Catherine L. Mah

Glossary for the implementation of Health in All Policies (HiAP)

Health in All Policies (HiAP) is becoming increasingly popular as a governmental strategy to improve population health by coordinating action across health and non-health sectors. A variety of intersectoral initiatives may be used in HiAP that frame health determinants as the bridge between policies and health outcomes. The purpose of this glossary is to present concepts and terms useful in understanding the implementation of HiAP as a cross-sectoral policy. The concepts presented here were applied and elaborated over the course of case studies of HiAP in multiple jurisdictions, which used key informant interviews and the systematic review of literature to study the implementation of specific HiAP initiatives.

Retail food environments research in Canada: A scoping review

OBJECTIVES The field of retail food environments research is relatively new in Canada. The objective of this scoping review is to provide an overview of retail food environments research conducted before July 2015 in Canada. Specifically, this review describes research foci and key findings, identifies knowledge gaps and suggests future directions for research. METHODS A search of published literature concerning Canadian investigations of retail food environment settings (food stores, restaurants) was conducted in July 2015 using PubMed, Web of Science, Scopus, PsychInfo and ERIC. Studies published in English that reported qualitative or quantitative data on any aspect of the retail food environment were included, as were conceptual papers and commentaries. SYNTHESIS Eighty-eight studies were included in this review and suggest that the field of retail food environments research is rapidly expanding in Canada. While only 1 paper was published before 2005, 66 papers were published between 2010 and 2015. Canadian food environments research typically assessed either the socio-economic patterning of food environments (n = 28) or associations between retail food environments and diet, anthropometric or health outcomes (n = 33). Other papers profiled methodological research, qualitative studies, intervention research and critical commentaries (n = 27). Key gaps in the current literature include measurement inconsistency among studies and a lack of longitudinal and intervention studies. CONCLUSION Retail food environments are a growing topic of research, policy and program development in Canada. Consistent methods (where appropriate), longitudinal and intervention research, and close partnerships between researchers and key stakeholders would greatly advance the field of retail food environments research in Canada.

