Introduction

Organizations in the voluntary sector play a wide range of roles in society, both singly and in combination.  These roles include providing ethical leadership; raising public awareness about important issues such as child exploitation, human rights or climate change; and testing innovative models of local governance and service delivery. Voluntary sector organizations also create the opportunity and the space for citizens from diverse backgrounds to engage in community and public issues.

Many voluntary sector organizations are known for their work in delivering health-related and social services. These include, for example, nutritious breakfast programs, early childhood development and learning, home health care, homemaker assistance, shelter for victims of physical or sexual abuse, aid to immigrant families and recreational programs for children and youth.

While service delivery is a core function, the broader roles that voluntary sector organizations can assume relative to public health are not well documented or understood. There are at least three major contributions that are explored in this paper.

First, the voluntary sector helps collect and interpret data that comprises the evidence base for informed action. Second, voluntary sector organizations are well positioned to convene citizens, diverse organizations and even different sectors around the myriad and linked factors that influence health. Finally, voluntary organizations monitor progress on the impact of government policy measures and community action to achieve identified goals.

i. Collect and interpret data

The collection and interpretation of data contribute to the knowledge base around public health and the social determinants of health, such as affordable housing, low income and social exclusion. The social determinants of health refer to the wide range of social and economic factors that influence health outcomes.

Many voluntary sector organizations are involved in gathering and publishing statistics relevant to public health and to the social determinants of health, more specifically. In addition to making public the relevant data, voluntary sector organizations provide interpretative explanation to ensure accurate and consistent application of the information.

The Canadian Housing and Renewal Association, for example, posts to its website a range of housing-related data, such as rental vacancies and statistics on core housing needs. It not only presents the data but also explains the implications of these numbers. This interpretive role is helpful to both governments and local organizations trying to understand the meaning of these figures and the implications for their respective areas of work.

Voluntary sector organizations are also in a position to link data to broader social, economic and political developments, which help provide an important causal or explanatory context. Reductions in income security caseloads, for example, may be due not to improved economic circumstances and higher employment levels but rather to more stringent eligibility criteria for these programs. A set of figures with no supporting explanation can be easily misinterpreted or misrepresented.

Another contribution of the sector involves the presentation of relevant data over time – a valuable perspective in that it is difficult to understand the dimensions of an issue or assess its impact unless considered over a given period. While the unstable financing of voluntary organizations in recent years has impeded their ability to carry out this role [Eakin 2005; Scott 2003], their capacity to present trends over time provides a depth of understanding that is not available through snapshot presentation of numbers.

Voluntary sector organizations are also in a unique position to recognize knowledge gaps arising from existing data. They are able to do this because their direct work on the ground or their indirect link to front-line issues through local members enables them to identify gaps in data and associated information. In the case of housing, for example, the Canadian Housing and Renewal Association (CHRA) built on efforts under way in the US to identify the limitations of the concept of housing affordability. The available statistics did not make an important connection between the two independent data sets on income levels and housing costs.

In response to this conceptual gap, the CHRA commissioned a study which produced the first Canadian report on the concept of ‘minimum housing wage’ [CHRA 2007]. The report identified the minimum wage levels that would be required to pay for decent housing in 28 cities across the country. The study added a significant conceptual component to the notion of housing affordability and proposed feasible policy measures to close the cost gap.

Data collection is important not only for making the case for intervening in a given area. It is also required in order to determine the specific interventions to be pursued in response to identified issues.  The evidence base helps make the case for the selected objectives and the particular directions chosen from many potential actions.

Poverty by Postal Code is an example of this data-for-action role.  The report was published in 2004 as part of research into social issues being undertaken by the United Way of Greater Toronto [UWGT and CCSD 2004]. The analysis of ‘poverty by geography’ enabled the identification of the precise neighbourhoods to target for specific interventions. These included youth engagement, literacy training, affordable housing initiatives and the development of social infrastructure – all of which are considered key social determinants of health.

