Using a Population Health Approach to Building Healthy Communities: Tools for Libraries

Michelle Helliwell and I are presenting on this topic at the 2016 Atlantic Provinces Library Association conference. Michelle is a health sciences librarian with experience working in interdisciplinary healthcare environments and is currently a Quality and Policy Support Consultant, Organizational Performance, with the Nova Scotia Health Authority (NSHA). Michelle has a passion for health literacy, healthy communities and population health approaches to health and healthcare and has been apart of the Population Health Working Group in the Western Zone of NSHA since 2004.

Michelle inspired me to think differently about how public libraries support health.  While I often thought of our role as a provider of health information, she reminded me to think more broadly and to align what we do in libraries with the social determinants of health.

The monumental challenges facing the health of Canadians today cannot be addressed by the healthcare system alone:

There is no amount of healthcare that can fix people whose health is impacted by poverty, stress, lack of access to safe places to sleep. Affordable healthy food, safe communities, fun places to play and learn…

From: Redefine. Rebuild. Reconnect. Changing Our Picture of Health

The solution to many of these challenges lies outside of healthcare. What is our role in libraries?  How can we use the community-led approach to address health inequalities?

We gathered lots of resources for our presentation and  are sharing them below (plus some additional resources we won’t have time to cover in the conference session).  Do you have some resources you’d like to add to this list?  Please comment below.

Sara Gillis
Community Engagement Manager
Halifax Public Libraries

Conference Session Description
Libraries of all kinds are integral to the health and well-being of those who use them. Atlantic Canadians are some of the unhealthiest populations in Canada and while much focus in the media is on issues related to wait times and access, access to healthcare services makes up/accounts for only 20-25% of the factors that comprise our health status. That leaves 75-80% rooted in other issues – poverty, social inclusion, education, culture, early childhood development, housing, and others. These are known as the social determinants of health. What are the determinants at play in your area, and knowing that, how can librarians, staff and partners work with communities to create programs that are responsive to these needs, or tweak existing ones to lessen unanticipated barriers? What are you doing already that is contributing to the health of your communities?

Resources

Social Determinants of Health & Population Health

Anderson, L.M., Scrimshaw, S.C., Fullilove, M.T., and Fielding, J.E. (2003).  The Community Guide’s Model for Linking the Social Environment to Health. American Journal of Preventative Medicine 24(3S), 12-20. Retrieved from http://www.thecommunityguide.org/social/soc-AJPM-c-model-link-soc-envr-health.pdf

• Researchers list almost 200 community-based interventions that can enhance the health of communities.  Take a look at their list – public libraries have done and can do many of these things.

Canadian Medial Association: health equity and the social determinants of health

Canadian Institute for Health Information. (2015). Trends in Income-Related Health Inequalities in Canada. Retrieved from https://www.cihi.ca/en/summary_report_inequalities_2015_en.pdf

Public Health Agency of Canada: Population Health

Early Development

Canadian Institute for Health Information (2014). Children Vulnerable in Areas of Early Development: A Determinant of Child Health. Retrieved from https://secure.cihi.ca/free_products/Children_Vulnerable_in_Areas_of_Early_Development_EN.pdf

Data

In 2014 the Arts Council of England commissioned a study to value the health and wellbeing benefits of public libraries.  They looked at two types of benefits related to library service and library engagement – primary benefits that impact an individual directly, and secondary benefits, which benefit society more widely. They determined that library use is positively associated with the well-being of library users, and that there are cost savings due to reductions in medical service usage because of improvements in general health.

Health Data – Canada

The Canadian Institute for Health Information (CIHI) site included data and information on Health Inequalities and Population Health. They also host a Your Health System tool with health indicator data from Search by hospital, long-term care organization, city, health region, province or territory

Health Data – Atlantic Provinces

Nova Scotia’s 2015 Population Health Profile

• In addition to provincial data, health authorities (now called “zones”) across the province often publish community-specific population health profiles.
• The Nova Scotia Health Authority’s Central Zone (formerly Capital Health) has published Community Profiles for each of the five Community Health Networks in that zone.
• Central Zone also has a Population Health Status Report
• South West Health developed a Community Health Profile in 2013.

Prince Edward Island’s Population Health and Surveillance

New Brunswick has published a 2016 Population Health Snapshot for the province and each of the 7 zones.

Newfoundland and Labrador’s Community Accounts includes well-being data at provincial, regional and community levels.

Other resources:

The Working Together Project’s Community-Led Libraries Toolkit

Public Libraries for Health: In 2012, the Blue Cross and Blue Shield of Minnesota Foundation accessed the unique community role of libraries by launching the Public Libraries for Health grant-making program. Seven libraries took on projects in the pursuit of health equity in their communities.

