________________________________________________________________________________

Below is a description of a project we (Ronald Labonte, Suzanne Jackson and
Shawn Chirrey) are undertaking for the Synthesis and Dissemination Unit of
Health Canada.  This synthesis project seeks to assess how Canadian health
systems have incorporated a population health/health determinants approach
in their work.  The project poses 6 specific questions.  We are seeking
assistance in assembling published and unpublished literature and contact
information on people who might help us, or be useful to interview, prior to
preparing our synthesis paper.

Specifically, we would like your help in the following (please refer to the
project description below for our 6 questions):  :

1.      References to, or copies of, published literature pertinent to our 6
questions, i.e. journal articles or mass distribution reports.

2.      References to, or copies of, institutional or "in-house" reports
pertinent to our 6 questions, e.g. limited distribution reports, internal
use policy documents, annual reports outlining organizational change.

3.      Contact information on health systems, or parts thereof, that have gone
some distance in incorporating a population health/health determinants
approach in their organizational restructuring and practice.

4.      Contact information on persons who may be able to help with the above.

5.      Contact information on persons who should be interviewed on our 6
questions, i.e. persons with local or provincial knowledge on the 6 questions.

        The research team recognizes that many of the questions it seeks to answer
require interviews with key informants.

The literature on population health/health determinants is large, as is the
literature on health system restructuring.  We want to analyze only that
literature that specifically addresses the relationship between the two.
Moreover, we are seeking recent literature and reports, dating 1990 or more
recent.

While we are predominantly concerned about this issue in the Canadian
context, we are also interested in learning about the experiences of
other nations as related to this issue.  In terms of other nations we are
only interested in reviewing pertinent literature.

We acknowledge the time it might take you to respond to this request.  We
encourage you to respond with whatever information you might have that comes
readily to mind.

Finally, this project is on a tight time-frame.  The team would appreciate
hearing from you by January 23, 1997

Please send your response to:
Shawn Chirrey, BA MA
MHSc HP Program, Department of Public Health Sciences, University of Toronto
E-mail: [log in to unmask]   or   [log in to unmask]


Any questions about or comments on this project should be directed to:

Dr. Ronald Labonte
Communitas Consulting
29 Jorene Drive
Kingston, Ontario   K7M 3X5
phone: (613) 634-7396
fax:      (613) 634-2384
e-mail: [log in to unmask]

Thank you.

______________________________________________________________________________

Project Description
______________________________________________________________________________

Population Health and Health Care Restructuring: Has Our Knowledge of Social
and Environmental Determinants of Health Made a Difference?
______________________________________________________________________________

The Synthesis and Dissemination Unit of Health Canada's Research Knowledge
and Development Division has contracted Dr. Ronald Labonte to undertake a
synthesis of how knowledge of social and environmental health determinants
is affecting organizational culture/structure and professional
roles/relationships in Canadian health systems.  In the context of this
project, population health is understood as an approach that supports
community and institutional actions and policies on the broad social and
environmental determinants of health.  Health systems are understood as all
of those institutions, organizations and services that fall within
provincial health mandates.  Policy authority for most of these determinants
lies outside of health systems.  Health systems nonetheless have a role to
play in supporting community actions and intersectoral collaboration in
formulating and ensuring implementation of health promoting public policies.

The synthesis paper seeks to answer the following questions:

1.      How is a population health approach incorporated within the stated goals
of health systems (e.g. in mission statements, policy statements, terms of
reference)?

2.      How is this approach understood by senior administrators, especially how
is it understood as being different from previous health system approaches?

3.      How is this understanding communicated to health system staff (e.g. in
training and development programs, internal communications)?

4.      How has this approach influenced health system organizational structures
(e.g. how staff are allocated, job roles defined, line systems of
accountability drawn, resource allocations made, organizational structures
named/mandated)?

5.      How has this approach changed roles and relationships between different
health system staff (e.g. in medical care, are patterns observed by primary
care staff that may reveal underlying socioenvironmental causes related to,
as examples, inadequate income or housing, social supports, environmental
risks; and how are these patterns communicated to other staff who may be
able to assist in intervening on these risks?)?

6.      How has this approach changed relationships between health systems and
the general public/community organizations (e.g. in governance style,
committees, engagement in program planning, availability of actual financial
resources to community groups working on socioenvironmental causes)?

Additional questions may arise as the research for this synthesis paper
proceeds.

A key aim of the synthesis paper is to understand opportunities and barriers
for health system incorporation of a population health approach.  This
understanding will be based on lessons learned from those currently
attempting such incorporation.  The synthesis paper, it is hoped, will help
administrators, practitioners and researchers attempting to act upon those
social and environmental conditions that are key determinants of population
health.

Over the next two months (January - February 1998), to assist in preparing
the synthesis paper, a team consisting of Dr. Ronald Labonte, Dr. Suzanne
Jackson and Mr. Shawn Chirrey will:

1.      Review published and unpublished literature pertinent to the 6 questions.
Some international literature will be examined, but the emphasis is on the
Canadian experience.

2.      Assemble and review organizational reports and documents from provincial,
regional and municipal health systems in Canada pertinent to the 6 questions.

3.      Identify and interview key informants across the country to provide
elaboration on the 6 questions.