Abstract
Background
The Canadian health system is undergoing reform. Over the past decade a prominent trend has been creation of health regions. This structural shift is concurrent with a greater emphasis on population health and the broad determinants of health. In parallel, there is a movement toward more intersectoral collaboration (i.e., collaboration between diverse segments of the health system, and between the health system and other sectors of society). The purpose of this exploratory study is to determine the self-reported level of internal action (within regional health authorities) and intersectoral collaboration around 10 determinants of health by regional health authorities across Canada.
Methods
From September 2003 to February 2004, we undertook a survey of regional health authorities in Canadian provinces (N=69). Using SPSS 12.0, we generated frequencies for the self-reported level of internal and intersectoral action for each determinant. Other analyses were done to compare rural/suburban and urban regions, and to compare Western, Central and Eastern Canada.
Results
Of the 10 determinants of health surveyed, child development and personal health practices were self-reported by the majority of health regions to receive greatest attention, both internally and through intersectoral activities. Culture, gender and employment/working conditions received least attention in most regions.
Conclusion
The exploratory survey results give us the first Canadian snapshot of health regions’ activities in relation to the broad range of non-medical determinants of health. They provide a starting data set for baselining future progress, and for beginning deeper analyses of specific areas of action and intersectoral collaboration.
MeSH terms: Health care systems, health care reform, regional health planning; collaboration
Résumé
Contexte
Le système de santé canadien fait l’objet de réformes. L’une des grandes tendances des 10 dernières années a été de créer des régions sanitaires. Ce changement structurel s’est fait en parallèle avec une concentration accrue sur la santé de la population et les déterminants généraux de la santé. Par ailleurs, on assiste à un mouvement en faveur de la collaboration intersectorielle (c.-à-d. entre les divers segments du système de santé et entre la santé et les autres secteurs de la société). Notre étude préliminaire visait à déterminer le niveau d’action interne autodéclaré (à l’intérieur des offices régionaux de la santé) et le niveau de collaboration intersectorielle entre les offices régionaux de la santé de tout le Canada par rapport à 10 déterminants de la santé.
Méthode
De septembre 2003 à février 2004, nous avons administré un sondage aux offices régionaux de la santé des provinces canadiennes (n=69). À l’aide du logiciel SPSS 12.0, nous avons produit des fréquences pour les niveaux autodéclarés d’action interne et intersectorielle par rapport à chaque déterminant. D’autres analyses ont été effectuées pour comparer les régions rurales et suburbaines aux régions urbaines, et pour comparer l’Ouest, le Centre et l’Est du Canada.
Résultats
Sur les 10 déterminants de la santé à l’étude, le développement de l’enfant et les pratiques d’hygiène personnelle ont été cités par la majorité des régions sanitaires comme étant parmi ceux qui reçoivent le plus d’attention, tant à l’interne qu’à la faveur d’activités intersectorielles. La culture, le sexe et l’emploi/les conditions de travail sont les déterminants qui ont reçu le moins d’attention dans la plupart des régions.
Conclusion
Les résultats de ce sondage préliminaire nous donnent un premier portrait pancanadien des activités des régions sanitaires portant sur les nombreux déterminants de la santé non médicaux. Ils constituent un ensemble de données de départ, à partir duquel on pourra évaluer les progrès futurs et amorcer des analyses approfondies de secteurs d’activité et de collaboration intersectorielle précis.
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