Letting experience speak: Addressing health equity in environmental public health
Over the past few years, there are two big things I have gained a bigger appreciation for in my work. One is that the more I talk to people, the more I learn about what really needs to be done and what works. The other is that there are different types of knowledge, and the type that is most applicable depends on the issue and context at hand. There aren’t many randomized control trials for how to address health equity in public health, for example, so we often need to draw on promising practices in the field, and from the experience of people who are out there doing the work.
The National Collaborating Centres for Determinants of Health (NCCDH) and Environmental Health (NCCEH) have been collaborating since 2013 to draw attention to the role that public health inspectors (PHIs, also known as environmental health officers, or EHOs) can play in addressing the social determinants of health (SDH) and health equity in their public health practice. This partnership has resulted in several products – a pilot study, practice stories, practice framework, and reading list. Because there is very little scientific literature about the role of PHIs in addressing health equity, the ideas for these products came up through conversations during workshops and through connections made before, during, and after events. During the national conference of the Canadian Institute for Public Health Inspectors (CIPHI) in 2016, in combination with the CIPHI conferences for New Brunswick and Nova Scotia shortly after, a number of themes came up that reflected what we learned from these events and provided direction for future areas of focus.
Some resource needs were identified including training related issues, such as integrating the concepts of SDH and health equity into education and practicum placements for PHI students, along with competencies and skill development for current professionals. Tools and data to help identify vulnerable groups, and practice stories to illustrate examples of action were mentioned as ways to help demonstrate the link between environmental public health (EPH) practice and health equity. Policies and guidelines that apply to PHI practice and allow for an upstream approach were also thought to be necessary.
Another area of focus emerged around the need to overcome challenges faced by PHIs to integrating equity into their practice. Clarifying when SDH are within the scope of practice for PHIs, integrating health equity concepts into work plans, and having organizational supports such as dedicated equity staff within environmental public health (EPH) programs were described as assets when PHIs don’t know how or when to address equity issues. Not having dedicated time to address SDH was thought to be one of the biggest challenges. Recognizing work done by PHIs in the area of SDH and providing guidelines for how to balance regulatory requirements with addressing underlying SDH-issues would create support for PHIs to spend time addressing health equity.
Identifying opportunities to integrate best practices into a PHIs role was also identified as a theme. Leadership support from managers and others at the executive level is thought to be critical for allowing PHIs to directly address SDH and health equity. Being able to work with other disciplines within and outside of public health allows for collaboration across sectors. Evaluation of programs, sharing of practice stories, and communication channels that support problem-solving among public health staff provide for sharing of successes and identifying opportunities for improvement.
Our colleagues at NCCEH have produced a detailed summary of the themes heard at these CIPHI events. In the coming year, we plan to expand work about how these issues affect the practice of PHIs to try and address the proverbial questions – HOW do I do this and WHAT do I do? Pursuing opportunities to support the integration of SDH and health equity into the education and professional development of PHIs, a workshop on addressing the organizational capacity for PHIs to do equity work, and continued gathering and dissemination of promising practice examples are among what is in store for 2017.