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ENHANCING HEALTH EQUITY:THE POTENTIAL OF PEER HEALTH AMBASSADORS

Bob Gardner and Estelle Sun

Canadian Public Health AssociationAnnual Conference, June 22, 2011

www.wellesleyinstitute.com

Problem:Health Inequities

Pervasive inequities in health outcomes are rooted in social determinants of health and systemic inequalities

The most disadvantaged in SDoH terms can become more marginalized in the health system

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• Language• Culture and Religion• Socioeconomic Status• Race

• Sexuality• Geography/Distance• Age

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POWER StudyGender and Equity

Health IndicatorFramework

Highlights

1. How the structure, resources and resilience of communities mediate the impact of SDoH

2. Why we need to take SDoH into account in health service planning and delivery

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Building Solutions → Comprehensive Health Equity Strategy

Need comprehensive strategy to address the foundations and impact of health inequities →

+ Macro social and economic policy to reduce overall inequality• from childcare through improving precarious employment to education

+ Comprehensive community initiatives to build resources and resilience+ Community mobilization to push for necessary policy changes

Even though roots of health disparities lie in far wider social and economic inequality, how the health system is organized and how services and care are delivered is still crucial to tackling health disparities, including:

• Reducing barriers to equitable access to high quality care• Targeted interventions to improve the health of the poorest, fastest• Up-stream investments in primary and preventative care directed to

most vulnerable• Delivering a full continuum of services in coordinated way at

community/local level

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Part of the Solutions:Community-Driven Innovation

Need innovative community-based service delivery and partnerships

Peer Health Ambassadors• Members of the community, from the community• Working with established healthcare providers to improve

access and quality of care for targeted populations

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Our ResearchPurpose• Survey the range and impact of Peer Health Ambassadors• Assess their potential to meet needs of marginalized

populations• Identify key success conditions and enablers to realize this

potential

Methods• Review of literature• Key informant interviews with 10 Toronto community

organizations currently working with peer-based models

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Findings:Great Potential

General congruence between literature review and key informant interviews:• Peer Health Ambassadors are a promising model for

improving health equity through eliminating barriers to health care and improving engagement

• Marginalized groups prefer healthcare providers who have personal experience with their problems, who understand their viewpoints, and who share key traits (race, gender, religion, sexuality, cancer, drug use, etc.)

• When community impact is reported, the results are generally very positive

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Findings:Characteristics of Peer Health

Ambassadors• Wide range and no clear definitions of ``peer``

• Varies in level of expertise and “peerness”• Three broad areas:

• navigating the system• health promotion• integrated into comprehensive service provision

• Volunteers vs. paid staff• Tend to be women

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Findings:Facilitators to Effectiveness and Impact

• Financial compensation• Initial and ongoing training/support/mentoring for peers• Clear roles and division of labour + flexibility to accommodate

dynamic needs of both peers and communities being served• Participation of peers in program or service planning and

development• Rigorous quality assurance at every stage• Program evaluation to improve practices

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Findings:Barriers

• Peer life-stage, ability to adapt their own health and lifestyle to work environment

• Breach of peers’ personal boundaries by clients and co-workers, because of the highly personal nature of this work

• Organizational capacity to support peer needs, service demands and client expectations

• Client preferences for credentialed professionals or specific delivery settings

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Findings:Barriers (cont’d)

• Resistance from professionals or institutions to community-based delivery

• Mainstream marketing doesn’t work for marginalized populations

• Unstable funding• Scaling up to larger projects

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Realizing the Potential of Peer Health Ambassador Initiatives

• Enlist users in planning and development• Provide ongoing training and support, driven by peer and

community needs• Provide financial compensation, even during training• Allow for adaptability and flexibility of training and program

to suit the needs of peer workers and clients• Monitor and evaluate for quality• Market the services using mediums that can reach the target

population• Actively pursue alternative funding sources

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Key Messages• Need comprehensive strategy to address health inequities• Part of this is ensuring equitable access to high-quality care

for all – even the most vulnerable and isolated• Peer ambassador type initiatives have shown great potential

in being able to reach, support and involve marginalized populations

• In line with key themes of this conference:• Address complexity of social determinants of health through flexible

and creative policy, programs and collaboration• Build on potential of community initiatives and innovation• Build on community empowerment and engagement

THANK YOUPlease visit us at

www.wellesleyinstitute.com