Quantifying Fluoridation Exposure Over Time in Alberta, Canada: Challenges and Implications for Dental Public Health Surveillance.

BACKGROUND: Community water fluoridation is one component of a multifactorial approach to preventing dental caries. Yet, fluoridation monitoring in Canada has historically been fragmented, and recent national estimates give little indication of trends at the provincial or municipal levels. We aimed to quantify fluoridation exposure trends in Alberta from 1950 to 2018 at both the population and municipal levels. Insights have implications for dental public health surveillance. METHODS: Drawing from various public sources, we compiled a list of all Alberta municipalities, noting type of municipality and annual population count from 1950 to 2018. We recorded fluoridation status (excluding naturally occurring fluoride) by year for each municipality, based on the start and end (if ever) dates. We calculated annual fluoridation exposure at the population level (% of Alberta population exposed) and the municipality level (number of municipalities exposed) to visually assess trends over time. RESULTS: Population exposure to fluoridation in Alberta generally increased from 1950 to 2010. A sharp drop occurred in 2011, after which exposure fluctuated at around 43-45%. Municipality exposure generally increased from 1958 to 2006 and from 2012 to 2018, except for small declines during 2007-2008 and 2010-2011. Challenges concerning data completeness were considerable. CONCLUSION: Our findings illuminate the substantial variation in fluoridation exposure of Albertans over time, and they elucidate the complexities of estimating such exposure. They speak to the value of centralized fluoridation monitoring mechanisms as a key part of dental public health surveillance infrastructure.

Policy diffusion theory, evidence-informed public health, and public health political science: a scoping review.

OBJECTIVES: Our aim was to synthesize published scholarship that applies policy diffusion-a theory of the policy process that considers the interdependence of government-level public health policy choices. We paid particular attention to the role of scientific evidence in the diffusion process, and to identifying challenges and gaps towards strengthening the intersection of public health, public policy, and political science. METHODS: We systematically searched 17 electronic academic databases. We included English-language, peer-reviewed articles published between 2000 and 2021. For each article, we extracted the following information: public health policy domain, geographic setting, diffusion directions and mechanisms, the role of scientific evidence in the diffusion process, and author research discipline. SYNTHESIS: We identified 39 peer-reviewed, primary research articles. Anti-smoking and tobacco control policies in the United States (n = 9/39) were the most common policy domain and geographic context examined; comparatively fewer studies examined policy diffusion in the Canadian context (n = 4/39). In terms of how policies diffuse, we found evidence of five diffusion mechanisms (learning, emulation, competition, coercion, and social contagion), which could moreover be conditional on internal government characteristics. The role of scientific evidence in the diffusion process was unclear, as only five articles discussed this. Policy diffusion theory was primarily used by public policy and political science scholars (n = 19/39), with comparatively fewer interdisciplinary authorship teams (n = 6/39). CONCLUSION: Policy diffusion theory provides important insights into the intergovernmental factors that influence public health policy decisions, thus helping to expand our conceptualization of evidence-informed public health. Despite this, policy diffusion research in the Canadian public health context is limited.

RéSUMé: OBJECTIFS: Nous avons voulu faire une synthèse des travaux d'érudition publiés sur la diffusion des politiques­une théorie du processus d'élaboration des politiques qui prend en considération l'interdépendance des choix de politiques de santé publique au niveau gouvernemental. Nous nous sommes intéressés en particulier au rôle des preuves scientifiques dans le processus de diffusion et à la mise au jour des difficultés et des lacunes associées au renforcement de l'intersection entre la santé publique, les politiques publiques et les sciences politiques. MéTHODE: Nous avons systématiquement interrogé 17 bases de données électroniques universitaires. Nous avons inclus les articles en anglais évalués par les pairs publiés entre 2000 et 2021. Pour chaque article, nous avons extrait les informations suivantes : le domaine de politique de santé publique, le lieu géographique, les orientations et les mécanismes de diffusion, le rôle des preuves scientifiques dans le processus de diffusion et la discipline de recherche des auteurs. SYNTHèSE: Nous avons recensé 39 articles de recherche primaire évalués par les pairs. La lutte contre le tabagisme et les politiques antitabac aux États-Unis (n = 9/39) étaient les domaines de politiques et le contexte géographique les plus couramment abordés; comparativement moins d'études portaient sur la diffusion des politiques dans le contexte canadien (n = 4/39). En ce qui concerne la façon dont les politiques se diffusent, nous avons relevé cinq mécanismes de diffusion (apprentissage, émulation, compétition, coercition et contagion sociale), qui peuvent de plus dépendre des caractéristiques internes du gouvernement. Le rôle des preuves scientifiques dans le processus de diffusion n'était pas clair, car seulement cinq articles en parlaient. La théorie de la diffusion des politiques était principalement utilisée par les théoriciens des politiques publiques et des sciences politiques (n = 19/39), avec comparativement moins d'équipes d'auteurs interdisciplinaires (n = 6/39). CONCLUSION: La théorie de la diffusion des politiques apporte des éclairages utiles sur les facteurs intergouvernementaux qui influencent les décisions en matière de politiques de santé publique, ce qui contribue à élargir notre conceptualisation de la santé publique éclairée par les données probantes. Malgré cela, la recherche sur la diffusion des politiques dans le contexte de la santé publique canadienne est limitée.

Survey Research on Health Inequalities: Exploring the Availability of Indicators of Multiple Forms of Capital in Canadian Datasets.

Objective: Much of the extensive quantitative research linking socio-economic position (SEP) and health utilizes three common indicators: income, occupation and education. Existing survey data may enable researchers to include indicators of additional forms of capital in their analyses, permitting more nuanced consideration of the relationship between SEP and health. Our objective was to identify the breadth of survey questions related to economic, cultural, and social capital available through Statistics Canada surveys, and the extent to which those surveys also include health measures. Methods: We compiled a list of all population-based Statistics Canada surveys, and developed a broad list of potential indicators of forms of capital. We systematically searched the surveys for those indicators and health measures, analyzing their co-occurrence. Results: Traditional SEP indicators were present in 73% of surveys containing health measures, while additional indicators of social and cultural capital were available in 57%. Conclusion: Existing national survey data represent an under-exploited opportunity for research examining the relationship between various forms of capital and health in Canada. Future empirical explorations of these data could enrich our theoretical understanding of health inequities.