Post on 19-May-2015
description
transcript
Acting on Social Determinants and Health Equity: An Equity
Toolkit for Public Health
Bob GardnerWindsor-Essex County Public Health
November 29, 2013
Problem to Solve: Systemic Health Inequities in Ontario
clear gradient in health in which people with lower income, education or other indicators of social inequality and exclusion tend to have poorer health however measured -- by conditions, quality of life, life expectancy
the gap between the health of the best off and most disadvantaged can be huge – and damaging
2
Towards Health Equity Solutionswill set out a toolkit of 18 ideas, directions and techniques• to build equity into public health
planning and delivery• and well beyond health system --
tackling the underlying roots of health inequality in the wider social determinants of health
• solidly based in research evidence and years of best practices
• action-orientated and manageable• measureable – so can monitor and
assess progress• adaptable to specific organizational and
local contextsthe particularly good news = don’t need to start from scratch
3
Todaykey message: • health inequities are pervasive, damaging and deep-rooted• but can be addressed through comprehensive health equity strategy
and concerted action
will set out a multi-facetted equity toolkit on how• ideas and directions, tools and techniques, you could adapt• will also highlight a few unintended consequences and challenges to
watch for
two exercises to test out these directions and tools at your tableslots of chance for discussion
will start by looking at underlying social determinants of health4
Gradient of Health Across Many Conditions
5
6April 12, 2023 | www.wellesleyinstitute.com
High Blood Pressure Arthritis Rates Diabetes Rates0
5
10
15
20
25
30
Windsor-Essex County Blood Pressure, Arthritis and Diabetes Rates by Income Quintile, 2007-2012
Quintile 1Lowest incomeQuintile 2Quintile 3 Quintile 4Quintile 5Highest income
Perc
enta
ge (%
)
Impact of Health Inequities on How We Live Our Lives
7
Impact of Health Inequities II
• not just inequitable differences in quality of life• inequality in how long people live
• difference btwn life expectancy of top and bottom income decile = 7.4 years for men and 4.5 for women
• more sophisticated analyses add the pronounced gradient in morbidity to mortality → taking account of quality of life and developing data on health adjusted life expectancy
• even higher disparities btwn top and bottom = 11.4 years for men and 9.7 for women
Statistics Canada Health Reports Dec 09
8
9
Acting on Social Determinants of Health
April 12, 2023 | www.wellesleyinstitute.com
Canadians With Chronic Conditions Who Also Report Food Insecurity
10
SDoH As a Complex ProblemDeterminants interact and intersect with each other → reinforcing and cumulative effect on:
• individuals throughout their lives; and
• on particular communities and populations
In constantly changing and dynamic social and policy environments
In fact, through multiple interacting and inter-dependent economic, social, environmental and health systems
11
12
Acting Across Systems and Sectors
even though roots of health inequities lie in social and economic inequalityneed to also look at how these other systems shape the impact of SDoH:
•access to health services can mediate harshest impact of SDoH to some degree•so too can responsive social services•structure, resources and resilience of communities shape impact and dynamics of inequalities
POWER Study: Gender andEquity Health Indicator Framework
April 12, 2023 | www.wellesleyinstitute.com
13
WHO Model Again: Focusing on the Right Policy Levels
April 12, 2023 | www.wellesleyinstitute.com
14
Three Cumulative and Inter-Dependent Levels Shape Health Inequities → Different Opportunities for Public Health Action
1. because of inequitable access to wealth, income, education and other fundamental determinants of health
→ gradient of health in which more disadvantaged communities have poorer overall health and are at greater risk of many conditions
2. also because of broader social and economic inequality and exclusion
→ some communities and populations have less infrastructure, resources and resilience to cope with the impact of poor health
3. because of all this, disadvantaged and vulnerable populations have more complex needs, but face systemic barriers within the healthcare and other systems
→ these disadvantaged and vulnerable communities tend to have inequitable access to services and support they need
15
Think Big, But Get Going• contradictions of SDoH analysis:
• health inequities can seem so overwhelming and their underlying determinants so intractable → can be paralyzing
• a classic ‘wicked’ policy problem – meaning long-term action is needed across many govts, depts and sectors
