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CONTEXT: The 2008 Public Health Agency of Canada's (PHAC's) "Core Competencies for Public Health in Canada" (the "Canadian core competencies") outline the skills, attitudes, and knowledge essential for the practice of public health. The core competencies represent an important part of public health practice, workforce development, and education in Canada and internationally. However, the core competencies are considered outdated and are facing calls for review, expansion, and revision. OBJECTIVE: To examine the literature on public health competencies to identify opportunities and recommendations for consideration when reviewing and updating the Canadian core competencies. METHODS: This narrative literature review included 4 components: 3 literature searches conducted between 2021 and 2022 using similar search strategies, as well as an analysis of competency frameworks from comparable jurisdictions. The 3 searches were conducted in collaboration with the Health Library to identify core competency-relevant scholarly and gray literature published in English since 2007. Reference lists of sources identified were also reviewed. During the data extraction process, one researcher screened each source, extracted competency-relevant information, and categorized these data into key findings. RESULTS: After identifying 2392 scholarly and gray literature sources, 166 competency-relevant sources were included in the review. Findings from these sources were synthesized into 3 main areas: (1) competency framework methodology and structure; (2) competencies to add; and (3) competencies to modify. DISCUSSION: These findings demonstrate that updates to Canada's core competencies are needed and overdue. Recommendations to support this process include establishing a formal governance structure for the competencies' regular review, revision, and implementation, as well as ensuring that priority topics applicable across all competency categories are integrated as overarching themes. Limitations of the evidence include the potential lack of applicability and generalizability to the Canadian context, as well as biases associated with the narrative literature review methodology.
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Práctica de Salud Pública , Salud Pública , Humanos , Canadá , Escolaridad , Personal de Salud/educaciónRESUMEN
Structural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.
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Salud Poblacional , Racismo , Femenino , Embarazo , Humanos , Grupos Raciales , Políticas , EscolaridadRESUMEN
BACKGROUND: Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. METHODS: A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. RESULTS: Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. CONCLUSIONS: This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity.
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Equidad en Salud/organización & administración , Administración en Salud Pública , Enfermería en Salud Pública/organización & administración , Conducta Cooperativa , Ambiente , Humanos , Rol de la Enfermera , Ontario , Investigación Cualitativa , Determinantes Sociales de la SaludRESUMEN
Introduction: In the early days of the COVID-19 pandemic there were numerous stories of health equity work being put "on hold" as public health staff were deployed to the many urgent tasks of responding to the emergency. Losing track of health equity work is not new and relates in part to the need to transfer tacit knowledge to explicit articulation of an organization's commitment to health equity, by encoding the commitment and making it visible and sustainable in policy documents, protocols and processes. Methods: We adopted a Theory of Change framework to develop training for public health personnel to articulate where and how health equity is or can be embedded in their emergency preparedness processes and documents. Results: Over four sessions, participants reviewed how well their understanding of disadvantaged populations were represented in emergency preparedness, response and mitigation protocols. Using equity prompts, participants developed a heat map depicting where more work was needed to explicitly involve community partners in a sustained manner. Participants were challenged at times by questions of scope and authority, but it became clear that the explicit health equity prompts facilitated conversations that moved beyond the idea of health equity to something that could be codified and later measured. Over four sessions, participants reviewed how well their understanding of disadvantaged populations were represented in emergency preparedness, response and mitigation protocols. Using equity prompts, participants developed a heat map depicting where more work was needed to explicitly involve community partners in a sustained manner. Participants were challenged at times by questions of scope and authority, but it became clear that the explicit health equity prompts facilitated conversations that moved beyond the idea of health equity to something that could be codified and later measured. Discussion: Using the indicators and prompts enabled the leadership and staff to articulate what they do and do not know about their community partners, including how to sustain their involvement, and where there was need for action. Saying out loud where there is - and is not - sustained commitment to achieving health equity can help public health organizations move from theory to true preparedness and resilience.
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COVID-19 , Defensa Civil , Humanos , Pandemias , Salud Pública , ComunicaciónRESUMEN
Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapid review included 42 articles. The findings identified examples of collaboration and community engagement in governing activities (e.g., using the Delphi method to develop CCPH) and different ways of approaching CCPH review and revision (e.g., every 3 years). Insights on monitoring and resource management were scarce. Preliminary lessons emerging from the findings point towards the need for systems, structures, and processes that support ongoing reviews, revisions, and monitoring of CCPH.
