The Old Rose Advisor, Volume II: Updated, Enlarged, and Revised Second Edition

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The Government of Manitoba provides a best practice, using a "whole government" approach to dealing with children and youth issues. In Manitoba, a Cabinet committee and committee of Deputy Ministers have been established, encompassing multiple ministries to focus, in totality, on the health issues affecting children and youth. These committees have had a significant and positive impact in influencing the programming and policies the Manitoba government has implemented.

A less complicated way to access federal, cross-departmental funding is needed. Currently, the system is far too complicated and piecemeal, even when one only considers programs, and grants and contributions available at the federal level. A coordinated approach must prevail between and among departments, thus allowing people who are providing programs for children to focus more on program delivery and less time on administration. In addition, it will decrease duplication, freeing up human resources to provide more robust services for children and youth.

Currently, Health Canada and the Public Health Agency of Canada's expenditures relating to programs and services for children and youth are largely targeted at vulnerable populations, rather than the entire child and youth demographic. While there is some interaction and overlap between the programs, they are mainly autonomous with separate funding, staff, and performance measurement targets. This results in program duplication both internally and across government departments. It is confusing to stakeholder groups who are unclear which departments have the ability to make decisions and authorize action.

There are several programs being duplicated both within and across the different branches and agencies of Health Canada, the Public Health Agency of Canada, and other departments and agencies within the federal government. While each existing program would have been created with the best of intentions, over time, an inefficient and overlapping set of programs has developed that fails to use scarce dollars as effectively as possible. As a result, federal programs are not impacting on the health and wellness of Canadian children to the level they should be.

Programs that do not specifically address the child and youth health priorities emphasized by parents and experts - injury prevention and safety, obesity and healthy lifestyles, and mental health and chronic illness - should not continue; the funding should be reinvested into expanding child and youth health programs that do meet these targeted health goals. There are numerous examples of program duplication within and across Health Canada, the Public Health Agency of Canada, and other departments of the federal government involving programs focusing on child and youth health.

There is an opportunity to consolidate the management of these programs and thereby reduce administrative costs, freeing up more funds that can be directly invested back into child and youth health programs and allowing the government to help more kids. While there are important roles the federal government can play in helping children and youth achieve better health status, there are also programs and areas in which the federal government should simply not be involved.

Thus, it is recommended that across the health portfolio an assessment of existing health programs that serve children and youth be completed to identify duplicate programs, and consolidate their management. For those few programs that are inter-departmental, central administration consolidation into a single department should be implemented. Currently, the dissemination of best practices across the country is not focused and disciplined. We need more efficient and effective mechanisms to successfully communicate and transfer best practices.

the old rose advisor volume ii updated enlarged and revised second edition Manual

The federal government has a role to fulfill in developing this network of collaboration, and in generating and disseminating best practices. One of the frustrations heard time and time again during the consultations for this Report was related to the inefficiency of program funding disbursement from government. Often, funds allocated in a spring budget were not available to the people implementing local programs until November or December of the same year, with an expectation that all funds be spent only a few months later by March 31 st - the end of the fiscal year.

The challenges associated with this 'funding crunch' are well documented in the report submitted by the Government of Canada's independent Blue Ribbon Panel on Grants and Contributions. They include:.

It is clear that the current system works for no one. It is critical that organizations receiving government support be funded on a more timely basis, early in the fiscal cycle. Adjustments must be made in the existing governmental budgeting and approval processes in order to guarantee this occurs. The current one-year funding model where funds arrive greater than six months into the year is unacceptable. With respect to the dissemination of funds, it is recommended that a specific annual timeline be produced and enforced for distributing funding grants among child and youth health programs and initiatives.

Programs that have demonstrated appropriate due diligence and planning should be awarded three-year funding envelopes , thereby allowing them to develop and implement sustainable programs - provided those programs and initiatives are proven to be accountable and responsible. In addition, this funding should start flowing within one month of the budget approval.

First, there is a need for a higher degree of rigour focused on appropriate health outcomes in the evaluation of existing programs at Health Canada and the Public Health Agency of Canada. Second, the current evaluation processes are frequently irrelevant or inappropriate for the program being evaluated. Third, the local individuals responsible for conducting the performance evaluations on their programs find them to be extremely time-consuming. In order to achieve world benchmarks related to health outcomes, appropriate evaluations are required.

The Old Rose Advisor : Volume II

However, the process of evaluation itself must be efficient, effective, and measure the right things. In evaluating all government departments, the Treasury Board of Canada has performance measures it uses to assess progress against the government's programs and initiatives. In child and youth health programs, the current performance measures are process outcomes. For example, specific performance measures for child health programs include the number of participants in programs by program types and the percentage of communities with programs.

