May 2011 - Hot Topic

Keeping Public Health Visible in the Community

In the Fall 2010 edition of Public Health Today magazine [PDF, 6.0MB], Betty Ann Horbul, Manager of Population Health/Nutrition Services at the Porcupine Public Health Unit, shared her thoughts on keeping public health visible in the community. The following are highlights of the interview.

Looking back over her more than 30 years of working in public health, Betty Ann muses that public health practice has continually changed over the years and that the recent changes are just part of the evolution of the field. Of the most significant recent changes, Betty Ann lists greater accountability and the increased use of evidence resulting from research methods in population health strategies.

Betty Ann’s view is that there is, and will be, greater accountability to the community and the provincial ministries through the use of program and organizational indicators that measure performance. The full impact of this change has yet to be seen, since the program indicators and the organizational standards and indicators are not yet released.

Another area of significant change identified by Betty Ann is the increase in research on population health interventions. Increases in research methods will enable smaller health units to be involved with evaluation and research to bring evidence into practice at the local level. “Not only will there be more use of research evidence from other jurisdictions but also more tools will be available to generate evidence of effectiveness of interventions that are designed at the local level,” Betty Ann states.

In the early 1980s, Betty Ann had her first experience in the development of core programs for public health. Betty Ann views the new Ontario Public Health Standards as a significant improvement to the 1997 version of the Mandatory Public Health Programs and Services Guidelines and the Mandatory Program Indicators Questionnaire for accountability. The provincial government has made greater investment in providing guidance to public health units for implementing public health programs.

The Protocols are an important addition to the Standards even though there are only two protocols in the Chronic Disease and Injury Prevention Standards — the Nutritious Food Basket Protocol and the Tobacco Compliance Protocol. Betty Ann expects that more protocols will be added in the future as more evidence of effective population health interventions becomes available. She also feels that the addition of Guidance Documents has helped local public health units focus their work and streamline their practice. Using a recent example of working with a priority population (Aboriginal youth suicide), Betty Ann reports that the Guidance Document has helped her team focus upstream in their approach to suicide prevention by looking at their programming around parenting, alcohol and substance misuse, and resiliency.

The importance of public health to the community is the reason why Betty Ann is so passionate about public health. The ongoing challenge of keeping public health visible in the community and ensuring that programs are effective brings continued excitement to the work.

Covering a large geographic area is another challenge of keeping public health visible in the community. To cover their large geographic area, the health unit has sub-offices in the smaller communities. Instead of having generalist public health nurses in those sub-offices, they are clustering program responsibilities among nurses. Clusters include Population Health, Family Health, and Infectious Disease nurses. This allows more effective program planning and tailored professional training. The Porcupine Public Health Unit has been able to expand the Quit Smoking Clinic to these smaller communities creating a good balance of population health strategies and some direct one-on-one service delivery. Again, this keeps their visibility in the community high and allows staff to utilize their broad range of nursing skills. This approach works well in their northern communities, and will be continued by Betty Ann and her colleagues.

 

 

Biography

Betty Ann Horbul studied nutrition during her undergraduate degree at the University of Guelph. She spent her first dietetic internship at the Royal Alex¬andra Hospital in Edmonton, and has worked in both hospital and nursing home settings. In 1979, she accepted a position with the Porcupine Health Unit in Timmins, Ontario as one of Ontario’s first Public Health Nutritionists – and hasn’t looked back. She is currently the Manager of Population Health/Nutri¬tion Services at the Porcupine Health Unit.