While the collection and analysis of local poverty data are crucial for developing strategic approaches to community interventions, relevant statistical data that support this type of neighbourhood-based targeting may be hard to obtain at the local level. National data are not easily disaggregated, making it difficult for communities to get a picture of their own face. One national initiative that helps respond to this gap is the Urban Poverty Project being undertaken by the Canadian Council on Social Development. The project draws on Census data and other sources to prepare analytical reports, resource tools and data profiles which explore various aspects of urban poverty.

Understanding the Early Years (UEY) is another example of data collection as the basis for action [SRDC 2005]. As part of the UEY process, the federal government enters into a three- year agreement with a voluntary organization, which becomes the project sponsor for the community. Up to 50 communities will be funded under this project by 2008. Its purpose is to provide members of participating communities with quality information on the school readiness of their kindergarten children. Through various instruments on child development and interviews with parents and teachers, UEY helps identify the family and community factors that influence child development and the availability of local resources to support young children and their families. For each community, these multiple sources of information form the basis of a Community Research Report on child well-being in that locale.

Voluntary sector organizations can also act as a repository and point of distribution for wide-ranging information and research results on factors that influence health outcomes. The Canadian Journal of Public Health, for example, is the official publication of the Canadian Public Health Association, a nonprofit association of public health professionals, that seeks to maintain and improve personal and community health. The journal assembles in one place extensive information on all aspects of public health, including epidemiology, nutrition, family health, environmental health, sexually transmitted diseases, gerontology, behavioural medicine, rural health, health promotion and public health policy.

Finally, voluntary sector organizations play an important role in knowledge translation. They are able to translate into practical terms the information derived from scientific studies or research in order to educate the public and to make the case for policy change.

Safe Kids Canada is a national voluntary organization, for example, whose purpose is to create a safe, injury-free Canada for children and youth. Building on a scald prevention campaign initiated by the Hospital for Sick Children, Safe Kids Canada assumed the leadership for a public education campaign on the prevention of tap water scalding, which is among the most devastating of all childhood injuries. It also launched a campaign to change the Ontario Plumbing Code on the temperature setting of hot water heaters [Hewitt, Macarthur and Parminder 2007].

Policy challenges

Despite the importance of this activity, voluntary sector organizations face a number of policy challenges in their data collection and interpretive role.  Sometimes it is difficult to see changes reflected in the actual data – though progress in respect of a certain goal appears to have been made. While poverty rates may not have dropped in a given community, for example, there may have been positive developments in indicators that are linked to progress in this area, such as improved literacy rates.  There is a need to identify appropriate proxy indicators around the various social determinants of health.

A related challenge involves the fact that some of the social determinants of health are less easily measured than others. Household income is more readily assessed, for example, than the extent of social exclusion. Guidance as to appropriate indicators would be helpful around some of the health outcomes that are not readily quantified.

There are technical problems as well. The Canadian Institute for Health Information reports, for example, that information about the homeless is defined, collected and reported in different ways throughout the country, which limits the comparability of data between cities. Variable methods for sampling or counting a city’s homeless can also result in over- or underestimates of the problem. Moreover, data are collected at different times of year, which may result in variability of the results because of seasonal variations in the presence of homelessness [CIHI 2007: 9].

Finally, the social determinants of health approach represents a large and growing body of literature. There needs to be a consistent process to sort through this wide-ranging information so that it can be more readily incorporated within an evidence base or employed for educational purposes or the development of strategic plans.

ii. Act as convener

Voluntary sector organizations make significant contributions to public health through the role they play as conveners of citizens, diverse organizations and sectors. Voluntary sectors organizations are well placed to play this coordinating role.

A background paper prepared for the Government of Saskatchewan for dialogue sessions on the relationship between government and the voluntary sector noted, for example, the credibility of the voluntary sector [Ministry of Tourism, Parks, Recreation and Culture 2006: 8]. Voluntary sector organizations are seen to be acting in the public interest and in support of the common good rather than their own individual well-being. They are able to make the links across various issues and can partner with diverse organizations and sectors more readily than can the private sector and government. Neither are they restricted by communication protocols and can work comfortably with all orders of government.