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Breastfeeding is internationally recognized as the optimal form of infant nutrition. The Baby-Friendly Initiative (BFI) is an evidence-informed program that leads to improved breastfeeding outcomes. Despite the benefits of breastfeeding, Nova Scotia has one of the lowest breastfeeding rates in Canada. Additionally, only two birthing hospitals in the province have BFI designation. We aim to address this gap using a sequential qualitative descriptive design across three phases. In Phase 1, we will identify barriers and facilitators to BFI implementation through individual, semi-structured interviews with 40 health care professionals and 20 parents. An analysis of relevant policy and practice documents will complement these data. In Phase 2, we will develop implementation interventions aimed at addressing the barriers and facilitators identified in Phase 1. An advisory committee of 10-12 administrative, clinical, and parent partners will review these interventions. In Phase 3, the interventions will be reviewed by a panel of 10 experts in BFI implementation through an online survey. Feedback on the revised implementation interventions will then be sought from 20 health system and parent partners through interviews. This work will use implementation science methods to support integrated and sustained implementation of the BFI across hospital/community and rural/urban settings in Nova Scotia. This study was not registered.
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INTRODUCTION: Equity and social justice have long been key tenets of health promotion practice, policy and research. Health promotion foregrounds the pertinence of social, economic, cultural, political and spiritual life in creating and maintaining health. This necessitates a critical structural determinants of health perspective that actively engages with the experiences of health and wellbeing among diverse peoples. The inequitable impacts of pandemics are well documented, as are calls for improved pandemic responses. Yet, current pandemic and emergency preparedness plans do not adequately account for the social and structural determinants of health and health equity. METHODS: Through five one-hour online conversations held in April 2020, we engaged 13 practice, policy, research and community leaders on the intersections of COVID-19 and gender, racism, homelessness, Indigenous health and knowledge, household food insecurity, disability, ethics and equitable futures post-COVID-19. We conducted a thematic analysis of speaker and participant contributions to investigate the impacts and influence of COVID-19 related to the structural and social determinants of health. We analyzed which policies, practices and responses amplified or undermined equity and social justice and identified opportunities for improved action. FINDINGS: Analysis of the COVID-19 pandemic revealed four broad themes:⢠oppressive, unjust systems and existing health and social inequities;⢠health and social systems under duress and non-responsive to equity;⢠disproportionate impacts of COVID-19 driven by underlying structural and socioeconomic inequity; and⢠enhanced momentum for collective mobilization, policy innovations and social transformation. DISCUSSION: There was a strong desire for a more just and equitable society in a post-COVID-19 world, going 'back to better' rather than 'back to normal.' Our analysis demonstrates that equity has not been well integrated into pandemic planning and responses. Social movement and systems theories provide insight on ways to build on existing community mobilization and policy openings for sustained social transformation.
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COVID-19 , Equidad en Salud , Pandemias , Determinantes Sociales de la Salud , Humanos , Pandemias/prevención & controlRESUMEN
Since December 2019, there has been a global explosion of research on COVID-19. In Canada, the six National Collaborating Centres (NCCs) for Public Health form one of the central pillars supporting evidence-informed decision making by gathering, synthesizing and translating emerging findings. Funded by the Public Health Agency of Canada and located across Canada, the six NCCs promote and support the use of scientific research and other knowledges to strengthen public health practice, programs and policies. This paper offers an overview of the NCCs as an example of public health knowledge mobilization in Canada and showcases the NCCs' contribution to the COVID-19 response while reflecting on the numerous challenges encountered.
The explosion of research on COVID-19 in Canada and around the world called for an improved capacity to support evidence-informed decision making (EIDM). Canada is fostering various mechanisms to achieve this goal; the National Collaborating Centres (NCCs) for Public Health are central to supporting EIDM during the pandemic. The NCCs, a network of networks anchored on six unique knowledge hubs, are well connected to provincial, territorial, local and international partners. In response to COVID-19, the NCCs are making an important contribution to building knowledge, skills and capacity in the public health sector, and to supporting public health professionals in synthesizing and using evidence-informed knowledge in policy and practice.
L'explosion de la recherche menée sur la COVID-19 au Canada et ailleurs dans le monde a nécessité une augmentation de la capacité à soutenir la prise de décisions informées par les données probantes. Parmi les divers mécanismes préconisés par le Canada pour atteindre cet objectif, les Centres de collaboration nationale (CCN) en santé publique jouent un rôle essentiel pendant la pandémie pour soutenir la prise de décisions informées par les données probantes. Les CCN, qui constituent un réseau de réseaux s'appuyant sur six centres de connaissances, ont des liens étroits avec plusieurs partenaires provinciaux, territoriaux, locaux et internationaux. Pour lutter contre la COVID-19, les CCN renforcent de façon significative les connaissances, les compétences et les capacités en santé publique et soutiennent les professionnels en santé publique en synthétisant des connaissances fondées sur des données probantes pour leur intégration aux politiques et aux pratiques.