Ready for Policy? Stakeholder Attitudes Toward Menu Labelling in Toronto, Canada

ObjectivesThe purpose of this research was to assess key stakeholder attitudes regarding menu labelling in Toronto, the largest municipality in Canada. Menu labelling is a population health intervention where food-labelling principles are applied to the eating-out environment through disclosure of nutrient content of food items on restaurant menus at the point of sale. Menu-labelling legislation has been implemented in the United States, but has yet to be adopted in Canada. As provincial voluntary programs and federal analyses progress, municipal jurisdictions will need to assess the feasibility of moving forward with parallel interventions.MethodsData were collected and analyzed in late 2011 to early 2012, including: a consumer eating-out module incorporated into a public health surveillance telephone survey (n=1,699); an online survey of independent restaurant operators (n=256); in-depth key informant interviews with executives and decision makers at chain restaurants (n=9); and a policy consultation with local restaurant associations.ResultsToronto residents, particularly men, younger adults, and those with higher income or education, frequently eat out. A majority indicated that nutrition information is important to them; 69% note that they currently use it and 78% reported they would use it if it were readily available. Resistance to menu-labelling requirements at the municipal level was articulated by franchise/chain restaurant executives and industry associations. Despite overall low interest among independent restaurant operators, 57% reported feeling some responsibility to provide nutrition information and 50% believed it could be good for business.ConclusionsThis research supports earlier literature that indicates strong public support for menu labelling alongside perceived barriers among the restaurant and foodservices sector. Leverage points for effective operator engagement for menu-labelling adoption were identified, nonetheless, highlighting the need for public health support.RésuméObjectifsÉvaluer les attitudes d’acteurs privilégiés à l’égard de l’étiquetage du menu à Toronto, la plus grande ville du Canada. L’étiquetage du menu est une intervention en santé des populations qui applique les principes de l’étiquetage des aliments à l’environnement de la restauration en divulguant la valeur nutritive des produits alimentaires au menu des restaurants, au point de vente. Des lois sur l’étiquetage du menu sont en vigueur aux États-Unis, mais il n’y en a pas encore au Canada. Avec l’évolution des programmes provinciaux volontaires et des analyses fédérales, les administrations municipales devront évaluer la faisabilité d’adopter des interventions parallèles.MéthodeEntre la fin de 2011 et le début de 2012, nous avons recueilli et analysé nos données: un module sur les consommateurs qui mangent à l’extérieur, intégré dans une enquête téléphonique de surveillance de la santé publique (n=1 699); un sondage en ligne auprès de restaurateurs indépendants (n=256); des entretiens approfondis avec des exploitants et des décideurs de chaînes de restauration (n=9); et une consultation stratégique avec les associations locales de restaurateurs.RésultatsLes Torontois, surtout les hommes, les jeunes adultes et les personnes dont le niveau de revenu ou d’instruction est élevé, mangent souvent à l’extérieur. La majorité des répondants considèrent que les données nutritionnelles sont importantes pour eux; 69 % disent consulter ces données, et 78 % disent qu’ils le feraient si elles étaient aisément accessibles. Les exploitants de franchises ou de chaînes de restauration et les associations du secteur ont exprimé de la résistance à la perspective d’une réglementation municipale de l’étiquetage du menu. Les restaurateurs indépendants ont manifesté peu d’intérêt, mais 57 % ont quand même dit se sentir responsables de fournir des données nutritionnelles, et 50 % pensent que cela pourrait être bon pour les affaires.ConclusionsL’étude confirme les résultats des travaux publiés antérieurement, qui font état à la fois d’un large soutien du public à l’étiquetage du menu et d’obstacles perçus par le secteur de la restauration et des services alimentaires. Nous avons néanmoins repéré les éléments les plus susceptibles de convaincre les exploitants d’adopter l’étiquetage du menu, d’où un besoin de soutien par la santé publique.

Cultivating Food Connections: The Toronto Food Strategy and Municipal Deliberation on Food

This paper shares an exploratory case study of the development of the Toronto Food Strategy as an urban food strategy, through the lens of public health. It asks: what is a food strategy and how does it work? We will answer these questions through an analysis and discussion of the Food Strategy development process and attention to three key mechanisms: (1) framing or directing attention to the diverse policy instruments that deal with food, (2) brokering working relationships between diverse stakeholders and across existing governance arrangements, and (3) leveraging existing resources. We also distinguish the work of the Food Strategy from the role of food policy councils in how they cultivate deliberative spaces to catalyse policy change.

Policy options for healthier retail food environments in city-regions

Public policy is central to health promotion: it determines the distribution of resources in a society and establishes the structural context for the actions of both corporations and consumers. With this in mind, the purpose of this paper is to begin a discussion on promising policy options for a health-promoting retail food environment. Drawing on specific municipal examples, we examine four groups of policy options for healthier retail food environments in city-regions: planning for health; transforming consumer environments; economic and fiscal instruments; and a culture of transparency and participation. We introduce examples of policy options that are receiving increasing attention in the public health and urban planning literature and that function at the municipal level. We also highlight how public health professionals have an important role to play in policy that shapes retail food environments, especially in making explicit the linkages between health and other policy goals. In doing so, this commentary aims to motivate public health practitioners in a variety of community contexts to consider the policy supports they need to advance their exploration, development, testing and evaluation of interventions for healthier retail food environments.

