A FEW POINTS ON VILLES ET VILLAGES EN SANTÉ AS A LOCAL OR REGIONAL PUBLIC POLICY IN OUR MILIEU

A presentation of Abitibi-Témiscamingue

This vast, scarcely populated region is located south of the 48th parallel and over 400 km from Montreal. It is only in the course of the last century that it was settled and developed. This territory’s wealth is mainly due to mining (gold, copper…) and forestry. Agriculture is also present, primarily in four of its five territories sub-regions. The region represents 4.3% of the surface area of the province of Québec.

Some socio-demographic characteristics are significant and must be mentioned: it numbers  145 964 inhabitants, representing a population density of 2.3 inhabitants per km², spread across 63 municipalities, 10 unorganized territories, 3 other territories as well as 4 First Nations reservations. Over two thirds of the localities are rural and under 1000 inhabitants. Only four of the sixty-three localities have more than 8 000 inhabitants.

During my presentation, I have presented specific details as to the region’s achievements in terms of healthy public policies, as means taken to improve life conditions.  Within the framework of VVS, a huge number of local decision makers, i.e. the municipal councils, have decided by resolution to support projects that have been identified by the population and endorsed by the leaders of their locality.

Achievements at the local level

In the region, over 31 municipalities and a First Nations council have been participating in VVS, which represents over 56 communities that implement initiatives toward the development of quality of life in their community. With resolutions confirmed by the local elected representatives of these VVS projects, community leaders have taken all sorts of local development opportunities regarding health and well-being. Here are a few examples:

• Welcoming youth and community participation toward their development
• Setting up of playgrounds with parents’ participation
• Implementation of safety measures for children, women and the elderly
• The financial, technical and structural support to  the Healthy Schools movement
• Support toward the development of measures aimed at the improvement of community quality of life, such as healthy and safe community codes of conduct

The interest toward the development of local healthy public policies was achieved progressively and with some difficulty because many politicians, when leaving office, did not ensure the continuity of the decisions they had made in the course of their mandate. Moreover, decisions could be long awaited and the ensuing delays would therefore impede the carrying out of projects agreed upon by the members of the community.

The Strategic Plan of the Regional council on development (CRD) in the past, the current one of the Regional council of mayors (CRÉ) as well as the Public Health Regional and Local Plans of the area were and still are the «driving forces for change» in local policies. Communications between the local and regional decision makers, as well as between the diverse sectors of activity (municipal, education, community setting,  enterprises and more) are generally smooth running.

Furthermore, another positive phenomenon has been observed because the following facts pertaining to the enhancement of life conditions and settings have been regularly expressed by leaders in a variety of decision-making events at the local and regional levels:

• Communities are ready for increased mobilization
• The physical environment is gradually improving thanks, to the involvement of a great number of individuals in the communities
• Community vitality is stimulated by the presence of these same individuals
• Several innovative projects, first approved by local resolutions, have been recognized at the regional and provincial (Québec) level and some of these are even seen as «forerunners».

Challenges to be met and role of partners

Nonetheless, there are still several challenges of diverse types to be met and efforts will be needed to identify their potential impacts and set actions plans. Within our region, we are dealing with the following issues:

• A population that is spread across a vast territory
• The decline and ageing of a young region’s population
• Certain health problems that are more acute than in the rest of Québec
• Several unhealthy lifestyles
• Several hazards linked to the physical environment
• A difficult socioeconomic context: the wood industry crisis, the embargo on beef imports and the closing of several industries, to name a few.

