était la préoccupation la plus importante chez les adultes en général (62 %), tandis que les parents s’inquiétaient surtout de l’innocuité du vaccin (61,5 %). Seulement 23 % des utilisateurs ont cherché « qu’est-ce que le VPH? », ce qui donne à penser que beaucoup de gens en Alberta ont maintenant des connaissances de base sur le virus. CONSéQUENCES: Nos résultats permettent de prendre le « pouls » en temps réel des connaissances et des attitudes à l’égard de l’immunisation contre le VPH, ce qui éclaire notre stratégie d’adaptation de nos messages en vue d’accroître le recours au vaccin en Alberta. Les résultats finaux fourniront les données probantes nécessaires pour éclairer de nouvelles interventions visant à accroître les taux d’immunisation contre le VPH.

Setting This paper documents a participatory process of Health Portfolio staff in the design of a clock, and announces the 2020 Canadian Health Clock, with links to numerous online health calculators. The clock is part of the Health Portfolio’s celebration activities in 2019 of “100 Years of Health”, as the Department of Health was established in Canada in 1919. Intervention The intervention was the development of a clock on the Government of Canada website with linkage to calculators as a health promotion tool. The clock was built on the concept of the 2004 Chronic Disease Clock, which shows the number of deaths so far today, and so far this year. The clock was developed using a consultative approach, following a review of the original clock. Outcomes The 2020 clock incorporates new data visualization concepts. New features, facilitated by improved technology, include: expansion to all causes of death; blinking red dots to enhance visual impact; and three clock versions (analogue, featuring a moving circle; digital, table format; and graphical, bar chart format). The clock also provides links to a number of health calculators, to allow people to seek personalized information to improve their health. Implications The online health clock and health calculators are good examples of innovation in health risk communication tools for effective knowledge translation and dissemination. They inform people about health statistics (clock) and their health (calculators). The clock engages people in the context of the Canadian population, whereas the calculators provide personalized information about improving an individual’s future health.

SETTING: The Winnipeg Regional Health Authority (WRHA) is one of the largest and most diverse health regions in Canada. Within the WRHA, the Population and Public Health (PPH) Surveillance Team provides epidemiological support across a variety of public health service areas. INTERVENTION: We developed and deployed a risk-based data disclosure protocol that balances the need to share public health surveillance data with the need to protect personal health information. OUTCOMES: Unlike the conventional data disclosure standard adopted in Manitoba (suppress cell sizes

Congenital anomalies (CAs) can cause lifelong morbidity and accounted for 23.2% of infant deaths from 2003 to 2007. In British Columbia (BC), surveillance of CAs has been irregular since the early 2000s. To enhance CAs surveillance in BC, the Public Health Agency of Canada has provided funding for the implementation of the BC Congenital Anomalies Surveillance System (BCCASS).BCCASS is a population-based surveillance system. The system leverages existing administrative data sources that capture information regarding vital events, disease status, drug prescription, and healthcare utilization. The system uses a series of algorithms to capture specific CAs diagnoses, some of which are further validated with the support of the Provincial Advisory Committee. This Advisory Committee is a multi-stakeholder coalition that includes the BC Office of the Provincial Health Officer, subject matter experts, data partners, users, and academia, and acts to provide support, expertise, and strategic guidance to BCCASS.Through BCCASS, prevalence and historical trends for 35 CAs in BC are available. Information pertaining to maternal place of residence, risk, and protective factors can be used for association studies such as links to environmental hazards and cluster analysis.BCCASS is a cost-effective and sustainable system that leverages existing data sources necessary to understand the overall burden of CAs across the BC population. This is fundamental to support data-driven decisions around policy development, program planning, and evaluation of preventive measures. Strong coalitions with stakeholders are instrumental to ensure successful implementation and expansion in the future.RéSUME: CONTEXTE: Les anomalies congénitales (AC) peuvent causer une morbidité à vie et ont représenté 23,2 % des décès infantiles de 2003 à 2007. En Colombie-Britannique, la surveillance des AC a été irrégulière depuis le début des années 2000. Afin d’améliorer la surveillance de l’AC en Colombie-Britannique, l’Agence de la santé publique du Canada a financé la mise en œuvre du BC Congenital Anomalies Surveillance System (BCCASS). INTERVENTION: Le BCCASS est un système de surveillance basé sur la population. Le système exploite les sources de données administratives existantes qui capturent des informations concernant les événements vitaux, les diagnostics médicaux, la prescription de médicaments et l’utilisation des soins de santé. Le système utilise une série d’algorithmes pour saisir des diagnostics d’AC spécifiques, dont certains sont ensuite validés avec le soutien du Comité consultatif provincial. Ce comité consultatif est une coalition multipartite entre le bureau de l’Agence de santé provincial de la Colombie-Britannique, des experts en la matière, des partenaires de données, des utilisateurs et des universitaires, qui agit pour fournir un soutien, une expertise et des conseils stratégiques au BCCASS. RéSULTATS: Par le BCCASS, la prévalence et les tendances historiques pour 35 AC en Colombie-Britannique sont disponibles. Les informations relatives au lieu de résidence de la mère, aux facteurs de risque et de protection peuvent être utilisées pour des études d’association telles que les liens avec les facteurs environnementaux et l’analyse typologique. INCIDENCES: Le BCCASS est un système rentable et durable qui tire parti des sources de données existantes nécessaires pour comprendre le fardeau global des CA dans l’ensemble de la population de la Colombie-Britannique. Ceci est fondamental pour soutenir les décisions fondées sur les données concernant l’élaboration de politiques, la planification de programmes et l’évaluation des mesures préventives. Des coalitions solides avec les parties prenantes sont essentielles pour assurer une mise en œuvre et une expansion réussie dans l’avenir.

Setting Syndemics occur when two or more health conditions interact to increase morbidity and mortality and are exacerbated by social, economic, environmental, and political factors. Routine provincial surveillance in Ontario assesses and reports on the epidemiology of single infectious diseases separately. Therefore, we aimed to develop a method that allows disease overlaps to be examined routinely as a path to better understanding and addressing syndemics in Ontario. Intervention We extracted data for individuals with a record of chlamydia, gonorrhea, infectious syphilis, hepatitis B and C, HIV/AIDS, invasive group A streptococcal disease (iGAS), or tuberculosis in Ontario’s reportable disease database from 1990 to 2018. We transformed the data into a person-based integrated surveillance dataset retaining individuals (clients) with at least one record between 2006 and 2018. Outcomes The resulting dataset had 659,136 unique disease records among 470,673 unique clients. Of those clients, 23.1% had multiple disease records with 50 being the most for one client. We described the frequency of disease overlaps; for example, 34.7% of clients with a syphilis record had a gonorrhea record. We quantified known overlaps, finding 1274 clients had gonorrhea, infectious syphilis, and HIV/AIDS records, and potentially emerging overlaps, finding 59 clients had HIV/AIDS, hepatitis C, and iGAS records. Implications Our novel person-based integrated surveillance dataset represents a platform for ongoing in-depth assessment of disease overlaps such as the relative timing of disease records. It enables a more client-focused approach, is a step towards improved characterization of syndemics in Ontario, and could inform other jurisdictions interested in adopting similar approaches.

