THE IMPORTANCE OF INTERSECTORAL COLLABORATIONS TO PROMOTE

HEALTHY PUBLIC POLICY

Ghazal Fazli, MPH, Phd(c)Centre for Research Inner City Health

Li Ka Shing Knowledge Institute,

St. Michael’s Hospital

Toronto, Ontario

ACT CANADA SUMMIT DECEMBER 2014

OBJECTIVES

• To share findings from consultations from a stakeholder engagement event including a variety of sectors and disciplines across Southern Ontario

• To discuss key findings on knowledge gaps, challenges and key steps to implementing policy changes related to the built environment that would promote physical activity and reduce obesity.

DIABETES EPIDEMIC

• Ontario is encountering an alarming burden of illness associated with diabetes

• Rising prevalence of type 2 diabetes will require population based interventions

Lipscombe L and Hux J. Lancet 2007;369:750-6

Neighbourhood Environments and Resources for Healthy

Living: A Focus on Diabetes in Toronto

www.ices.on.ca

Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto

30 - 50,000 50 - 75,000 75 - 100,000100- 150,000150- 375,000

The built environment as a potential target for intervention

FEATURES OF WALKABLE NEIGHBOURHOODS

• More compact/dense

• Grid-like street pattern (shorter blocks)

• Mixed land use

• Destinations within walking distance

• Sidewalks

More walkable neighbourhoods more walking

Suburban design discourages walking and increases reliance on

cars• Large lot sizes (more sprawl)

• Less connected streets (longer blocks)

• Purely residential zoning

• Few walkable destinations

• Often no sidewalks

Less walkable neighbourhoods less walking, less physical activity and more

obesity

MORE TIME SPENT IN CARS HIGHER RATES OF OBESITY

Frank LD et al Am J Prev Med 2004

TORONTO RESIDENTS LIVING IN MOST WALKABLE AREAS WERE APPROXIMATELY:

three times more likely to walk to work

twice as likely to take public transit

one-half as likely to drive to work

one-quarter less likely to be obese

As those living in the least walkable areasGlazier et al., PLoS One 2014

4-YEAR CIHR PROPOSED RESEARCH PLAN

• Dr. Gillian Booth of St. Michael’s Hospital holds a 4 year CIHR Grant on the built environment and its impact on health outcomes – obesity and diabetes

• Multiple studies designed to: • Examine 10-year trends in the incidence of diabetes in urban settings that

differ on the basis of walkability, access to healthy resources, and exposure to unhealthy vs. healthy foods (Time series methodology - area level study)

• Evaluate the impact of area walkability, access to resources, and exposure to unhealthy vs. healthy food on the development of diabetes (propensity-matched retrospective cohort study – individual level study)

• Model a series of predictive algorithms using hierarchical modeling techniques to model the impact of built environment interventions - changes in neighbourhood walkability, access to healthy resources and retail food environment) on diabetes incidence (using linked CCHS data)

• Critical components of this research program include integrated knowledge translation events and opportunities to engage important stakeholders, knowledge users and policymakers to identify policy solutions and recommendations

RESEARCH PLAN - STUDY AREA

How do we get multiple sectors and agencies involved in translating evidence into planning

and practice?

URBAN PLANNING

• City of Toronto planning department

• Parks and recreation

• Transit• Private and public

urban planning groups

• Canadian Urban Institute

• LEED-ND

PUBLIC HEALTH

• Public Health Agency of Canada

• Ministry of Health

Promotion

• Toronto Public

Health

• Public health units

• Community health

centers

FOOD SECTOR

• Food policy

experts

• City of Toronto, Food programs and strategies

• Nutritionists

KNOWLEDGE USERS AS DISSEMINATORS

INTEGRATED KT EVENT : A COLLABORATIVE INITIATIVE

• In collaboration with Public Health Ontario (PHO) a knowledge user and stakeholder engagement event was organized on October 4th 2013 in Toronto

• Stakeholders were invited from planning, transportation and public health sectors, plus government, NGOs representatives from across Southern Ontario

The objectives of this meeting were:

