Here, Patricia Beattie-Huggan, President and Principal Consultant from The Quaich Inc, provokes a discussion on how collective leadership can bridge the gap between evidence and action, with examples from the Canadian context

The value of investment in the social determinants of health is well documented. However, several factors impede the creation of policies and structures to support this. Public endorsement and political will are needed for action. This article provokes a discussion on how collective leadership can bridge that gap, with examples from the Canadian context.

The ongoing effects of COVID-19

The pandemic has amplified inequities. Canada’s Chief Public Health Officer has proposed an equity approach to pandemic recovery(1). Yet there is a danger that we may retrench to the familiar. Already, the urgency for greater investment in the healthcare system is dominating the political agenda. But there are cautionary voices. Government spending on social programs often has a stronger association with population health than medical care investments(2). Closing the gap between the science of well-being and the spending priorities of governments is urgent(3), yet not visible to most Canadians.

“As long as we have high levels of poverty; as long as we have mental health issues not being addressed at a fundamental level, not just being reacted to when an acute episode happens; as long as we don’t invest in children early; as long as we don’t have age-friendly communities, we’re not going to change health outcomes”

Source: Sister Elizabeth Davis, CBC Interview, February 8, 2023

Evidence for action on the determinants of health

Research from many jurisdictions supports action on the determinants of health. The World Health Organization(4) has long called for action on determinants of health [Alma Ata Declaration (1978), the Ottawa Charter (1986) and most recently the Geneva Charter for Well-Being (2022)]. The United Nations Sustainable Development Goals provide a framework for recovery from COVID-19 (5) and accountability for action on determinants.

To facilitate knowledge translation, since 2005 the Public Health Agency of Canada has funded six National Collaborating Centres for Public Health(6). As a result, tools to promote equity, intersectoral action, and Health in All Policies (HiAP) have been developed and disseminated.

The challenge of collective leadership

Why not use the evidence? Investing upstream is long-term and extends beyond the political cycle of elected leaders. Grassroots leaders, typically in NGOs, are often in survival mode, responding to political decisions, and may not have the platform for influence or access to elected leaders. Municipal governments depending on their size, are somewhere in between.

Currently, most leaders are on a steep learning curve, paddling unknown waters amidst multiple challenges. Recovery from COVID-19 is in the context of a climate crisis, public misinformation, and social justice issues. The time for effective leadership in navigating this complexity is critical.(7)

Increasing leadership capacity

Canada, once seen as a leader in health promotion, now has limited government investment. Many professional organizations, universities and speciality institutes play a role in increasing leadership capacity. The Tamarack Institute for Community Engagement, instructs a Collective Impact approach(8) to advance population-level change and

collaborative leadership. Health Promotion Canada is mobilizing health promoters.(9)
However, to truly change systems and rebuild better post-pandemic, Weaver and colleagues (2020) propose that leadership will require a significant shift in mental models, from leadership as an individual role or attribute to investing in the collective capacity of all involved as leaders.(10)

Mental Models: A shared view of holistic health

To engage Canadians’ collective capacity, we need a culture change(11), a shared view of holistic health and an increased understanding of what creates health.

The Circle of Health© (COH); a health promotion framework developed on Prince Edward Island (1996)(12), has been noted as effective in transforming the view of health(13). It is well tested, appeals to many learning styles and ages(14), and stimulates innovation in education, planning of policy and programs, and engagement of intersectoral partnerships. It has been used across geographical and cultural contexts, demonstrating its value in advancing health promotion.

The COH is ideally placed to bridge the theory-to-practice gap in health promotion(15). Importantly, it also helps to bridge the distance between lifestyle and social determinants approaches, and can assist policymakers and community leaders to find a shared understanding of health and undertake steps at a community and system level.(16)

The future of Canadian collective leadership

Canada has the players, evidence and foundational pieces to build systems more inclusively, equitably, and sustainably over the long term. During the pandemic, siloed government departments worked across sectors. Adopting HiAP could take us to the next step. Augmented by a whole-of-society approach, investing in communities, creating a sustainable funding model for upstream work,(17) as proposed by the Atlantic Summer Institute, a strategy for bridging the gap between evidence and action, is tangible.

The work ahead will be challenging, demanding innovation, creative minds, excellent planning and collective leadership, learning together through dialogue, building on and contributing to evidence. It is time to foster relationships across sectors and cultures, maximize health promoters’ skills, seek community input, and strive for public engagement in a shared vision.


  1.  Public Health Agency of Canada. (2020) Risk to Resilience – An Equity Approach to COVID-19.
  2.  Kershaw, P., A “health in all policies” review of Canadian public finance. Canadian Journal of Public Health (2020) 111:8–20
  3.  Get Well Canada, Brochure (2022).
  4.  World Health Organization.
  5.  United Nations. The Sustainable Development Goals: Our Framework for COVID-19 Recovery. sdgs-framework-for-covid-19-recovery/
  6.  National Collaborating Centres for Public Health.
  7.  Weaver, L., Fulton, B and Hardin, J. (2020) Leadership for Navigating Uncertainty library/paper-leadership-navigating-change-liz-weaver-bill-fulton-jodi-hardin-civic-canopy
  8.  Kania, J. & Kramer, M. (2011) Collective Impact, Stanford Social Innovation Review, Winter 2011
  9.  Health Promotion Canada.
  10.  Weaver, L., Fulton, B and Hardin, J. (2020) Leadership for Navigating Uncertainty https://www.tamarack
  11.  Get Well Canada, Brochure (2022).
  12.  PEI Health and Community Services Agency. (1996). The Circle of Health: PEI’s Health Promotion Framework.
  13.  The Quaich Inc. (2016). Learning from International Experience: The Circle of Health in education, policy and research, 6th Global Forum on Health Promotion, Charlottetown, Canada, 2016.
  14.  Rocha, D., de Lima, J., Nogueira, J., Prado Alexandre-Weiss, V. (2022) Pedagogical Experiences in Teaching and Learning Health Promotion in Undergraduate Education. Chapter 23, International Handbook of Teaching and Learning Health Promotion, Springer.
  15.  Beattie-Huggan, P., Harsch, S., and Steinhausen, K. (2019). A framework for global health promotion – the Circle of Health. Research Outreach, Issue 107, p.118-121
  16.  Mitchell, T., & Beattie-Huggan, P. (2006). Bridging the distance between lifestyle and determinants of health approaches: The Circle of Health as a synthesis tool. International Journal of Health Promotion17. Atlantic Summer Institute on Healthy and Safe Communities. (2022). Investing Upstream: Placing infant, child and youth mental health promotion at the forefront. Policy brief.
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