March 25, 1999

To:Board of Health

From:Dr. Sheela V. Basrur, Medical Officer of Health

Subject:Status Report: Progress in the formation of a Toronto Cancer Prevention Coalition

Purpose:

To report on progress to date in the formation of a Toronto Cancer Prevention Coalition based on the recommendations of the Ontario Task Force on the Primary Prevention of Cancer (1995) and on the requirements and standards for the early detection of cancer outlined in the Mandatory Health Programs and Services Guidelines (Public Health Branch, 1997).

Source of Funds:

Not applicable.

Recommendation:

It is recommended that the Board of Health receive this report for information.

Background:

At its meeting on July 27, 1998 the Board of Health considered a report from the Medical Officer of Health respecting a strategy for cancer prevention in the City of Toronto. The report proposed the formation of a Toronto Cancer Prevention Coalition to address the unique needs and populations of Toronto's diverse multicultural metropolitan area in relation to cancer prevention. Such a coalition had been mandated by participants in the forum "Towards a Toronto Cancer Prevention Council," co-sponsored by Toronto Public Health and the Centre for Health Promotion at the University of Toronto in February, 1998.

The report proposed a coalition model comprising a steering committee and working groups related to the main areas of primary prevention mentioned in the Report of the Ontario Task Force on the Primary Prevention of Cancer--tobacco use, dietary risk factors, alcohol use, physical inactivity, occupational carcinogens, environmental carcinogens, sunlight, reproductive life and related factors, infections, medications, and socio-environmental determinants of cancer--as well as to the prevention and early detection mandate outlined in the Mandatory Health Programs and Services Guidelines for Ontario health units.

The Board of Health took the following action with respect to the report from the Medical Officer of Health:

(1)supported the formation of a Toronto Cancer Prevention Coalition to coordinate a program of primary and secondary cancer prevention activities in the City of Toronto;

(2)agreed to explore options for resourcing a Toronto Cancer Prevention Coalition through City staff, the Ontario Ministry of Health, Cancer Care Ontario, and other community partners;

(3)approved, in principle, the "Citizens' Proposal for Cancer Prevention Activities in the New City of Toronto" appended to a joint communication from Dr. Irving Rootman, Dr. Richard Schabas and Jack Shapiro, and referred this proposal to the new coalition for consideration and appropriate amendments; and

(4)requested the coalition to report back to the Board of Health with a proposed City of Toronto Action Plan for the Prevention of Cancer.

The following report outlines progress to date with respect to the formation, resourcing and activities of a Toronto Cancer Prevention Coalition.

Discussion:

Subsequent to the Board of Health actions outlined above, Public Health staff organized a half-day founding meeting of the Toronto Cancer Prevention Coalition in the fall of 1998. Participants in the meeting included groups and individuals from across the City who had identified a strong interest in the coalition following the forum at the University of Toronto earlier in the year. They included representatives from the Centre for Health Promotion, University of Toronto; Cancer Care Ontario, Central East Region Prevention and Screening Network; Canadian Autoworkers; FoodShare Metro Toronto; the Canadian Cancer Society; Interlink Community Cancer Nurses; the Toronto Environmental Alliance; Toronto-Sunnybrook Regional Cancer Centre; the Ontario Breast Screening Program Metro Toronto; the Centre for Addictions and Mental Health; Toronto Public Health; and community representatives.

Participants confirmed the model approved by the Board of Health, discussed the values and principles by which the coalition might operate, and their aspirations for and roles in the coalition. Terms of reference (Appendix A) were proposed and an interim steering committee formed.

Over the winter of 1998-99 the interim steering committee, comprising Public Health staff , representatives of other agencies, and community representatives has met at two-week intervals to work on the following key priorities and needs:

(a)Identifying cancer prevention activities across Toronto, including those within Toronto Public Health, for the purpose of building on existing efforts and/or folding them into the coalition;

(b)Attracting more members to the interim steering committee, particularly people who are well connected to cancer issues and activities;

(c)Developing key contacts and members on the working groups;

(d)Developing resources for building and operating the coalition.

With the assistance of the Centre for Health Promotion, University of Toronto, a part-time coordinator was secured for a three-month period. Her responsibilities include implementing an outreach plan to attract members to the steering committee and working groups, developing practical roles for members, determining what is going on in Toronto in relation to cancer prevention and connecting these efforts to the coalition, identifying gaps in policies and activities related to the areas of emphasis of the working groups, and recommending priorities and activities for the ongoing coalition. This is an ambitious list, which requires considerable support from the interim steering committee and Public Health staff.