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COVID-19/prevención & control , Control de Enfermedades Transmisibles/organización & administración , Colaboración Intersectorial , Administración en Salud Pública , COVID-19/epidemiología , COVID-19/transmisión , Canadá , HumanosRESUMEN
Decades of work by professional associations, regulators and educators have produced an ethical, reliable, robustly educated and regulated nursing workforce that enjoys high levels of respect in Canada and around the world. The officers of the Canadian Nurses Association comment here on the organization's history and changing role in regulatory policy over the past decade during the introduction of the American NCLEX-RN examination as the assessment tool for entry-to-practice for Canadian registered nurses. Facing forward, to maintain a strong, trusted nursing workforce the association remains committed to meaningful collaboration among nursing's professional, regulatory, education and union sectors.
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Evaluación Educacional/normas , Historia de la Enfermería , Licencia en Enfermería/tendencias , Enfermería/tendencias , Canadá , Evaluación Educacional/métodos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Enfermería/organización & administraciónRESUMEN
In 1987, six Canadian community health nursing leaders recognized the need for a national body to represent and advocate for the diverse practice of community health nursing and the health of communities. Their vision and action three decades ago resulted in the formation of the Community Health Nurses of Canada (CHNC), a national professional nursing association. This paper will describe the development of CHNC from an early vision to a recognized centre of excellence for community health nursing in Canada. Significant milestones described include developing structures to advance excellence in practice, creating and acting on a vision, advancing leadership capacity, supporting professional development and promoting best practice, advancing community health nursing in undergraduate education and advocating for health policy.
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Liderazgo , Enfermeros de Salud Comunitaria/tendencias , Canadá , Política de Salud , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Rol de la Enfermera , Enfermeros de Salud Comunitaria/educación , Enfermeros de Salud Comunitaria/historiaRESUMEN
Critical caring is a midrange theory proposed as a framework to guide public health nursing practice. This article reports findings of a study that examined the relevance of the theory to the practice of expert public health nurses (PHNs). Twenty-six PHNs participated in this study: 10 in interviews and 16 in 2 focus groups. Findings support the relevance of critical caring to PHN practice, explicated, and further refined the theory through the richness of participants' practice accounts As such, it has potential as a tool of resistance to forces that limit PHNs working to their full scope of practice.
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Medicina Comunitaria/organización & administración , Relaciones Interpersonales , Rol de la Enfermera , Enfermería en Salud Pública/organización & administración , Medicina Comunitaria/métodos , Medicina Comunitaria/normas , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Teoría de Enfermería , Ontario , Enfermería en Salud Pública/métodos , Enfermería en Salud Pública/normas , Investigación CualitativaRESUMEN
Two aspects of a study examining the congruence of critical caring theory with public health nursing practice are reported. They confirm a congruence between expert public health nursing practice and the theory in terms of (a) a caring/social justice ethics that underpins practice and (b) the relevance to their practice of the carative health promoting process of contributing to the creation of supportive and sustainable physical, social, political, and economic environments. Public health nurse participants encountered many barriers to a practice underpinned by a caring/social justice ethic, some of which limited their moral agency.
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Actitud del Personal de Salud , Cuidados Críticos/ética , Enfermería en Salud Pública/ética , Justicia Social , Adulto , Canadá , Femenino , Promoción de la Salud , Atención Domiciliaria de Salud/ética , Humanos , Persona de Mediana Edad , Modelos de Enfermería , Enfermería en Salud Pública/tendenciasRESUMEN
As health care is shifting from hospital to community, community health nurses (CHNs) are directly affected. This descriptive qualitative study sought to understand priority issues currently facing CHNs, explore development of a national vision for community health nursing, and develop recommendations to shape the future of the profession moving toward the year 2020. Focus groups and key informant interviews were conducted across Canada. Five key themes were identified: community health nursing in crisis now, a flawed health care system, responding to the public, vision for the future, and CHNs as solution makers. Key recommendations include developing a common definition and vision of community health nursing, collaborating on an aggressive plan to shift to a primary health care system, developing a comprehensive social marketing strategy, refocusing basic baccalaureate education, enhancing the capacity of community health researchers and knowledge in community health nursing, and establishing a community health nursing center of excellence.