Chronicling changes to the chronic disease prevention landscape in Canada's public health system 2004-2010.

The collective impact of major shifts in public health infrastructure and numerous new chronic disease prevention (CDP) capacity-building initiatives that have taken place in Canada over the last decade is unknown. The objective of this study was to determine if CDP capacity (i.e., skills and resources) and involvement in CDP programming improved in public health organizations in Canada from 2004 to 2010. Data for this repeated cross-sectional study were drawn from two waves of a national census of organizations mandated to carry out primary prevention of chronic disease and/or promotion of healthy eating, physical activity and tobacco control. Medians for continuous variables and frequencies for categorical variables were compared across time. Neither resources nor level of priority for CDP increased over time. There was little difference in the proportion of organizations with high levels of skills and involvement in core CDP practices (i.e., needs assessment, identification of relevant practices, planning, evaluation). Skills and involvement in CDP risk factor programming showed some gains, some steady states and some losses. Specifically, skill and involvement in tobacco control programming declined markedly while the proportion of organizations involved in healthy eating and physical activity programming increased. Skills to address and involvement in programming related to social determinants of health remained low over time as did involvement in programming addressing multiple risk factors concurrently. The lack of marked improvement in CDP capacity between 2004 and 2010 against a backdrop of initiatives favourable to strengthening the preventive health system in Canada suggests that efforts may have fallen short.

Tensions entre rationalité technique et intérêts politiques : l'exemple de la mise en œuvre de la Loi sur les agences de développement de réseaux locaux de services de santé et de services sociaux au Québec.

This article focuses on the decision-making processes surrounding the implementation of Bill 25, Quebec's Act Respecting Local Health and Social Services Network Development Agencies. Our intention is to shed light on the strategies of the various groups or institutions that expressed their preferences and attempted, with varying degrees of success, to influence decisions with respect to this major reform of the Quebec health system structure. On a theoretical level, we are relying mostly on the models for analysing the lobbying process, which, since the seminal work of Milbrath (1960, 1963), have essentially presented this practice as a process for exchanging information. Based on the information gathered in the re-transcribed interviews, the strategies observed are actually in line with the constitutive characteristics of lobbying and, in some situations, those of patronage. Ultimately, the combination of these various elements makes it obvious that the implementation of Bill 25 was, first and foremost, a clearly political process. The technical arguments on which the initial objectives of the act were centred have thereby been relegated to the backstage.