SETTING: There is a multitude of health equity tools but little guidance on how to effectively use these tools in public health nursing practice. In BC, public health nurses who are certified in sexually transmitted infection care utilize guidelines authorized by the nursing regulatory body. INTERVENTION: As part of the Equity Lens in Public Health (ELPH) research project, an assessment of the nursing guideline, Sexually Transmitted Infection (STI) Assessment Decision Support Tool, was undertaken using the Assessing Equity in Clinical Practice Guidelines health equity assessment tool. The chosen tool is intended for use by health care providers, is broadly applicable to clinical practice guidelines, can be used retrospectively, and falls within the category of equity checklists and audits. OUTCOMES: Overall, the tool was useful in assessing the inclusion and omission of an equity focus in the guideline. However, there were several challenges: the identification of an appropriate health equity tool; the absence of an evaluation of the chosen tool; the tool’s focus on chronic disease versus communicable disease; and the difficulty of obtaining client perspectives. IMPLICATIONS: For an improved equity lens in the STI Assessment Decision Support Tool, future revisions should be equity focused and include perspectives from affected populations, an emphasis on the determinants of health that perpetuate inequities for populations who experience a disproportionate burden of STI, information on provincially available resources, and service delivery models that improve timely and equitable access to treatment and care.

SETTING: The Simcoe Muskoka District Health Unit (SMDHU) is a local public health agency in Ontario, serving the County of Simcoe and District of Muskoka’s population of over 540,000 people in a mixed urban-rural environment. SMDHU has had a strategic focus on the determinants of health since 2007. INTERVENTION: The use of the Health Equity Impact Assessment (HEIA) tool was encouraged throughout SMDHU. An online survey was conducted to assess the implementation of mitigation strategies identified through the HEIAs; in particular, the facilitators and barriers/challenges, and the impacts at both the program level and the level of priority populations, themselves, were assessed. OUTCOMES: Agency programs reported 40 HEIAs conducted between 2013 and 2017. While three of the 40 HEIAs were at an early stage, the remaining 37 were at an advanced stage of implementing mitigation strategies, or beyond. Reports from these 37 advanced-stage HEIAs indicated that 30 of them observed or measured impacts on their programs, services, and/or policies (i.e., program-level impacts), following the implementation of HEIA mitigation strategies. These impacts included improved collaboration with external partners, development of more accessible and inclusive communication, increased availability of information and population health data, increased access to services for priority populations, reduced financial barriers for accessing services, and increased staff training on health equity and priority populations. However, few respondents had measured or purposefully assessed impacts on target populations themselves (i.e., population-level impacts); therefore, such impacts are unknown. Key facilitators to the implementation of mitigation strategies were availability of staff, collaboration and support from other areas of the organization, sufficient time, collaboration with community partners, and the inclusion of HEIAs in program operational plans. Absence of these facilitators was identified as a barrier to implementation of mitigation strategies. IMPLICATIONS FOR POLICY AND PRACTICE: The use of HEIAs served as a catalyst for change in this local public health agency, leading to equity-oriented impacts on public health programming, planning, service delivery, and organizational policy. Support and capacity-building for measuring and evaluating impacts of mitigation strategies on intended priority populations themselves are recommended, to ensure more robust learning and improvement.

SETTING: Consumption of raw game meats is important for Inuit health and well-being but may sometimes increase risk of exposure to parasites. In Nunavik, following trichinellosis outbreaks in the 1980s caused by raw walrus consumption, a diagnostic test was developed for the region and offered to all Inuit communities by 1997. Despite this prevention program, an important trichinellosis outbreak occurred in 2013, affecting 18 inhabitants of Inukjuak. INTERVENTION: Because the classical outbreak investigation did not rapidly converge toward a common food source or specific event, a local response group, composed of four community members appointed by the Municipal Council as well as the regional public health physician, nurse and wildlife parasitologist, was created. Their objective was to investigate potential sources of infection related to the outbreak, hence the investigation of the types of meats consumed, the movement of meats between and within the community, and the local practices of processing game meat. OUTCOMES: Though the source of infection was not fully confirmed, this local investigation identified the distribution of transformed polar bear meat as the most probable source of infection. The creation of this unique, intersectoral and intercultural local response group fostered the use of local knowledge to better understand aspects of the modern food system, and is one of the most innovative outcomes of this investigation. IMPLICATIONS: Integrating multiple ways of knowing was critical for the management of this important public health issue and contributed to community members’ mobilization and empowerment with respect to local food safety issues.

SETTING: The first regulated supervised inhalation site (safer smoking room) in North America has opened in Lethbridge, Alberta, as part of a supervised consumption site addressing all routes of consumption. When designing the service, we felt it was important to accommodate not just injection drug use but also inhalation because (1) it is not the method of drug use that kills but the drug itself, (2) all people who use drugs deserve service regardless of their mode of use, and (3) people who use drugs should have the opportunity to use the method with the lowest risk. INTERVENTION: We received approval from Health Canada to offer supervised inhalation services in addition to supervised injection services. Based on a European model, we worked with a local commercial heating, cooling, and ventilation (HVAC) company to create rooms with ventilation systems that complied with Canadian health and safety regulations. OUTCOME: People who use drugs by inhalation have repeatedly told us that they want to use indoors and will do so given the option. Since opening the supervised consumption service at the end of February 2018, the response has been overwhelming and both of the inhalation rooms are constantly in use. IMPLICATIONS: Supervised inhalation services provide an alternative to public drug use and an opportunity for people who use drugs to engage with harm reduction services. Other supervised consumption services in Canada may also wish to pursue exemptions for this service.

