Adolescent dietary phytoestrogen intake may be associated with a decreased risk of adult breast cancer. If verified, this finding has important implications with regard to breast cancer prevention since diet is a potentially modifiable factor.

IntroductionPromoting health equity is a key goal of many public health systems. However, little is known about how equity is conceptualized in such systems, particularly as standards of public health practice are established. As part of a larger study examining the renewal of public health in two Canadian provinces, Ontario and British Columbia (BC), we undertook an analysis of relevant public health documents related to equity. The aim of this paper is to discuss how equity is considered within documents that outline standards for public health.MethodsA research team consisting of policymakers and academics identified key documents related to the public health renewal process in each province. The documents were analyzed using constant comparative analysis to identify key themes related to the conceptualization and integration of health equity as part of public health renewal in Ontario and BC. Documents were coded inductively with higher levels of abstraction achieved through multiple readings. Sets of questions were developed to guide the analysis throughout the process.ResultsIn both sets of provincial documents health inequities were defined in a similar fashion, as the consequence of unfair or unjust structural conditions. Reducing health inequities was an explicit goal of the public health renewal process. In Ontario, addressing “priority populations” was used as a proxy term for health equity and the focus was on existing programs. In BC, the incorporation of an equity lens enhanced the identification of health inequities, with a particular emphasis on the social determinants of health. In both, priority was given to reducing barriers to public health services and to forming partnerships with other sectors to reduce health inequities. Limits to the accountability of public health to reduce health inequities were identified in both provinces.ConclusionThis study contributes to understanding how health equity is conceptualized and incorporated into standards for local public health. As reflected in their policies, both provinces have embraced the importance of reducing health inequities. Both concepualized this process as rooted in structural injustices and the social determinants of health. Differences in the conceptualization of health equity likely reflect contextual influences on the public health renewal processes in each jurisdiction.

This health technology assessment examines vascular ultrasound screening for abdominal aortic aneurysm (AAA) in asymptomatic populations. Screening reduces the incidence of AAA ruptures, rates of emergency surgical repair and AAA-attributable mortality in males ages 65 to 74. The benefit of screening women has not been established. Ontario data suggest that AAA is underdiagnosed in women, and that women are systematically undertreated. Targeting smokers for screening was found to maximize cost-effectiveness. Economic analysis found that screening may generate savings from the avoidance of emergency surgeries. Based on these findings, the Ontario Health Technology Advisory Committee has recommended screening for AAA in both male and female ever-smokers ages 65 to 74. Résumé L'évaluation de cette technologie de la santé se penche sur le dépistage, par échog-raphie vasculaire de l' anévrisme de l' aorte abdominale (AAA) auprès des populations asymptomatiques. Le dépistage permet de réduire l'incidence de ruptures d' AAA ainsi que le taux d'interventions chirurgicales urgentes et le taux de mortalité attribuables aux AAA chez les hommes de 65 à 74 ans. Les avantages du dépistage auprès des femmes n' ont pas encore été démontrés. En Ontario, les données suggèrent que les taux de prévalence et de détection chez les femmes sont sous-estimés et que celles-ci reçoivent un traitement systématiquement insuffisant. On observe que le dépistage ciblé auprès des fumeurs permet de maximiser le rapport coût-efficacité. L'analyse économique révèle que le dépistage peut mener à des économies, notamment en permettant de réduire le recours aux chirurgies urgentes. Le Comité consultatif ontarien des technologies de la santé recommande le dépistage de l' AAA chez les hommes et les femmes, entre 65 et 74 ans, fumeurs ou ex-fumeurs.

This paper introduces the Migrant Populations Equity Extension for Ontario's Health Equity Impact Assessment (HEIA) initiatives. It provides a mechanism to address the needs of migrant populations, within a program and policy framework. Validation of an equity extension framework using community leaders and health practitioners engaged in HEIA workshops across Ontario. Participants assessed migrants' health needs and discussed how to integrate these needs into health policy. The Migrant Populations Equity Extension's framework assists decision makers assess relevant populations, collaborate with immigrant communities, improve policy development and mitigate unintended negative impacts of policy initiatives. The tool framework aims to build stakeholder capacity and improve their ability to conduct HEIAs while including migrant populations. The workshops engaged participants in equity discussions, enhanced their knowledge of migrant policy development and promoted HEIA tools in health decision-making. Prior to these workshops, many participants were unaware of the HEIA tool. The workshops informed the validation of the equity extension and support materials for training staff in government and public health. Ongoing research on policy implementation would be valuable. Public health practitioners and migrant communities can use the equity extension's framework to support decision-making processes and address health inequities. This framework may improve policy development and reduce health inequities for Ontario's diverse migrant populations. Many countries are now using health impact assessment and health equity frameworks. This migration population equity extension is an internationally unique framework that engages migrant communities.

BackgroundNational health surveys are sometimes used to provide estimates on risk factors for policy and program development at the regional/local level. However, as regional/local needs may differ from national ones, an important question is how to also enhance capacity for risk factor surveillance regionally/locally.MethodsA Think Tank Forum was convened in Canada to discuss the needs, characteristics, coordination, tools and next steps to build capacity for regional/local risk factor surveillance. A series of follow up activities to review the relevant issues pertaining to needs, characteristics and capacity of risk factor surveillance were conducted.ResultsResults confirmed the need for a regional/local risk factor surveillance system that is flexible, timely, of good quality, having a communication plan, and responsive to local needs. It is important to conduct an environmental scan and a gap analysis, to develop a common vision, to build central and local coordination and leadership, to build on existing tools and resources, and to use innovation.ConclusionsFindings of the Think Tank Forum are important for building surveillance capacity at the local/county level, both in Canada and globally. This paper provides a follow-up review of the findings based on progress over the last 4 years.