Sodium reduction messages for Canada - and an inherent process problem in their development

Sodium reduction was touched on this blog DrPHealth july 24, 2011.  In early December, Health Canada began to release some resources to support sodium reduction nationally Health Canada sodium in Canada .  Included in this resource are key messages; the link is provided as it is somewhat buried on the website Proposed sodium reduction messages.  All this is good.  The messages are worth reading although there might be some question about the sustainability and dynamic need for change of the messages that have not been addressed. 

The downside is in a separate communication that isn’t posted that speaks to the process used to develop the messages.  Let us consider it a case study in how not to do consultation within public health.  A contract was let to a national professional discipline specific organization who set up an advisory committee - only listed as from Health Canada, one provincial Ministry of Health and their own organization. They appointed a project manager from the within themselves.  Criteria for an ‘expert” validation panel based were developed and requests for participation were distributed only to BC and Central/South Ontario region members.  The criteria being

·         Member of the professional organization carrying the contract.

·         > one year in practice

·         In a community setting such that it would exclude academic, industrial, hospital and long term care personnel

·         Between ages of 25-55

·         Were from greater Vancouver, greater Toronto or Kitchener

The messages were translated into multiple languages and then focus tested using the same markets served by the validation panel - with the addition of Ottawa for the French speaking component. 

After development they were then distributed for further validation to a limited number of hand picked discipline specific professionals in the same BC and Ontario regions. 

Hence the ranting blog.  The process smacks of professional incestuous behaviour.  There are other Canadian experts in client communication, knowledgeable other professionals in aspects of nutrition or health, and most critically experts in the users of the information that is being generated when working with patients/clients. The absence of at least Quebec/New Brunswick francophone professionals and any Aboriginal populations are notable from this process. There would be an interesting debate on the representativeness of Kitchener for rural lifestyle from at least the north, prairies and Atlantic.  It is not surprising that there is supposed “regional consistency” from the focus testing. 

One of the great strengths of the public health community has been its historic commitment to a multidisciplinary team approach.   Such approaches can be readily eroded by professional elitism and protectionist approaches that we all must guard against and unmask when identified. The added concern of conflict of interest is raised by several of the criteria and the decisions undertaken further undermine the product.  

One also wonders why this material was so quickly posted to the Health Canada website, when many other contracted and more important works remain buried in bureaucracy. 

The messages may or may not stand the test of time.   However, can we learn from the errors inherent in the process?