A frame-critical policy analysis of Canada's response to the World Food Summit 1998-2008

BackgroundThe 2012 visit to Canada of Olivier De Schutter, the United Nations Special Rapporteur on the Right to Food, led to a public rebuff by Canadian governmental officials. This paper adapts the frame-critical policy analysis of Schön and Rein (1994), to explore the rhetorical basis for this conflict. This examination is offered as an illustrative example of how food insecurity is framed as a public policy problem in a high-income nation and how this framing has changed over time.MethodsWe analyze Canada’s decade of sequential responses to the 1996 World Food Summit, spanning 1998–2008, in the form of Canada’s Action Plan on Food Security, and its subsequent Progress Reports. We conducted a qualitative policy analysis, adapting the frame-critical approach first delineated by Schön and Rein (1994). This analysis uses a social constructionist approach to map out the relationships between tacit understanding of policy by particular actors, explicit rhetoric in the public domain, and action in this policy area over time.ResultsWe identify three key ways in which competing rhetorical frames arise over time: frame shifts (e.g., a shift away from language highlighting the right to food and health); frame blending (e.g., discussion about poverty becomes obscured by complexity discourse); and within-frame incongruence (e.g., monitoring for health indicators that are unrelated to policy solutions). Together, these frames illustrate how the conflict embodied in the UN Special Rapporteur’s visit has been deeply woven into the policy discourse on food insecurity in Canada over time.ConclusionFrame-critical analysis is instructive for exposing and also predicting tensions that impede forward progress on difficult policy issues. Accordingly, such analyses may be helpful in not only dissecting how policy can become ‘stuck’ in the process of change but in active reframing towards new policy solutions.

Using Vignettes to Tap Into Moral Reasoning in Public Health Policy: Practical Advice and Design Principles From a Study on Food Advertising to Children

In this article, we describe a process for designing and applying vignettes in public health policy research and practice. We developed this methodology for a study on moral reasoning underpinning policy debate on food advertising to children. Using vignettes prompted policy actors who were relatively entrenched in particular ways of speaking professionally about a controversial and ethically challenging issue to converse in a more authentic and reflective way. Vignettes hold benefits and complexities. They can focus attention on moral conflicts, draw out different types of evidence to support moral reasoning, and enable simultaneous consideration of real and ideal worlds. We suggest a process and recommendations on design features for crafting vignettes for public health policy.

Another Look at the Human Papillomavirus Vaccine Experience in Canada

Policy debates about immunization frequently focus on classic trade-offs between individual versus collective well-being. Publicly funded immunization programs are usually justified on the basis of widespread public benefit with minimal individual risk. We discuss the example of the policy process surrounding the adoption of the human papillomavirus (HPV) vaccine in Canada to consider whether public good arguments continue to dominate immunization policymaking. Specifically, we show how a range of stakeholders framed HPV vaccination as a personal-rather than a public-matter, despite the absence of a controversy over mandatory immunization as was the case in the United States. Our findings suggest an erosion of the persuasiveness of public good arguments around collective immunization programs in the policy discourse.

Canada: variations on a common theme

Canada faces health care challenges common to all industrialized countries – how to ensure timely access to high quality care, close to home, at an affordable cost. Addressing these challenges is complicated by interjurisdictional variation in both how health care is managed and delivered, and in health outcomes. Canada can be described as a non-system of 10 provincial and three territorial health insurance plans which mandate publicly-funded coverage for medically necessary hospital and physician services, based upon common principles and shaped by a federal governance structure that affords substantial power and autonomy to the provinces/territories over matters of health and health care. This article first examines the structural context of the health care system in Canada, including the range of services publicly funded, the public-private mix, and the complexities of current governance arrangements. It then discusses several issues affecting health policy reform: costs versus access; questions of sustainability, quality, and performance; human resources capacity; and the provision of public and population health services.

Legislation Debated as Responses to Household Food Insecurity in Canada, 1995–2012

ABSTRACT Household food insecurity (HFI) is a persistent problem in Canada affecting over 4 million people in 2012. This study identifies the policy actions that Canadian legislators in 4 jurisdictions advanced to address HFI between 1995 and 2012 and examines which suggestions led to legislation. We reviewed Hansard extracts from legislative debates to identify specific policy proposals as a starting point for finding bills. We found that legislators debated a variety of policy actions but legislative proposals were from a narrow range that focused on food provision and contributed to the validation of food banks as a policy response to HFI.