Planning and designing thermally comfortable outdoor spaces is increasingly important in the context of climate change, particularly as children are more vulnerable than adults to environmental extremes. However, existing playground standards focus on equipment and surfacing to reduce acute injuries, with no mention of potential negative health consequences related to heat illness, sun exposure, and other thermal extremes. The goal of this project was to develop proposed guidelines for designing thermally comfortable playgrounds in Canada for inclusion within the CAN/CSA-Z614 Children's playground equipment and surfacing standard.The project to develop guidance for thermally comfortable playgrounds was initiated with a municipal project in Windsor, Ontario, to increase shade, vegetation, and water features at parks and playgrounds to provide more comfortable experiences amid the increased frequency of hot days (≥30°C). The lack of available information to best manage environmental conditions led to a collaborative effort to build resources and raise awareness of best practices in the design of thermally comfortable playgrounds.A group of multidisciplinary experts developed technical guidance for improving thermal comfort at playgrounds, including a six-page thermal comfort annex adopted within a national playground and equipment standard. The annex has been used by Canadian schools in a competition to design and implement green playgrounds.Both the technical report and the thermal comfort annex provide increased awareness and needed guidance for managing environmental conditions at playgrounds. Thermally safe and comfortable play spaces will help ensure that Canada's playgrounds are designed to minimize environmental health risks for children.RéSUMé: CONTEXTE: À l’ère des changements climatiques, le confort thermique n’a jamais été si important pour la planification et l’aménagement d’espaces extérieurs, surtout car les enfants sont plus sensibles que les adultes aux chaleurs brûlantes. Cependant, les normes qui encadrent actuellement les aires de jeu s’articulent autour d’une logique de prévention de traumatismes. Elles portent donc principalement sur les équipements et leurs revêtements plutôt que sur les conséquences des canicules, des malaises liés à la chaleur et des insolations. L’objectif du présent projet est de rédiger un projet de directives pour favoriser le confort thermique des aires de jeu au Canada et d’intégrer ces directives à la norme CAN/CSA-Z614 Aires et équipements de jeu. INTERVENTION: Les origines du projet remontent à une action municipale à Windsor, en Ontario. Celle-ci avait pour but d’augmenter la quantité de zones d’ombres, de végétation et de jeux d’eau dans les parcs et les aires de jeu en vue de favoriser le confort thermique vu la fréquence croissante des canicules (≥30°C). Le constat de lacunes d’informations autour de la gestion des conditions écologiques a suscité une concertation pour créer des ressources et faire rayonner des pratiques d’aménagement optimales pour l’amélioration du confort thermique des aires de jeu. RéSULTATS: Une équipe transversale d’experts a rédigé des directives techniques pour améliorer le confort thermique des aires de jeu, ainsi qu’une annexe de six pages sur la question qui a été intégrée à une norme nationale. Dans le cadre d’un concours, des écoles canadiennes se sont servies de l’annexe comme référentiel pour penser et aménager des aires de jeu vertes. IMPLICATIONS: Le rapport technique et l’annexe mettent en valeur le besoin d’encadrer la gestion des facteurs environnementaux des aires de jeu. L’amélioration du confort thermique de ces espaces et la réduction des risques environnementaux permettent de protéger la santé des enfants au Canada.

SETTING: One of the greatest challenges of Nunavut’s health care system is its reliance on short-term professionals, many of whom are not oriented to the Inuit historical/cultural context and the organization of health care in the territory. Our objective was to develop a free iOS/Android app to address this knowledge gap. INTERVENTION: We reviewed existing literature and interviewed key stakeholders to develop the content of the app covering the following: Inuit ways of communicating and expectations in the health care setting; Inuit history, settlement, and societal values (including a bibliography and a list of Inuktitut language phrases and resources); health care model (including referral pathways for tertiary care and mental health referrals); maps and community information; and useful information to prepare for your arrival. The app, HealthNU, was launched in September 2017. We targeted new and short-term health care providers in Nunavut, and the app has also been circulated and used by social workers, educators, and health care providers outside of the territory. OUTCOMES: By September 5, 2019, the app had been downloaded more than 700 times. To evaluate the app, we conducted interviews and a brief survey with key stakeholders (n = 18), who indicated that (1) the app was easy to use; (2) the content was highly relevant and would result in improved cultural competencies; and (3) they would recommend the app to colleagues and were already using it for recruitment/orientation. Challenges and limitations included: ensuring practitioners “completed” all modules while reading/using the app, and low response rate among providers who were solicited for feedback. IMPLICATIONS: HealthNU is an example of how technology solutions developed in partnership with community members, health care providers, researchers, and government can improve the quality of care for Nunavummiut. We are currently working with the Nunavut Department of Health to develop similar apps in other contexts.

SETTING: Shambhala is a 5-day electronic dance music (EDM) festival held in rural British Columbia that annually hosts between 15,000 and 18,000 people on a 500-acre ranch. The AIDS Network Outreach & Support Society (ANKORS) has provided harm reduction services throughout the duration of the festival since 2003, including point-of-care drug checking, which allows real-time testing of illicit substances to assess their composition. Drug checking results are provided directly to clients and displayed in aggregate on a screen for all attendees to see. INTERVENTION: In 2017, ANKORS added fentanyl checking to their repertoire of drug checking technologies for festivalgoers. Volunteers used a brief survey to collect information on what clients expected the samples to contain. Volunteers carried out drug checks and subsequently logged test results. ANKORS provided an amnesty bin at the tent for clients who chose to discard their substances. OUTCOMES: Of the 2683 surveys, 2387 included data on both the client’s belief and the actual test result. Clients were more likely to discard when the test result differed from their belief (5.16%) than when their belief was confirmed (0.69%). Discarding increased to 15.54% when the test could not clearly identify a substance and to 30.77% if the client did not have a prior belief of the substance. Of 1971 samples tested for fentanyl, 31 tested positive and 16.13% of clients discarded compared to 2.63% in the negative group. IMPLICATIONS: Drug checking services appeal to festivalgoers who, when faced with uncertainty, may discard their substances. This innovative harm reduction service allows for a personalized risk discussion, potentially reaching others via word-of-mouth and early warning systems. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.17269/s41997-018-0126-6) contains supplementary material, which is available to authorized users.

BACKGROUND: Population health approaches are visible among multidisciplinary methods used in urban design and planning, but attention to health equity is not always an explicit focus. Population and Public Health—Saskatoon Health Region recognized the need for frameworks to prioritize, integrate and measure health equity within local built environments. SETTING: A cross-department healthy built environment (HBE) initiative coordinated activities involving Health Promotion, Environmental Public Health, Public Health Observatory, and Medical Health Officers engaged with municipal, academic and community partners in Saskatoon, Saskatchewan. INTERVENTIONS: The HBE team conducted evidence reviews and consulted with partners to identify common health equity issues in built environments and best and leading practices to address them. The HBE team then prioritized and undertook projects to model a health equity approach. OUTCOMES: Projects included the following: (1) developing a Health Equity in Healthy Built Environment Framework; (2) engaging in a partner campaign highlighting built environment and health equity during a municipal election; (3) producing a Health Equity Impact Assessment (HEIA) report on the City of Saskatoon’s growth plan; and (4) developing a monitoring and evaluation framework for health equity outcomes. Other outputs include making new connections between local HBE and poverty reduction efforts and promoting social inclusion guidelines in consultation processes. IMPLICATIONS: Within a population health approach to HBE, an explicit focus on health equity can be a catalyst for engaging partners in cross-sectoral action for building inclusive physical and social environments.

