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About Welcome to the Core Public Health Functions Research Initiative (CPHFRI), a collaborative program of research focused on public health systems renewal in British Columbia (BC). This research initiative brings together a team of inter-disciplinary academic researchers, and national, provincial and local public health decision-makers and practitioners. The overarching goal of the CPHFRI (“see-free”) is to develop a research program, along with training opportunities, aimed at studying the impact and outcomes of the Core Public Health Functions Framework in BC. Inherent in this goal is the intent to increase the capacity of decision makers to use evidence to improve public health policy and practice so that ultimately, the health of the population is improved. Our specific goals are to: a) advance the field of public health services research in Canada by implementing a consensus-based research agenda and through the application and development of innovative research methodologies; b) broadly inform public health systems renewal in Canada that, in turn, will contribute to improving population health and reducing health inequities; c) contribute to better integration and linking of public/population health services and health services more broadly, particularly primary care; and d) train expert public health services and population health researchers. The CPHFRI team has been engaged in an extensive collaboration and team building process since 2006, initally supported by a Michael Smith Foundation for Health Research (MSFHR) Team Planning grant and now by a MSFHR Team Start Up grant. CPHFRI’s research has primarily focused on public health systems renewal in BC but is expanding to include a national focus and inter-provincial comparisons. • Public Health Systems Renewal • Research Priorities • Collaborative Public Health Research • Guiding Principles Public Health Systems Renewal In recent years, concerns have been raised about the inability of current Canadian public health infrastructures to adequately meet the growing health needs of the population. Several Canadian reports have identified systematic deficiencies in the Canadian public health system and have made recommendations to strengthen the public health system structures, to strengthen the supportive elements for effective service delivery, and to collaborate to achieve common health goals. One infrastructure element that has been identified as necessary for an effective public health system is clearly defined essential functions of public health. BC Framework for Core Functions in Public Health In BC, a Framework for Core Functions in Public Health is a central component of a comprehensive approach to public health services. The main components of the framework are: (a) 21 core public health programs in four broad areas (health improvement; disease, injury and disability prevention; environmental health; and health emergency management); (b) public health strategies used to implement core programs (health promotion; health protection; preventive interventions; and health assessment/disease surveillance); (c) a population and an equity lens applied to core programs to ensure that the needs of disadvantaged groups are met thereby reducing inequalities; and (d) system capacity requirements to deliver core programs (e.g., a competent workforce, information systems, public health services research). A provincial logic model and evaluation framework has been developed by the BC Ministry of Health in collaboration with the health authorities to guide the core functions process. Each core program is based on: (a) a systematic review of the evidence; and (b) a model core program paper that defines ‘best or better practices’ and identifies outcome indicators. Logic models for each core program are also being developed. Each health authority is responsible for establishing its own plans for core program implementation to meet local population health needs, based on the evidence reviews and model core program papers. These plans will be reflected in a publicly posted performance improvement plan that identifies success indicators, and regular public progress reports that ensure accountability. Each health authority has allocated different resources to this so each core program may look different in each health authority. There is thus considerable flexibility within the overall approach in how the health authorities will define and implement core public health services. The Research Opportunity There are three highly innovative aspects of the implementation of the public health renewal processes in BC that makes it a superb research laboratory that the rest of Canada and other countries can learn from: • They are major policy level population health intervention. • The planned process constitutes a 'natural experiment'. • The process of implementation is an integrated and evolving knowledge translation and exchange process.
Research Priorities In April 2007, the team held a Think Tank to identify research priorities related to the impact and outcomes of the implementation of core public health functions renewal in BC. This think tank was funded by a MSFHR Team Planning Grant, as well as funding from the Public Health Agency of Canada and the BC Ministry of Healthy Living and Sport. The think tank brought the BC team together with national and international public health experts; the outcomes were a well defined research agenda, a set of time-ordered research priorities, and a conceptual framework to guide proposal development.  The CPHFRI research framework is represented as a 3 dimensional matrix. Along the first dimension are five proposed studies identified as priorities by the team. First, defining the context and process of public health systems renewal, beginning with BC and Ontario and expanding to include other provincial comparisons. Second, capturing the impacts and outcomes of public health systems renewal and whether variations in implementation affect these. Third, examining the implications of public health systems renewal for public health human resources planning related to workforce competency, skill development, and education. Fourth, how and to what extent is an equity lens integrated into the public health systems renewal process and with what impact? Finally, exploring the relationships between the public health and primary care sectors and the effects these relationships have on effective health services. The second dimension encompasses four cross cutting themes: a) knowledge translation and exchange; b) equity; c) partnerships; and d) methods development. Knowledge translation and exchange (KTE) is critical to ensuring that the products of our research are relevant, accessible and utilized. KTE is also a central principle in the BC public health renewal framework. To achieve equity in health requires attention to the infrastructure that supports and organizes public health. Health inequities embedded in health and societal structures are potentially remediable and we aim to operationalize the equity lens in our frameworks to address inequities at the structural level. The principle of partnership is a guiding philosophical value for our team work. The kind of knowledge construction relevant for public health services renewal must be created in partnership to be integrated into practice at every system level. The complexity inherent in studying implementation processes in complex systems creates many methodological challenges; we aim to contribute to methods development by focussing on methods for studying context, mapping causal processes in complex systems, operationalizing the equity lens in the core programs, and exploring social networks. The third dimension of the matrix is the core public health functions renewal process, which represent the content and focus of the projects, and within which the cross-cutting themes are integrated. The team has primarily focused on public health systems renewal in BC, and more recently Ontario and plan to include other provincial comparisons in the future as the team expands.
Collaborative Public Health Research We are committed to a research approach that permits an ongoing exchange among team members, and one in which all participants are both knowledge consumers and knowledge producers. Knowledge is broadly defined, and includes not only knowledge from scientific research but also experiential and tacit knowledge. The process is a collaborative exchange between researchers and decision makers throughout the entire research cycle from setting the research agenda and defining research questions through to data collection, analysis, interpretation, dissemination and integration into policy and practice. Although a core team of both researchers and decision makers is involved throughout the entire cycle, a range of additional stakeholders from the policy and practice community are involved at different stages in the process. The purpose of our program of research is to engage in a collaborative, participatory process between researchers and decision makers. Our research team consists of academic researchers as well as key decision makers and practitioners from the public health sector (for a list of team members and collaborators click here). We have partners at regional, provincial and national levels and across multiple disciplines. The overall goal of our research is to increase capacity of decision makers to use evidence to improve public health policy and practice so that ultimately, the health of the population is improved.
Guiding Principles The members of CPHFRI have collaborated since 2006 and have established a set of guiding principles for our research. These principles also outline a framework for collaborations among team members. • We commit to a collaborative, inclusive process, recognizing the contributions of each member. All members are respected, valued and treated equitably. • We consider, value, and respect multiple research paradigms and methodologies. • We strive to support the goals of all partners involved while simultaneously recognizing potential constraints. • We strive to reach a consensus regarding research priorities, and projects endorsed by our team must fall under the team’s agreed upon research priorities. • We commit to ensuring that the research is relevant to our stakeholders and has the ability to influence decision-making in a timely manner. • We honor transparency and declare conflicts of interest where appropriate. • We support capacity building in partner organizations, and encourage active student participation in our research to enhance their learning. • We strive to be a model for effectively linking policy, practice, and research. • We commit to attend meetings regularly or to send a representative. If this is not possible, we agree to send our regrets to the chair and to review the minutes to follow up on decisions.
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