As an initial outreach strategy, a progress report and letter of welcome were sent to everyone who participated in the 1998 cancer prevention forum. To date it has produced considerable interest in membership on the steering committee and working groups. The coordinator has also invited interested organizations and individuals from multicultural communities to participate in the coalition, and established a resource bank of key contacts, cancer data, literature on coalition building, and effective cancer education strategies for a diverse, urban population. In addition, the conference "Everyday Carcinogens: Stopping Cancer Before It Starts" at McMaster University March 26 and 27 affords a further opportunity to attract support to Toronto's cancer prevention initiative. As a sponsor of the conference, Toronto Public Health staff will be leading the concluding summary discussion on building local coalitions for cancer prevention.

The Toronto Cancer Prevention Coalition has added value as a focal point for Public Health staff to build on the strengths of cancer prevention efforts in the former health units and work in concert in the new city. Early evidence from the coordinator's research indicates that Public Health is the only City-wide body working on cancer prevention with a consistent and multi-faceted approach that includes a range of activities from data gathering to education.

The issue of ongoing resourcing of the coalition continues to be a high priority for the interim steering committee. An initial meeting of Public Health staff with Cancer Care Ontario was positive and supportive, and a funding proposal to CCO through the prevention and screening coordinator of Central East Region is currently in preparation. In addition, a meeting with the Director of the Public Health Branch of the Ministry of Health is planned in the near future. As more community partners commit to working with the coalition, their ability to contribute resources will be a central point of discussion. The continuation of the role of the part-time coordinator is critical, both because of its importance in maintaining needed momentum and because of the massive amount of development work currently underway, which is well beyond the capacity of available staff.

In addition, as the coalition grows and develops, the coordinator will play a key role in implementing a strategic planning and policy process to bring together all cancer prevention stakeholders and issues across Toronto and consolidate the coalition, moving it to an operational phase that will begin to realize the goal proposed in the terms of reference. With ongoing resourcing of the coordinator's position, a strategic planning and policy session will likely be held in the fall of 1999.

Conclusion:

Considerable progress has been made in initiating and developing a Toronto Cancer Prevention Coalition to coordinate a program of primary and secondary cancer prevention activities in the City of Toronto. Public Health has taken a lead role in this process. The coalition has focussed the cancer prevention activities of Toronto Public Health, and is developing the potential for a broad range of community partners to work with combined strength and resources on issues of municipal cancer prevention.

Contact Name:

Valerie Hepburn, Health Education Consultant

Public Health

Tel: 392-7451

Fax: 392-1483

vhepburn@toronto.ca

Carol Timmings, Regional Director, East Region

Public Health

Tel: 392-1355

Fax: 392-0713

ctimming@toronto.ca

Dr. Sheela V. Basrur

Medical Officer of Health

Appendix A

Toronto Cancer Prevention Coalition

Proposed Terms Of Reference

Goal:To reduce cancer incidence by creating a high profile/effective/ powerful/ multi-stakeholder/ sustainable coalition, evidence and suspect based, which advocates for prevention policy, education and action at the local government level and beyond.

Objectives:

• To coordinate cancer prevention initiatives including public education regarding primary and secondary prevention of cancer in Toronto;

• To provide and enhance a visible presence in acting as a watchdog, promoting and advocating for cancer prevention in Toronto;

• To provide and enhance a strong voice for influencing policy decisions, especially at the municipal level, and to act on issues that impact on cancer prevention in communities across Toronto;

• To provide a context for groups and individuals to work together with an outcome-oriented approach to take action on preventable cancers and their associated risk factors;

• To accomplish objectives beyond the scope of any one organization;

• To provide a forum for planning, decision making, discussion, networking and collaboration;

• To provide a forum for sharing, debating and reaching consensus on evidence regarding cancer causation and prevention;

• To provide an opportunity for the community to raise concerns, seek support, and advocate for action;

• To bring equity and accessibility to the prevention of cancer in the diverse Toronto community;

• To develop an environmental scan of risk-issue groups and their activities;

• To set strategic directions and track progress toward specific goals;

• To start forming a steering committee.

Chairperson:

A community-based individual (job description required)

Membership:

Organizations and their representatives

• Interest groups
• Agencies
• Service providers
• Healthy City Office
• School boards
• Child care centres
• Public Works, Parks and Recreation and other City departments
• Individual members

• Consumers
• Survivors
• Advocates

Criteria for Membership:

• Commitment to cancer prevention
• Commitment to joint efforts
• Willingness to contribute in-kind or financial support to the activities of the coalition

Selection Criteria:

• Diverse representation of organizations which have a mandate in cancer prevention and/or in addressing cancer-related risk factors
• Volunteer
• Recruited
• Open
• City-based and City-wide

Accountability:

• The coalition is accountable to its members.
• Each member representing an organization is accountable to that organization.
• There should be an annual report to the community and City Council.

Meetings:

A minimum of six meetings per year

Communication:

An overall communication plan needs to be developed.