SETTING: In response to the opioid overdose crisis, a Public Health Emergency was declared in British Columbia (BC) in April 2016. There were 1448 deaths in BC in 2017 (30.1 deaths per 100,000 individuals). INTERVENTION: Approximately one third of all overdose deaths in BC in 2016 (333/993) and 2017 (482/1448) occurred within the region served by Fraser Health Authority (FH). We identified a need for a supervised drug use site in Surrey, the city with FH’s highest number of overdose deaths in 2016 (n = 122). In order to ensure low-barrier services, FH underwent an internal assessment for a supervised drug use site and determined that a supervised injection site was unlikely to meet the needs of individuals who consumed their drugs using other routes, choosing instead to apply for an exemption to the Controlled Drug and Substances Act in order to open a Supervised Consumption Site (SCS). OUTCOMES: In assessing population needs, injection was identified as the mode of drug administration in only 32.8% of overdose deaths in FH from 2011 to 2016. Other routes of drug (co-) administration included oral (30.6%); smoking (28.8%); intranasal (24.2%); and unknown/other (17.1%). Interviews with potential service users confirmed drug (co-) administration behaviours and identified other aspects of service delivery, such as hours and co-located services that would help align the services better with client needs. With Health Canada’s approval, SafePoint in Surrey opened for supervised injection on June 8, 2017 and received an exemption to allow oral and intranasal consumption on June 26, 2017. IMPLICATIONS: By assessing drug use practices, the evolving needs of people who use substances, and tailoring services to local context, we can potentially engage with individuals earlier in their substance use trajectory to improve the utility of services and prevent more overdoses and overdose deaths.

Setting This paper chronicles the transformational process through which a national intersectoral collaboration, the Canadian Partnership for Children’s Health and Environment (CPCHE), came to embrace a more upstream, equity-based focus in its mandate to advance children’s environmental health. Intervention After 15 years of working within a conventional, evidence-informed approach to health promotion and policy advocacy, in 2010–2013, CPCHE had the opportunity to collaborate on the development of equity-focused knowledge translation (EqKT). EqKT is a relational approach to knowledge practices that challenges intersectoral actors to work to uncover biases and limitations within their own institutional paradigms and professional practices that constrain their capacity to address population health inequities. Outcome The ensuing transformation towards equity-focused intersectoral practice led CPCHE to create an intersectoral initiative called RentSafe. Conceptually and operationally, RentSafe provides an intersectoral space within which the grounded expertise of people with experience of unhealthy and undignified housing provides a roadmap for public health and other practitioners to critically explore professional and institutional blind spots and barriers. With RentSafe as its watershed moment, CPCHE is shifting from a top-down “for whom” orientation to an authentically engaged “with whom” approach that seeks to work integrally with community partners to expose and challenge systemic roots of health inequity. Implications The transformational story of CPCHE underscores the competencies needed for public health professionals to acknowledge the sources of our own biases and limitations as a necessary first step in equity-focused intersectoral practice (EquIP). It also affirms the value of working in partnership with those who experience the environmental health inequities that such efforts seek to address.

SETTING: During a period of regulatory uncertainty, a local public health unit in Ontario was notified of an exhibition for electronic nicotine delivery systems (ENDS) and novel tobacco delivery products (NTDs), specifically e-cigarettes and waterpipes, which have seen increasing use particularly among youth. Relevant statutes creating regulatory uncertainty included a new provincial Electronic Cigarettes Act (ECA) with certain sections awaiting proclamation, and a local waterpipe bylaw awaiting approval, which would have prohibited the use of these products in public spaces if they entered into force ahead of the exhibition date. Public health staff had concerns the event would normalize use of ENDS/NTDs, particularly among youth, and also planned to enforce already proclaimed ECA sections, as well as the existing Smoke-Free Ontario Act (SFOA) with regulations applicable to use of tobacco shisha in waterpipes. INTERVENTION: Public health staff contacted event organizers and proprietors to communicate obligations under the SFOA and ECA, as well as share hypothetical implications from pending regulatory changes, including risk of charges for regulatory non-compliance if regulations came into force ahead of the planned event. OUTCOMES: Following discussion with health unit staff and legal consultation, the exhibition was cancelled. IMPLICATIONS: By directly communicating regulatory uncertainty, a public health unit was able to achieve local health goals. In this situation, public health advised exhibition proprietors of potential event disruption implicated by forthcoming regulatory changes. Subsequent cancellation of the event prevented potential adverse health impacts for at-risk groups. A similar communications approach could be used to achieve public health goals during a period of regulatory uncertainty.

SETTING: The Conference Board of Canada cites that 77% of employees want to receive health information in the workplace. From 2014 to 2016, Ottawa Public Health (OPH) partnered with 25 construction companies, to implement smoking cessation programs on 41 construction sites. INTERVENTION: OPH partnered with local construction companies, unions, and workers to design, deliver, and evaluate a tailored initiative to build smoke-free culture and encourage quit attempts. Workers received group and one on one counseling and nicotine replacement therapy (NRT) from OPH staff. Client satisfaction was assessed and used to inform ongoing quality improvement. OUTCOMES: Since 2014, this project has expanded from one pilot site to 41 sites and has engaged two of the largest construction companies in Canada. A participant’s survey (N = 62) found that at 1 month, 40% remained smoke-free and 38% had reduced the amount tobacco smoked. At 6 months, 34% remained smoke-free and 45% had reduced their consumption of tobacco. IMPLICATIONS: Construction workers typically have high smoking rates and low engagement with cessation programs. Public health practitioners working with the construction industry must understand the culture, engage on-site champions, and articulate the added value of tobacco cessation to the business. Using this information on partnering with the construction industry, this innovative program, first of its kind in Canada, could be duplicated in other communities.

