Ontario Public Health Standards

Principles

The delivery of public health programs and services occurs in diverse and complex geographic, physical, cultural, social, and economic environments that differ significantly across Ontario. There are systemic differences in health status that exist across socio-economic groups (i.e., health inequities). Thus, there are both common and diverse factors that influence and shape the public health response required to achieve a desired health outcome.

Effective public health programs and services take into account communities' needs, which are influenced by the determinants of health. As well, an understanding of local public health capacity and the resources required including collaboration with partners to achieve outcomes is essential for effective management of programs and services.

To ensure that boards of health assess, plan, deliver, manage, and evaluate public health programs and services to meet local needs, while continuing to work towards common outcomes, boards of health shall be guided by the following principles:

  1. Need
  2. Impact
  3. Capacity
  4. Partnership and Collaboration

1. Need

The principle of need acknowledges the importance of using data and information to inform decision-making at the local level regarding program assessment, planning, delivery, management, and evaluation. This principle must be continuously applied at all levels of program and service delivery to ensure optimal performance. In order to be successful in achieving outcomes, boards of health shall continuously tailor their programs and services to address needs that are influenced by differences in the context of their local communities. The Ontario Public Health Standards allow for flexibility in local public health programming by emphasizing the importance of population health assessment and surveillance to inform program planning and service delivery.

Public health programs and services must consider the health needs of the local population. Need is established by assessing the distribution of determinants of health, health status, and incidence of disease and injury. Boards of health shall engage in ongoing population health assessment and surveillance. Information to support this analysis shall be derived from a range of provincial and local indicators using identified data sets and methodologies. These analyses shall use specific information on the following: demographics; burden of disease, including mortality and morbidity rates; reproductive outcomes; risk factor prevalence; cultural and social behaviours related to health; health conditions (including injury and substance misuse); environmental conditions and hazards; health determinants; and other risks to the public's health.

The determinants of health will often inform the needs of a community. It is evident that population health outcomes are often influenced disproportionately by sub-populations who experience inequities in health status and comparatively less control over factors and conditions that promote, protect, or sustain their health. By tailoring programs and services to meet the needs of priority populations, boards of health contribute to the improvement of overall population health outcomes. Boards of health shall also ensure that barriers to accessing public health programs and services are minimized. Barriers can include but are not limited to education; literacy levels; language; culture; geography; economic circumstances; discrimination (e.g., age, sexual orientation, race, etc.); social factors, including social isolation; and mental and physical ability.

Many of the requirements can be more optimally achieved through partnerships with community partners, non-governmental organizations, governmental bodies, and others. The attainment of desired population outcomes, as identified in the Ontario Public Health Standards, is dependent upon the degree of integration of public health programs and services with broader community goals. Collaboration among boards of health, their local community partners, academic institutions, and government is integral to the interpretation and prioritization of needs. Shared knowledge can assist in leveraging resources and aligning community goals and objectives.

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2. Impact

The ability to influence broader societal changes is the responsibility of many parties. As a sector, public health not only acknowledges the impact of the determinants of health but also strives to influence broader societal changes that reduce health disparities and inequities by coordinating and aligning its programs and services with those of other partners. Public health has a leading role in fostering relationships to support broader health goals to achieve the best possible outcomes for all Ontarians.

Boards of health shall assess, plan, deliver, and manage their programs and services by considering the following:

