White Paper on The Value of Local Health Promotion

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#Executive Summary

This White Paper demonstrates the value of a strong investment in local health promotion, delivered by Ontario public health units (PHUs), and how maintaining the breadth and scope of health promotion work outlined in the Ontario Public Health Standards can be an effective strategy in addressing Ontario’s healthcare crisis. Not only does health promotion yield significant returns on investment, but it is also the most viable strategy for ensuring resilience and preparedness for future pandemics and emergencies.

• Ontario is currently facing competing crises, including a healthcare crisis, an opioid epidemic, and crises related to mental health, homelessness, and climate change.
• Health promotion, a core pillar of effective public health action (1), prevents disease, injury, and poor health outcomes by addressing the factors that shape health, healthy communities, and healthy populations. It is a cost-effective, evidence-driven strategy that helps to mitigate these and other crises.
• Health promotion offers returns on investment in both the short- and long-term through the prevention of disease, injury, and poor health outcomes (2–38). A recent systematic review of 52 studies found that local level health promotion interventions have a return on investment of 4:1, while larger-scale, upstream interventions at a national level yield even larger returns (2).
• Health promotion provides value to the healthcare system, as it reduces the burden of disease and injury for which people need treatment. As such, health promotion efforts help minimize hospital overcrowding and patient wait times, and end hallway healthcare in Ontario (39). It also improves the health of populations, reduces health inequities, and strengthens local readiness for future threats.
• The sustained pause in health promotion work due to COVID-19 (such as programming related to healthy eating, physical activity, oral health, mental health, and substance use) has and will continue to have a significant and measurable effect on the health of Ontarians in the years to come, including reduced quality and quantity of life and increased healthcare costs (40). This impact must be remediated, as any delays in addressing this work will magnify poor health outcomes and inequities.
• Health promotion is a multi-faceted approach that is used locally to support healthy behaviours and healthy communities through:
  • building healthy public policies,
    • creating supportive environments,
    • strengthening community action,
    • developing personal skills,
    • and reorienting health services (for a health system that not only treats illness but also enhances health).
• Local initiatives are developed with an understanding of the local population and context. Health promotion efforts also forge strong links with the social service system. Given that most of what determines people’s health is outside of the healthcare system, these partnerships are critical to keeping people healthy. Furthermore, these bridges to sectors outside of health allow for the application of a health equity lens to best support the populations most at risk for poor health outcomes.