SETTING: In 2009, Peel Public Health set a vision to transform the work of public health from efficient delivery of public health services as defined by provincial mandate to the robust analysis of the health status of the local population and selection and implementation of programming to achieve best health outcomes. A strategic approach to the workforce was a key enabler. PPH is a public health unit in Ontario that serves 1.4 million people. INTERVENTION: An organization-wide strategic workforce development program was instituted. It is theory-based, evidence-informed and data-driven. A first step was a conceptual framework, followed by interventions in workforce planning, human resources management, and capacity development. The program was built on evidence reviews, theory, and public health core competencies. Interventions spread across the employee work-life span. OUTCOMES: Capacity development based on the public health core competencies is a main focus, particularly analytical capacity to support decision-making. Employees gain skill and knowledge in comprehensive population health. Leadership evolves as work shifts to the analysis of health status and development of interventions. Effective human resource processes ensure appropriate job design, recruitment and orientation. Analysis of the workforce leads to vigorous employee development to ensure a strong pool of potential leadership successors. IMPLICATIONS: Theory, research evidence, and data provide a robust foundation for workforce development. Competencies are important inputs to job descriptions, recruitment, training, and human resource processes. A comprehensive workforce development strategy enables the development of a skilled workforce capable of responding to the needs of the population it serves.

The Indigenous Tobacco Program (ITP) operated by the Indigenous Cancer Care Unit at Cancer Care Ontario provides customized tobacco prevention workshops to First Nations youth across Ontario, in partnership with First Nations communities and partner organizations.First Nations youth in Canada are more likely than non-Indigenous youth to be smokers. The ITP aims to address the negative health impacts of commercial tobacco, using culturally relevant approaches, tools and resources while remaining respectful to the significance of sacred tobacco. This paper aims to determine whether a culturally tailored tobacco prevention workshop increases tobacco-related knowledge among First Nations youth in Ontario.The workshops exhibited promise in impacting First Nations youth knowledge on the harms of commercial tobacco, as after the workshop intervention, all indicators showed improved knowledge. Building strong and ongoing relationships with communities and partner organizations is vital to the success of the program.Culturally tailored workshops grounded in traditional knowledge and values provide an opportunity to increase the knowledge of the harms of commercial tobacco among First Nations youth in Ontario. With commercial tobacco use and exposure having tremendous health consequences, such interventions are essential.RéSUMé: CADRE: Le Programme pour la lutte contre le tabagisme chez les peuples autochtones (PLTPA) administré par l’Unité des soins de cancérologie chez les peuples autochtones à Cancer Care Ontario dispense des ateliers personnalisés de prévention du tabagisme aux jeunes Autochtones dans tout l’Ontario, en partenariat avec les communautés et organismes partenaires des Premières Nations. INTERVENTION: Les jeunes des Premières Nations canadiennes sont plus susceptibles de fumer que les jeunes non autochtones. Le PLTPA vise à remédier aux effets négatifs sur la santé du tabac commercial à l’aide d’approches, d’outils et de ressources pertinents sur le plan culturel, tout en demeurant respectueux de l’importance du tabac sacré. Cet article vise à déterminer si un atelier de prévention adapté sur le plan culturel permet d’accroître les connaissances relatives au tabac parmi les jeunes des Premières Nations de l’Ontario. RéSULTATS: Les ateliers ont eu des répercussions prometteuses sur les connaissances des jeunes des Premières Nations ayant trait aux effets néfastes du tabac commercial, puisqu’à la suite de l’atelier d’intervention, tous les indicateurs dénotaient une amélioration des connaissances à ce sujet. L’entretien de relations solides et continues avec les communautés et organismes partenaires est essentiel à la réussite du programme. IMPLICATIONS: Les ateliers culturellement adaptés et fondés sur des connaissances et des valeurs traditionnelles permettent d’accroître les connaissances des jeunes des Premières Nations ontariennes ayant trait aux effets néfastes du tabac commercial. Au vu des impacts énormes sur la santé, liés à la consommation de tabac commercial et à l’exposition à celui-ci, de telles interventions sont essentielles.

Background Heat wave early warning systems help alert decision-makers and the public to prepare for hot weather and implement preventive actions to protect health. Prior to harmonization, public health units across Ontario either used independent systems with varying methodologies for triggering and issuing public heat warnings or did not use any system. The federal government also issued heat warnings based on different criteria. During heat events, adjacent public health units in Ontario and the federal government would routinely call heat warnings at different times with separate public messages, leading to confusion. This article describes the collaborative process and key steps in developing a harmonized Heat Warning and Information System (HWIS) for Ontario. Setting Public health units across Ontario, Canada, collaborated with the federal and provincial government to develop the harmonized HWIS for Ontario. Intervention In 2011, stakeholders identified the need to develop a harmonized system across Ontario to improve heat warning services, warning criteria, and health messaging. Through a 5-year process facilitated by a non-governmental organization, the three levels of government collaborated to establish the Ontario HWIS. Outcomes The province-wide HWIS was implemented in 2016 with the Ontario Ministry of Health and Long-Term Care’s release of the harmonized HWIS Standard Operating Practice, which outlined the notification and warning process. Implications The lessons learned could help spur action in other provinces and jurisdictions internationally in the development of similar health evidence-based warning systems, including in particular those for protecting public health during extreme heat events.

SETTING: The Inuit community of Rigolet experiences greater rates of self-reported acute gastrointestinal illness (AGI) compared to southern Canada. INTERVENTION: A whiteboard video tool was collaboratively developed by Rigolet youth, community members, the research team and key regional stakeholders to share public health recommendations for reducing the risk of AGI. The video debuted in Rigolet at a community event in August 2016 and was later provided online for community members and local and regional health departments. Interviews and focus group discussions were used to evaluate the ability of the video to communicate public health information to community members in Rigolet. OUTCOMES: Community and government viewers reported that the whiteboard video was novel and engaging. Evaluation participants believed the video was suitable for promoting Inuit health because of the use of locally relevant visuals and narrative, which reflect Inuit art and storytelling traditions. Furthermore, participants indicated that the video co-development process was critical to ensuring community relevance of the video. Short-term outcome results suggest the video can reinforce health knowledge and potentially encourage behavioural change. IMPLICATIONS: The results suggest this whiteboard video was an effective tool to share information and could increase intention to change behaviours to reduce the risk of AGI in Rigolet. While tools like the whiteboard video are gaining popularity, the participatory approach was used to develop the video, and its use in an Inuit context illustrates its innovation and novelty. This tool may be a useful health promotion tool among Indigenous communities in Canada.

