Paving the Way for Healthier Communities through Public Policy


The Challenge

The Region of Peel, Ontario is experiencing a rapid increase in diabetes, with rates in Peel (10%) exceeding the provincial average (8.3%). The physical and social environments are the underlying causes of physical inactivity, unhealthy eating and sedentary behaviour, all of which are key risk factors in the development of diabetes. This environment is particularly harmful to the almost 25% of Peel residents who are of South Asian descent, and are at an increased risk for diabetes. Without intervention, projected rates of diabetes are estimated to grow to one in six by 2025.  This poses a significant risk to health and well-being, healthcare system sustainability and workforce productivity in Peel.

The Improvement Project

 For their Canadian Foundation for Healthcare (CFHI) Improvement Project, EXTRA fellows Dr. Eileen de Villa, Associate Medical Officer of Health and Gayle Bursey, Director of Chronic Disease and Injury Prevention, Peel Public Health, sought to achieve organizational-level and public policy changes related to activity, food and land use for Peel residents by: 1) Improving the rigour of policy analysis at Peel Public Health and 2) Engaging the community to achieve policy change, especially within Peel’s South Asian community. To support their effort, they completed evidence reviews on policy analysis frameworks and community engagement, as well as a document review on past policy development initiatives at Peel Public Health.

 “The key to successful training was the use of the evidence reviews to inform the development of policy analysis templates and corresponding staff workshops,” says de Villa.

A series of training workshops were developed for staff at Peel Public Health. The first two day workshop was intended to increase the writing skills of all 129 staff within the Chronic Disease and Injury Prevention division. The second workshop focused on developing policy analysis skills and was targeted to the 33 supervisors, analysts, advisors and front line staff involved in policy work from across Peel Public Health. Both workshops were highly interactive, providing staff the opportunity to apply new skills using case studies and receive immediate feedback from workshop facilitators.

Policy change at the organizational-level and more broadly in Peel Region was implemented using the following steps: documenting the problem; identifying the problem as a strategic priority; developing a strategy to address the problem that considered diversity and health inequities; discussing policy change with leaders to seek commitment and endorsement; and developing policies in settings where Peel was accountable and in cultural organizations.

Key Results and Impacts

Evaluation of the workshops indicated that staff acquired new skills, knowledge and confidence in policy analysis. Several policy analysis tools were piloted during the training process and are currently being used at Peel Public Health.  Progress towards change in public policy included several milestones, such as two major forums with community leaders, 18 media spots (e.g., CBC Radio, the Globe and Mail), 15 council resolutions and four community organizational-level policies related to activity, food and land use. For example, a Regional Council resolution was passed, directing the Region of Peel, as an organization, to become a model employer for healthy living by considering design, facilities and service improvements in Regional buildings to promote physical activity and reduce sedentary behaviour among its workforce. This resulted in added bike storage, increased stair usage and improvements to the outdoor space. As well, within the community, several organizations have adopted healthy food policies and active design guidelines are being applied to public facilities (e.g., parks, schools and social housing).

 “Profiling leaders who demonstrated a commitment to policy change, both at the Region of Peel and within the South Asian community was crucial to the success of the project,” says Bursey.

 This approach to policy analysis and community engagement is applicable across the spectrum of public health practice, but was associated with considerable leadership support and investment of resources. This project fostered successful collaboration and leadership among various levels of government (i.e., municipal and regional) and across different disciplines (e.g., public health, land use planning and social services) internally and externally to the Region of Peel.  For example, Peel Public Health, in partnership with the South Asian Professional Network for Health Awareness, hosted a community event in which there was a noticeable shift in interest towards population-level approaches to diabetes prevention, with prominent community leaders committing to policy change within their organizations. This public commitment will continue to have significant impact on diabetes prevention work in the future.

The early results and successes at an organizational-level in the Region of Peel will provide leverage for policy changes in more settings and to the implementation of more complex, longer-term policy and environmental changes.


Eileen-DeVilla_forWebDr. Eileen de Villa, Associate Medical Officer of Health
Peel Public Health 



Gayle-Bursey_forWebGayle Bursey, Director of Chronic Disease and Injury Prevention
Peel Public Health



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