Pierre Bergeron

Health promotion research and practice require sound policy analysis models: The case of Quebec's Tobacco Act

In this paper we illustrate how policy analysis models can deepen our understanding of the challenges facing health promoters advocating for policy change. Specifically we describe the factors underpinning the adoption of Québecs Tobacco Act (1998) and the role played by actors from governmental public health agencies (GPHAs). Data were collected through interviews (n=39), newspapers articles (n=569) and documents (n > 200) from GPHAs, NGOs, the Québec National Assembly, and opponents to the legislative measures. Data collection and analysis were based on Sabatier and Jenkins-Smiths Advocacy Coalition Framework (1999) and Lemieuxs theorization of coalition structuring (1998). We explain the adoption of the Act by: (1) the broad recognition within the policy elite of the main parameters of tobacco use (i.e. lethality, addictive properties, and legitimacy of governmental intervention), (2) the impacts of a series of events (e.g. cigarette contraband crisis) that enabled tobacco control advocates to influence public debates, and the governmental agenda, (3) the critical contribution of a coalition of GPHAs pooling resources to address both the sanitary and economic aspects of the legislation while countering the oppositions strategy, and (4) the failure of the opponents to present an unified voice on the definition of the tobacco policy. This study illustrates the merits of applying a policy-change model to grasp the complexity of the process. Our findings call for the development of permanent policy analysis capabilities within public health agencies and for a broader scrutiny of the non-health-related dimensions of policy debates.

Hereditary tyrosinemia in the province of Quebec: Prevalence at birth and geographic distribution

Hereditary tyrosinemia is a severe metabolic disorder of the newborn for which a very low prevalence at birth has been reported throughout the world. During a 2‐year period, the Quebec Network of Genetic Medicine has tested blood tyrosine in 81.6 % of newborns. Twelve babies with hereditary tyrosinemia were detected by biochemical screening and two more cases were identified by pediatricians. Prevalence at birth way 0.8 case per 10,000 live births in the province of Quebec as a whole; the Chicoutimi‐Lac St. Jean region was found to have an exceptional concentration of 14.6 caqes per 10,000 live births and a frequency of carriers of 1 in 14 persons. such an experimental screening program helps define health problems in a population.

Atención primaria y responsabilidades de salud pública en seis países de Europa y América del Norte: un estudio piloto

BACKGROUND Rapidly occurring changes within the health care systems are creating an opportunity to re-orient the relationships between their different sectors. In order to know the locus of responsibility for various types of preventive activities, we undertook an inquiry on eight areas in six countries from Europe and North America. METHODS An inquiry among experts based on a matrix which arrayed the type of preventive health services against the target population. Eight clinical conditions were identified (childhood immunizations; adult influenza vaccination; mammography screening, tuberculosis screening, hypertension screening. PKU screening, HIV screening, and osteoporosis testing) trying to know their target population and the locus of responsibility for setting of policy, level to contact individuals for testing, follow-up of people with abnormal tests and maintenance of their medical records. RESULTS This pilot study showed very little results coincidence either within the eight surveyed areas or across them. There was no regular pattern for the preventive activities studied among the different countries, neither according to the type of health system, nor to the primary health care orientation of the different systems. CONCLUSIONS There was a limited consensus in the activities studied concerning the best mode of doing public health interventions for personal health services.Fundamento: Los rapidos cambios en los sistemas sanitarios son una oportunidad para reorientar las relaciones entre sus diferentes componentes. Con el objetivo de conocer donde se ubica la responsabilidad para la realizacion de diferentes tipos de actividades preventivas, se realizo una encuesta en ocho areas geograficas de seis paises de Europa y Norteamerica. Metodos: Encuesta entre expertos basada en una matriz que relaciona servicios sanitarios preventivos con la poblacion a la que se dirigen. Se establecieron ocho situaciones clinicas (vacunaciones infantiles y antigripal adultos; y deteccion precoz: de cancer mediante mamografia, de tuberculosis, de Hipertension Arterial, de fenilcetonuria, del virus de la inmunodeficiencia humana, y de osteoporosis), con el fin de conocer en relacion a las mismas la poblacion diana, nivel de establecimiento de las politicas, nivel de contacto con los individuos, seguimiento de los individuos con diagnosticos positivos y registro de sus datos clinicos. Resultados: Este estudio piloto mostro muy escasa coincidencia de los resultados tanto entre las ocho areas encuestadas como en cada una de ellas. No se encontro un patron regular para las actividades de prevencion exploradas entre los diferentes paises, ni en funcion de la tipologia de sus sistemas sanitarios, ni por la orientacion hacia la atencion primaria de los diferentes sistemas. Conclusiones: Existe un escaso consenso en las areas estudiadas en relacion con la mejor forma de realizar las intervenciones de salud publica que conllevan prestacion de atencion sanitaria personal.

The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models that Bridge Individual and Population Perspectives

AbstractIntroduction: Public health and primary care are often conceived as two entities providing complementary services within the health system. This scoping review aims to better understand how the two sectors interact by identifying their shared functions, and by identifying organizational models that could facilitate the interaction between the two domains. Methodology: We conducted a review of published literature using PubMed and CINAHL journal indices. Our search yielded 179 articles. We reviewed abstracts and retained 55 relevant articles. We developed an extraction grid, based on a conceptual framework of functions of public health and primary care, in order to evaluate the relevance of selected articles, classify the information according to their functional connection, and identify interactions between them. Results: Our search identified various activities through which public health can contribute to more effective primary care, and functions usually performed by primary care that seemed to support a population health approach. Most authors identified screening and immunization as actions that are carried out in primary care, but that can benefit from the support of public health. Health promotion and lifestyle modification are also shared responsibilities that can take the form of collective or individual intervention. The surveillance and protection function of public health, which actually takes place in primary care, consists of case identification for prevention or early treatment. Primary care is the setting where patients present, whereas public health has the role of investigation and of providing advice to clinical settings. Planning and evaluation are also emerging activities that concern both public health and primary care. Many authors recognized that public health provides tools that enhance the planning of primary care activities and are more aligned with the actual needs of populations. Others noted that public health is able to assess primary care in light of the changing health of populations, which may lead to better results for groups of patients. Conclusion: One of the routes to a better understanding of how public health and primary care organizations can better interact is to identify the different contexts in which they collaborate successfully. Our scoping review of the scientific and gray literature identified various ways by which public health and primary care either reinforce each other through their respective functions, or increasingly act in a collaborative manner to increase population health and improve health systems performance.

Une stratégie d' advocacy pour favoriser l'adoption d'une politique publique provinciale en matière de réduction du tabagisme Une campagne publique qui met en relief des portraits épidémiologiques de l'usage de tabac, des études d'impacts des mesures de réduction du tabagisme, et des rapports sur les activités de l'industrie du tabac

Nous analysons le rôle joué par les données probantes dans la planification et l’implantation d’une stratégie d’advocacy visant à neutraliser l’opposition à l’adoption de la Loi sur le tabac (1998) du Québec. Ce cas illustre la nécessité de compléter les données épidémiologiques traditionnelles avec d’autres informations faisant écho aux objections (principalement économiques) formulées contre le projet de loi. Il met également en exergue l’importance pour la santé publique de s’associer à des acteurs dont la légitimité leur confère le droit de cité dans les débats publics débordant des préoccupations sanitaires.