• can't do everything at once• don’t wait for perfect strategy or evidence that connects and understands
everything• keep the fundamentals of SDoH in mind, but get going:
• make best judgement from available evidence and experience• identify actionable and manageable initiatives that will make a difference• innovate and evaluate → learn lessons and adapt
• start from where you are – and focus here is on building equity into public health practice
April 12, 2023 | www.wellesleyinstitute.com
Health Equity = Reducing Unfair Differences
• Health disparities or inequities are differences in health outcomes that are avoidable, unfair and systematically related to social inequality and disadvantage
• This concept:• is clear, understandable and actionable• identifies the problem that policies will try to solve• is also tied to widely accepted notions of fairness and social justice
• The goal of health equity strategy is to reduce or eliminate socially and institutionally structured health inequalities and differential outcomes
• A positive and forward-looking definition = equal opportunities for good health
• Equity is a broad goal, including diversity in background, culture, race and identity
Powerful Starting Point = Equity Is a Priority Within Public Health
17
18
+ Promising Strategic Environment
can bring tradition, expertise and local strengths to key system challenges:• Excellent Care for All Act enshrines
equity and population health as fundamental principles
• Action Plan emphasizes keeping people healthier -- preventing chronic and other conditions, childhood obesity, screening, smoke-free
→ opportunity to demonstrate that these challenges can be met – and howPH has more experience than acute sector:• building necessary cross-sectoral
collaborations• up-stream interventions to sustain
healthier communities → opportunity for public health leadership
April 12, 2023 | www.wellesleyinstitute.com
19
Starting Point: Solid Commitment + Strategic Opening + Community Engagement
• can’t just be ‘experts’, planners or professionals who define issues and drive system transformation• have to build diverse voices and perspectives into planning• not just as occasional community engagement, but to identify
fundamental service needs and priorities, and opportunities for creating healthier community structures and resources
• and to evaluate how we are doing→ need to start from communities and residents
• involving all types of people – diverse cultures, backgrounds and perspectives, and unequal social and economic conditions?
• specifically, how to involve and empower those not normally included• adapt different and innovative methods – e.g. principles of inclusion
research, go where people are, build trust
April 12, 2023 | www.wellesleyinstitute.com
20
1. Operationalizing Commitment: Build Health Equity into All Planning and Delivery
• doesn’t mean all programs are all about equity• but equity is built into working culture and routine
planning → all programs take equity into account in planning their services and outreach• obvious example – given inequitable gradient of prevalence and
impact of chronic diseases + impact of living conditions → CDPM programs have to take social determinants and community conditions into account
• not so obvious example – from acute side• concern about reducing hospital re-admission rates → need to
understand living and social conditions into which people are being discharged → need to ensure more intensive discharge planning and web of community-based support
April 12, 2023 | www.wellesleyinstitute.com
2. Into Practice Through Equity-Focused Planning
• addressing impact of health disparities at system level requires a solid understanding of:• the needs of health-disadvantaged populations• gaps in available services for these populations• key barriers to equitable access to high quality care
• at delivery level:• considering equity in all program planning means drilling
down on above questions to identify specific needs and barriers for that particular service
• requires an array of effective and practical equity-focused planning tools
21
23
Always Plan through a Health Equity Lens
Providers should apply this type of basic equity lens routinely – from strategic to service planning
if we don’t know → find out• highlights importance of collecting
better equity-relevant data across the system and by every provider
• can use proxy data from postal code = neighbourhood characteristics from census data
• can use case studies and draw on provider experience and community perceptions
•if evidence indicates there could be inequitable impact → then drill down using fuller HEIA
April 12, 2023 | www.wellesleyinstitute.com
Could this program or policy have a differential and inequitable impact on some populations or communities?