OBJECTIVES: The objectives of the study were to 1) describe the implementation of the “Testing is Healthy” campaign in four locations in British Columbia (BC) and 2) report process evaluation indicators for the campaign. PARTICIPANTS: Young adults ages 20–29 years, the age group with the highest reported rates of chlamydia and gonorrhea in BC. SETTINGS: Movie theatres located in Langley, Burnaby, Coquitlam and Surrey, which are communities served by the Fraser Health Authority (FHA) in BC. INTERVENTION: The FHA launched the campaign in 2014 and 2015 to bring down the prevalence of sexually transmitted infections (STIs) and HIV in the region. The campaign used the Cineplex TimePlay platform to engage moviegoers in answering STI/HIV-related questions, and to connect them to a clinic finder on the BC Centre for Disease Control Sex Smart Resource (SSR) website. TimePlay includes elements of gaming, is technology-based, and has been a successful advertisement platform for consumer products and services. However, this is the first time it has been used for sexual health promotion. The campaign was evaluated for 1) reach, based on theatre attendance and TimePlay participation, and 2) the effectiveness of connecting people to sexual health information using SSR web analytics. OUTCOMES: In total, the campaign received 548 410 views and 77 149 plays. SSR web analytics showed a significant increase in unique page views of the Clinic Finder page between the first and the second campaign. IMPLICATIONS: The campaign reached a large population at a low cost and was correlated with spikes in the unique page views for the Clinic Finder page.

BACKGROUND: In 2012, Ottawa Public Health (OPH) partnered with the City of Ottawa Municipal Child Care (MCC) Services to develop Healthy Eating and Active Living (HEAL) Guidelines. SETTING: The Guidelines aim to promote consistent standards of practice in child care settings related to healthy environments and food, physical activity, physical literacy, decreased sedentary behaviours, and positive role modeling by staff. The Guidelines targeted 498 children aged 18 months to 5 years, attending MCC centres. Resources and training were provided to 10 supervisors, 63 child care educators and 9 cooks. INTERVENTION: Components of the Guidelines were piloted in 5 MCC sites prior to being launched in 10 MCC sites across Ottawa, Ontario. Two project Advisory Groups supported the development of the Guidelines. Staff training, resources, recipes and menus were provided. An evaluation was conducted and has informed the Guidelines’ subsequent community implementation. In 2015, accompanying web-based resources and e-modules were developed. OUTCOMES: The evaluation demonstrated environmental and programming changes. Parent satisfaction was high and preliminary findings showed no real changes in food costs. Following implementation, the cooks reported high compliance to the 6-week menu plans provided, and the number of sites offering 120 minutes or more of daily physical activity increased. IMPLICATIONS: Through novel intersectoral partnerships, OPH was able to implement and evaluate HEAL Guidelines in tandem. The interdisciplinary project Advisory Groups, training of cooks, and engagement of the Ontario Coaches Association were all innovative elements of this project and may influence future public health activity in this area.

SETTING: Canadian youth (aged 15–29 years) are more diverse, educated, connected and socially engaged than ever before. However, many face health-related challenges, including mental health problems (10–20%), substance use concerns (14%) and obesity (45%). INTERVENTION: The Young Canadians Roundtable on Health (YCRH) was created in 2013 to be Canada’s youth voice on health. Supported by the Sandbox Project, this youth-led advisory works primarily virtually, leading advocacy projects and wide-ranging health initiatives. OUTCOMES: Youth and adult allies engaged in a participatory research evaluation of the YCRH, which was identified as a living laboratory, where youth could experiment with ideas and provide new perspectives on health issues. Adult allies reported learning new skills from youth, and youth gained advocacy and leadership skills. Collaborative projects resulted in a sense of shared achievement. Further, youth increased their connections to health and youth-serving spaces across the country. Identified challenges included difficulties in coordinating a national roundtable and defining shared responsibilities. IMPLICATIONS: The researchers generated the following evidence-based promising practices for youth engagement in health systems and program planning: (1) provide a consistent platform for youth input; (2) appreciate different forms of knowledge, expertise and communication methods; (3) invest in relationships and build mutual understanding among youth and adults; (4) for adult allies, be patient and comfortable with the ambiguity and unpredictability of working with youth; and (5) continually revisit and renegotiate structure and flexibility.

SETTING: Montréal. INTERVENTION: The lack of common knowledge about what public health does is a hindrance to its recognition and capacity to act. Montréal’s regional public health department set an explicit goal to clarify and better communicate its specific contributions when it developed its 2016–2021 action plan. This article briefly describes the efforts made to classify public health practice, introduces a typology of public health interventions and discusses its application and benefits. OUTCOMES: The typology that was developed defines 29 types of interventions grouped into four categories: direct action targeting the population; advocacy (persuading partners to take action); support (helping partners take action); collaboration (taking action with partners). The analysis of Montreal’s most recent action plan, completely drafted in terms of the typology, provides an insightful characterization of public health practice. Globally, four out of five interventions target partners (indirect), with more than half falling within the support category. Other indirect interventions are divided almost equally between advocacy and collaboration. Following a rigorous planning process and enforcing the use of the typology also had a significant structuring effect on the organization and its teams and enabled greater synergy with partners from other sectors. IMPLICATIONS: Very few people are familiar with everything public health does, sometimes not even the responsible political decision-makers. This situation poses a threat to the survival of its prevention mission. The typology of public health interventions is an innovative tool that can be used to better inform the public and decision-makers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.17269/s41997-019-00268-3) contains supplementary material, which is available to authorized users.

SETTING: Municipal buildings and corporate events in the City of Hamilton, Ontario. INTERVENTION: In 2011, the City of Hamilton adopted a healthy food and beverage policy. The intent of the policy is to demonstrate the City’s commitment to healthy eating by providing food and beverages that are healthy, safe, and free of industrially produced trans fats, and promoting a sustainable, local food system. The corporate policy applies to all City facilities, meetings and events. In this article, we explore adoption and implementation of the policy, as well as key lessons for healthy public policy change. OUTCOMES: Integrating the policy into corporate culture and practice through the provision of ongoing supports and resources helped the City of Hamilton overcome barriers and achieve implementation success. IMPLICATIONS: Through exploration of the City of Hamilton’s healthy food and beverage policy, we identified a number of lessons for policy change and implementation. When viewed in context, these lessons may help to support policy work in other Canadian jurisdictions.

SETTING: The majority of Canadians’ food acquisition occurs in retail stores. Retail science has become increasingly sophisticated in demonstrating how consumer environments influence population-level diet quality and health status. The retail food environment literature is new but growing rapidly in Canada, and there is a relative paucity of evidence from intervention research implemented in Canada. INTERVENTION: The healthy corner store model is a comprehensive complex population health intervention in small retail stores, intended to transform an existing business model to a health-promoting one through intersectoral collaboration. Healthy corner store interventions typically involve conversions of existing stores with the participation of health, community, and business sector partners, addressing business fundamentals, merchandising, and consumer demand. OUTCOMES: This article introduces pioneering experiences with the healthy corner store intervention in Canada. First, we offer a brief overview of the state of evidence within and outside Canada. Second, we discuss three urban and one rural healthy corner store initiatives, led through partnerships among community food security organizations, public health units, academics, and business partners, in Manitoba, Ontario, and Newfoundland and Labrador. Third, we synthesize the promising practices from these local examples, including aspects of both intervention science (e.g., refinements in measuring the food environment) and community-based practice (e.g., dealing with unhealthy food items and economic impact for the retailer). IMPLICATIONS: This article will synthesize practical experiences with healthy corner stores in Canada. It offers a baseline assessment of promising aspects of this intervention for health and health equity, and identifies opportunities to strengthen both science and practice in this area of retail food environment work.