Many voluntary sector organizations maintain national networks to keep informed of developments across the country. They also help connect national and local organizations with relevant international research, projects and policy measures. Inclusion International, for example, is a global federation of organizations advocating for the human rights of people with intellectual disabilities. It links with the Canadian Association for Community Living and its provincial/territorial and local affiliates to maintain updates to relevant international developments.

Unlike the voluntary sector, the private sector is not regarded as a neutral convener – although there are notable exceptions, such as the Business Community Anti-Poverty Initiative in Saint John, in which business has played the convening role with some success. The private sector is perceived to have a self-interested agenda concerned primarily with private profit. While many businesses have adopted socially responsible practices by adhering to the principles of corporate social responsibility, they are still seen as interested mainly in their own well-being rather than that of the public [Torjman 2007]

Neither is it easy for governments to play the convening role required to organize for complexity. Public officials are not generally well positioned to move away from the mandate of the single department or ministry with which they are affiliated. The vertical lines of accountability embedded in government structures make it difficult to work across mandates, let alone head up an intervention that crosses diverse interests and boundaries. Governments have a difficult time addressing issues that require them to operate horizontally – though there has been clear recognition in numerous reports of the need to move in this direction [Task Force on Community Investments 2006; Blue Ribbon Panel 2007].

Moreover, government officials cannot comfortably participate as active partners in comprehensive community initiatives. They need to be perceived as objective representatives of the public interest writ large.  (This perspective gradually is changing, however, as they experience the value of engaging in these efforts.) Finally, governments are bound by political cycles which often make it difficult for them to commit to long-term objectives or plans.

The convening function involves acting as host – bringing together key parties to take coordinated action. The Social Planning Network of Ontario has explored the role that social planning councils can play as convening bodies seeking to build the social capital of their communities.  Social capital involves the creation of social networks and plays a significant role in tackling social exclusion [Putnam 2000].

Another example of this type of convening involves the Wellesley Institute, a Toronto- based nonprofit organization that conducts research and develops policy solutions to the problems of urban health and health disparities. Wellesley recently invited the residents of St. James Town to talk about their neighbourhood and how its various qualities affected their health and well-being.  Residents were encouraged to voice their views through stories, photos, maps and videos, and then formulate a plan for a healthier community. Wellesley also initiated a series of forums with health and social service providers, researchers and residents; their proposals contributed to the development of a framework for addressing health disparities.

Voluntary sector organizations give a voice to the concerns of certain groups, such as persons with disabilities, Aboriginal Canadians or immigrants and refugees, often overlooked in public discourse.  The Council of Canadians with Disabilities, for example, acts as convener for the diverse organizations throughout the country that represent the wide-ranging needs of persons with disabilities. As an umbrella organization, the Council comments on policy measures and puts forward a disability perspective on major public issues – e.g., supports for independent living, income security and accessible transportation.

In other cases, the convening function goes beyond the expression of voice and the development of an action plan to the coordinated implementation of that strategy. In fact, a new generation of local initiatives has arisen to tackle problems in a more coherent and cohesive way than has been the case in the past. These efforts seek to forge links between and among key social determinants through various forms of collaborative work [Connor and Kadel-Taas 2003]. Coordinated action is undertaken through collaborative strategies that bring together multiple players. The strength of collaborative actions is that they provide a mechanism to tackle complexity and are organized explicitly to address the root causes of problems.

The development of collaborative approaches involves representatives from diverse sectors, including business, government and voluntary organizations, that come together to work on multifaceted solutions to identified challenges. These multisectoral approaches often form a table, sometimes referred to as a ‘local governance body.'

These governance bodies play a foundational role in complex initiatives by providing a focal point for local expression and acting as its champion. They set out a guiding vision for the community effort and associated strategic plan. They link the comprehensive initiative with relevant organizations, projects and resources including financing and technical expertise. They provide opportunities for learning and monitoring results on an ongoing basis.

