The Integrated Pan-Canadian Healthy Living Strategy

Objectives

The Integrated Pan-Canadian Healthy Living Strategy provides a population-health framework for sustained, coordinated action to improve overall health outcomes and reduce health disparities, supporting a vision in which all Canadians experience conditions that enable good health.[1][2]It initially concentrates on healthy eating, physical activity and their relationship to healthy weights, while identifying mental health and injury prevention as possible future areas of action.[1][3]

• Address common preventable risk factors for chronic disease and obesity, including physical inactivity, unhealthy diet and tobacco use, alongside social and environmental determinants such as income, employment, education, geographic isolation and social exclusion.[4]
• Apply a population-health approach across living and working environments, conditions supporting healthy choices, and services that promote and maintain health.[3]
• Prioritise the whole population while giving particular attention to children and young people, Aboriginal communities, and isolated, remote and rural communities, and addressing disparities associated with socio-economic status, sex, disability, culture and geography.[3]
• Focus action in homes and families, schools, workplaces, communities and health settings.[3]
• Improve healthy eating patterns, behaviours and choices; increase access to affordable healthy food; expand appropriate and accessible physical-activity opportunities; and reduce inequalities in activity levels.[5][6]
• Create supportive physical and social environments through healthier neighbourhood design, transport, infrastructure, food access and community facilities, making healthy choices easier.[7][6]
• Pursue four strategic directions: Leadership and Policy Development, Knowledge Development and Transfer, Community Development and Infrastructure, and Public Information.[3]
• Increase by 20% by 2015 the proportions of Canadians making healthy food choices, undertaking regular physical activity, and having a body mass index of 18.5 to 24.9, using 2015 as an initial marker within a proposed ten-year horizon.[8][9][10]
• Measure the intended 20% increases against 2003 baselines, including fruit and vegetable consumption at least five times daily of 39.0%, regular physical activity of 50.4%, and healthy body weight of 46.7%, with illustrative 2015 targets of 46.8%, 60.5% and 56.0% respectively.[11][12]
• Achieve short-term gains in knowledge, access to information and health-promoting programmes, and collaboration; medium-term improvements in environments, community capacity and healthy behaviours; and longer-term reductions in disparities and disease burden, alongside improved health and quality of life.[3]
• Develop an Aboriginal-specific component that responds to diverse community realities and incorporates physical activity, healthy eating, food security, mental health, housing, violence, sexual and reproductive health, and the circumstances of Aboriginal women and communities.[13][14]

Implementation

Implementation is designed as an integrated, intersectoral and pan-Canadian model that builds on existing initiatives and combines shared responsibility among governments, communities, Aboriginal organisations, voluntary organisations, private-sector actors, researchers and the public.[3][12]The strategy uses policy, regulation, public education, advocacy, social marketing, fiscal measures and community action to influence the conditions shaping health.[15]

• Provide leadership through the Intersectoral Healthy Living Network Coordinating Committee, established in September 2004 with representatives from government, private-sector and non-governmental health and non-health sectors.[2]
• Coordinate federal, provincial and territorial action while recognising Quebec's responsibility for developing and implementing healthy-living programmes within its territory and its intention to exchange information and expertise with other governments.[1][16]
• Engage parents and families, professionals, health authorities, municipalities, community and non-profit organisations, national networks, Aboriginal Peoples, the media and private industry in practical delivery.[12][17]
• Establish working groups on healthy-living priorities and targets, integrated research and surveillance including best practices, and public information and social marketing.[9][2]
• Strengthen partnerships and cross-sector planning through mechanisms including the Joint Consortium for School Health, regional and national networks, bilateral federal-provincial-territorial agreements, and links with jurisdictional initiatives.[18][17]
• Support locally adapted initiatives such as community food-security programmes, school nutrition standards, professional education, healthy workplaces, community gardens, active transport and accessible recreational facilities.[5][19][20]
• Engage Aboriginal governments, national Aboriginal organisations, service-delivery bodies, communities, women and youth through national, regional and local dialogue, information sessions, advisory processes, surveys and group-specific reporting.[13][14]
• Respect First Nations jurisdiction in health-service delivery founded on Treaty and Inherent Rights, and support Aboriginal control of relevant off-reserve programmes through Aboriginal organisations.[14]
• Develop an integrated research and surveillance agenda that links research, surveillance, policy, programmes and practice; supports intervention research; identifies best practices; improves knowledge exchange; and provides timely, meaningful evidence for decisions.[21][22]
• Use the Canadian Community Health Survey, National Population Health Survey, Statistics Canada and Canadian Institute for Health Information indicators, and physical-activity benchmarks or monitoring programmes to track the core targets.[8][9][12]
• Develop disparity indicators and improved tools for older adults, Aboriginal Peoples and other cultural groups, while allowing targets and measurements to evolve as evidence and data improve.[9][10]
• Make evaluation an early implementation priority, undertake ongoing monitoring and adjustment, and provide annual progress reports to federal, provincial and territorial Deputy Ministers and Ministers of Health.[23][24]
• Deliver consistent public information through a national advertising campaign, Aboriginal-specific communications, a healthy-living website, the 1 800 O Canada service, strategic alliances and a partner toolkit.[25][26][27]