How do we need to take the specific needs of disadvantaged individuals and communities into account in planning and delivering this service?
24
First Exercise: Using a Health Equity Lens
At your tables, quickly apply this basic equity lens to a program you are working on
We’ll then share the possible barriers, gaps and inequitable impacts you identified.
And the innovations underway to address them.
April 12, 2023 | www.wellesleyinstitute.com
Could this program or policy have a differential and inequitable impact on some populations or communities?
How do we need to take the specific needs of disadvantaged individuals and communities into account in planning and delivering this service?
• analyzes potential impact of program or policy change on health disparities and/or health disadvantaged populations
• using HEIA can help • uncover unintended consequences or nuances easily missed in program planning• embed equity into routine planning processes and working culture• ensure that projects not specifically about equity or particular populations, will take
language, diversity, local community conditions, etc. into account• especially important for health service providers who are not experienced with
equity and for non-health organizations to take the population health impact of their policies into account
• growing, if uneven, use:• across LHINs -- Toronto Central has required HEIA within recent funding application
processes, and refreshing hospital equity plans → some hospitals have built HEIA into their routine planning processes
• adaptation geared to public health settings and standards been developed and promoted by Public Health Ontario
25
3. Collect SDoH/Equity Data
need solid equity-orientated data• to identify gaps and needs of
disadvantaged patients• to measure and monitor progress
pilot project in 3 Toronto hospitals (and Toronto Public Health) to collect patient SDoH type data scaled up to all hospitals in Toronto Central LHIN valuable website of resources on how to collect and use this data
Action idea = adapt and use framework in Windsor• at best, across public health settings and
whole health system27
Make That Data Actionable
promising practice = Public Health Observatories
• consistent and coherent collection and analysis of pop’n health data
• UK has system of observatories specializing in different spheres – London on inequities
• Saskatoon Observatory is innovative example
opportunity: public health to use its analytical capacity/expertise to support wider health system
• partnering in community health profiles
action idea = adapt observatory model regionally or provincially
• role for PHO?28
4. Build Knowledge We Can Act Onneed broad research base and expansive view of knowledge:• epidemiological – scale of
disparities, disadvantaged communities/groups
• population level linked datasets• community-based research = unique
understanding of needs and interests of marginalized populations
• evaluation – need to know what works and why, for which populations, in varying contexts
systematic data collection + capacity to measure/monitor /evaluate + rich research evidence = knowledge to guide/ground action
5. Beyond Planning: Embed Equity in Targets, Deliverables, and Performance Management
• clear consensus from research and policy literature, and consistent feature in comprehensive policies on health equity from other jurisdictions: • setting targets for reducing access barriers, improving
health outcomes of particular populations, etc• developing realistic and actionable indicators for more
equitable service delivery and health outcomes• tying funding and resource allocation to performance• closely monitoring progress against the targets and
indicators• disseminating the results widely for public scrutiny
= embedding equity into comprehensive performance measurement and management strategy
30
Effective Public Health Equity Targets
• various national projects underway to develop equity indicators• can also build equity into indicators already being collected → equity angle is
to reduce inequitable differences faced by particular populations or communities on these indicators
• reducing impact of diabetes is prov priority• equity target = reduce differences in prevalence, complications and
hospitalization rates by income, ethno-cultural backgrounds, etc. and among neighbourhoods or regions
• achieving that will require targeted programming and proactive engagement with under-served communities
• also good reform driver = can only be achieved through coordinated action• similarly, common goal is increasing rates of childhood immunization
• equity target = reduce the differentials in % of kids immunized by neighbourhood, gender, ethno-cultural background, etc.
