My new health equity position: Where do I start?
Guest blogger Christine Johnson
I joined the public health team at the Guysborough Antigonish Strait Health Authority (GASHA) in Nova Scotia as Health Equity Lead in June of 2014. The pressing questions for me were: Where do we start with health equity? What tools can we use to do health equity work? This blog describes my initial work in matching the NCCDH’s four "Public Health Roles for Improving Health Equity" with concrete examples and tools. This piece of work gave me some sense of ‘where to start.’ Public Health Roles for Improving Health Equity.
This fall I was asked to present a workshop on health equity at a shared service area, all-staff day in western Nova Scotia. While my position is based in Antigonish, part of my mandate is to connect province-wide around health equity. As the name suggests, all-staff days are attended by everyone in public health, from administrative support to directors. I worked with the area’s Director of Public Health and Medical Officer of Health, and the NCCDH (which is conveniently located, for me, in Antigonish) to design the workshop. Our challenge was to find approaches and tools that could speak to people in all of these job positions, not just program planners and decision makers. How does a health promoter speaking to municipal council, or an administrative assistant tracking participation rates, incorporate health equity thinking? How could we highlight that everyone has a role to play in health equity action?
We offered two, hour-and-a half interactive sessions on health equity to two small groups. Karen Fish from the NCCDH gave participants a chance to reflect individually and in small groups on what creates and maintains disadvantage. Then the area’s Medical Officer of Health, Lynda Earle, presented her group’s key learnings from piloting a health equity lens tool to local influenza planning. In the final segment, I presented the four roles as a broad framework for public health action and, to make those roles come to life, gave specific examples of local level actions as well as a tool that could further support work within each role. The roles, actions and tools are summarized below:
Assess and report - Assess and report on a) the existence and impact of health inequities, and b) effective strategies to reduce these inequities.
- A local level example: “Understanding Our Health Community Profiles” compiled by Public Health which detail various health and socio-demographic characteristics of community members.
- A tool: from the Support Tools for Evidence Informed Policy Making series: Taking equity into consideration when assessing the findings of a systematic review. This tool supports an evidence-based approach that considers equity when planning interventions.
Modify and orient interventions - Modify and orient interventions and services to reduce inequities, with an understanding of the unique needs of populations that experience marginalization.
- A local level example: the application of a health equity lens to influenza planning.
- A tool: Health Equity Mapping Checklist developed by the Sudbury & District Health Unit to support program planning and monitoring. The tool can be applied to a program to assess which determinants of health are addressed and how access considerations are applied.
Partner with other sectors - Partner with other government and community organizations to identify ways to improve health outcomes for populations that experience marginalization.
- Local level example: coalitions addressing determinants of health such as poverty and housing.
- A tool: in the inclusion checklist from the Inclusion within Activating Change Together for Community Food Security: Overview and Worksheet which supports groups in considering and incorporating inclusion strategies when planning meetings and community events that aim to engage diverse partners.
Participate in policy development -Lead, support and participate with other organizations in policy analysis and development, and in advocacy for improvement in health determinants and inequities.
- Local level example: participation in municipal planning processes as well as the development of position statements and advocacy frameworks for public health.
- A tool: produced by GASHA Public Health, this tool was designed to support practitioners in communicating more clearly and persuasively about the social determinants of health and health equity. The tool is designed to help public health reach a broader audience, and encourage an understanding of the importance of the underlying environments and conditions that shape our health. We use this tool to create messages.
Reflecting on this workshop, two main messages emerged: 1) we can be assured that we are already doing health equity work, but there is more to do, and 2) there is a wealth of tools that can support us in this work. However, a tool is simply a device that can assist us in accomplishing a task, and tools can be adapted for our local context. Feedback from the session indicated that while participants still felt overwhelmed by how to go about equity work, the opportunity to test out a tool in their own contexts had cracked some of the fear about starting a health equity action.