Two Manitoba health authorities rise to the challenge!
We often get asked “How?” How does a public health agency identify actions that can be taken to address health equity? How can a smaller agency balance the need to address equity with other population health needs? How can a health unit/authority integrate equity and social determinants of health (SDH) into what guides their day-to-day work? Two rural Manitoba health units have given us a “how” option.
Integrating equity and SDH into a community health assessment provides opportunities for a few things. It specifically names indicators that point to health inequities, such as housing and the socioeconomic factor index. It provides visual and tangible information to educate staff and partners about the existence of health inequities in the population. And by identifying inequities in an official document, it also demonstrates the need for committing resources to address them.
Southern Health has just released their Community Health Assessment. This document uses the health indicator framework outlined by the Health Council of Canada that puts the concept of equity at the centre of all the indicators measured. The concepts of equity and equality are explained, and health disparities are identified as a key theme of the report. The Executive Summary pulls out key statistics related to health disparities in the region. The assessment incorporates a magnifying glass graphic beside indicators that show differences in health status among groups within regional populations - this makes it very easy to see where disparities exist and find the statistics about that region. Quotes from individuals and organizations are woven throughout, and the report contains a section on community engagement. You can read residents’ voices about the causes of inequities and possible actions.
Prairie Mountain Health has also just released the first comprehensive Community Health Status Report for the region. An introductory message from the Medical Officer of Health quotes: “We need to acknowledge that health services are solely one component of the broad factors that determine our health”, positioning leadership as a driver to address health equity. Equity and equality are explained, and a description of 12 key determinants of health that forms the framework for the indicators is included. A section called “Mind the Gap” outlines how the equity gap continues to widen and inequities still exist and may worsen as the health status of lower income areas improved more slowly as the health of some segments of the population (e.g., more affluent) improves. Indicators specific to measuring health equity included Disparity Rate Ratio (DRR; relative increase/decrease in inequality) and Disparity Rate Difference (DRD; how many events occur in lowest vs. highest income quintile). Clear explanations are given linking individual indicators to health, such as employment and housing, as well as the relationship between indicators (e.g., unemployment linked to poor health, and is associated with difficult living conditions, low socioeconomic status, and social problems). Evidence for the link between income and chronic diseases is woven throughout the report. And explanations of the relationship between individual indicators and equity are provided throughout the report.
It is important that a community health assessment/status report incorporates equity related themes and data. Applying this data to program and operational plans is the critical next step. Describing how specific indicators impact health equity shifts the focus beyond just reporting data and moves it towards understanding the health impact of those indicators. Where equity is positioned as a key theme, it is then important to avoid the tendency to base recommendations on the need for improved individual lifestyle choices.
We would like to highlight other examples like this! Tell us when your agency incorporates the SDH and health equity into a community health report. E-mail me firstname.lastname@example.org with any examples or ideas you have about this!