To describe community-based stakeholders' views of how safe and responsive care "makes a difference" to health and well-being for pregnant and parenting Aboriginal people. Community-based stakeholders included community members, providers of health and social care, and health care and community leaders.
A postcolonial standpoint, participatory research principles and a case-study design were used to investigate two Aboriginal organizations' experiences improving care for pregnant and parenting Aboriginal people. Data were collected through researcher field notes, exploratory interviews and small group discussions with purposively selected community-based leaders, members and providers. Data were analyzed using an interpretive descriptive method.
Community participants' views of "making a difference" emphasized: recognizing relevant outcomes of care; acknowledging progress over time; and using a strengths-based approach in which providers appreciate individuals' efforts and the challenges of their contextual circumstances.
"Making a difference" to pregnant and parenting Aboriginal people would facilitate Aboriginal peoples' efforts to tackle the deeply embedded socio-historical determinants of well-being and capacity, and thus shift priorities for care upstream to focus on such determinants. Such a paradigm for care would integrate multiple perspectives on desirable outcomes within local frameworks based on values and priorities of Aboriginal parents, while also incorporating the benefits and wisdom of existing yet further downstream approaches to care.
Design and evaluation of care based on community values and priorities and using a strengths-based approach can improve early access to and relevance of care during pregnancy and parenting for Aboriginal people.
Resource allocation is a critical issue for public health decision-makers. Yet little is known about the level and type of resources needed to build capacity to plan and implement comprehensive programs. This paper examines the relationships between investments and changes in organizational capacity and program implementation in the first phase (1998-2003) of the Ontario Heart Health Program (OHHP)--a province-wide, comprehensive public health program that involved 40 community partnerships. The study represents a subset of findings from a provincial evaluation. Investments, organizational capacity of public health units and implementation of heart health activities were measured longitudinally. Investment information was gathered annually from the provincial government, local public health units and community partners using standard reports, and was available from 1998 to 2002. Organizational capacity and program implementation were measured using a written survey, completed by all health units at five measurement times from 1994 to 2002. Combining provincial and local sources, the average total investment by year five was $1.66 per capita. Organizational capacity of public health units and implementation of heart health activities increased both before and during the first 2 years of the OHHP, and then plateaued at a modest level for capacity and a low level for implementation after that. Amount of funding was positively associated with organizational capacity, yet this association was overpowered by the negative influence of turnover of a key staff position. Regression analysis indicated that staff turnover explained 23% of local variability in organizational capacity. Findings reinforce the need for adequate investment and retention of key staff positions in complex partnership programs. Better accounting of public health investments, including monetary and in-kind investments, is needed to inform decisions about the amount and duration of public health investments that will lead to effective program implementation.
To date, some work has been undertaken to define a code and stewardship framework for public health ethics. However, gaps in our understanding and application of ethics to the field of population and public health (PPH) remain. This paper presents the approach to building capacity for PPH ethics by three national-level organizations: the Canadian Institutes of Health Research-Institute of Population and Public Health, the National Collaborating Centre for Healthy Public Policy, and the Public Health Agency of Canada. By first looking at each of the organizations' respective activities and then across organizations, we synthesize our common approaches, highlight future directions and pose questions aimed at stimulating dialogue about the role of, and challenges confronting, the emerging field of PPH ethics in Canada.
Social justice is a core value of public health. However, the public health core competencies for Canada document (release 1.0) does not contain any explicit reference to the essential attributes of social justice within the competencies themselves. We argue that social justice attributes should be integrated into the core competencies and propose examples for consideration.