Brent W. Moloughney

New Era for Schools and Programs of Public Health in Canada

In Canada, in the last few years, there has been a very rapid expansion of programs and schools of public health in response to several crises or emergency situations. Provincial and national investigations convened after the Severe Acute Respiratory Syndrome outbreak in Toronto in 2003 underlined important deficiencies in the institutional capacity of the public health system and the need to develop training of public health professionals and managers on a large scale.

Identifying Public Health Competencies Relevant to Family Medicine

Abstract Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from “post-MD” to “enhanced.” Feedback from family medicine and public health educator–practitioners regarding the set of proposed “essential” competencies indicated the need for a more limited, feasible set of “priority” areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Torontos Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying “teachable moments” during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine–public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations—from common to emergent.

A Multicomponent Intervention to Encourage Stair Use in Municipal Buildings

Purpose: Evaluate the incremental impact of environmental stairwell enhancements on stair usage in addition to prompts. Design: Phased, nonrandomized, quasi-experimental intervention. Setting: Two 6-story and one 8-story municipal government office buildings—each with 2 stairwells. Participants: Approximately 2800 municipal employees and 1000 daily visitors. Intervention: All stairwells received door wraps and point-of-decision and wayfinding prompts. Environmental enhancements were installed in 1 stairwell in each of the 2 buildings: wall paint, upgraded stair treads and handrails, artwork, light-emitting diode (LED) lighting, fire-rated glass doors, and removal of security locks on at least the ground floor. Measures: Staff surveys and focus groups, electronic and direct measures of stair and elevator use occurred at baseline and over 3 years of phased implementation and follow-up. Analysis: Change in the proportion of vertical movement by stairs using χ2 analysis. Results: The prompts were associated with a significant increase in stair use (odds ratio [OR] = 1.36; 95% confidence interval [CI]: 1.31-1.41), with an average absolute increase of 3.2%. Environmental enhancements were associated with an additional significant increase in stair use (OR = 1.31; 95% CI: 1.25-1.37) beyond prompts alone with an average absolute increase of a further 3.5% that was sustained for 1 year. The initial increases in stair use with prompts alone were not sustained. Conclusion: Implementing environmental stairwell enhancements in office buildings increased stair usage in a sustained manner beyond that achieved by prompts alone.

Incorporating consideration of health impacts into land use development approval processes: Development of a Health Background Study Framework

RésuméObjectifsNotre projet impliquait l’élaboration d’un cadre d’étude de base sur la santé (ÉBS) qui permette de tenir compte des impacts sur la santé dans le processus d’approbation des plans d’aménagement du territoire des municipalités.ParticipantsLe Bureau de santé de la région de Peel et Santé publique Toronto ont dirigé le projet avec la participation de planificateurs, d’urbanistes, d’ingénieurs, de fonctionnaires en santé publique et de représentants du secteur de l’aménagement.LieuLa croissance historique dans la Région de Peel et en banlieue de Toronto a entraîné un aménagement à faible densité généralisé, créant ainsi des communautés tributaires de l’automobile avec des rues sans issue et des utilisations compartimentées des terrains.InterventionL’inclusion d’une ÉBS dans les demandes que les promoteurs présentent aux municipalités est une approche permettant d’établir des attentes sanitaires pour le milieu bâti dans le processus d’approbation. L’élaboration du cadre d’ÉBS a utilisé les six éléments fondamentaux du milieu bâti pour lesquels il existe les indications les plus solides d’impacts sur la santé et s’est fondée sur l’analyse des contextes des politiques provinciales et locales, sur les pratiques d’autres municipalités et sur des entrevues avec les acteurs. Le contenu du cadre a été peaufiné à la lumière de la rétroaction d’ateliers multipartenaires et multidisciplinaires.RésultatsLe cadre d’ÉBS définit des normes minimales pour les éléments fondamentaux du milieu bâti que les promoteurs doivent aborder dans leurs demandes. Ce cadre se veut un outil simple et instructif qui peut s’appliquer à un éventail de lieux et d’échelles d’aménagement et aux diverses étapes du processus d’approbation des plans d’aménagement. Le Bureau de santé de la région de Peel dirige plusieurs initiatives qui appuient l’utilisation de l’ÉBS dans le processus de demande des plans d’aménagement.ConclusionLe cadre d’ÉBS est un outil dont les fonctionnaires en santé publique et en planification peuvent se servir pour appuyer la prise en compte des impacts sur la santé dans les processus d’aménagement du territoire des municipalités.