  • Is there reasonable evidence of the effectiveness of the intervention in the scientific literature or in reviews of best practices? Boards of health shall draw on relevant research, evidence, and best practices to support integration of the Ontario Public Health Standards' requirements within their specific context in order to achieve intended outcomes. Wherever possible, boards of health are encouraged to use integrated and comprehensive approaches for the assessment, planning, delivery, management, and evaluation of programs. Comprehensive approaches require a broad-based, multifaceted range of activities that employ more than one health promotion strategy.
  • Are the interventions compatible with the scope of programming for boards of health? The Ontario Public Health Standards incorporate clearly defined public health functions to assist boards of health in managing their programs and services within established roles. The majority of public health activities shall be aimed at primary prevention, using a population-based approach. Some activities shall be aimed at the secondary prevention level in order to achieve broader population-based effects. All activities shall be developed to:
    • Prevent diseases or eliminate conditions that are important contributors to the burden of disease;
    • Prevent diseases or eliminate conditions that are potentially important threats to health; and/or
    • Improve the overall health, wellness, and resilience of the population as a whole, or of priority populations.
  • What are the barriers to achieving maximum health potential for individuals, groups, and communities and to narrowing inequities in health? Public health interventions shall acknowledge and aim to reduce existing health inequities. Furthermore, boards of health shall not only examine the accessibility of their programs and services to address barriers (e.g., physical, social, geographic, cultural and economic), but also assess, plan, deliver, manage, and evaluate programs to reduce inequities in health while at the same time maximizing the health gain for the whole population.
  • What relevant performance measures exist or can be developed to assess the impact and effectiveness of programs and services? Management of public health programs and services shall require ongoing monitoring of key performance indicators to support continuous quality improvement and evidence-informed public health practice.
  • Do interventions have unintended consequences that need to be further assessed to improve understanding of the program itself or the context in which it is being implemented? Boards of health shall continually re-examine program and service delivery by engaging in relevant assessment and information management, and where appropriate, program evaluation as outlined in the Foundational Standard.

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3. Capacity

Understanding local public health capacity and the resources required to achieve outcomes is essential for effective management of programs and services. All boards of health shall strive to achieve the needed capacity and resources required to meet these standards. Continuous measurement of the resource implications of the standards supports boards of health in their decision-making for managing towards optimal achievement of outcomes.

Capacity includes many areas: organizational structures and processes; workforce planning, development, and maintenance; information and knowledge systems; and financial resources. Therefore, it is important that boards of health assess their capacity with respect to the breadth and scope of programs and services in relation to the skill levels of their staff, the accessibility of relevant and timely information, and the financial implications involved in achieving the desired outcomes for their populations.

The cornerstone of public health is the quality of its workforce. Programs and services provided by boards of health shall be planned and delivered by staff with both the required technical and professional skills, including core competencies in public health as well as competencies in public health disciplines. Boards of health shall employ the services of appropriately trained professionals as mandated by the HPPA (e.g., medical officers of health, public health dentists, dental hygienists, public health inspectors, public health nurses, and public health nutritionists). Furthermore, staff shall have appropriate training in interdisciplinary public health program planning and effective program delivery (e.g., epidemiology, health promotion, toxicology, program evaluation, informatics, etc.).

Building and sustaining public health human resource capacity is also dependent on continuing educational opportunities and the influx of new professionals into the system. Boards of health shall ensure a competent and diverse public health workforce by providing ongoing staff development and skill building related to public health competencies. This shall include quality improvement and life-long learning programs for staff members, as well as the provision of opportunities for formal and informal public health leadership development. Boards of health shall foster an interest in public health practice for future health professionals by supporting student placements.

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4. Partnership and Collaboration

Public health programs and services involve extensive partnerships within the health sector (e.g., Local Health Integration Networks and primary health care) and other sectors (e.g., education, social services, housing, workplace health and safety system, and environment). Public health promotes community capacity building by fostering partnerships and collaborating with community partners, including the voluntary sector, non-governmental organizations, local associations, community groups, networks, coalitions, academia, governmental bodies, the private sector, and others. Where appropriate, boards of health shall collaborate with other boards of health to coordinate the delivery of public health programs and services.

Boards of health shall foster the creation of a supportive environment for health through community and citizen engagement in the assessment, planning, delivery, management, and evaluation of programs and services. This will support improved local capacity to meet the public health needs of the community.

The quality and scope of local partnerships shall be an essential indicator of success for boards of health in achieving and maintaining the leadership role required to create the conditions necessary for effective change. Boards of health shall continually monitor and evaluate local partnerships and collaborations to determine their effectiveness.

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