Ontario Public Health Standards and ProtocolsAPHEO Core Indicators Strategic Planning December 5, 2008

Joanne ThanosPublic Health Standards Branch

2

Overview of Presentation

1. Overview of Ontario Public Health Standards (OPHS) and Protocols

2. OPHS Foundational Standard and Population Health Assessment and Surveillance Protocol

3. Intersection of OPHS and Core Indicators

Overview of the OPHS and Protocols

4

Development of the OPHS and Protocols – History• In Operation Health Protection MOHLTC committed to initiate a review

of the MHPSG as part of the overall strategy to renew public health in Ontario

• In its final report (May, 2006), the Capacity Review Committee also proposed that the existing MHPSG should be replaced with new program standards as part of a new vision for public health in Ontario

• The Program Standards Technical Review Committee (TRC), as well as the OPHS Writing Teams and the Protocol Development Teams provided strategic and technical advice to guide the OPHS and Protocols to completion

• The OPHS were developed over a two-year period in close and ongoing consultation with the public health sector

• The development, completion and release of the OPHS represent the first comprehensive, consultative review and re-development of guidelines for mandatory public health programs and services in Ontario in 11 years

5

7 (1) – provides the minister the authority to issue guidelines7 (2) – requires that guidelines are transmitted to boards of health7 (3) – states that a guideline is not a regulation7 (4) – clarifies that a guideline is subordinate to a regulation

Legislative Authority for the Ontario Public Health Standards and Incorporated Protocols

Enforceable Not Enforceable

BEST PRACTICE / GUIDANCE DOCUMENTS

Documents, or sections of documents, which may be referenced in protocols are not enforceable when referred in such a manner as to indicate that they are being provided for guidance purposes only. An example of this would be where the document is referred to as being provided to the board of health for their “further information”.

LEGISLATION

The Health Protection and Promotion Act, 1990

Section 7 provides the Minister of Health and Long-Term Care with the

authority to issue guidelines

The OPHS includes 1 foundational standard and 13 program standards. Each program standard includes goals, societal

outcomes, board of health outcomes, and requirements.

GUIDELINES = ONTARIO PUBLIC HEALTH STANDARDS (OPHS)

PROTOCOLS - 26 in total

BEST PRACTICE / GUIDANCE DOCUMENTS

Documents, or sections of documents, which may be referenced in protocols are enforceable when referred to as “in accordance with”.

Protocols - Protocols include detailed direction to assist boards of health to operationalize specific requirements in the OPHS.26 protocols in total are included in the OPHS.

HPPA, Section 7

7 (5) – allows for the adoption of other documents by reference, in a guideline7 (6) – specifies that a document incorporated by reference should be referred to as “amended from time to time”7 (7) – states that a document comes into effect when the MOHLTC notifies boards of health and when it publishes a notice

Foundational Standard

1 Standard

Chronic Diseases & InjuriesStandard

2 Program Standards

Family Health Standard

2 Program Standards

Infectious Diseases Standard

5 Program Standards

Environmental Health Standard

3 Program Standards

Emergency Preparedness Standard

1 Program Standard

6

Structure of the OPHS• The 1997 MHPSG included objectives with numerical targets which in some cases were too

prescriptive, out-of-date, and unachievable

• The Standards replace objectives with directional outcomes; specific performance targets are not reflected in the standards but may be captured in supporting documentation

Reflect the broadest level of results to be achieved in a specific standard. The work of boards of health, along with community partners, non-governmental organizations, and other governmental bodies, as well as community members, contributes to achieving the goal.

Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices. Societal outcomes result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population.

Board of health outcomes are the result of endeavours by boards of health. Outcomes often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health shall direct their efforts towards, and shall be held accountable for, board of health outcomes.

Specific statements of action grouped into assessment and surveillance, health promotion and policy development, disease prevention, and health protection.

