Upstream Approaches to Canadian Population Health

Upstream Approaches to Canadian Population Health

  1. Provide a description of an existing intervention in Canada, intended to improve
    health inequities. Include an explanation of the inequity and how the intervention
    targets upstream determinants of health.
  2. Describe the organizations involved and/or social policies enacted in the
    implementation of the intervention.
    3.Explain whether or not the intervention was/is successful and what lessons public
    health practitioners can learn from that experience that might improve population
    health in the United States.

Health inequities are avoidable imbalances that contribute to poor health. Solutions
for such inequities may be found in upstream interventions that address social, economic and
environmental situations. Social determinants include preventative strategies such as physical
activity and proper diet as important ways of preventing chronic diseases and improving
overall health (Gore & Kothari, 2012). In Canada, Ontario implements interventions aiming
to influence environmental and social factors to address inequities in health.
There is increasing prevalence of chronic disease among certain pockets of the
Canadian population. Problems associated with the high cost of treating such diseases
necessitate efforts to implement interventions targeting their underlying causes. Canada
renewed its commitment to public health in 2003 in a response strategy targeted towards
addressing Severe Acute Respiratory Syndrome through healthy living interventions. The
associated cost of treating chronic diseases threatens the sustainability of the healthcare

system. This realization informs the implementation of a healthy living intervention in
Canada through development of chronic diseases prevention guidelines (Gore & Kothari,
In Canada, low economic social status is measured in terms of literacy and income
levels. It determines citizens’ vulnerability to cardiovascular disease, diabetes, asthma and
chronic obstructive pulmonary disease (Dinca-Panaitescu, Dinca-Panaitescu, Bryant, Daiski,
Pilkington, & Raphael, 2011). Studies show higher prevalence of chronic disease and lower
life expectancy in low -income areas as compared to wealthier areas. Research also shows
that job insecurity, unemployment, part-time employment and temporary employment
negatively affects health as it is associated with elevated levels of chronic diseases such as
blood pressure and increased risk of death from cardiovascular diseases. Aborigines,
immigrants and people of color also have low incomes and are at higher risks of stress that
triggers development of chronic diseases (Gore & Kothari, 2012).
Canada implements health policies aimed at preventing chronic illnesses by
addressing upstream causes encompassing lifestyle, socioeconomic and environmental
factors. One example of the policies is the 2009 Canadian Cardiovascular Society Guidelines
advocating for reduced salt and simple sugars intake. It promotes the replacement of saturated
and trans-fats with unsaturated, as well as higher consumption of vegetables and fruits. The
guideline also recommends greater attention to weight control to prevent obesity and ensure
that more citizens maintain a healthy body weight (Raine, 2010).
Health boards received instructions on the appropriate way to evaluate the population
needs and tailor interventions to the groups facing the highest risk. Another policy is the
Ontario guidelines for healthy eating and active living that informs various interventions to
address health inequities in Ontario (Gore & Kothari, 2012). Aboriginal people and new
comers in Canada have a higher prevalence of chronic illness often because of poor

nutritional decisions and lack of opportunities for physical exercise. To address inequities
among aboriginal people, there is an initiative to provide recreation and fitness equipment
and youthful fitness ambassadors in their various locations. Other interventions in the Ontario
guidelines for healthy eating and active living include provision for a web and phone based
dietitian serving populations in remote areas. It also includes providing fruits and vegetables
to schools through partnership with the ministry concerned with agriculture. Efforts to
encourage physical activity include collaboration with urban planning designers to ensure
that cities promote healthy living and that schools have routes that encourage physical
exercise through walking and biking. The local public health units also oversee the
compulsory programs and 36 heart health community partnerships to reduce cardiovascular
disease (Ministry of Health Promotion, 2006).
The Ontario plan on active and healthy living is also referred to as ACTIVE2010
supports communities to implement community sports and physical activity and nutrition
projects (Ministry of Health Promotion, 2006). The plan adopted a multi-sectoral approach
targeting the population on a variety of levels. It includes actors from NGOs, private industry,
service providers, and communities. Partnership between actors in healthcare is imperative in
addressing the wide-ranging impact of social determinants in populations residing in diverse
settings (Gore & Kothari, 2012).
The government in Ontario supports the intervention through policies that guide
enhanced physical activity in schools, providing access to nutritious foods to children and
encouraging hygiene and safety in the environment. Community organizations actively
participate through facilitating health promotion trainings to prevent the occurrence of
chronic illnesses among at risk individuals. Private companies also participate by creating
health and wellness programs for their staff including healthier food choices and exercise.

Some companies in the food industry are also keen in providing healthier food selection and
creating awareness on the same (Ministry of Health Promotion, 2006).
The physical exercise interventions are tenable and have resulted in substantial
benefits to the population. The interventions assist Ontarians to become more physically
active through community sports and physical activity projects that are largely supported
through the communities in action fund. The implementation of the Ontario’s trail strategy
also encourages physical activity through provision of outdoor walking spaces in various
areas for all (Ministry of Health Promotion, 2006). In as much as interventions targeting to
reduce salt content in packaged and restaurant foods are tenable, the dietary
recommendations for preventing chronic diseases remain largely unmet in Canada. Only a
few companies have positively responded to the guidelines’ recommendations. The industry
progress is underwhelming because many other companies are yet to take voluntary measures
to reduce salt in their food products. It shows that regulatory controls are necessary to
increase the number of companies acting to reduce sodium levels in processed foods (Raine,
The Canadian Heart and Health strategy and Action Plan recommends that creating
heart friendly environments through education, legislation, and policies aimed at promoting
healthy eating and physical activity are efficient interventions in addressing upstream
determinants of health. An examination of environment-based interventions to prevent
cardiovascular diseases in Ontario and indicates that they failed to address the social causes
or determinants of illnesses. Interventions in settings at schools, workplaces, government
buildings and communities are insufficient in addressing unfavorable living conditions and
factors that create inequity. There is need for greater political will to invest more aggressively
in prevention to achieve success (Raine, 2010).

Complete success of the Ontario’s healthy eating and active living plan is dependent
upon greater political will to support aggressive implementation including legislative
measures. Public health practitioners in the United States must ensure that when adopting
such interventions, there is a solid legal foundation to ensure success. The US requires
implementing strategies that address health inequities emanating from low-income and racial
factors are addressed through population specific measures. A multidisciplinary approach is
also imperative in ensuring that communities, government agencies and private sector players
coordinate their efforts. There must be enforceable laws on wellness programs, food industry
parameters and urban planning. These factors coupled with concerted efforts between public
health agencies, education, food and agriculture, companies and the communities provide
prime conditions for success.


Dinca-Panaitescu, S., Dinca-Panaitescu, M., Bryant, T., Daiski, I., Pilkington, B., & Raphael,
D. (2011). Diabetes prevalence and income: Results of the Canadian Community
Health Survey. Health Policy, 99(2), 116-123.
Gore, D., & Kothari, A. (2012). Social Determinants of Health in Canada: Are Health
Initiatives There Yet? A Policy Analysis. Internatinal Journal for Equity in Health,
11(41), 1-14.
Ministry of Health Promotion. (2006). Ontario’s Action Plan for Healthy Eating and Active

Raine, K. D. (2010). Addressing Poor Nutrition to Promote Heart Health: Moving Upstream.
Canadian Journal of Cardiology, 21-24.

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