Sharing your passion for health equity: Building our collective understanding

April 9, 2013Charlottetown, PEI

The 10 Promising Practices for Advancing Health Equity

Hannah Moffatt Knowledge Translation Specialist

Public health roles for health equity1. Assess & report on: a) the existence & impact of

health inequities, & b) effective strategies to reduce these inequities.

2. Modify & orient interventions & services to help reduce inequities, with an understanding of the unique needs of populations that experience marginalization.

3. Partner with other government & community organizations to identify ways to improve health outcomes for populations that experience marginalization.

4. Lead, support & participate with other organizations in policy analysis & development, & in advocacy for improvements in the determinants of health.

Forthcoming, NCCDH 2013

10 Promising Practices to Reduce Social Inequities in Health

• Intersectoral action

• Targeting with universalism

• Purposeful reporting

• Social marketing• Health equity target

setting

• Equity-focused health impact assessment

• Competencies/organizational standards

• Contribution to evidence base

• Early childhood development

• Community engagement

http://nccdh.ca/resources/entry/10-promising-practices-guide

Sudbury & District Health Unit 2009

Competencies & Organizational Standards• Guide public health practice • Competencies - essential knowledge, skills and

attitudes• Organizational standards - internal guidelines used

by organizations to outline expected levels of service and to provide benchmarks for performance and accountability

Core Competencies & the Determinants of Health

• An assessment and comparison of determinant of health content in the Core Competencies for Public Health in Canada

• The explicit inclusion of determinants of health in public health competency statements ensures that action on the determinants is a visible and concrete part of public health practice

http://nccdh.ca/resources/entry/core-competencies-assessment

An Assessment and Comparison of Determinants of Health Content

• The determinants of health are throughout PHAC’s Release 1.0

• The references are often general, implicit and contained in sections other than the Core Competency Statements (e.g., values; examples)

• International sets of competencies were sometimes more explicit in their inclusion of health equity work

Organizational Standards as a Promising Practice for Health Equity: Conversations with Public Health Experts• Four public health experts interviewed about

their experiences and reflections on the conceptualization, development, and implementation of organizational standards

We have also been able to use the Standards as a bit of a rallying cry to encourage other partners to work with us. We’ve been able to leverage the requirements and the societal goals as a conversation starter to say, ‘we need to work together on this’ – Dr. Rosana Pellizzari

Forthcoming, NCCDH 2013

Nova Scotia Public Health Standards

• The work of public health is grounded in: – health equity and

social justice – the principles of the

Ottawa Charter for Health Promotion

• Requirements for Health Equity and Social Justice

We interviewed the usual and unusual suspects and it just became clearer and clearer to us across the health system that there was no one area that really took health equity on. And it became clearer and clearer through our process that this could be a very strong role for public health. We couldn’t walk away from that role. – Janet Braunstein Moody

http://www.gov.ns.ca/hpp/yourmove/Public_Health_Standards_EN.pdf

Intersectoral Action• The solutions to health inequities lie outside the health sector • To intervene on the social determinants of health partnerships

are required• Strong relationships, common understanding, shared

objectives

What’s the evidence? Intersectoral Action

• What is the impact/effectiveness of intersectoral action as a public health practice for health equity?

• Rapid systematic literature review

– Total of17 articles included: 1 systematic review, 14 quantitative studies & 2 qualitative studies

– Difficult to determine how observed outcomes relate to intersectoral action http://nccdh.ca/resources/entry/asses

sing-the-impact-and-effectiveness-of-intersectoral-action-on-the-SDOH

General Implications of the Review

• positive effect for children, especially for early literacy among children of low-income mothers

Intervene in early childhood

• improve housing and employment conditions, evidence of impact for other social determinants of health is limited

Upstream interventions

• employment/working conditions, child literacy, dental health, housing, and organizational change

Midstream interventions

• increase access to oral health services, immunization rates, appropriate use of primary health care services, and referrals from school readiness checks.

Downstream interventions

Intersectoral Action: Sudbury & District Health’s

Experience• Poor housing conditions

in rural and northern regions

• Vulnerable individuals, limited resources

• Going “above and beyond”

• Referral to or consultation with community partners– Relationships

– Clarity of roles Sudbury & District Health Unit, 2010http://www.sdhu.com/uploads/content/listings/ExecSummary_TheRoleofPublicHealthInspectors1.pdf

Community Engagement• Involving the community in the development,

implementation of policies, programs and services• Empowering communities, building relationships • Interventions are more likely to be appropriate and

response

What’s the evidence? Community engagement

• Review of reviews on community engagement, the social determinants of health and health equity

Questions:• What is the impact (direct and indirect) of community

engagement on the community and community members who are involved?

• What is the experience of community engagement for the communities and/or community members involved? – How are power and control in interventions addressed? – What role do communities play? – What is the quality of the engagement?

Coming soon from NCCDH

• What level of engagement occurs? Are different levels of engagement associated with different outcomes?

• What are the processes and approaches for community engagement? How can public health implement an inclusive practice at all levels of the planning cycle? What is the optimal intensity of community engagement?

(Expanded and adapted from Kelly et al, 2007:63-64 and Popay et al. 2007)

What’s the evidence? Community engagement

Community Engagement: New Brunswick’s Experience

• Empowering communities to address poverty

• 2500 residents contributed to the development of the plan

• Local organizations & unusual suspects

http://nccdh.ca/resources/entry/casestudy-NB

Purposeful Reporting•Intentionally reporting the relationship between health and social determinants of health •Measuring the breadth and depth of health differences – stratifying by socioeconomic status, using indicators •Guide future interventions, assess the impacts of interventions

Population Health Status Reporting • A “Learning Circle” to help modify population health

status reporting to advance equity

What is a health status report and why is it important?“A report that doesn’t get used won’t help us to advance health equity.”

Selecting health status indicators

http://nccdh.ca/resources/entry/population-health-status-reporting

“… every indicator has advantages and disadvantages and needs to be considered in context. There is no such thing as a “perfect” health inequality indicator.”

Learning Together Series

Population Health Status Reporting

• A knowledge translation tool that seeks to: o Effectively disseminate information o Facilitate intersectoral collaboration

by demonstrating links between sectors

o Result in action

• An iterative process• Requires a culture of using evidence to inform decisions

Purposefully Reporting: Saskatoon’s Experience

• Population health status reporting

• Conducted over 200 community consultations

• Gather opinions to rank recommendations

http://nccdh.ca/resources/entry/casestudy-SK

Contact Us National Collaborating Centre for Determinants of

HealthSt. Francis Xavier UniversityPO Box 5000 , Antigonish, NS B2G 2W5

Email: NCCDH@stfx.ca

Phone: (902) 867-5406 Fax: (902) 867-6130 www.nccdh.ca and www.ccnds.ca

@NCCDH_CCNDS