Goals (16)

Societal Outcomes (69)

Board of Health Outcomes (122)

Requirements (147)

7

OPHS “Atlas”

OPHS Foundational Standard and Population Health Assessment and Surveillance Protocol

9

The OPHS Foundational Standard

• Through evidence-informed program planning and service delivery, public health practice is responsive to the local needs and emerging issues of the health unit

• Using the best possible evidence to inform programmatic decision-making ultimately improves public health programs and services

• Designed to be the cross-cutting foundation of the OPHS and thus be used to support evidence-informed public health across all of the Program Standards in the OPHS; the “lens” used to view public health programs and services through components of the Foundational Standard and accompanying Population Health Assessment and Surveillance Protocol, 2008

10

Shift from Mandatory Programs to OPHS

Components of:

• Equal Access

• Program Planning and Evaluation

• Foundational Standard

MHPSG 1997 OPHS 2008

11

The OPHS Foundations: Foundational Standard• The OPHS includes a Foundational Standard which is intended to

acknowledge and reinforce the importance of foundational public health activities to under-pin the planning, delivery and evaluation of all public health programs and services – including each of the Program Standards in the OPHS

Population Health Assessment

Surveillance

Research and Knowledge Exchange

Program Evaluation

12

Foundational Standard • Goal:

• Public health practice response effectively to current and evolving conditions, and contributes to the public’s health and well being

• Societal Outcomes:

• Population health needs are anticipated, identified, and evaluated;

• Emerging threats to the public’s health are prevented or mitigated; and

• Community-based planning and delivery of public health programs and services incorporate new public health knowledge

13

Population Health Assessment Requirements I

1. The board of health shall assess current health status, health behaviours, preventive health practices, health care utilization relevant to public health, and demographic indicators in accordance with the Population Health Assessment and Surveillance Protocol, 2008 (or as current)

2. The board of health shall assess trends and changes in local population health in accordance with the Population Health Assessment and Surveillance Protocol, 2008 (or as current)

3. The board of health shall use population health, determinants of health and health inequities information to assess the needs of the local population, including the identification of populations at risk, to determine those groups that would benefit most from public health programs and services (i.e., priority populations)

14

Population Health Assessment Requirements II

4. The board of health shall tailor public health programs and services to meet local population health needs, including those of priority populations to the extent possible based on available resources

5. The board of health shall provide population health information including determinants of health and health inequities to the public, community partners, and health care providers, in accordance with the Population Health Assessment and Surveillance Protocol, 2008 (or as current)

15

Surveillance Requirements

6. The board of health shall conduct surveillance, including the ongoing collection, collation, analysis, and periodic reporting of population health indicators, as required by the Health Protection and Promotion Act and in accordance with the Population Health Assessment and Surveillance Protocol, 2008 (or as current)

7. The board of health shall interpret and use surveillance data to communicate information on risks to relevant audiences in accordance with the following protocols:

• Identification, Investigation and Management of Health Hazards Protocol, 2008 (or as current);

• Infectious Diseases Protocol, 2008 (or as current); • Population Health Assessment and Surveillance Protocol, 2008 (or as

current); • Public Health Emergency Preparedness Protocol, 2008 (or as current);

and • Risk Assessment and Inspection of Facilities Protocol, 2008 (or as

current).

16

Population Health Assessment and Surveillance Protocol, 2008

• Accompanies the Foundational Standard and all Assessment and Surveillance Requirements across the 13 Program Standards

• Operationalizes specific requirements in the Population Health Assessment and Surveillance Requirements of the Foundational Standard

• Provides boards of health with direction on applying and meeting minimum requirements where standardization across the province is required for the Foundational Standard

17

Population Health Assessment and Surveillance Cycle

18

Highlights from the PHAS Protocol: Types of Data Required

• Socio-demographics

• Mortality

• Morbidity

• Reproductive outcomes

• Growth and development

• Risk Factors

• Preventive health practices

• Physical environment factors

• Other relevant data and information regarding: attitudes, awareness, and knowledge; public health policies, programs and services; the legal and political environment; stakeholder perspectives; and program evaluation

OPHS and Core Indicators

20

APHEO Core Indicators and the OPHS

• Named in the Population Health Assessment and Surveillance Protocol under the following sections:

1) Data Collection, Access, and Management; and

2) Data Analysis and Interpretation

“The Association of Public Health Epidemiologists in Ontario (APHEO), Statistics Canada, and the Canadian Institute for Health Information provide standard definitions for population health assessment and surveillance indicators which shall be used where available”

21

APHEO Core Indicators

• Linked to requirements/outcomes in the MHPSG and to some requirements in the OPHS

• Provide key information on standardized data access, collection, analysis and interpretation of program level indicators: important resource to support public health staff

• Requirements in the OPHS may impact development or reorganization of Core Indicators

• May reconsider types of health data and information required Access to data from “non-traditional” data sources (e.g. Ministry of

Transportation, Police Services, other partnerships and collaborations); new indicators, methods, and interpretation

• Linkages with community partners for dissemination and knowledge translation of health data and information

Thank you

joanne.thanos@ontario.ca