To counter these, the contribution of the partners involved in VVS is crucial. At the local level, it is expected that they play the following roles

• INFLUENCE, via the promotion of a health promotion approach within local policies, to foster fitness and well-being
• ADVOCATE in  various discussion forums and with groups

• SUPPORT the implementation of individual and collective spaces of participation and empowerment, as well as local leaders and organizations

• SUPPORT local actors and their organizations for the development of collaborative projects
• CONTRIBUTE to the evaluation of processes and results

At the regional level, we hope that the partners will:

• INFLUENCE, through the promotion of community development within local and regional policies in a health and well-being perspective
• SUPPORT the local and territorial organizations that contribute to development in terms of health, well-being and quality of life
• PARTNER with the regional leaders and the organizations that contribute to social development and to the development of communities
• INITIATE and COORDINATE the evaluation of the processes within the communities, including the participation of the latter and of the local elected members of their locality

For this purpose, the writings of Syme (2000) are quite interesting, as they specify that it is important to take into account the fact that the genuine choices regarding health matters belong to individuals and communities.

A CRITICAL REFLECTION ON MY PARTICIPATION AT THE SYMPOSIUM ON THE OTTAWA CHARTER

As a public health professional for over twenty years, this day first gave me the opportunity to realize that an evolution had occurred for all its strategies since the proclamation of the Ottawa Charter. These strategies referred as much to individuals as they did to their immediate environment, community action, reorganization of health services and the development of healthy public policies. I have noticed that since this time, it is possible to observe an ever-increasing involvement on the part of the population to enhance its well-being and quality of life. There is also a more systematic involvement in health related issues from the intersectoral and economic partners as expressed in their decisions in favour of community development and health promotion.

I also became even more aware of the relevance of certain authors that influenced me over time. The social and human capital identified by Hancock (2000) is at the base of the enhanced health and well-being of a population. My public health provincial counterparts, as well as me and my regional and territorial colleagues, now make regular reference to the social indicators of health required to set strategies for action that are in favour of community health and well-being. To support this practice, Lomas (1997) specified, in his book entitled Social Capital and Health: Implications for Public Health and Epidemiology and Biostatistics, that social support and associative networks seem to be able to reduce mortality in the population; inversely, disinvestments in social capital essentially explain the relationship between income inequalities and a lowered population health (Kawachi, Kennedy, et Lockhner, 1997). With this in mind, the presentations during the 2006 JASP symposium regarding the Bangkok Charter (World Health Organization, 2005) reaffirm the importance of the Ottawa Charter (World Health Organization, 1986) and broaden the actions linked to the five strategies of 1986. And, in order for these actions to take place, the actors must come as much from the local as from the national and international levels. They have roles and mandates connected to their level of power and cover various fields, whether social, environmental or economic.

Finally, since I have been working in community health and public health for over twenty-five years and that I sustain and participate in the development of communities regarding health, well-being and quality of life, I gave myself the task, before the 2006 JASP, of preparing a work tool I could share. Produced in the form of a poster, this tool offers a summary of the contents of the Ottawa Charter, the Jakarta Declaration (World Health Organization, 1997) and the Bangkok Charter, as well as links between these documents. The objective of the poster is to offer content that illustrates the basics of the Ottawa Charter for health promotion and makes it possible to appreciate what has been generated between 1986 and 2006. This tool is currently being used when training new professionals in our Regional Public Health Agency and can be utilized for action purposes. This tool has also been presented to the National Coordination Table on Prevention and Promotion by our regional representative. It has finally been disseminated to community organizers and to the managers of the health and social service centres of the region. I would be pleased to send a copy (in French) to anyone interested. Simply contact through e-mail. 

MY MESSAGE FOR THE 19^TH WORLD CONFERENCE OF IUHPE ON HEALTH PROMOTION AND EDUCATION.

The Ottawa Charter for health promotion represents a global reference for the development of communities in matters of health, well-being and quality of life. This Charter and the declarations that have ensued have contributed to the development of human, social, environmental and economic capitals all over the world. This was conducted through the mobilization and participation of citizens in defining their needs with regards to health and through the implementation of actions that are favourable to their well-being. 

The declarations subsequent to the Ottawa Charter, such as those of Jakarta and the Bangkok Charter, have indeed contributed to setting solid groundwork toward a harmonious social, environmental and economic development within a perspective of sustainable development.  Put together, they supply us with a leitmotiv that rallies us towards improving population health, in a very broad sense, now and for future generations.

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