October 2005

Information

Integrated Strategy on Healthy Living and Chronic Disease

Overview

The Government of Canada's investment of $300 million over five years and $74.4 million per year ongoing in funding under the Integrated Strategy on Healthy Living and Chronic Disease is an historic step forward in health promotion and disease prevention. Canada now joins numerous other countries with this significant investment in innovative and integrated approaches to combat major preventable chronic diseases. This strategy is balanced by complementary disease-specific investments for cardiovascular disease, cancer and diabetes.

The Integrated Strategy represents a new way of working with a diversity of partners. Improved collaboration among organizations, jurisdictions and sectors (and within sectors) is critical. With improved engagement, the Integrated Strategy is intended to positively influence individual and community capacity as well as the capacity of organizations and service providers. Enhanced capacity for action at various levels is expected to contribute to stronger public policies and more integrated, evidence-based and responsive health systems.

This integrated approach is supported by international experts as well as past experiences in other countries. It is endorsed by the World Health Organization (WHO). Scientific evidence demonstrates, for example, that healthy eating and physical activity protect against many chronic diseases, including cancer, heart disease and stroke, and diabetes, so it makes sense to integrate certain health promotion efforts. Likewise, the major chronic diseases share several common risk factors such as obesity. Greater impacts can be achieved by collaboration among jurisdictions, across sectors and on several diseases. Integration does not rule out employing specific approaches to address individual diseases. In fact, the principles of integrated action mandate a balance between integrated and disease-specific efforts. That is exactly what the Integrated Strategy on Healthy Living and Chronic Disease will do - integrate efforts where appropriate and make disease-specific ones where necessary.

Changes are expected to benefit Canadians on many levels through:

• more supportive physical and social environments, as well as healthier behaviours (all Canadians);
• decreased risk factors and risk conditions among high-risk groups (many Canadians); and
• earlier detection and better management of chronic disease among those who are directly affected (some Canadians).

While respecting the federal role in public health (a shared federal and provincial/territorial responsibility), the Integrated Strategy will take public health action on three interrelated pillars across the spectrum of health and chronic disease, as well as through specific strategies to address diabetes, cancer and cardiovascular disease.

The three pillars of the Integrated Strategy are:

• promoting health by addressing the conditions that lead to unhealthy eating, physical inactivity and unhealthy weights;
• preventing chronic disease through focussed and integrated action on major chronic diseases and their risk factors; and
• supporting the early detection and management of chronic diseases.

Promoting Health

Work based on this first pillar will promote health by addressing the conditions that lead to unhealthy eating, physical inactivity and unhealthy weights. Integrated Strategy partners will conduct activities on the combined theme of physical activity, healthy eating and healthy weights - including collaborative actions to address the underlying conditions that lead to unhealthy choices and to promote the health of children in schools. Activities undertaken by Healthy Living partners will cross many sectors. As well, the Integrated Strategy will support developmental collaboration towards the promotion of mental health.

• Healthy Living Fund ($27.6 million over five years , and $7.15 million per year ongoing)
  
  Funding through contribution agreements to support and engage the voluntary sector and to build partnerships and collaborative action among governments, non-governmental organizations and other agencies. The Healthy Living Fund will support healthy living actions (on physical activity and healthy eating, and their relationship to healthy weights) that have community-level, regional, national and international impact.

• Intersectoral Healthy Living Network ($2.75 million over five years, and $0.55 million per year ongoing)
  
  A pan-Canadian network that will bring together key players to integrate and coordinate activities related to healthy living. Specifically, the IHLN will act as a vehicle to direct and advance the implementation and further development of the Integrated Pan-Canadian Healthy Living Strategy.

• Healthy Living Knowledge Development and Exchange ($9.2 million over five years, and $2.5 million per year ongoing)
  
  Integrated efforts in surveillance and for the development, synthesis, translation and exchange of knowledge on physical activity and healthy eating, that will be undertaken to guide population and public health promotion activities.

• Healthy Living Social Marketing ($14 million over five years, and $3 million per year ongoing)
  
  A social marketing campaign and public education in support of the Integrated Pan-Canadian Healthy Living Strategy will foster positive societal behavioural change through the aligned efforts of a federal social marketing campaign and a pan-Canadian social marketing strategy.

• Mental Health ($4.5 million over five years, and $1 million per year ongoing)
  
  Activities related to coordination, consultation and partnerships, and knowledge development to support the establishment of a pan-Canadian mental health strategy. Mental health has also been identified as a potential future area of focus for the Healthy Living Strategy.

Supporting An Integrated Approach To Chronic Disease Prevention

"Supporting platforms or structures" is the term used to describe the important tasks that are of benefit in more than one of the individual disease areas. These program components will enable implementation of innovative chronic disease prevention approaches.

• Demonstration Projects for Integrated Chronic Disease Prevention ($18.4 million over five years, and $4.35 million per year ongoing)
  
  A series of demonstration sites, or trial projects, centered on knowledge development, exchange and dissemination, will be supported across the country to improve our understanding of best methods for implementing health promotion and chronic disease prevention and control programs. The federal contribution to these sites will support the application of standard scientific assessment techniques, for program evaluation and reporting purposes.

