Assessing the Impact of a Policy or Program on the Mental Health of a Population

There are many definitions of mental health promotion that have been put forward by organizations, governments, and individuals from around the world. While all similar, there are some important differences that impact how mental health promotion is understood and practiced. One of my favourite definitions is this one: the “actions taken to maximize the mental health and wellbeing of populations by improving social, physical and economic environments; and strengthening the understanding and skills of individuals in ways that support their efforts to achieve and maintain mental health” (Victorian Government Department of Health, 2010).

The reason I’m so partial to this definition is because it highlights the fact that mental health is influenced not just by the knowledge and behaviours of the individual, but also by the environment in which he/she lives, works, and plays; what’s more, the environmental factors influencing mental health are mentioned first in the definition, implying considerable weight should be given to these factors. I find too often, emphasis is placed on what an individual can do to promote their mental health, with little acknowledgement of the structural and environmental conditions that play a significant role in one’s mental health and well-being.

This is the definition that is utilized within the Victorian Government Department of Health’s recent publication, Using policy to promote mental health. This publication is intended to provide policymakers with the skills to be able to understand and consider the social and environmental determinants of mental health when developing or reviewing policies. Some of these key determinants include social inclusion, freedom from violence and discrimination, education, income, employment, and working conditions. One of the things I appreciate most about this document is that it provides some concrete steps policymakers can take to assess the mental health promoting impact of a policy or program.

Because mental health is influenced by such a broad range of social, environmental and economic factors, a large majority of programs and policies could benefit from having their mental health promoting impact assessed. For instance, an assessment of the mental health promoting impact of the City of Vancouver’s Healthy City Strategy (which I have previously written about here) could be very useful in deciding which programs and policies to implement. I would encourage anyone involved in developing or reviewing economic, social, or environmental programs or policies to think about these programs/policies through a mental health promotion lens, and consider assessing the mental health promoting impact of their program/policy.

Victorian Government Department of Health (2010). Using policy to promote mental health. Melbourne, Victoria, Australia.

Masthead photo courtesy of Pink Sherbert Photography from Flickr

Bridging the Gap between Research and Action

Go to any academic journal and pull up a random scientific article. Can you understand it? Chances are you will probably not understand all of it. Even if you do understand all of it (yes, even including the statistical analysis section), do you understand how this relates to the dozens, hundreds, or even thousands of other articles done on the same subject? And equally as important, do you have the time to sift through stacks of articles to make an informed decision on a program, policy or service you are considering implementing in either your private or professional life? Herein lies the value of knowledge translation. Knowledge translation is the process of taking research and translating it into something practitioners, professionals, policy-makers and the general public can understand and use.

While this type of undertaking doesn’t happen enough in Canada (e.g. with professionals being given the time and resources to review research and translate it into understandable language), a good example of structures being put in place to support such KT activity is the National Collaborating Centres (NCC) for Public Health. These Centres aim to translate academic evidence and develop resources that can be used by public health practitioners and policy-makers to address a number of public health topics, including infectious diseases, health inequities, environmental health, and healthy public policy.

Living up to their name, the Centres also collaborate with one another on a number of special projects, including a structural profile of public health systems and functions across Canada. A particularly interesting project that has recently commenced within the National Collaborating Centre for Determinants of Health looks at how the social determinants of health and health equity can be integrated into population health status reporting, and in turn how such reports can result in effective health equity policies, and improved health equity in Canada.

While research and practice are equally as important and in many ways dependent on one another to fuel their respective activities, the importance of having systems in place that allow for critical and independent translation between the two is crucial to ensuring valid and reliable research is driving quality, evidence-based practice and policy.

What Makes for a Happy Country?

Recently, the very first World Happiness Report was launched by the United Nations, and Canada faired pretty darn well. After Denmark, Norway, Finland, and the Netherlands (all Northern European countries, of note), Canada ranked a respectable fifth. The least happy countries are all in Sub-Saharan Africa (Togo, Benin, Central African Republic, Sierra Leone). The report speaks to two broad measurements of happiness: the ups and downs of daily emotions, and an individual’s overall evaluation of life.

