Bridging the gap between evidence and action for health promotion – shifting the public narrative

This is the fourth article in a series published by Open Access Government ^(1,2,3) that addresses the gap between evidence and action in health promotion. This article focuses on how we might foster collective leadership by influencing the public and media narrative regarding health and investment upstream⁽⁴⁾ in the determinants of health

It is well documented that political decisions are influenced not always by evidence but by the concerns amplified in a crisis. These issues attract politician reaction, public pressure, and media coverage, resulting in a “downstream” response to resolve the issues. Is it possible that a shift in the public narrative and a greater understanding of what it takes to create health, would empower the public to better serve as advocates for health promotion and system change⁽⁵⁾ and develop their collective capacity as leaders of a well-being society? This article will explore a case study that pursues answers to this question.

Case Study

Influencing Upstream Policy in Prince Edward Island (PEI), Canada: Investing Upstream – Putting Infant, Child and Youth Mental Health at the Forefront

The Atlantic Summer Institute on Healthy and Safe Communities (ASI), launched a policy brief Investing Upstream – Putting Infant, Child and Youth Mental Health at the Forefront.⁽⁶⁾ on March 9, 2022. Supported by 1-year funding from the Public Health Agency Intersectoral Action Fund, ASI engaged in knowledge mobilization throughout Atlantic Canada.

Complementary to this work, ASI received 3-year funding from the PEI Alliance for Mental Well-Being (the Alliance) to implement the brief on PEI. As an Atlantic pilot site, the PEI project provides an ideal opportunity for a case study exploring the promotion of intersectoral collaboration, and uptake of evidence in a microcosm of Canadian society.

The Project

The project advances the premise that all policies impact mental health and calls for transformative change in the way policy is developed.

1. To implement Mental Health in All Policies (MHiAP) in Prince Edward Island, an interconnected network of mental health supports will be established, which in turn will establish responsive relationships situated within healthy communities for all residents of PEI.
2. To provide training and capacity building to realize and sustain the implementation of a whole-of-society, whole-of-community approach to mental health promotion for children and youth, achieving lifelong mental well-being for current and future generations.

The Context

The policy brief, publicly launched in March 2022, received positive interest from politicians. Presentations were made to the Official Opposition (Green Party) caucus and the Third Party (Liberal) caucus of the day. Motion 83 was put forward to the PEI Legislative Assembly, calling for the implementation of the ASI Policy Brief’s recommendations. The motion was unanimously approved on March 24, 2022.

Follow-up meetings were held with the Minister of Health and Wellness, the Standing Committee on Health and Wellness, and the Deputy Ministers of Social Policy. All meetings were well received, with the Minister of Health noting that “the policy brief provided government with a road map” and the Deputy Ministers of Social Policy offering to set up a meeting of all deputy ministers in the fall.

Given this context, invitations to join an Advisory Committee were enthusiastically accepted, creating a dynamic committee with multi-sectoral representation. A request from committee members to “get on the same page” resulted in an educational session on the Health in All Policies (HiAP) Framework,⁽⁷⁾ as MHiAP builds on that framework. The National Collaborating Centre in Healthy Public Policy (NCCHPP) was invited to present on HiAP in the Canadian context, specifically training programs. Questions followed: How can PEI build on the current government lens for policy – poverty reduction, diversity, sustainability, anti-racism, environment, reconciliation, gender sensitivity? How close is PEI to implementing HiAP? The questions led to information sharing on the PEI context during monthly meetings, and it was learned that HiAP had been recommended by the Chief Health Office since 2016. The Committee was introduced to these reports, and reports and tools from other jurisdictions. Gathering evidence and learning together in response to critical questions confirmed the hypothesis that co-learning is an effective method of capacity building. Momentum was building.

Early Outcomes

• Partnerships:
  • A partnership was formed with the PEI Coalition of Women in Government and the Federation of Municipalities in a project Fostering Resilience in Women Municipal Leaders, also funded by the Alliance. ASI offered 4 workshops to 30 municipal leaders over one year, providing insight that while larger municipalities possess the infrastructure to advance Mental Health in all Policies, smaller municipalities cannot, but are receptive to promoting mental health by fostering resilient communities.
• National Acknowledgement:
  • NCCHPP invited ASI to present during their national webinar on HiAP, February 2023 and to present at the first meeting of the Canadian Network on Health in All Policies (CNHiAP) in September 2023. The work of ASI as a “grassroots” organization advocating for MHiAP, particularly work at the community level, was of interest.
• Knowledge Development:
  • A literature review of programs developing capacity to implement MHiAP, resulted in the development of a Framework for MHiAP in which fostering resilient communities is foundational. Investing in education was identified as the first step, and a list of training opportunities created.
• Educational Opportunities:
  • The ASI Policy Forum, August 2023 featured a panel on initiatives aligned with the ASI Policy Brief, profiling the PEI Project; a workshop to test the MHiAP Framework; and roundtables on the concept of “Upstream”. These sessions increased collective understanding of a broader audience.

Planning a strategy – Going Forward

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.

While initial enthusiasm of government officials was encouraging, it slowed with the impact of Tropical Storm Fiona in September 2022 and a change in elected and internal personnel due to a provincial election in May 2023.

Given the pause in access to government officials and confidence that co-learning is effective in developing capacity, a work plan developed in September 2023 (8) set the direction: “to be successful in having the Premier take action, it will be necessary to build a widespread narrative to influence public perception of why Mental Health in All Policies matters. When this is seen as equally pressing to Islanders as addressing the downstream problems that have arisen, it will be significantly easier to persuade the government to give this the attention it deserves.” The Committee believed that amplifying key messages and creating learning opportunities will increase the collective leadership capacity in influencing system change at both the local and provincial levels.

In February 2024, in partnership with the Alliance and the National Collaborating Centre on the Determinants of Health, a workshop was piloted with 24 PEI community organizations to explore a shared understanding of “upstream” and MHiAP and increase the capacity of participants as “informal messengers”, thus broadening the network of influence on public discourse. The evaluation is now underway and there is much to be learned. Next steps include offering refined workshops to multiple community organizations, a social media campaign, and meetings with government officials.

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