Berk, J. (2015, January 5). Mental Health Training in Public Libraries. Public Libraries Online. Retrieved from http://publiclibrariesonline.org/2015/01/mental-health-training-in-public-libraries/

The Librarian’s Guide to Homelessness, a video and training tools developed by Ryan Dowd of Hesed House, the 2nd largest shelter in Illinois. These training tools provide an opportunity to discusses what a person who is experiencing homelessness may have to contend with on a day-to-day basis  and how a library might respond.

WebJunction’s Health Happens in Libraries

Roads and Fences: the Myth of Public Library Neutrality

John Pateman explores political neutrality in his latest Open Shelf: Open for All? column, Roads and Fences: the Myth of Public Library Neutrality

The great strength of the public library is that it provides democratic, public space that is open to all. This should never be truer than when people are given the opportunity every four years to have a say in the future of their country, their communities and their public libraries. By staying out of the road and off the fence, public libraries can demonstrate that they are both community-led and needs-based.

VPL Access Card

Hi all,

The Vancouver Public Library Board approved the permanent adoption of the Access card at its July 2015 meeting. This low-barrier card had been introduced as a pilot in March 2013. The pilot was extended with different parameters in September 2014. The approved parameters enable the card to be used by those with and without address ID. Borrowers are limited to 2 items at a time, and do not incur late fines. You can read the report at http://www.vpl.ca/images/uploads/file/pdf/AccessVPLCardPilotSixMonthPilotExtensionEvaluation.pdf.

Beth

Series Roundup: Community-Led Work in Practice

One of the CLA Community-Led Library Service Network’s goals for 2014-2015 was to create a series of posts exploring aspects of community-led work, providing an opportunity to share information about the work being done in Canadian libraries and offering useful information and ideas to others in an accessible and readable format.

To date, Network members have contributed eight posts as part of our Community-Led Work in Practice: Experiences from Canadian Libraries series. Laura Young wrote about Edmonton Public Libraries’ epl2go, a mobile service providing communities with library services when access to a traditional library branch is limited. In Let the Community Lead, Andrea Cecchetto and Leah Rucchetto shared Markham Public Library’s experience using a community-led approach in developing their strategic plan. Rejuvenating library service in a rural community through community engagement was the focus of a post by Amanda Fullerton and Sara Gillis of Halifax Public Libraries.

John Pateman of Thunder Bay Public Library contributed a series of posts on developing a community led strategy, staff and service structures, systems, and service culture.

PDF versions of these posts, and a lengthy list of other community-led resources, are available on the Network website’s Resources page.

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Developing a Community-Led Service Culture

This latest addition to the Community-Led Work in Practice: Experiences from Canadian Libraries series is from John Pateman and examines the development of an organizational culture that supports community-led work, “the most crucial element in any successful transformation process.” A PDF of this post is available here. A list of John’s other posts on developing community led strategies, structures and systems, as well as the other articles in this series, can be found on the Resources page. 

by John Pateman

My previous postings have explored how Strategies, Structures and Systems must be community-led if public libraries are to meet community needs. But the most crucial element in any successful transformation process is the organizational culture, or ‘the way we do things around here’. These are the attitudes, behaviours and values which are unique to each public library. Strategies, Structures and Systems can come and go but nothing really changes unless the culture is changed. Strategy, Structures and Systems are tangible and visible, but culture lies ‘below the water line’ like the hidden part of an iceberg. Culture has sunk many attempts at organisational change. Research has indicated that it can take five, ten or even fifteen years to effect sustainable culture change. This time period is often beyond the life of a Strategic Plan or the tenure of a CEO. That is part of the problem – changing culture takes time and effort, persistence and resilience, and many attempts at cultural change are abandoned prematurely through inertia or attrition.

So what does culture look like in practice? Part of the problem is that it is difficult or even impossible to see. It is the wallpaper and the background noise that surrounds us at work every day. We take it for granted. We don’t challenge or question it. It is always there. It includes the written, but most often the unwritten, rules of the workplace. Someone new to the organisation may ask the innocent question ‘why do we do things this way’ to which the answer may well be ‘because we always have.’ This is the ‘if it’s not broken, it doesn’t need fixing’ school of thought, which is deeply embedded in the public library. One way to change culture is to use inclusive and transparent processes to develop new Strategies, Structures and Systems. The process of reviewing existing Strategies, Structures and Systems allows the question to be asked (at least five times), ‘why do we do things this way.’ The ultimate answer must be related to the Strategic Objectives of the organisation, because if ‘the way that we do things around here’ does not enable the delivery of these objectives, then we have to make changes to the way we do things. In this sense the development of community-led Strategies, Structures and System act as Cultural Change Accelerators.

Developing Community-Led Systems

A PDF of this post is available here. For a complete list of of the Community-Led Work in Practice: Experiences from Canadian Libraries series visit the Resources page.

by John Pateman

Systems are policies, procedures and processes which enable a library to operate. They are the rules and regulations which determine attitudes and behaviour. They should be driven by the library Purpose, Vision and Values. They should be in alignment with the organisation’s Strategy, Structures (staff and buildings) and Culture. They should enable rather than disable. They should include rather than exclude. They should be used to guide rather than govern. But in so many cases this does not happen. Why? – because systems can also be used to create a comfort zone for staff which prevents them from having to make discretionary decisions. For example, I have heard many times that ‘Library rules should be applied equally to all library customers because this ensures both fairness and consistency.’ But equality is not the same as equity. Every library user is different. They all have different needs. So applying the same rule in the same way to every patron cannot meet their needs.

