Community-Based Advocacy

Provincial Community Health Boards

Krista McMullin, Public Health CEHHAJames Shedden, Mental Health and Addiction Services

Largest impact

Smallest impact

Reducing societal harms

(Adapted from Frieden, T.R., AJPH. 2010; 100:590-595)

COM

PREH

ENSI

VE A

PPRO

ACH

Systems (municipal, provincial,

federal legislation)

Environment(community

Collaboration)

Individual

Advocacy• Advocacy is an effective strategy for

addressing the social determinants of health.– visible leader or spokesperson – raise awareness and represent the need

• (public, media and political bodies).

– Social, political and economic factors are all potential areas of advocacy

Advocacy Process• Process is key

– Provide education to Decision Makers/targets first– Once you have educated the targets and no

action, go to the opposition – Takes time, expect setbacks

Examples of Advocacy- Lobbying - Coalitions

- Campaigning - Media

6

Withdrawal ManagementTreatment Issues Upon Program Registration

2012-2013 Fiscal; DHA 5 & 6

0

50

100

150

200

250

300

350

400

450

500

Withdrawal Management 436 102 253 81 197 474 98

Alcohol Benzo CannabisCocaine/

CrackNicotine Opiate Other+

- May 2011 The Gould Report Was Released .- August 2011 The Nova Scotia Health’s

Working Groups Recommendations On Prescription Drug Overdoses is released

- August 2011 N.S. Government makes Prescription Monitoring Program 24/7

- October 2011 N.S. Government gives Annapolis Valley Health funding for methadone treatment.

Community Advocacy – Amy Graves

1996 1998 2002 2007 2012

35%36%

23%16%

13%

Past Year smoking - Youth

NSSDUS 2012

2008 2009 2010 2011 201218

19

20

21

22

23

24

Canada 20.3

Nova Scotia 23.7

Tobacco Usage in Canada (12+)

%

190,986

battery, atomizer, cartridge

battery + cartomizer

E-cigarettes for nicotine use Illegal

E-cigarettes not for nicotine use that make a health claim Illegal

Nicotine cartridges/liquid Illegal

E-cigarettes not for nicotine use that do not make a health claim Legal

Health Canada’s Position

Opponents Proponents

• E-cigarettes are unproven cessation devices; should be required to undergo same rigorous testing for safety/efficacy as other NRTs

• E-cigarettes have potential to undermine major tobacco control gains

• E-cigarettes are clean drug delivery device that can satisfy smokers’ addiction to nicotine and to smoking behaviours

• Even if untested, health risks of e-cigarettes could not come close to those of cigarettes

• How do we motivate communities?• When can we coordinate our efforts?• What happens when community energy is not reflected

in DHA mandates or management?• When do we (as staff) lead and when do we follow• How do we best facilitate community-based advocacy?

Discussion