Vibrant Communities is an example of a major national initiative that embodies a multisectoral approach and in which voluntary sector organizations play a prominent convening role. At the core of the initiative are 15 cities throughout the country, all seeking local solutions to reduce poverty. While the selected strategy in each of the cities varies widely, they are joined in their respective efforts through a structured learning circle, known as the Pan-Canadian Learning Community [Torjman 2005a].

Finally, the voluntary sector is well placed to convene conversations between communities and governments, and within governments themselves. As part of Vibrant Communities, the Caledon Institute convened a policy dialogue which brought together representatives from 10 federal departments including Human Resources Development, Health, Heritage, Justice, Status of Women, Industry, Citizenship and Immigration, Privy Council Office (Urban Aboriginal Strategy), Indian and Northern Affairs, and the Canada Mortgage and Housing Corporation. While the government representatives met in person, phone lines were hooked up across the country to enable the communities to participate as they wished.

Although many policy-makers recognize the role that communities can play in addressing the social determinants of health, public servants rarely have an extended opportunity to explore with grassroots practitioners the challenges involved in local work. Participants noted that they appreciated the ‘safe space’ to engage in dialogue about their respective and shared concerns [Torjman 2005b].

A more recent example of the convening function involves a meeting held in Alberta in February 2008 to explore the relationship between provincial governments and the voluntary sector, and the various ways in which provinces and voluntary sector organizations can identify possibilities for cooperation and collaboration.  Several organizations were responsible for planning the event including the Community Services Council based in St. John’s, the Canadian Federation of Voluntary Sector Networks, Alberta Non-Profit and Voluntary Sector Initiative, Calgary Chamber of Voluntary Organizations, Muttart Foundation and Wellesley Institute. The meeting represented the first time that officials from different provinces had come together with representatives from organizations whose work focuses on policy and capacity issues for the voluntary sector.

Policy challenges

It is clear from the examples presented here that there are many groundbreaking efforts under way in which voluntary sector organizations have played a significant convening role. One of the major policy challenges that the voluntary sector faces is that, despite the range of exemplary models, there are few opportunities for scaling up of successful practice through focused opportunities for learning and the strategic application of effective approaches.

Voluntary sector organizations are hard-pressed within their modest budgets to find sufficient time or resources for staff development or training around new models. The application of good practice to other geographic areas and issues requires explicit planning and support, which can take the form of coaching on a one-on-one or group basis. It can mean training the trainers who, in turn, teach relevant skills to community members. It is also helpful to facilitate exchange either in groups or even in pairs whereby two communities join together for the purpose of peer learning. A recent paper on accelerating the impact of innovative approaches suggests that funders should consider making available a roster of screened consultants, coaches and mentors to provide timely, targeted advice to organizations at various stages of initiative design and implementation [Pearson 2006: 19].

iii. Monitor progress

In addition to their roles in collecting data and convening diverse sectors, voluntary sector organizations can help assess progress in respect of selected outcomes of health and well- being. This monitoring function involves two key streams of activity: the monitoring of government or corporate progress relative to key objectives and the assessment of community progress in relation to its own goals.

The voluntary sector acts as a vital external watchdog on government activity. It effectively builds in a crucial accountability component within a democratic society by providing an important check and balance on traditional sources of power. Democracy Watch plays this role, for example, around government ethics, the accountability of the banking sector and corporate social responsibility.

The Council of Canadians with Disabilities, earlier described, monitors progress on all aspects of disability.  It also watches relevant Supreme Court proceedings and has applied for intervener status in cases where it believes that the equality rights of persons with disabilities need to be better represented – e.g., the accessibility of Via Rail cars.

Another example of monitoring involves the work of Campaign 2000, a national voluntary sector coalition of more than 120 partners seeking to end child and family poverty. The group came together in 1991 out of the concern about the lack of improvement in addressing child poverty. Campaign 2000 produces an annual “Report Card on Child Poverty” that measures progress in respect of the unanimous all-party House resolution passed in the House of Commons in 1989 “to seek to achieve the goal of eliminating poverty among Canadian children by the year 2000.”