So what makes a country happy? Some of the criteria is fairly obvious – for example, wealthier countries ranked higher that poorer countries – while some criteria is a bit more surprising. Take, for instance, the role that political freedom and an absence of corruption play – together, these two factors, along with having strong social networks, play a greater role in well-being than income. In fact, while basic living standards were found to be essential for happiness, after the baseline was met happiness was found to vary more with quality of human relationships than income. Additional factors impacting happiness, at an individual level, included mental and physical health, job security, and stable families.

Not only does this information provide us all with some tips about where we might consider relocating, or changes we might consider making in our personal lives, it also offers important information about the society in which we live. As discussed within the report, such information can signify underlying crises or hidden strengths, and can often suggest the need for change. Such findings can also help countries to develop healthy public policies and practices. For example, based on the findings in the report, policy goals should include high employment and high-quality work; a strong community with high levels of trust and respect, which government can influence through inclusive participatory policies; improved physical and mental health; support of family life; and a decent education for all. With the attention paid over the last few years to the financial status of countries around the world, a report that focuses on happiness provides a refreshing lens through which to view true wealth.

Did BC just radically change our energy policy?

In four years as a Refrigeration Apprentice I learned that it takes a lot of energy to convert a gas into to a liquid.   Which is why I did a double-take when I read that the BC government has endorsed three liquified natural gas (LNG) plants near Kitimat.  In a province that has grown in leaps in population and energy consumption, I thought “Wow, that’s a lot of energy, where will it come from?”

BC’s wonderfully ludicrous politics makes for  excellent dinnertime conversation.  One of my favorite anecdotes is about a bunch of dam happy BC Hydro engineers who lost their jobs in the early 1980s because BC’s load forecast flattened.  Plans for a Site C dam were shelved simply because we had overdosed on capital-intensive projects and never had to give a second thought to energy consumption.

Fast forward 30 years, BC’s population has grown by a few million, average home has grown from 1400 sq ft to 2700 sq ft, and I suspect the number of electrical outlets in the average home has more than doubled.  Items once reserved for elites are now everywhere, from residential hot tubs to energy-vamping home theatre systems.  Suddenly in the 2000′s, the energy picture looks different: BC Hydro steps up “Power Smart” conservation campaigns, proposes 10% per year rate hikes, and claims that infrastructure needs to be upgraded to accommodate increased demand.  We’re indoctrinated with the idea that conservation and retrofitting is considerably cheaper (and more environmentally friendly) than developing new energy sources.  Not a bad strategy.

Jump forward a few more years to 2008:  Gordon Campbell is elected to a second term and makes it clear that BC will lead the world in reducing GHG emissions, signing deals with Washington, Oregon and Arnold Schwartzenegger to create a “Green Corridor”.  Ambitious provincial targets are set to achieve 93% clean energy production and 33% reduction in GHG emissions by 2020 (80% reductions by 2050!)  Neat!

So in a time of unprecedented conservation, I was surprised when I found out that BC was wholeheartedly buying into the LNG movement.  Not that I disagree with it – it sounds pretty cool actually.

We don’t have to look far for the energy to drive these projects after all.  The plan to develop Site C (although still controversial and under review) was announced before Campbell was shooed from Office (he was pretty crafty in maneuvering the Climate Action Plan and allowing for economic development – I wouldn’t want to play chess against him).  Under traditional policy, BC is required to be energy-self sufficient when its dams are at “critical low” levels – enough cushion to weather 3 consecutive years of drought.  On Feb. 3rd 2012, however, new Liberal Premier Christy Clarke announced a significant change: BC dams would now only have to ensure self-sufficiency at “average” water levels.  In doing this, she reduced the need to build new generation projects and freed the necessary capacity for LNG.  We’ve essentially had free energy sitting around all along and we’ve been hedging it based on some apocalyptic scenario… like Global Warming or something.