• Observatory of Best Practices ($6.5 million over five years, and $2 million per year ongoing)
  
  Activities related to the development, exchange and dissemination of knowledge in order to implement and maintain a Best Practice Information System and mechanisms for identifying, making recommendations and exchanging knowledge on best practices in Canadian settings. The Observatory of Best Practices will build collaborative linkages, nationally and internationally, between researchers, policy-makers and practitioners for the purpose of increasing the use of "what works."

• Evaluation, Monitoring and Coordination ($4.75 million over five years, and $1.05 million per year ongoing)
  
  The Evaluation, Monitoring and Coordination component will provide support for the overall evaluation, monitoring, leadership, coordination and horizontal linkages needed for the implementation of the Integrated Strategy. It will ensure the establishment and support of internal coordination, management and accountability mechanisms within the Public Health Agency of Canada (PHAC) to implement the Integrated Strategy program structure.

• International Collaboration ($4.9 million over five years, and $1.1 million per year ongoing)
  
  International collaboration work will contribute to uphold the commitment made by the Minister of Health in the Framework of Cooperation on Chronic Diseases signed with the World Health Organization (WHO) and other chronic disease and health promotion organizations. It will utilize and extend PHAC's expertise in chronic disease policy development and analysis through the work of its WHO Collaborating Centre on Non-Communicable Disease Policy. Health Canada will strengthen international partnerships and collaboration to share expertise to help improve the nutritional health of Canadians.

Programs That Involve The Three Pillars

These programs include disease-specific strategic initiatives to address the three leading causes of death in Canada: cardiovascular disease (heart and stroke), cancer and diabetes. They also include support for school health and chronic disease activities that span health promotion, disease prevention and early detection and management.

• Joint Consortium on School Health ($2.5 million over five years, and $0.5 million per year ongoing)
  
  A collaboration of provincial and territorial ministries of Health and Education and the federal government to promote the health of children and youth in schools. Activities will help to strengthen federal leadership efforts to promote health and prevent chronic disease among school-aged children, and to better align policy and program contributions, both within the federal health portfolio (Health Canada PHAC, CIHR and related agencies) and throughout the Government of Canada.

• Enhanced Surveillance for Chronic Disease ($36.5 million over five years, and $10.5 million per year ongoing)
  
  Investments will facilitate and support the development and establishment of an integrated chronic disease surveillance approach to provide leadership and to coordinate and oversee all disease surveillance elements of the Integrated Strategy as well as to address gaps in the surveillance for asthma and arthritis. It will also provide information relating to public health indicators, in order to support the measurement of progress toward public health goals and targets. Scientific and technical capacity in both central and regional operations will be enhanced, particularly with respect to epidemiological expertise. In addition, nutritional surveillance capacity will be developed and improved to support evidence-based and effective nutrition policies and programs.

• Renewal of the Canadian Diabetes Strategy ($90 million over five years, and $18 million per year ongoing)
  
  Renewal and improvement of the non-Aboriginal elements of the Canadian Diabetes Strategy, with new policy directions to reflect lessons learned and progress made to date. Changes will mirror the strategic direction of the framework for the national diabetes strategy jointly developed by federal and provincial/territorial governments, Aboriginal organizations and non-governmental organizations (NGOs). A significant new direction will be followed: targeting populations that are at higher risk for developing diabetes, especially those who are either overweight (or obese) or have pre-diabetes.

• Canadian Strategy for Cancer Control ($59.5 million over five years, and $17.5 million per year ongoing)
  
  Building upon existing federal program activities that contribute to cancer
  prevention and control, the cancer program component will manage the federal contribution toward a cancer control strategy for Canada. Investments will be made in five of the strategic priority areas determined by the Canadian Strategy for Cancer Control (CSCC) - Primary Prevention (preventing disease in the first place), Clinical Guidelines, Standards, Surveillance and Analysis, and Rebalancing the Focus - in a manner consistent with federal roles in this area.

In addition to the Integrated Strategy, the federal government is investing in other strategic priority areas of the CSCC including:

• Budget 2005, including a $10 million grant to the Terry Fox Foundation for cancer research;
• Investments of $5.5 billion over 10 years to reduce treatment wait times; and
• a $90 million investment in environmental health to fulfill outstanding obligations under the Canadian Environmental Protection Act. This investment will help reduce the exposure of Canadians to toxic, potentially cancer-causing, substances in the environment.

• Cardiovascular Disease ($18.9 million over five years, and $5.2 million per year ongoing)
  
  Cardiovascular disease (CVD) is the leading cause of death for both men and women in Canada and the most common cause of hospitalization. New CVD investments will focus on establishing a specific pan-Canadian strategic framework for cardiovascular disease, in collaboration with the provinces and territories, professional associations and other non-governmental partners, as well as in putting in place the public health structures necessary to support this approach.