It is far less comfortable but much more empathetic to recognise that library users are not equal – some have greater needs than others. Our Systems should be nimble and flexible enough to recognise and reflect this. Library fines are a case in point. A $5 fine for one person may be nothing, just the small change in their pocket; but for another person it may be a big deal. An accumulated debt of $15 may make the difference between them using the library service or not. What is more important – getting $15 in income or getting the books back and the patron (and their family) using the library. Open to All? (Resource, 2000) found that those who use libraries the most, need them the least; and those who use libraries the least, need them the most. This is in no small part due to the exclusive Systems which we operate.

Developing a Community-Led Service Structure

Following on his previous posts about strategy and staff structure, John’s latest contribution to the Community-Led Work in Practice: Experiences from Canadian Libraries series is on developing a community-led service structure.  A PDF of John’s paper can be found here, and link to all of the papers in the series is located on the Resources page.

Please also visit John’s regular column, Open for All?, in OLA’s online magazine, Open Shelf.

by John Pateman

The service structure should be determined by the purpose, values, vision and strategic directions of the public library. Form should follow function. This will ensure that the right services are in the right places and at the right times. This will define the size and shape of the library network (the number and location of branches, opening hours), collections (size, range, formats) and programming (community development).

The strategic directions can be used as a Service Sieve. When an opportunity (project, idea, partnership, funding, other) is presented to or identified by the public library it can be put through the Service Sieve. Each sieve represents a strategic direction. The more sieves that an opportunity can pass through will determine its priority level. If an opportunity passes through one sieve it will be a Level 1 (low) priority. If an opportunity passes through several sieves it will be a Level 5 (high) priority. If an opportunity does not pass through any of the sieves it will not be a priority and should not be taken forward. This enables the public library to say yes or no (with a strategic rationale) to new opportunities. This will facilitate the development of a realistic and achievable Service Plan.

Most service structures are driven by history, culture and opportunity rather than by strategy. The size and shape of the library network was determined by historical settlement patterns. But demographics change, both in the size and composition of local communities. A library may have been built to meet the needs of a specific community which has changed or moved away completely. It’s a similar story with opening times. These may have been introduced for a specific reason at a moment in time which no longer applies. But service structures rarely keep up with the times and often become increasingly out of sync with

Strength in Partnerships: Rejuvenating library service in a rural community

This is the fifth paper in the Network’s Community-Led Work in Practice: Experiences from Canadian Libraries series. A PDF of the the paper is available here. You will find the entire Community-Led Work in Practice: Experiences from Canadian Libraries series in the Resources section.

By Amanda Fullerton and Sara Gillis

In 2013 we were challenged with the task of investigating a sustainable service delivery model for the Musquodoboit Valley, a rural region of Halifax and Halifax Public Libraries’ (HPL) only catchment area without a library branch. During the course of our six-month project we built relationships with the community, collaborated to bring programs to the area, and created a plan for service delivery by applying a community engagement approach, using both community-led and traditional service planning strategies.

A History of Library Service in the Community
The Musquodoboit Valley, and other rural and suburban communities, had access to Mobile Library service until 2012 when, due to a combination of reduced usage, increasing costs, and a reduction in the library’s operating budget, the service was cancelled. Studies of usage indicated many communities were choosing to instead visit their nearest library branch. The exception to this was the Musquodoboit Valley which is geographically isolated from HPL branches.

At the time of its discontinuation, there were six Mobile Library stops in the Musquodoboit Valley totaling just over 7.5 hours of service a week. The Mobile served a group of loyal customers with a strong attachment to both the service and the library staff who worked on the bus. The community response to the cancellation in the Musquodoboit Valley was vocal with residents actively trying to save the service which they’d known since 1961. When Mobile Library service ended, customers were directed to HPL’s Borrow By Mail, a service which had been in place for rural communities since 1981.

In 2013 the library committed to investigating a sustainable service delivery model for this region with the mandate of identifying potential ways to serve a community without a physical library branch in the vicinity. Under the direction of the Library’s Director of Community and Branch Services, a term Community Librarian position was created to work with the Community Engagement Manager on a six-month project to better understand community needs and pilot services.

Honoraria and food

Hi everyone,

I’m curious about what various library systems do to acknowledge participants’ time when seeking input from community members for library purposes.

At VPL, we’re compiling a report on our Access VPL card (low-barrier card) and are interviewing community members about their experiences in order to create case studies. Our general policy is that we don’t provide honoraria, but this is one of those cases where we’re looking at the possibility.

Thanks for any input!

Beth