Thankfully people much smarter than me make sure that our energy supply (and water supply) is protected.  Not to mention the slap and tickle of overlapping natural gas, electricity and rival energy markets that buttress LNG production (markets are never wrong.)   Unforeseen environmental considerations aside, this seems to me like a fairly intelligent investment in BC’s future.  Premier Clarke is quoted as saying, “It is an opportunity to establish an entirely new industry in British Columbia.  This isn’t something that happens every day and it’s not something that even happens every decade,” and I’m tempted to agree.

Still, in years when BC drops “below average”, we may need to import dirty electricity from Alberta.  Coal is a filthy energy source, far worse than oil sands bitumen or natural gas, and if BC’s water dries up anywhere similar to the Colorado River, we can kiss our 93% clean energy target goodbye.

So here we stand.  I still think I’m behind Clarke on this and when the NDP win the next election, I hope they back LNG too.  Real environmental solutions require the ability to make major energy shifts.   And although the Energy Industry likely doesn’t produce a fraction of the jobs that people think it does, the jobs it does produce are intelligent and high-paying.  LNG also creates nice royalties that pay for cool things like health care and education.  See you soon, Alberta and Saskatchewan!

Compared to hydroelectricity, burning natural gas may not seem like a step forward, but considering that hydro reserves are limited and the rest of the world is burning coal, LNG may save countless tonnes of CO2 emissions.  LNG may prove an absolute environmental disaster for other reasons, but again, hopefully there are smarter people than me working on this.   Fracking is already happening and we won’t be the only ones to head down this fracking path; hopefully BC can establish “Best Practices” for the rest of the world to follow.

All-in-all, LNG may have benefits worth the risk.  Some suggest that developing the natural gas economy could eventually lead to a hydrogen economy as both energy sources will likely require similar infrastructure.

Photo courtesy of Steve Punter

BC Liberal Position Tracker

As you can imagine, it’s an interesting time in the BC Liberal world. Five leadership candidates spanning the Conservative/Liberal spectrum. As campaigns rev up, we can watch the promises fly. To try to keep track of everything, I’ve tried to mount the most recent issues and the candidates’ positions on them in a table format.

If you have other issues/stances – please feel free to comment below…


Candidate HST Minimum Wage Snap Election Carbon Tax Lower Voting Age Translink Charity Grants
Christy Clark A free vote on the HST ahead of  planned referendum next September Signalled her support for a carefully considered increase Yes Doesn’t support freezing the carbon tax on the fly Said on Twitter and Facebook she supports lowering the voting age in BC N/A Will boost gaming grants by $15 million
Mike De Jong Referendum on tax moved up earlier than Sept Increase minimum wage but declined to say by how much. No Supports the carbon tax Lower the voting age in British Columbia from 18 to 16 years of age N/A N/A
Kevin Falcon Will travel to Ottawa to seek Prime Minister to reduce the HST by a percentage point

Proposing the referendum be moved ahead to June

Promises to look at raising minimum wage No Said a freeze on the carbon tax might be an option Supports it in conjunction with mandatory civics courses as a part of the high school curriculum Extended hours for TransLink services on Friday and Saturday nights Promised to restore arts funding, suggested de-linking charities and gambling
Moira Stilwell Would seek to have the referendum date moved up Says the minimum wage should be raised to $10 an hour over a two-year period No Pricing carbon is widely viewed as good policy, supports tax Wants to hear from the public N/A Gaming grants should be “restored to their original purpose,” including three-year funding agreements instead of year-to-year deals
George Abbott Proposing the referendum be moved ahead to June. Call for a review of B.C.’s $8 minimum wage – to see whether it is time to raise it No Believes it is too soon to start planning to change it Supports dropping voting age to 16 N/A Liberals should “do the right thing” and promised $4.5 million to restore grants for arts groups to 2008 levels