31
Challenges: Equity Indicators and Targets• can’t just measure activity, like number or % of priority pop’n that participated in
program• if theory of change for particular health program begins with enabling more
exercise or healthier eating – then we measure change in that initial step• need to measure contribution to health outcomes – even when impact only
shows up in long-term• need to assess reach
• differentiate those with greatest need who need program/support most• are these populations signing up? • who stuck with program and what impact did it have on their health – and
how this varies by sub-pop’n• then adapt incentives and drivers
• develop weighting that recognizes more complex needs and challenges of most disadvantaged, and builds this into funding and incentive system
32
33
6. Use Effective Levers to Institutionalize Equity
• public health standards have been effective way to prioritize and embed equity:• as foundational element of high-performing public health• assessing needs, identifying priority populations, underlying SDoH
• interesting work underway to help implement:• PHO on how to assess and identify priority populations • alPHa/OPHA Health Equity Working Group is also an effective
forum • some lessons to be learned from acute side:• following equity standards arose out of WHO Health Promoting
Hospitals project• adapted to Canadian context, starting with hospitals
April 12, 2023 | www.wellesleyinstitute.com
34
Promising Practice: Actionable Equity Standards
April 12, 2023 | www.wellesleyinstitute.com
7. Align Equity in Public Health With Key System Priorities
• showing how equity will be critical to achieving system goals and linking equity into central priorities will enhance uptake and success
• one overarching system priority is sustainability:• powerful case to be made for preventative programs and health
promotion as key to reducing avoidable acute care use/costs • another priority is chronic disease prevention and management
• long been key focus of PH health promotion efforts• a challenge for health reform is finding cross-cutting goals/projects that
can address a key issue and help to transform the wider health care system
• reducing prevalence and impact of chronic disease could be such a common goal to integrate upstream health promotion, primary care and chronic care
• and it necessarily involves cross-sectoral collaboration
35
36
Always Drill Down: For Diabetes and Other Conditions, What Are Key Dimensions of Inequities? What Determinants and
Barriers Underlie These Inequities?
April 12, 2023 | www.wellesleyinstitute.com
Born in Canada Immigrant0
2
4
6
8
10
12
14
16
Windsor-Essex County Diabetes Rates by Immigration Status, 2007-2012
Perc
enta
ge (%
)
8. Embed Equity into Quality
• quality improvement is another key transformational driver across the health system
• taking social context and living conditions into account are part of good service delivery• when people face adverse social determinants of health → fewer
resources to cope (from supportive social networks, to good food and being able to afford medication)
• e.g. primary care guidelines on best care for people living in poverty• providers and programs need to know this, to customize and adapt care to
SDoH and specific needs and contexts• e.g. well-baby care has to be more intensive for poor or homeless women• to get beyond barriers, preventative screening and health promotion has
to be delivered in languages and cultures of particular population/community
37
38
Not Just at Individual Level: Build Equity-Driven Service Models
peer programs• CHCs, public health and many community providers have established ‘peer health
ambassadors’ to provide system navigation, outreach and health promotion services to communities facing particular barriers
• Waterloo has had peer program for over 20 years – nutrition, parenting, social support – partnering with community groups
neighbourhood focus of many health promotion initiatives:• not just disease by disease, or lifestyle elements in isolation, but coordinated
programming to meet local needsbeing part of hub-style multi-service centres
• a range of health and employment, child care, language, literacy, training and social services are provided out of single ‘one stop' locations
• based solidly in local communities and responding to local needs and priorities → can become important community ‘space’ and support community capacity building
• from provider and funder points of view = more efficient use of scarce resources and better overall coordination
April 12, 2023 | www.wellesleyinstitute.com
39
9. Priority Populations Target Programs and Resources for Equity Impact
