Chronicling changes to the chronic disease prevention landscape in Canada's public health system 2004–2010

Abstract

The collective impact of major shifts in public health infrastructure and numerous new chronic disease prevention (CDP) capacity-building initiatives that have taken place in Canada over the last decade is unknown. The objective of this study was to determine if CDP capacity (i.e., skills and resources) and involvement in CDP programming improved in public health organizations in Canada from 2004 to 2010. Data for this repeated cross-sectional study were drawn from two waves of a national census of organizations mandated to carry out primary prevention of chronic disease and/or promotion of healthy eating, physical activity and tobacco control. Medians for continuous variables and frequencies for categorical variables were compared across time. Neither resources nor level of priority for CDP increased over time. There was little difference in the proportion of organizations with high levels of skills and involvement in core CDP practices (i.e., needs assessment, identification of relevant practices, planning, evaluation). Skills and involvement in CDP risk factor programming showed some gains, some steady states and some losses. Specifically, skill and involvement in tobacco control programming declined markedly while the proportion of organizations involved in healthy eating and physical activity programming increased. Skills to address and involvement in programming related to social determinants of health remained low over time as did involvement in programming addressing multiple risk factors concurrently. The lack of marked improvement in CDP capacity between 2004 and 2010 against a backdrop of initiatives favourable to strengthening the preventive health system in Canada suggests that efforts may have fallen short.

Needed Improvements in Diabetes Prevention and Management in Brazil

“…In Brazil, much of the advice promoting healthy eating and physical activity for people with diabetes is carried out in primary health care services (4,21), in a strategy similar to that adopted in countries with comprehensive health systems such as Canada (22) and Australia (23). Specific protocols for the management of diabetes, such as Estratégias para o cuidado da pessoas com doença crônica: Diabetes Mellitus ( Strategies for Care of People With Chronic Disease: Diabetes Mellitus ) (4) and the strategic plan to tackle noncommunicable diseases, Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis (DCNT) no Brasil, 2011–2022 (21), reinforce the importance of our findings by proposing actions and targets to control noncommunicable diseases.…”

Mapping collaborative relations among Canada's chronic disease prevention organizations

“…We believe the CDP network presented in this study is a fair representation of the Canadian CDP structure, as it is based on a national census of organizations comprising the preventive health system (Hanusaik et al 2010, 2014). However, as there were certain limitations in the data collection process, some variations in CDP structure could occur in other iterations of this study.…”

“…The preventive health system (i.e., the segment of the public health system engaged in primary CDP and promotion of tobacco control, physical activity and healthy eating) comprises many organizations that vary in size, mission, resources and jurisdictions (Hanusaik et al 2010, 2014). While public health units constitute half the Canadian preventive health system and frequently serve as leaders for prevention activities (Varda and Retrum 2012), other organizations within the system also provide public health services and play vital roles in CDP.…”