Three recent ground breaking reports exemplify RNAO’s influential work: Primary Solutions for Primary Care; Enhancing Community Care for Ontarians (ECCO): A Three Year Plan; and RNAO’s Submission to the Government of Ontario’s Senior Care Strategy. The three, are central pillars to improve health system integration and ensure Ontario becomes a high-performing health system that achieves the ‘triple aims’ of improved patient experiences, enhanced population outcomes, and health system cost-effectiveness. The focus of these work is on locating care coordination and system navigation within primary care, with a strong emphasis on health promotion, disease prevention, chronic disease prevention and management, and mental health – resulting in a system that is upstream and more responsive to the public’s needs.
Equally vital in our quest to advance quality care, and improve population and system outcomes, is RNAO’s Best Practice Guidelines Program. Launched in 1999 and funded by the Ministry of Health and Long-Term Care, the program has evolved into an internationally acclaimed one that is influencing nursing practice and policy in Ontario, Canada and abroad.
RNAO has long advocated for healthy children as cornerstone to building healthy and vibrant communities. RNAO is the voice of the public in shaping healthy public policy, strengthening our publicly funded and not for profit health care system, and providing evidence-based unbiased facts that inform discussion and deliberations. It is in this context, that the articles and opinions that appear on the Healthy Debate website are important additions to the public discourse about health care in Ontario.
Taking Action on All Fronts
Recommendation 1: Improve health and decrease health inequities, including childhood obesity, by addressing social inequities through recommendations to provincial government on action such as:
A. Ensure that momentum and progress continues with Ontario’s Poverty Reduction Strategy that is coming up for its legislated five-year review in 2013.
B. Transform the social assistance system with its dangerously low rates and confusing, punitive rules to a person-centred system, where the rates correspond to the actual cost of living.
C. Increase the minimum wage, which has been frozen since 2010, so that subsistence wages become living wages. Protect precarious workers against exploitation through enforcement of Employment Standards Act and ensure pay equity.
D. Work with other governments, including First Nations, to address the urgent need for affordable, healthy housing across the province.
In addition to robust action on these structural issues, there are a variety of other actions that must be implemented to address our current obesogenic environment. Governments at the federal, provincial, and territorial levels have identified a Framework for Action to Promote Healthy Weights as well as provided financial support for reports with multiple recommendations related to activity, nutrition, and built environments.
When the Active Healthy Kids Canada 2012 report card, Is Active Play Extinct? was released, a headline in the Globe and Mail focused on “Parental fear contributing to sedentary lifestyle of Canadian children.” The framing of blaming parents for “helicopter parenting” reinforced a focus on individual/family gaps in knowledge and poor choices. In a similar way, Participaction public service ads that throw water or a ball at a mother for an incorrect answer on needed activity levels alienates some viewers as it normalizes physical violence, bullying, and disdain for women.
Recommendation 2: Encourage all levels of government to make public policy decisions based on public health science rather than ideology.
A. Implement the recommendations of the Office of the Chief Coroner for Ontario related to Accidental Drowning Deaths in Ontario.
B. Implement the recommendations of the Office of the Chief Coroner for Ontario related to Cycling Death Review.
C. Implement the recommendations of the Office of the Chief Coroner for Ontario related to Pedestrian Death Review.
D. Model Ontario’s approach to multi-faceted, complex health challenges on the approach taken by the Office of the Chief Coroner when reviewing Youth Suicides at the Pikangikum First Nation.
E. If market forces are reluctant to change, use legislative powers to prohibit inappropriate advertising to children, restrict unhealthy content such as high levels of sodium or transfats, require nutritional information on restaurant menus, etc.
With all the best intentions, we have a history at government levels of recommending actions related to a myriad of specific “social catastrophies” that if implemented in a systematic way would begin to make a difference for broader health and social issues. Recommendation 2 presented clearly reflects this in identifying the need to implement recommendations related to accidental drowning, cycling deaths, pedestrian deaths and youth suicide. All these recommendations if implemented would lead to supporting and enabling increased safe participation in physical activity for youth and all Ontarians.
Recommendation 3: That the recommendations in the RNAO Primary Prevention of Childhood Obesity be embraced as key actions for nurses and other health care professionals, governments, corporations, communities and schools. Such recommendations include:
A. Advocating for healthy public policies related to activity and nutrition;
B. Promoting healthy eating and physical activity at the populations, community, family, and individual levels;
C. Supporting exclusive breastfeeding for infants until six months of age;
D. Promoting healthy eating using Canada’s Food Guide and healthy eating patterns;
E. Promoting increased physical activity and decreased sedentary activities;
F. Working with school communities to implement school-based strategies;
G. Supporting a family-centred approach to promote healthy weights;
H. Regular Assessment of physical growth and development of children.
Recommendation 4: That a Champion Network modeled after RNAO’s successful Champion Network be established to be led by nurses to work with teachers, students and others in the school system to begin to champion healthy lifestyles and healthy weights for children and families.
The RNAO Best Practice Champion Network, consists of a set of workshops, and an ongoing Champion Knowledge Exchange Network, that is used by RNAO and now many others, to advance guideline uptake, and initial and sustained evidence based practice change. RNAO would be prepared to target some of our Champion workshops to focus on obesity prevention and offer such workshops to nurses in all relevant sectors as well as to teachers and others who are leaders and mentors for children and youth, as well as youth groups themselves. The Champion model in this case can be very successful, as it utilizes a peer to peer strategy to share a good health, good feeling, good to do message.
RNAO strongly believes that Childhood obesity can be successfully addressed. We do have the evidence to direct actions at all levels. We urge the Healthy Kids Panel to utilize all the resources to recommend involvement of all stakeholders to take an integrated approach to development and implementation of healthy public policy. Finally we need to ensure consistency in healthy policy uptake in all levels of government, our corporations, communities, and schools such that families and individuals can find it easier to engage in healthy behaviours especially those that impact healthy weights.