To Learn More
Ottawa Charter for Health Promotion. World Health Organization, 1986. On the site of the World Health Organization.

Beyond Health Care: From Public Health Policy to Healthy Public Policy. Trevor Hancock,  465 K, available on this site with the permission of the Canadian Journal of Public Health (76, Supplement 1, 1985)

The Chief Public Health Officer's Report on the State of Public Health In Canada 2008: Addressing Health Inequalities. Dr. David Butler-Jones. On the site of the Public Health Agency of Canada.

A Healthy, Productive Canada: A Determinant of Health Approach. The final report of the Senate Subcommittee on Population Health, 2009. On the site of the Government of Canada.

Closing the Gap in a Generation: Health equity through action on the social determinants of health.  World Health Organization, Commission on Social Determinants of Health, 2008. On the site of the World Health Organization.

Social Determinants of Health: The Canadian Facts. By Mikkonen, J. and Raphael, D. 2010. Available on the site, thecanadianfacts.org.

CHNET-Works! Fireside chats (webinars and blog in population health). On the site of CHNET-Works!

Social Determinants of Health On the site of the World Health Organization.

Determinants of Health On the site of the Public Health Agency of Canada.

Social Determinants of Health: The Solid Facts. Wilkinson, R. and Marmot, M. Eds., 2003.  469 K. On the site of the World Health Organization.

SUPPORT Tools for evidence-informed health Policymaking. On the site of the Canadian Foundation for Healthcare Improvement.


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ncchpp@inspq.qc.ca

Learn about public policies and their effects on health

Policy decisions affect population health. This is not limited to policies in the health sector. In fact, policies from other sectors have been shown to have a much more profound impact than those in health. This is because policies in sectors like housing, education, transportation, income, employment, social assistance, and others affect what are called the social determinants of health. The challenge is to recognize what the effects are on these determinants, upon what groups, when they occur, how they affect some more than others, and so on.

Image of ripples © iStockphoto.com/ Vladimir Vladimirov   It is clear that in order to build healthy public policies we must understand as best we can the effects of policies, both the intended effects and the unintended ones. Often we can find downstream effects in unexpected places and policies with relatively clear outcomes in one area can cause ripples in other sectors. These can be positive or negative.

It is thus important to consider a few factors that are essential to seeing the connections between public policies and population health.

Complexity
The first and most important is that when we talk about the social determinants of health we must acknowledge that social determinants are usually deeply woven into social structures with multiple factors influencing them. For example, poverty and wealth are strongly linked to overall health at the population level, but income and the factors influencing it is a highly complex social phenomenon.

Embeddedness
Even for relatively straightforward instances of policy, it is difficult to examine effects in isolation. Other factors will typically influence effects, and isolating a policy from the social context within which it unfolds (i.e. eliminating background “noise”) will yield a limited picture of a policy's effects as they occur among people in real environments. The “noise” of context is relevant to understanding effects. For example, a policy which was thought to have certain effects may have different effects by the same measures five years later, because the society (or some other factor) has changed.

Multisectoral in nature
This consideration follows from the first two. When we accept that social determinants have multiple influences from multiple sectors, we have by definition embarked on a multisectoral issue. By thinking multisectorally, we must explicitly expand the circle of discourse around an issue to consider different ways of framing the problem, different underlying values, and different sets of assumptions, definitions, methodologies and limits. When working across sectors, it is more clearly necessary to take a step back to frame issues and discover (as much as possible) a collective understanding to build collective responses.

How to proceed, then?
One option for finding an appropriate balance is to look for a mixture of scientific evidence, local knowledge of important contextual factors, and examples of promising practices. These elements can all be informed by a range of perspectives, expertise, values and advice from different sectors and stakeholders. By navigating among the values of rigour and openness, between the general and the specific, between the most persuasive evidence and the importance of how effects unfold in specific situations, we can better address the challenges presented above.

Analyzing public policies
Given the challenges above, one important dimension of the policy analysis method that the Centre has developed is that it does not only consider the effects or effectiveness of policy options. Reviewing scientific and gray literature is an essential part of the process, but then the policy options in question are contextualized by deliberative means to consider their implementation, effectiveness, feasibility and other factors from the perspective of local stakeholders. The goal is to combine the available evidence with the most context-specific understanding possible.

Evidence of effectiveness
We have collected some resources on this website to help you find evidence relating to healthy public policy:

• Our search engine allows you to search a series of websites with resources in public policy, social policy and public health.
• We have posted links to databases with some work on evidence-based healthy public policy.
• We have also posted links to a series of newsletters and bulletins of interest.

Learn about public policies and their effects on health
Generate and use knowledge about healthy public policies
Identify models and actors for intersectoral collaboration
Influence the development of healthy public policies


Photo Credits:
© iStockphoto.com/ Vladimir Vladimirov
For information about how to legally obtain these images,
click here.


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The production of the NCCHPP website has been made possible through a financial contribution from the Public Health Agency of Canada.