CHNET-Works Fireside ChatDecember 1, 2009

The vision for AHRNI was for it to be a coordinated, pan-Ontario effort

Two networks emerged from the discussions of the HSLRUs in early 2009:• System Innovation and Integration (SIIReN) Moira Stewart from the TVFPRU at the University of Western

Ontario was invited to lead this network hub• Population Health Improvement (PHIRN) Ivy Lynn Bourgeault from the CHRU at the University of

Ottawa was invited to lead this network hub

The population health improvement research network would contain two research programmes:

• Patterns & Pathways of Inequity co-led by: Ronald Labonté (UOttawa) CRC in Global Health Equity Carlos Quiňonez (UToronto) formerly with the CDHSRU

• Population Health Interventions co-led by: James Dunn (McMaster) CIHR/PHAC Chair in Applied Public Health,

specializing in residential neighbourhoods and population health Douglas Manuel (Ottawa Hospital Research Unit) CIHR/PHAC Chair in

Applied Public Health

Other pan-Ontario research networks that cut across the system and population health themes have been established:

• Health of Francophone Minorities led by Louise Bouchard and Marie-Hélène Chomiene

• Health Human Resources led by Ivy Lynn Bourgeault• Performance Measurement led by Louise Lemieux-Charles

Two other pan-Ontario research networks are under development:

• Aboriginal People’s Health • Multicultural Health

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to support high-quality applied population health research that addresses complex issues that affect health using a collaborative, networked approach;

to build capacity by linking established researchers, community partners, decision-makers, and emerging leaders in open, collaborative, and inter-disciplinary networks.

to be the applied health services focus for Ontario, supporting evidence-informed policy development and decision-making in the ministry, the health system, and at other social and economic policy ministries;

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Each network is to devote approximately 60% of its activities towards MRR and 40% towards IDR

The kind of KTE Tools discussed by the Ministry can be categorised primarily in terms of time:

• Rapid Response – responding to a critical issue that the Ministry must respond to within 24 to 48 hours

• Technical Briefing – responding to a less urgent issue pulling together existing knowledge within 4 to 6 weeks

• Knowledge Synthesis – responding to anticipated issues with a longer time frame of 6 to 12 months

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The timeline for the evolution of the HSLRUS into AHRNI took place Sept. 1, 2009

From September to the end of December 2009 each network is to undertake work in developing the goals, structure, membership and research priorities for the 3-5 year duration of each programme

To undertake more and better population health research in Ontario/with an Ontario focus

• Leverage funds from other sources To enhance capacity in population health research in the

province• Research production capacity in terms of graduate students, postdoctoral

fellows and junior faculty development• Research user capacity enhancement

To inform policy and practice related to population health in the province with the ultimate goal of improving overall health and health equity

Management Committee• Leads of network and programmes plus

Senior Manager – Corinne Packer & Scientific Advisor – Nancy Edwards Advisory Committee

• Management Committee plus Knowledge users – one each for Equity and Interventions plus

other key agencies Population Health reps. from other AHRNI networks

Membership• Open to Ontario-based researchers

OPHS acknowledge that the health of individuals and communities is significantly influenced by complex interactions between social and economic factors;

OPHS stress the fundamental need to reduce health inequities;

State that public health interventions shall aim to reduce existing health inequities.

Face-to-Face consultation held in Toronto, Nov. 3rd; 30 participants

Online Consultation – Nov. 10-30th; now nearly 200 members• http://www.rrasp-phirn.ca/index.php?option=com_content&view=article&id=11&Itemid=16

CHNET-Works Fireside Chat on PHRIN – Dec. 1st, 1:00-2:30pmTo join chat, go to:

• http://www.chnet-works.ca/index.php?option=com_attend_events&task=view&id=94&Itemid=56

Who has participated and should participate?• Students, fellows, academic and community-based researchers• Community decision-makers• Cross-sectoral; not just health

Health equity as an achievable social goal has gained new policy relevance.

The Patterns and Pathways of Inequities Program will seek to expand the evidence base for policy interventions related to the social determinants of health.

• a considerable base of research evidence already exists, but needs to be improved particularly with respect to policy influences on health inequities.

The research strategies would go beyond the individual determinants of illness and examine:

• the intersections among different forms of social stratification;• the institutions and processes that influence the allocation of

health and social resources; • the context affecting choices about resource allocation at

provincial, national and international levels;

paying special attention to all relevant evidence, qualitative or quantitative.

What do Ontarians think about health disparities and what are their policy preference to address them?

From a social determinants of health perspective, what data sources are in place to examine the impact of public and private sector policies on health?

What facilitates inter-sectoral action on health, and in this regard, what facilitates institutional change?

What are the economic impacts of health inequalities? Does access to dental care influence employment outcomes?

What knowledge exists around the concept of ‘guaranteed social minimums’ in terms of health states and the rationing of social goods?

What are the distributional impacts of social policies in

Ontario? For example, how do subsidization policies across different social sectors influence household outlays on things like food and health care?

Draft Research Questions – Patterns & Pathways of Inequity

Need to pay attention to vulnerable/high risk populations;

Consider generational inequity;

Consider impact of economic crises and intersections with work, gender and health;

Challenges include a fractured policy environment and depoliticizing problems.

Population health interventions either improve the overall health of Ontarians and/or reduce health inequities. • Interventions come in many forms and may target entire

populations or groups of people who bear a disproportionally large amount of ill health.

• Interventions address health opportunity structures (e.g., physical barriers, policies, norms) that shape health across whole populations

There are two proposed goals of this programme:

• 1) To perform more and better population health intervention studies in Ontario.

• 2) To support Ontario’s efforts to achieve our population health goals by identifying and filling gaps in knowledge related to population health interventions.

Examples of potential interventions include:

• Making modifications to residential build environments to create more opportunities for physical activity

• Introducing regulations to reduce harmful additives or ingredients to the food supply

More and better use of existing data for evaluating health interventions and policies. Data development and better access for intervention research;

Need to address sustainability of community interventions;

Address process challenges for partnering and performing research (e.g. obtaining research partners and ethics approval for interventions in different community sectors).

Support expressed for conducting research on `natural experiments’ in various contexts, including schools, families, neighbourhoods, and at the level of provincial policies;

• There are methodological and feasibility challenges to such research. Role of PHRIN could be to offer materials to network members that provide solutions to these (e.g. educational models in evaluation research)

Build on and develop synergies with LHINs (e.g. mental health, addictions and chronic disease);

Need strong intersectoral approach;

Need to better understand how to increase citizen engagement (e.g. input from local population health citizen groups).

Need to better understand how to engage with media to raise awareness of population health issues;

How best can a network approach achieve these goals?• What might be other goals for PHIRN we should

consider? Who should be involved and how should they be

involved? Key research & capacity building priorities? Any other relevant topics.

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