A range of environmental organizations track performance not only on government activity but also on the state of environmental health, more generally. The World Wildlife Federation, for example, produces the “Living Planet Report” as a periodic update on the state of the world’s major ecosystems. The report is built around two main indicators: the Living Planet Index that reflects the health of ecosystems and the Ecological Footprint, which shows the extent of human demand on these ecosystems. These measures are tracked over several decades to identify past trends and future challenges. The “Canadian Living Planet Report” focuses on Canada’s part in the global picture and the specific problems associated with oil and gas production.

Some voluntary sector organizations are involved in monitoring progress on more than one issue. The Canadian Index of Well-being, for example, is a national collaborative effort spearheaded by the Atkinson Charitable Foundation in association with several voluntary sector partners. The initiative seeks to identify, develop and publicize measures that present valid and regular reports on progress toward well-being outcomes that it believes Canadians seek as a nation. Its goals are to build a foundation on which to articulate a shared vision of the factors that comprise sustainable well-being.

There is significant voluntary sector activity under way as well at the local level to track progress on outcomes of health and well-being. Vital Signs, launched by the Community Foundations of Canada, is one such example. Vital Signs is a yearly check-up that measures the vitality of a community, identifies significant trends and assigns grades in core areas deemed critical to the quality of life in such areas as learning, housing, belonging and leadership. Community foundations in Toronto, Ottawa, Montreal, Vancouver, Victoria, Calgary, Red Deer, Medicine Hat and Waterloo Region were involved in the initial pilot of the instrument.

Voluntary sector organizations are also actively involved in monitoring their own progress when they have chosen to work in strategic collaborative efforts. The Quality of Life CHALLENGE in BC Capital Region, for example, selects a cluster of indicators of well-being as a means of measuring progress and of identifying areas for future work. To the extent possible, the data are made consistent with the Quality of Life Monitoring System developed by the Federation of Canadian Municipalities. This approach enables BC Capital Region to compare its progress not only against its own targets but also in relation to other communities engaged in similar processes. In addition, the Quality of Life CHALLENGE holds annual reflection sessions in which key partners are invited to share their views on the effectiveness of the work and to help redraw the pathway of its future efforts.

Policy challenges

As in the case of data collection and convening, there are policy challenges associated with the monitoring function. One clear difficulty involves the ability of the voluntary sector organizations to act as independent monitors of government progress if they rely primarily or even partially on public funding.

A second challenge involves the complexity of the monitoring process when many diverse and interrelated variables are involved.  Moreover, it is difficult to monitor progress toward addressing root causes when many of the changes require long periods of time – often well beyond the life of any government or the Board term of a voluntary sector organization. Governments and the voluntary sector may consider the joint development of evaluation protocols to determine how best to assess long-term work within shorter-term time frames.

Funders more generally can provide support for ‘developmental evaluation,’ which is emerging as a form of assessment that embeds a learning component. This form of assessment may be particularly appropriate for knowledge dissemination and transfer because it seeks to incorporate how a given process might change for the future rather than looking only at what it has achieved in the past.

Traditional evaluation pushes for a high degree of internal validity (a tight experiment), which may be necessary in certain circumstances but may constrain the adaptive capacity required for the adoption of complex approaches.  In contrast developmental evaluation lays out the issues and a range of potential responses, which is useful information for potential or actual program implementers [Pearson 2006: 21].

Conclusion

Voluntary sector organizations play a range of significant roles in promoting public health and in tackling the social determinants of health. They gather quantitative and qualitative evidence to make the case for intervention and to determine the most appropriate points of leverage.  They are well placed to convene citizens, diverse organizations and sectors in order to raise awareness of problems, develop strategic plans and undertake comprehensive action. Voluntary sector organizations contribute immeasurably to the monitoring of progress achieved though public policy measures and community-based interventions.

Despite their considerable strengths and contributions, voluntary sector organizations face diverse challenges from both knowledge and practice perspectives. A clear articulation of these challenges represents an important step forward in their resolution, ideally in association with government partners.

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"VSO Roles in Public Health"

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links to other reports from Sheree Torjman and the Caledon Institute

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• R-E-S-P-I-T-E Spells Respect
• Talking Turkey on Taxes

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