• consistent tradition within PH has been to identify priority populations and target services to:• those facing the harshest disparities – to raise the worst off fastest• or most in need of specific services – e.g. poor young moms• or the worst barriers to equitable access to high-quality services – newcomers,
Aboriginal populations• this requires sophisticated analyses of the bases of inequities:
• which requires good local research and detailed information • community health profiles to identify local disparities, unmet needs and
gaps• community-based research to provide rich and deep local knowledge –
especially for designing effective program solutions• involvement of local communities and stakeholders in planning and priority
setting is critical to understanding the real local problems
40
Effective Targeting = Clear Focus
• defining priority populations• not just a general or statistical category – bottom 20 %, all immigrants• but social groups who face particularly poor health or inequitable
determinants of health – and why• these populations could occupy particular positions – precarious workers,
recent immigrants – or may share common backgrounds, identities or other community interests – Aboriginal people, LGBTQ, homeless
• could be people who live in particularly disadvantaged neighbourhoods• get priority populations involved in what matters to them and what
programs will meet their needs• however defined, no population or community is ever homogeneous
• need to drill down further – e.g. youth within Francophone African immigrants have specific needs
April 12, 2023 | www.wellesleyinstitute.com
10. Not Just Priority Populations: Target Systemic Barriers
in Toronto and other cities: people without health insurance
• immigrants in 3 month wait time, refugees, undocumented
• inequitable access → delayed care and worse outcomes
• TPH staff have played a key role in Scarborough Volunteer Clinic and networks
federal cuts to refugee healthcare→ adverse impact on particularly
vulnerable people→ increased healthcare costs/demands at
prov and provider levelsequity is ‘wicked’ policy problem, but not always = predictable and avoidable results of bad policyaction idea = create local network to improve access for uninsured and/or refugees
41
42
Problem = Newcomers Face Service BarriersOne Solution = Interpretation as a Key Quality and Equity Lever
•access to interpretation underlies wait times, safety and other acute system priorities•requirement that adequate interpretation be available wherever needed → improves quality and equity•equally crucial for health promotion
•action idea = Windsor area LHIN, PH, acute, community health and other providers consider centralized/coordinated interpretation services
April 12, 2023 | www.wellesleyinstitute.com
43
Inequitable Access to Preventative Care: Pap Smears
Toronto Public Health: health status indicator series Sept 2011
Problem = Under-Screened PopulationsSolution = Focused Community Partnerships
lower screening rates in particular ethno-cultural or disadvantaged groups e.g. South Asian women in Peel
→ community-based research to assess why→ broad partnerships of Public Health, providers and trusted community organizations to get beyond barriers→ outreach to diverse community settings where women live, work
45
11. Health Promotion Through an Equity Lens
• need to customize and concentrate health promotion programs to be effective for most disadvantaged
• programs have to take account of inequitable resources of vulnerable individuals and communities• advice to manage chronic conditions by exercising depends upon
affording a gym or being close to safe park• diet and nutrition are key – yet high degree of food insecurity
• adjust programs to specific barriers and community needs• deliver in languages and cultures of particular population/community• go where people are -- e.g. CHCs/health promoters into malls• Immigrant Women's’ Health Centre, Sherburne, Aboriginal
communities and other vans in Toronto
April 12, 2023 | www.wellesleyinstitute.com
46April 12, 2023 | www.wellesleyinstitute.com
Lowest Income Lower-Middle Upper-Middle Highest Income0
5
10
15
20
25
30
35
40
45
Windsor-Essex County Vegetable and Fruit Consumption Five or More Times a Day, by Income Category, 2009-2010
Annual Household Income
Perc
enta
ge (%
)
Build Equity Upstream: Chronic Disease Prevention and Management
start by identifying populations and communities at greater risk
• South Asian immigrants had 3X and Caribbean and Latin American 2X risk of diabetes than immigrants from Western Europe or North America
→ design programs to meet specific needs
build in equity target = common goal is reducing childhood obesity → if goal is to increase the % of kids who exercise regularly
• equity target = reduce the differentials in % of kids who exercise by neighbourhood, gender, ethno-cultural background, etc.