SETTING: Dental decay is most prevalent among low socio-economic status (SES) groups where cost limits access to dental care. To address inequities in oral health outcomes, Alberta Health Services (AHS) Oral Health Action Plan encompasses a population health approach that redirects fluoride varnish (FV) applications to low SES children. Using low SES measures to establish the eligibility criteria is fundamental to the delivery of FV applications to the target population. INTERVENTION: A series of four FV applications over two years is directed to children age 12–35 months and two applications per year to children in Kindergarten and grades 1 and 2, using low SES measures for eligibility criteria. The provincial objective for children receiving the first FV application is 10%–20% of the population age. Additional objectives are set for rates of subsequent FV applications for each population group. OUTCOMES: From 2015 to 2016, the rate of first FV applications for eligible target populations is below the provincial objective for children age 12–35 months (5%) and within the objective for children in Kindergarten and grades 1 and 2 (16%). Rates of subsequent FV applications in the school setting are being met. IMPLICATIONS: Encompassing a population health approach to deliver standardized fluoride varnish applications to low SES children better targets inequities in oral health outcomes in Alberta. Challenges of redirecting the FV intervention include creating the eligibility criteria and engaging the target population, particularly for the preschool population. Achieving population objectives are challenged by unequal distribution of resources across the province.

OBJECTIVE: We describe the adaptation of an early childcare and development program to the Indigenous context of the Cree territory in Québec. We also share lessons on the challenging implementation of home visits by Indigenous family support workers (FSWs), which is a critical component of the intervention. PARTICIPANTS: Â Mashkûpímâtsît Awash (AMA) aims to enhance the health and well-being of pregnant mothers, young children, and their families by providing intensive interdisciplinary care and follow-up. Indigenous female FSWs from the community are the key frontline workers and cornerstone of the program. SETTING: AMA is implemented as part of the multidisciplinary services provided by the Community Miyupimaatisiiun Centres (primary health care centres) in three pilot communities of Eeyou Istchee. INTERVENTION: AMA builds on family centredness and cultural safety, integration of services, and creation of family-friendly communities. It emphasizes the role of female local Indigenous FSWs in providing culturally safe outreach services in the form of home visits. OUTCOMES: The main challenge was conducting home visits. FSWs’ view of the pertinence of home visits, as well as their personal stories, seemed to influence their motivation to conduct home visits. Their level of experience appeared to facilitate home visits. Encouraging creativity, fostering autonomy, ensuring a step-by-step implementation, and promoting communication were found to create a supporting environment to facilitate home visits. IMPLICATIONS: Hiring local Indigenous workers is necessary to ensure that early childhood development programs are culturally safe. Success of such programs relies on team management, provision of culturally adapted training, and quality of the ongoing emotional support provided to the FSWs.

SETTING: On July 6, 2013, a train carrying oil derailed in downtown Lac-Mégantic (Quebec, Canada), causing major human, environmental, and economic impacts. We aim to describe, and learn from, public health strategies developed to enhance community resilience following the train derailment though the lens of the EnRiCH Community Resilience Framework for High-Risk Populations. INTERVENTION: Annual population-level surveys were conducted in Lac-Mégantic and surrounding areas to assess the long-term impacts of the disaster. Findings suggested that a solid upstream investment towards the development of adaptive capacity was needed. A “Day of Reflection” bringing together local stakeholders and citizens was organized, inspiring the elaboration of an innovative action plan. Leaders advocated for funding to support its implementation, leading to a substantial investment from the provincial government. Through a wide range of actions, the plan aims to bring psychosocial services closer to people, stay connected with the community, and foster community engagement. OUTCOMES: Several lessons have been identified. After a disaster, there needs to be a balanced focus between the gaps/needs and strengths/capacities of a community. Moreover, public health actors must collaborate closely, all along the continuum of the upstream-downstream paradigm, with local organizations and citizens. IMPLICATIONS: This unique experience, supported by an empirically-based framework, suggests that three vital ingredients are required for success in recovering from a disaster: (1) fostering community strengths and valuing citizen participation, (2) a strong political commitment to support upstream actions, and (3) a public health team able to support these actions.

SETTING: The World Health Organization Commission on the Social Determinants of Health (SDoH) observes that building political will is central to all its recommendations, because governments respond to those who organize and show up. Since younger Canadians are less likely to vote or to organize in between elections, they are less effective at building political will than their older counterparts. This results in an age gap between SDoH research and government budget priorities. Whereas Global AgeWatch ranks Canada among the top countries for aging, UNICEF ranks Canada among the least generous OECD (Organisation for Economic Co-operation and Development) countries for the generations raising young children. INTERVENTION: A surgical intervention into the body politic. Guided by the “health political science” literature, the intervention builds a non-profit coalition to perform science-based, non-partisan democratic engagement to increase incentives for policy-makers to translate SDoH research about younger generations into government budget investments. OUTCOMES: All four national parties integrated policy recommendations from the intervention into their 2015 election platforms. Three referred to, or consulted with, the intervention during the election. The intervention coincided with all parties committing to the single largest annual increase in spending on families with children in over a decade. IMPLICATIONS: Since many population-level decisions are made in political venues, the concept of population health interventions should be broadened to include activities designed to mobilize SDoH science in the world of politics. Such interventions must engage with the power dynamics, values, interests and institutional factors that mediate the path by which science shapes government budgets.

SETTING: Alberta is a prairie province located in western Canada, with a population of approximately 4.3 million. In 2016, 363 Albertans died from apparent drug overdoses related to fentanyl, an opioid 50–100 times more toxic than morphine. This surpassed the number of deaths from motor vehicle collisions and homicides combined. INTERVENTION: Naloxone is a safe, effective, opioid antagonist that may quickly reverse an opioid overdose. In July 2015, a committee of community-based harm reduction programs in Alberta implemented a geographically restricted take-home naloxone (THN) program. The successes and limitations of this program demonstrated the need for an expanded, multi-sectoral, multi-jurisdictional response. The provincial health authority, Alberta Health Services (AHS), used previously established incident command system processes to coordinate implementation of a provincial THN program. OUTCOMES: Alberta’s provincial THN program was implemented on December 23, 2015. This collaborative program resulted in a coordinated response across jurisdictional levels with wide geographical reach. Between December 2015 and December 2016, 953 locations, including many community pharmacies, registered to dispense THN kits, 9572 kits were distributed, and 472 reversals were reported. The provincial supply of THN kits more than tripled from 3000 to 10 000. IMPLICATIONS: Alberta was uniquely poised to deliver a large, province-wide, multi-sectoral and multi-jurisdictional THN program as part of a comprehensive response to increasing opioid-related morbidity and mortality. The speed at which AHS was able to roll out the program was made possible by work done previously and the willingness of multiple jurisdictions to work together to build on and expand the program.

