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report from the Community Action and Public Health Study (CAPHS). The CAPHS provides an opportunity to reflect upon how politics at different levels of government can affect public health practice and research. Beginning as action research in 1991 and ending with qualitative case studies in 1998, the study was inextricably linked to the context of data collection which included political upheavals and changes to public health funding. In this commentary, we draw upon previously unpublished data to discuss links among politics, practice and research in public health. The CAPHS was initiated because, while numerous policy documents underscore the potential contribution of community strategies on the determinants of health, few explicitly acknowledge the role of public health. Accordingly, there is little systematic analysis of community action in public health practice. During the late 1980s and early 1990s, the spirit of collaboration and community development was expanding in public health units, other health, education and social services, and NGOs. In 1989 Ontario introduced the Mandatory Program and Services Guidelines (MPSG) to help shape the core business, organization and practice of local health units. The Guidelines discouraged individual case management, accentuating the social determinants of health, working with local communities, and accelerating discussions of community development and partnerships within public health. In addition, the left-leaning New Democratic Party formed the government from 1990 until 1995. During that time, community partnerships were strongly encouraged, most notably by the Premier’s Councils, especially the Premier’s Council on Health, Well-being, and Social Justice. Within this context, the CAPHS explored public health’s role in community action, finding tensions around the “legitimacy” of such work; however, political events shifted the atmosphere within health units, such that broader questions of legitimacy emerged – questions about the core mandate of public health itself. The provincial government had shifted to the right with the mid-1995 election of the Progressive Conservatives. The new government introduced a broad businessoriented, government-shrinking agenda which emphasized fiscal responsibility and accountability across health and social services. Following the election, the government’s stance towards grassroots community partnerships to achieve social equity in health shifted: Premier’s Councils were disbanded, the provincial (and federal) Health Promotion offices lost their prominence, funding of public health was declared fully “downloaded” to local governments, and Ministry of Health officials sought research that informed questions that they posed directly. In the wake of these changes, the CAPHS supporting organization – the North York Community Health Promotion Research Unit – lost its funding. The study itself, however, had secured NHRDP funding and in-kind support from the University of Toronto and the North York Public Health Department, enabling completion of data collection and maintenance of an advisory group of public health colleagues. In addition, early in 1997 (midway through CAPHS data collection), the Ontario government announced that some health units would amalgamate, prompting research interview discussions of the implications of downloaded funding and amalgamation for community action and public health. Uncertainty and anxiety pervaded these issues; as one manager said, “These days everybody’s playing on shifting sand... you keep trying to move forward but...people...don’t know if they’re going to have a job.” By late 1997, there was some sense of diminished legitimacy for community action work, translating into a diminished legitimacy for its related research – a sense that health promotion and community action had become “bygone” issues. These events coloured, first, public health professionals’ understandings of the role of public health and political support C O M M E N T A R Y

“Playing on Shifting Sand”: Reflections on the Impact of Political Shifts on Community Action and Public Health