April 3, 2019

Using evidence to change public health policy

Unhealthy diets are now the leading risk for death in Canada — and the cost of doing nothing is becoming increasingly hard to swallow.

Diets high in sugar and processed food are leading to higher rates of heart disease, cardiovascular disease, diabetes and other health challenges among Canadians. One study published in PLOS ONE last year estimates the economic burden of unhealthy eating on the Canadian health-care system at nearly $14 billion in 2014. Other studies peg the cost even higher. Dr. Dana Olstad, PhD, is researching the role government and policy can play in taking a bite out of those numbers.

“Diet is not a simple choice,” says Olstad. “What we eat is shaped by our environment. It is shaped by what is available, what is affordable, what we can access and how attractive these products are on the shelf. If we change our food environments, we can make a difference in what Canadians eat.”

Olstad and a team of researchers from across Canada have been connecting recreation centre managers with dietitians, local community supports and local vendors who provide healthier options — a strategy called capacity building. The team recently completed a randomized controlled trial involving 49 facilities in four provinces — the first of its kind in Canada.

The study showed that this type of on-theground, practical knowledge is effective in improving the food environments, with rec centres increasing the number of healthier items available in vending machines after participating in the capacity building and randomized trial. The amount of unhealthy items available also decreased.

“So many times researchers will go in, do the intervention and then leave. Capacity building is about researchers working with these rec centres to teach them about opportunities around better nutrition and healthy food options,” she says. “When centres learn how to improve their own food environment, the changes are more likely to be sustained after the research ends.”

It’s one of several initiatives Olstad is juggling on her mission to change the way Canadians, and especially policy-makers, think about food, diets and health. Another was done to kick-start dialogue among food experts around healthy eating prior to the release of an updated Canada Food Guide, a nutrition guide produced by Health Canada to support healthy eating and help reduce chronic illness.

Last year Olstad helped organize the largest food policy forum of its kind in Canada, co-hosted by the O’Brien Institute for Public Health and the Libin Cardiovascular Institute of Alberta. The forum convened international leaders in industry, health and policy and led to a national call-to-action seeking immediate and longterm measures to improve diets, including restrictions on marketing unhealthy foods to children and greater taxation of unhealthy foods.

“Even small improvements in diet quality can help to prevent chronic diseases in Canada,” Olstad says. “The effects would be far-reaching. They will help reduce the costs to the health-care system and absenteeism from work while increasing productivity.”

Informing and shaping public health policy

Olstad is one of many researchers at the O’Brien Institute for Public Health informing — and helping shape — public policy.

Another example, the Raising Canada report, is getting attention from policy makers in Ottawa.

The report provides a snapshot of child health in Canada and helped spark a national conversation around improving the well-being of Canadian kids.

For example, it highlighted that one in 10 children experience moderate or severe food insecurity, which can negatively impact their readiness to learn or complete tasks at school. One in five children live in poverty or lowincome households, with the rate even higher among Indigenous youth. Dr. Amy Metcalfe, PhD’12, the lead author of the report, addressed the Senate of Canada during a special meeting on child well-being on Parliament Hill after the report’s release last year.


The O’Brien Institute’s Health Technology Assessment (HTA) Unit, a researcher team led by Dr. Fiona Clement, PhD’06, produced the Cannabis Evidence Series, one of the most comprehensive examinations of cannabis in the Canadian context. The report was used by Health Canada to inform legalization and regulation and informed the Government of Alberta’s framework for legalization introduced in 2018. It was also provided to other provinces as they prepared for cannabis legalization.

“We are engaging in scholarly work that inform public policy in many domains at the local, provincial, national and international levels,” says Dr. William Ghali, MD’90, scientific director of the O’Brien Institute.“The ultimate goal is to achieve a paradigm shift that leads to more evidence-informed public policy and researchers like Drs. Olstad, Metcalfe and Clement are leading the way.”

Dr. Dana Olstad, PhD, is an assistant professor in the Department of Community Health Sciences and member of the O’Brien and Libin Institutes at the CSM.

Dr. Amy Metcalfe, PhD, is an assistant professor in the departments of Obstetrics and Gynaecology and Community Health Sciences and a member of the O’Brien and Alberta Children’s Hospital Research Institutes.

Dr. Fiona Clement, PhD, is an associate professor in the Department of Community Health Sciences and director of the HTA Unit at the O’Brien Institute.

Dr. William Ghali, MD, is scientific director of the O’Brien Institute, professor in the departments of Medicine and Community Health Sciences and member
of the Libin Institute.