1. Disseminate research findings to key stakeholders

2. Engage key stakeholders to explore potential applications

3. Provide a forum for sharing success stories and barriers to achieving changes in the built environment

4. Establish partnerships with researchers, planning and public health

INTEGRATED KT EVENT: OBJECTIVES

Participants = 55

Public health = 20

CRICH and PHO Staff and team =

13

Transportation = 10

Planning = 12

INTEGRATED KT EVENT: PARTICIPANTS ATTENDED

Regions/Municipalities

• Toronto• Ottawa• London• Peel• Hamilton• Halton• Durham• York

Non-governmental organizations

• Canadian Diabetes Association

• Canadian Partnership Against Cancer

• Ontario Professional Planners Institute

• Ontario Public Health Association

• Heart & Stroke Foundation

• Canadian Institute for Health Research

Government

• Public Health Agency of Canada

• Ministry of Health and Long-Term Care

• Ministry of Infrastructure

• Ministry of Municipal Affairs and Housing

• Public Health Ontario

INTEGRATED KT EVENT: INVOLVING MULTIPLE SECTORS

THEMATIC ANALYSIS

• A preliminary qualitative thematic analysis was conducted to identify:• emerging themes related to gaps in knowledge and

barriers that impede evidence-based decision-making and policy development related to the built environment

• Relevant themes and sub-themes were identified and validated through post-meeting consultations using online surveys.

• Survey response rate was 73% (stakeholders further validated the themes, knowledge gaps and actions identified)

Cross-cutting ThemesPartnership and Collaboration

System Integration

THEMATIC ANALYSIS RESULTS: THEMES AND KNOWLEDGE GAPS

Emerging Themes from Research on

the Built Environment

Targeted and

Impactful Messaging

Common Measures and Tools

Policy informed

and actionable research

Intersectoral

collaboration

within/between

Levels of Governme

nt

Importance of Public

and Private Sector

Advocacy

Solution-focused

implementation

• Economic arguments/tools

• Awareness of Political Environment

• Public awareness

• Changing Perceptions

• Communicating across sectors/agencies

• Intersectoral Partnerships

• Identifying champions

THEMATIC ANALYSES RESULTS: BARRIERS/ENABLERS AND ACTIONS

RESEARCH AND INFORMATION GAPS

Research and Information Gaps with respect to evidence that can help promote actions and policy on the built environment

71% (15)67% (14)

52% (11)

38% (8)

24% (5) 24% (5) 24% (5)

Research and Information Gaps related to the Built Envi-ronment Top Priorities

Lower Priorities

NEXT STEPS TO SUPPORT POLICY AND PLANNING

Summary of recommended Next steps to support policy and planning related to the built environment

Data

Acces

sibi

lity

and

Availa

blili

ty

Built

Envi

ronm

ent A

ctio

n Net

wor

k (B

EAN)

Advoc

ate

for O

ntar

io C

hief

Pla

nner

Health

Indi

cato

rs in

Ont

ario

Gro

wth

Pla

n

Set U

p Bes

t Pra

ctice

s Por

tals

Stra

tegi

es to

Sha

re/E

xcha

nge

Resea

rch

Find

ings

Concu

rrent

Stra

tegi

es fo

r Diss

emin

atio

n

Prov

ide

Wor

ksho

ps, P

rese

ntat

ions

, Web

inar

s

68% (13)

53% (10) 53% (10)47% (9)

26% (5) 26% (5)21% (4)

5% (1)

Top Priorities

Lower Priorities

• Interventions targeting the built environment that encourage physical activity may have tangible health benefits for the population if multiple sectors are engaged from earlier on

• Challenges in translating research findings into policy and planning initiatives aimed at promoting physical activity and curbing the rise in obesity will require addressing the barriers, enablers and gaps

SUMMARY

QUESTIONS

PEEL REGION HEALTHY DEVELOPMENT EVALUATION TOOL

AIM:•Tool to rate development submissions

•To encourage future development to proceed in a form more conducive to healthy living with a focus on physical activity

INVOLVING MULTIPLE STAKEHOLDERS

• Peel Diabetes Atlas

• Healthy development tool

• New partnership, shared interest in obesity-prevention

• Toronto Diabetes Atlas

• Toronto Community Health Profiles

• Consulting re: Ontario Diabetes Strategy

• Mapping of services

MOHLTCToronto Public Health

Peel Region

Public Health Ontario

INTEGRATED KNOWLEDGE TRANSLATION APPROACH

Policy and Planning

Research