• and achieving that won’t be just a question of education and awareness, but proactive empowerment of kids and ensuring equitable access to facilities, space and programs
47
Watch for Unintended Consequences
• health promotion that emphasizes individual health behaviour or risks without setting it in wider social context• can lead to ‘blame the victim’ portrayals of disadvantaged who practice ‘risky’
behaviour• focus on individual lifestyle in isolation without understanding wider social forces that
shape choices and opportunities won’t succeed• universal programs that don’t target and/or customize to particular
disadvantaged communities• inequality gap can widen as more affluent/educated take advantage of programs
• programs that focus on most disadvantaged populations without considering gradients of health and specific need• the quintile or group just up the hierarchy may be almost as much in need• e.g. access to medication, dental care, child care and other services for which poorest
on social assistance are eligible do not benefit working poor• supporting the very worst off, while not affecting the ‘almost as worse off’ is unlikely
to be effective overall
48
12. Key Lever for Acting on SDoH: Inter-Sectoral Collaboration and Coordination
• equity-driven quality care is not just customizing immediate service delivery, but ensuring networks of community-based care and support• particularly important in less advantaged communities with less resources
• needs good cross-sectoral coordination and planning • can identify community health needs, access barriers, fragmentation, service
gaps, and how to address them• public health units and LHINs are pulling together or participating in cross-
sectoral planning tables• also Local Immigration Partnerships, Social Planning Councils
• and looking beyond vulnerable individuals to the communities in which they live• providing and partnering to provide related services/support such as
settlement, language, child care, literacy, employment training, youth programs, etc.
• a number of PHUs have been pioneering social determinants approaches through broad community collaborations on food security, poverty reduction and other facets of building healthier communities
49
Structural Determinants of Health Inequities: and Simultaneously Always Local
poor housing, high levels of poverty and precarious employment can be concentrated in particular neighbourhoods and areas, compounded by racism and other forms of social exclusion
impact and severity of health inequities can also be concentrated in particular populations and neighbourhoods
+ inequitable access to healthcare and other services
+ services can be poorly coordinated and planned
50April 12, 2023
51
13. Plan Strategically/Act Locally
• clear benefits of comprehensive national/prov health equity strategy:• but even best national strategy needs to be adapted/implemented locally• and even without national strategy, can still act locally• recent Wellesley comparative survey of local health equity strategies
• many innovative local strategies at LHIN level, RHAs from other prov, PHUs• again, potential of PH:
• many PHUs work closely with local partners in community collaborations, networks and planning forums
• tradition of researching/understanding local health needs and challenges • Manitoba has provincial community health mapping initiative, • many Ontario PHUs have done local health mapping -- Toronto profiles,
Waterloo partnered with LHIN
April 12, 2023 | www.wellesleyinstitute.com
52
Realizing the Potential of Collaboration: Equity and Community-Driven Local Planning Forums
pre-condition for coordination = creating effective local cross-sectoral planning forumscrucial to sustaining broad action needed to address deep-seated structural problems
action idea = create Windsor health equity forums with concrete planning mandate• to develop a Windsor health
equity plan?
