Prevention

ESN-CA has been inspired to contribute to ESIC’s proposed prevention ‘spoke’ by a number of factors:

• centrality of prevention in Ontario Health Teams’ (as well as other ‘accountable care’ type organizations’) use of a population-health management approach to equitably improving quadruple-aim metrics (improving population health, as well as improving care experiences, keeping providers engaged, and keeping per-capita costs manageable)
• modernization of Canada’s approach to prevention guidelines via the newly re-launched and re-named National Advisory Committee on Preventive Health Services
• creation of the ‘healthspan’ institute (formally the McCall MacBain Kinesiology and Healthspan Institute) at McMaster University.

Prevention includes disease and injury prevention as well as health promotion. Prevention can include primary prevention (stopping a disease or injury before it starts) and secondary prevention (detecting a condition early and treating it quickly to stop it getting worse). Health promotion can include what the Ottawa Charter called:

• building healthy public policy, which includes putting health on the agenda for policymakers across all sectors
• creating supportive environments, which includes making safe, stimulating, and enjoyable living and working conditions
• strengthening community action, which includes empowering local communities to set priorities and drive health initiatives
• developing personal skills, which includes supporting personal and social development through information and education
• reorienting health services, which includes shifting health sector focus away from only treating illness toward injury and disease prevention.

Through Health Systems Evidence and the McMaster Optimal Aging Portal, and partnerships with groups that maintain complementary databases, we already have access to the richest set of quality-appraised evidence syntheses in the prevention space. We hope to contribute relevant data to ESIC’s open-data system (ODS) and to leverage the ODS to move to continuous evidence surveillance, living evidence maps, policy-scale living evidence synthesis, and decision-ready evidence products.

An example of a ‘policy scale’ prevention question is: What prevention opportunities should be actively offered to each population segment to improve the quantity and quality of life? Opportunities range from:

• individual behaviours (e.g., exercising and eating well)
• clinical care (e.g., screening and prevention in primary care, and secondary prevention in acute and long-term care)
• public health (e.g., programs targeting groups and populations)
• social determinants of health (e.g., municipal government services like housing and recreation and policy about income redistribution)
• implementation strategies for any of the above (e.g., subsidizing smart watches and social prescribing).