Program and public policy

This document is intended for public health actors who, given their role as health promoters, are interested in how public policy can act as a lever for action that affects population health and its determinants. More specifically, this document seeks to meet the needs of public health actors acting as expert advisors to decision makers during the promotion, adoption, and implementation of public policies. Fulfilling this role requires them to synthesize knowledge about how effective public policies are at promoting health (including how effective they are in a given context) and about the issues surrounding the implementation of these policies.

The objective of this document is to propose a knowledge synthesis method that is applicable to public policies and takes into account not only data linked to their effectiveness, but also data on issues related to their implementation, with the aim of identifying the policies that are most likely to succeed in the specific context i…

Public policies affect population health. Public health actors are called upon to document this phenomenon, in particular, by producing knowledge syntheses. To meet the needs of decision makers, a knowledge synthesis must consider not only the effects and the equity of the public policy being studied, but also the issues surrounding its implementation (cost, feasibility, acceptability).

Drawing inspiration from political science, from literature on evidence-informed decision making in public health, and from work on evaluation and on deliberative processes, the NCCHPP has developed a method for producing such syntheses. This method is presented in the form of a step by step guide incorporating questions to ask oneself, practical advice, and several tools for facilitating the process, so as to enable public health actors to synthesize knowledge about public policies, a specific subject of study.

This summary sets forth the method in an abridged format. It first presen…

We gathered data from the scientific and grey literature and from Canadian actors involved in addressing obesity to document the effectiveness of nutrition-labelling policies, as well as their unintended effects, equity, cost, feasibility, and acceptability. Presented here is a broad outline of the results.

The nutrition-labelling policies studied target pre-packaged foods or restaurant menus, and require them to display nutrition information either in a detailed format (Nutrition Facts table) or a simplified format (logos). These policies may make labelling mandatory or leave it optional but subject to guidelines with which companies must comply if they choose to display nutrition information on their products.

The intervention logic of labelling policies assumes that nutrition information will be read, that it will be understood, and that it will lead to healthier diets, both in terms of quantity and quality, which will help prevent obesity.

In practice, th…

This document is a summary version of the report, Public Policies on Nutrition Labelling: Effects and Implementation Issues – A Knowledge Synthesis, produced by the National Collaborating Centre for Healthy Public Policy (NCCHPP). For readers who would like to learn more about the knowledge synthesis method used as well as the knowledge gathered and the full bibliographic references, we invite you to consult the full report.

Nutrition labelling on pre-packaged foods and on restaurant menus is one of the public policies proposed to address obesity, a problem that is affecting a growing portion of the Canadian population and is associated with numerous health problems and high economic costs.

Today, the links between poverty and health are well-established (Phipps, 2003) and the resulting inequalities in health have proven to be persistent (Whitehead & Dahlgren, 2007). Indeed, the population groups with the worst health status are materially underprivileged and socially excluded (De Koninck et al., 2008), leading many analysts to single out poverty as one of the primary determinants of health.

In 2002, the Government of Québec adopted An Act to Combat Poverty and Social Exclusion (R.S.Q., c. L-7). This legislation is the first of its kind in North America.

This series of background papers presents the history that preceded this legislation, and highlights key elements of its application. This paper addresses the following questions:

• How is An Act to Combat Poverty and Social Exclusion formulated and applied?
• What impact has this legislation had on poverty and social exclusion in Québec?

Today, the links between poverty and health are well-established (Phipps, 2003) and the resulting inequalities in health have proven to be persistent (Whitehead & Dahlgren, 2007). Indeed, the population groups with the worst health status are materially underprivileged and socially excluded (De Koninck et al., 2008), leading many analysts to single out poverty as one of the primary determinants of health.

In 2002, the Government of Québec passed An Act to Combat Poverty and Social Exclusion (R.S.Q., c. L-7). This legislation has received interest from the public health community because it is an example of healthy public policy.

This series of background papers presents the history that preceded this legislation, and highlights main elements of its application. In this background document, we address the following question:

• What are the events that led to the adoption of An Act to Combat Poverty and Social Exclusion?

Public policies of various governmental sectors can influence, directly or indirectly, the health of the population. Whether they be policies related to transportation, environment, income, education, child-care, or social housing, these can all impact the determinants of health. As a consequence, decision makers are increasingly being called to adopt healthy public policies; that is, policies which have integrated a preoccupation with population health.

However, adopting healthy public policies is complex. On the one hand, there are many uncertainties as to the potential effects of specific policies on health. On the other, there is often no consensus among civil society, experts and decision makers, as to which policies should be privileged. Indeed, the different actors who will be affected by the policies may have divergent points of view based on their values, needs, preferences, and interests. Thus, decision makers are often stuck in gray zones within which it is diffic…

Public health actors are increasingly being called upon to base their decisions on the best available knowledge. Various knowledge translation strategies have therefore been proposed as a means of drawing together the world of research with that of decision making (Mitton et al., 2007).

Yet, knowledge translation still faces many challenges: research is not always valued as an input in the decision-making process; research is not always relevant to the issues faced by public health actors; research is not simple to use or the findings are not always effectively communicated; and research is in competition with many other factors that influence decision making (Lavis, 2008).

The use of deliberative processes appears to be a promising strategy for overcoming these difficulties. This fact sheet briefly describes the deliberative model of knowledge translation and its objectives. Two concrete examples are also given to illustrate this discussion.

Deliberative processes such as citizens’ juries, consensus conferences, or deliberative polls are increasingly used to engage citizens and stakeholders about challenging public health issues for the purposes of informing policymaking (Abelson, 2009; Scutchfield, Hall, & Ireson, 2006). Yet, there is a paucity of research evidence about the effectiveness of deliberative processes in real settings (Culyer & Lomas, 2006; Mendelberg, 2002).

The purpose of this fact sheet is to introduce public health practitioners to the evaluation of deliberative processes, specifically:

• Why should we evaluate deliberative processes?
• What should be the focus of an evaluation?
• What are the different evaluative approaches? And
• What contextual factors matter when evaluating deliberative processes?

Finally, the fact sheet presents three frameworks that could be relevant to supporting more effective evaluative practices.

Alcohol consumption is a public health issue because it causes many health and social harms:

• Alcohol consumption is associated with deaths, chronic diseases, cancers, injuries, violence, mental health problems, addiction and social problems.
• In 2002, the World Health Organization (WHO) estimated that alcohol was the third leading risk factor for mortality and morbidity in developed countries, after smoking and high blood pressure. In North America, alcohol accounts for 14.2% of the burden of disease in men and 3.4% in women. In Québec, 1.8% of deaths are attributable to alcohol.
• Total alcohol-related healthcare costs are approximately the same as revenue from alcohol sales in Québec; in 2002 in the province, over $3 billion in costs were attributable to alcohol, the equivalent of $416 per inhabitant. Healthcare costs represent 22% of this total, that is, $651 million; this is about equal to the net income from alcohol sales for that year.
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