Looking for Ideas : SETO
•arose out of community concern re access•brings together public health, CHCs, shelters, researchers and service providers serving marginalized communities in south-east Toronto•for an overview of SETo’s development see http://knowledgex.camh.net/researchers/projects/semh/profiles/Pages/seto.aspx •ongoing collaboration and idea sharing → supports service coordination and problem solving•emphasized concrete demonstration projects → many with lasting impact•advocacy with institutions and governments around key issues such as harm reduction, dental care and access for non-insured people
April 12, 2023 | www.wellesleyinstitute.com
15. Realizing the Potential of Equity-Driven Innovation
potential:• huge number of initiatives already
addressing equity across province• + equity focused planning will yield useful
information on existing system barriers and the needs of disadvantaged populations
• and we’ll be seeing more and more population-specific program interventions
but• these initiatives and interventions are not
being rigorously assessed• experience and lessons learned are not
being shared systematically• so potential of promising interventions is
not being realizedneed forums to share and build innovation• NCCDH bringing together SDoH PHNs• another advantage of local equity forum • role for PHO or OPHA? 54
16. Add Public Health Voice: Policy Advocacy
• long tradition of advocating for healthy public policies• Healthy Cities movement• linking pop’n health into wide ranging issues -- climate change, city
design, transportation• policy advocacy = one of key roles identified in NCCDH model
• public health has unique position:• part of local govt• protected by provincial mandates and responsibilities• long been solidly based in local communities and collaborations
• can use credible professional/evidence-based voice to intervene in public debates
• need to identify most effective platforms and policy opportunities• and what the key issues are in your communities
55
57
Policy Windows: II
also partnership with community agencies, CHCs and other providers and public health – Peterborough
extended to developing an on-line tool to track impact of these cuts
current focus – again in broad collaborations – is on municipal housing plans to ensure they include this kind of flexible support
April 12, 2023 | www.wellesleyinstitute.com
© The Wellesley Institutewww.wellesleyinstitute.com 58
17. Shifting the Frame: Health = Healthy and Equitable Communities
Sudbury & other public health videos, flyers, etc.
April 12, 2023 | www.wellesleyinstitute.com
Back to Community Again: Build Momentum and Mobilization
• sophisticated strategy, solid equity-focused research, planning and innovation, and well-targeted investments and services are key
• but in the long run, also need fundamental changes in over-arching social policy and underlying structures of economic and social inequality
• these kinds of huge changes come about not just because of good analysis, but through widespread community mobilization and public pressure
• key to equity-driven reform will also be empowering communities to imagine their own alternative health futures and to organize to achieve them
59
60
Second Exercise
From this equity toolkit, what are two or three ideas or directions that you could develop here?
How would you adapt them to your context?
April 12, 2023 | www.wellesleyinstitute.com
18. Pull All This Together into a Strategic
Roadmap
• from a large toolkit, develop a roadmap of what you will do – how and when
• can’t be a rigid blueprint, needs to be adapted and implemented flexibly to contexts and circumstances
• but need clear sense of direction and overall goals
• needs to pull various initiatives into a coherent and connected action plan
62
Promising Practice: Potential of Equity Plans Demonstrated
April 12, 2023 | www.wellesleyinstitute.com
63
Build a Cycle of Equity-Driven Planning and Innovation
• not just a one-off plan• but building equity into
ongoing cycle of analysis, planning and implementation
• see Saskatoon health equity audit process
• embed equity into routine planning and performance management processes
• build evaluation and learning into continuous innovation
Analysis
Plan and
engage
Implement
Evaluate
Innovation
April 12, 2023 | www.wellesleyinstitute.com
Health Equity and Community Mobilization
• we need to find ways that governments, providers, community groups, unions, and others can support each others’ campaigns and coalesce around a few ‘big ideas’
• health equity could be one of those ‘big’ unifying ideas..• if we can shift the public and policy frame to see opportunities for good
health and well-being as a basic right for all• if we frame the damaged health of marginalized populations as an
indictment of an unequal society – but also show that focused initiatives can make a difference
• if we recognize that coming together to address the social determinants that underlie health inequalities will also address the roots of so many other social problems
• thinking of what needs to be done to create health equity is a way of imagining and forging a powerful vision of a better future for all
• and showing that we can get there from here
64
Key Messages• health inequities are pervasive and deep-seated – but can’t let
that paralyze us• do need a comprehensive and coherent health equity strategy –
but don’t wait for perfect strategy• think big and think strategically – but get going• have set out a roadmap – of strategies, principles and tools -- to
drive equity into action
• there is a solid base of public health evidence, experience, commitment and community connections to build on
• real opportunity within the current health and policy environment for public health to lead the way on equity
65