SETTING: Falls incur significant health and economic costs, particularly among older adults. Physical activity has been found to be the single most important fall prevention behaviour an older adult can do. This manuscript describes Ottawa Public Health’s (OPH) experience implementing the Better Strength, Better Balance! (BSBB) program, a fall prevention exercise program for older adults, through an innovative partnership with the local Recreation, Cultural & Facility Services (RCFS) Department. BSBB aims to reach 1300 community-dwelling adults (aged 65 years and older) per year through approximately 86–130 exercise programs. Designed as a universal program, BSBB addresses participation barriers such as transportation, cost and location. BSBB was enabled with funding from the Champlain Local Health Integration Network, and coincided with the implementation of an Older Adult Plan for the City of Ottawa. INTERVENTION: BSBB is a beginner-level, fall prevention exercise and education program that takes place twice a week, over 12 weeks. Certified RCFS instructors delivered the exercise components of the program and OPH staff incorporated fall prevention messaging and conducted the evaluation. OUTCOMES: The formative evaluation indicated that participants experienced improved strength and balance, decreased fear of falling and the intent to adopt new fall prevention behaviours following the program. The partnership between OPH and RCFS allowed both partners to leverage their unique and mutual strengths to continually improve the program. IMPLICATIONS: Improving access to strength and balance programming is an important public health strategy to reduce falls. The recreation sector is an ideal partner to help public health in this pursuit.

OBJECTIVES: The Canadian Partnership Against Cancer funded 12 large-scale knowledge to action cancer and chronic disease prevention projects between 2009 and 2016 through the Coalitions Linking Action and Science for Prevention (CLASP) initiative. Two projects, Healthy Canada by Design (HCBD) and Children’s Mobility, Health and Happiness (CMHH), developed policies to address physical activity and the built environment through a multisectoral approach. A qualitative analysis involving a review of 183 knowledge products and 8 key informant interviews was conducted to understand what policy changes occurred, and the underlying critical success factors, through these projects. SETTING: Both projects worked at the local level to change physical activity and built environment policy in 203 sites, including municipalities and schools. Both projects brought multisectoral expertise (e.g., public health, land use planning, transportation engineering, education, etc.) together to inform the development of local healthy public policy in the areas of land use, transportation and school travel planning. INTERVENTION: Through the qualitative analysis of the knowledge products and key informant interviews, 163 policies were attributed to HCBD and CMHH work. OUTCOMES: Fourteen “pathways to policy” were identified as critical success factors facilitating and accelerating the development and implementation of physical activity and built environment policy. Of the 14 pathways to policy, 8 had a focus on multisectoral collaboration. IMPLICATIONS: The lessons learned from the CLASP experience could support enhanced multisectoral collaborations to accelerate the development and implementation of physical activity and built environment policy in new jurisdictions across Canada and internationally.

OBJECTIFS : Le projet pilote ISPP (Immediate Staging Pilot Project ou projet pilote de mise en place immediate) visait a ameliorer le lien vers les soins du virus de l’immunodeficience humaine (VIH) en augmentant le nombre d’orientations vers les soins du VIH, et a reduire le delai entre le diagnostic et le lien vers les soins pour les patients ayant recu un diagnostic recent de VIH. Le projet pilote pouvait potentiellement reduire la transmission du VIH dans l’ensemble de la population en amorcant le traitement des patients plus tot. LIEU : Les cliniques Bute Street Clinic et Health Initiative for Men on Davie de Vancouver (Colombie-Britannique) sont des etablissements de sante publique a seuil bas qui offrent le depistage du VIH et des ITS principalement aux hommes ayant des relations sexuelles avec des hommes (HARSAH). INTERVENTION : Pour ameliorer l’integration des HARSAH dans le flot des soins du VIH, le BC Centre for Disease Control a mis en oeuvre ce projet pilote de 12 mois pour les patients ayant recu un diagnostic recent de VIH. Le projet pilote offrait la numeration des lymphocytes CD4 et la mesure de la charge virale au moment du diagnostic, appliquait une procedure d’orientation amelioree et rehaussait le soutien infirmier des patients. RESULTATS : En comparant les resultats du lien vers les soins entre un groupe ayant recu la norme de soins (NDS) et un groupe d’intervention ayant recu la mise en place immediate des soins, la duree mediane du lien vers les soins a diminue, passant de 21,5 a 14 jours, respectivement ( p = 0,053). Les taux d’orientation vers les soins du VIH etaient de 56,1 % dans le groupe de la NDS et de 94,1 % dans le groupe d’intervention ( p < 0,001). CONCLUSION : La creation de pratiques exemplaires incluant la numeration des lymphocytes CD4 et la mesure de la charge virale au moment du diagnostic, un soutien infirmier renforce et des processus d’orientation standardises a favorise une amelioration de la qualite des services VIH offerts aux patients HARSAH frequentant des cliniques a seuil bas.

SETTING: A harm reduction program at a public health unit in Toronto, Ontario, between August 31, 2011 and August 31, 2013. INTERVENTION: We conducted a process evaluation of the first two years of an opioid overdose prevention and response program, Prevent Overdose in Toronto (POINT), including analysis of data from program documentation forms, as well as qualitative interviews with program staff, representatives from partner agencies, and program clients. OUTCOMES: In the first two years of the program, 662 individuals (52.4% male; mean age 38.3 years) were trained in opioid overdose prevention and given a naloxone kit. Among clients currently using opioids, the most frequently reported opioids were oxycodone (40.4%) and heroin (34.4%). Clients reported 98 administrations of naloxone, primarily to friends and acquaintances. Nearly all naloxone recipients reportedly survived; one did not survive, and one had an unknown outcome. Staff and partner agencies feel the program reaches the target population and that POINT training meets clients’ needs. Clients would like to see the training offered more widely. Overall, staff, partner agencies and clients were pleased with the POINT program, and they offered suggestions on program recruitment and delivery. IMPLICATIONS: Individuals at risk of opioid overdose have participated in overdose prevention and response training, and reported using naloxone in overdose events. Results of this initial program evaluation are being used to improve the delivery of the POINT program and can inform broader public health practice in opioid overdose prevention.