Monitoring & Evaluation

The Strategy establishes a results-oriented monitoring approach centred on population targets for healthy eating, physical activity and healthy weights, supported by research, surveillance, evaluation and knowledge exchange. It envisages continuous monitoring beyond 2015, so that progress can be assessed and implementation and targets adjusted over time.[8][10]

• Measure healthy eating through the Canadian Community Health Survey, Statistics Canada and Canadian Institute for Health Information indicators, including healthy food choices, food insecurity, and fruit and vegetable consumption.[11][12]
• Measure physical activity through the Canadian Community Health Survey and the Physical Activity Benchmarks/Monitoring Program, using regular moderate-to-vigorous activity of at least 30 minutes per day as the benchmark.[8][11][12]
• Monitor healthy weights through the National Population Health Survey, the Canadian Community Health Survey, and Statistics Canada and Canadian Institute for Health Information indicators, using body mass index classifications.[8][9][12]
• Use 2003 Canadian Community Health Survey data as the principal baseline for the proposed national targets, with earlier survey data used to assess trends.[11][12]
• Track the proposed 2015 targets for a 20% increase in Canadians making healthy food choices, being regularly physically active, and having body mass indexes of 18.5 to 24.9.[8][9]
• Incorporate indicators of health disparities and disparity reduction by sex, Aboriginal identity, geographic location and socio-economic factors, while developing measures suitable for older adults, Aboriginal Peoples and other cultural groups.[9][10]
• Provide annual progress reports to federal, provincial and territorial Conferences of Deputy Ministers of Health and to federal, provincial and territorial Ministers of Health.[23][24]
• Use an evaluation strategy as an implementation priority to assess progress towards targets and the benefits and success of intersectoral action for Canadians.[23][24]
• Integrate research, surveillance and evaluation with policy and programme development, using timely and meaningful data to inform decisions and identify effective interventions and best practices.[18][28][22]
• Undertake population-level intervention research to assess the real-world effects of policies and programmes, including their impacts on health disparities and their likely effects before implementation.[21]
• Use health surveillance to track overall progress, priority factors, subpopulations and trends, and the combined population-level effects of policies and programmes.[21]
• Develop common data-collection, analysis, translation and surveillance mechanisms, including a longitudinal healthy-living study examining population-level indicators.[29]
• Conduct regular tracking surveys and use the Advertising Campaign Evaluation Tool for the healthy living and sport participation advertising campaign; undertake qualitative research to test campaign materials, the website and associated tools before evaluation.[29]

Anticipated results provide broad assessment horizons: short-term outcomes within 6 to 18 months, medium-term outcomes within 18 to 60 months, and longer-term outcomes after five years. These cover knowledge, access to information and programmes, collaboration, supportive environments, community capacity, healthy behaviours, reduced disparities, lower disease burden, improved health outcomes and quality of life.[3]The source does not specify a consolidated national indicator set, reporting templates, performance thresholds, independent review arrangements or a formal accountability framework beyond the identified reporting, surveillance and evaluation activities.[23][22]

Costing & Financing

The Strategy provides evidence on the economic burden of chronic disease and physical inactivity, but does not set out a comprehensive programme budget, financing plan, quantified resource-mobilisation target, funding allocation or economic assumptions for implementation.[4][1]

• Recognise that illness, disability and death attributable to chronic diseases cost Canada more than 80 billion Canadian dollars annually.[4]
• Recognise that physical inactivity creates at least 2.1 billion Canadian dollars in annual direct health-care costs and an estimated annual economic burden of 5.3 billion Canadian dollars.[4]
• Address the identified lack of implementation and costing data through the Integrated Research and Surveillance Agenda, which also identifies cost-benefit and cost-effectiveness analysis as important for prevention research and decisions on limited resources.[28][21][22]
• Respond to chronic underfunding of prevention research and public-health capacity for surveillance, knowledge synthesis and knowledge exchange, including difficulties financing local data systems, linked databases and technology-based interventions.[22]
• Align investments and plans across organisations and support federal leadership for relevant knowledge-development and exchange infrastructure, although no funding values are specified.[30][29]
• Consider resource measures such as subsidies for healthy food and physical activity access, reduced user fees, infrastructure investment, fiscal measures including tax credits, penalties, subsidies and price supports, and federal, provincial and territorial bilateral agreements.[17]
• Note the proposed but unquantified 2005 Federal Budget carve-out for an integrated Aboriginal healthy living and chronic disease prevention strategy.[18]
• Allocate unspecified funding to Aboriginal organisations leading development of the Aboriginal-specific component at national and regional levels.[14]
• Enhance unspecified funding for healthy-living infrastructure, processes, policies, programmes and other initiatives across Canada.[19]

No amounts are provided for the proposed Aboriginal carve-out, Aboriginal component funding, enhanced funding, fiscal measures, bilateral agreements, infrastructure investments, website, advertising campaign, strategic alliances or toolkit.[18][14][19][17][26][27]