Reference 16 These measures do not ensure that the health of our children and youth will improve over time, which fundamentally, is what these programs are meant to achieve. If we wish to achieve specific health outcomes for children and youth, all mechanisms of government must measure the same items using consistent methodologies.

Hence, just as the evaluation processes for each program need to be focused on health outcomes utilizing specific health indicators, the Treasury Board of Canada should also focus on measurements related to results, not process. It is recommended that for the next business planning cycle, Health Canada and the Public Health Agency of Canada present Treasury Board with specific health outcomes to be utilized as performance measures for child and youth programming rather than process-based outcomes.

The feedback from the national consultations was clear; Canadian parents want the efficient and effective delivery of health programs for their children and youth - no matter who is responsible for delivering the services.

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By making sure that health programs and services for children and youth delivered by the federal government are actually addressing the priority areas articulated by Canadian parents, guaranteeing these programs receive government support in a timely and efficient manner, and ensuring that there are proper and appropriate performance measures in place that are enforced, the Government of Canada can ensure that our children and youth have a greater opportunity for healthier lives.

Federal programs that impact and monitor the health of Canadian children and youth are largely contained within Health Canada and the Public Health Agency of Canada.

There is no precise branch at either Health Canada or the Public Health Agency of Canada that is specifically responsible for child and youth health issues; rather, these issues are addressed by broader programs, many of which primarily serve adults. While there are programs at other departments that influence child and youth health, including the Department of Indian and Northern Affairs, Human Resources and Social Development Canada, the Department of Canadian Heritage Sport Canada , the Department of Justice, Environment Canada, the Department of Public Works and Government Services amongst others , the review of existing federal government programs contained in this Report, unless specifically noted, only includes departments under the purview of the federal Minister of Health.

The federal Budget recommended strategic reviews of all departments over the next four years. At the portfolio level, the Honourable Tony Clement, Minister of Health, has initiated changes to the strategic planning processes of Health Canada and the Public Health Agency of Canada, including the launch of a strategic plan by the Public Health Agency of Canada and a cross portfolio review of departmental and policy processes.

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Given the suggestion to undertake strategic reviews in Budget , this Report should be incorporated and used within the context of that process. Currently, the role of the federal government in health care is largely to provide transfer payments to provincial and territorial jurisdictions, allowing them to provide health services. However, the federal government is also directly involved in:. During the national consultations for this Report, governments, organizations and parents told us that the Government of Canada has a meaningful role to play in helping to make Canadian children and youth healthier.

While the provinces and territories have the primary responsibility for the delivery of health programs and services, Canadians feel that the Government of Canada has an opportunity to provide national leadership, encourage national collaboration and ensure national standards are established. It is only through this national collaboration and cooperation among all levels of government that we can be confident that our children and youth will receive outstanding health care - no matter where in Canada they live.

We heard from Canadians that they would like the federal government to focus on the following eight areas:. Parents, children, and youth told us the federal government has a responsibility to provide national leadership and set the strategic direction and goals for the health of our children and youth. The Government of Canada should especially focus on injury prevention and safety, obesity and healthy lifestyles, and mental health and chronic illnesses afflicting children and youth. Social marketing has played an important role in encouraging healthy behaviours.

Parents and organizations that are primarily involved with children recognized the substantive impact that large social marketing and public awareness campaigns have had on educating and influencing the behaviour and attitudes of children and youth.

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Numerous examples were cited including smoking, and littering where social marketing has had a real impact on child and youth behaviour. Parents believe it is the role of the federal government, working with the provinces and territories, industry, and NGO s to undertake meaningful and targeted social marketing campaigns. Recommendations for marketing and public education, in particular in obesity and injury prevention, were brought forward over the course of the consultations.

Providing parents with the tools to help their children, and incenting them and their children to adopt healthier behaviours, were important themes. Parents know that they are the best people to provide advice and direction to their children regarding healthy activities. However, they need the tools to help their children engage in healthy and safe behaviours.

We are extremely fortunate in Canada to have world-class researchers, NGO s that are global leaders in child programming, provincial and territorial governments that are setting best practice standards internationally, and parents who are engaged in the lives of their children.


Creating opportunities for these groups to collaborate can lead to significant change. Seeking new opportunities to involve industry and NGO s in more meaningful ways was mentioned during the public consultations in every province and territory. Health Canada and the Public Health Agency of Canada need to be more proactive and play a leadership role in encouraging and facilitating the involvement of industry and NGO s in key health priority areas for children and youth.

Currently, Health Canada and the Public Health Agency of Canada do not have a mechanism which allows them to incorporate industry and NGO initiatives and ideas which support child and youth health into the policies and best practices led by the Government of Canada.