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Promising practices in suicide prevention across Inuit Nunangat: NISPS research and data collection project

This resource is available in English only.

The National Inuit Suicide Prevention Strategy

With the publication of the National Inuit Suicide Prevention Strategy in 2016, Inuit Tapiriit Kanatami (ITK) launched a rich discussion on both protective and risk factors for suicide in Inuit communities. The organization also used the resource to identify six priority action areas for action regarding suicide, such as creating social equity and mobilizing Inuit knowledge for resilience.

Contribution to the evidence base

This 2019 environmental scan provides an update on the state of knowledge as the 2016 strategy continues to be funded and implemented. Moreover, it shares what tractics are currently in place to address the disproportionate rate of suicide across the four regions of Canada’s Arctic that make up Inuit Nunangat.

Drawing from a review of grey and academic literature, as well as interviews with key informants, the scan presents findings and promising practices across six topic areas:

  • Links between childhood adversity and suicide;
  • Promising practices with respect to addressing child sexual abuse across Inuit Nunangat;
  • Promising practices with respect to social emotional development in Inuit Nunangat;
  • Promising practices with respect to safe shelters focusing on children and youth within Inuit Nunangat;
  • Promising practices with respect to current supports for Inuit within the justice system with a specific focus addressing child sexual abuse; and
  • Promising practices with respect to parenting and family support programs. (p. 11)

Gaps and opportunities

The results of this scan include many promising practices for suicide prevention identified by key informants. These practices are summarized in section 4.8 (p. 67) and include:

  • hiring and training local people to deliver programs;
  • involving elders in programming as often as possible;
  • moving slowly at early stages or program delivery; and
  • being responsive to changes suggested by community members.

Upstream interventions

Readers may also wish to note that promising upstream interventions for Inuit children and youth are most discussed in the context of

  • addressing child sexual abuse (section 4.3, p.23);
  • supporting social and emotional development (section 4.4, p. 32);
  • ensuring access to safe shelters and spaces; and
  • supporting parents and families (4.7, p.59).

Use this resource to

  • increase your overall understanding of Inuit suicide prevention, including the current state of knowledge, available programs and services, challenges and opportunities;
  • reflect on the six priority areas and their related promising practices; and
  • consider how the knowledge shared relates to public health programming in your jurisdiction, particularly if you are working within Inuit Nunangat.

Reference

Inuit Tapiriit Kanatami. (2019). Promising Practices in Suicide Prevention across Inuit Nunangat: NISPS Research and Data Collection Project. Ottawa (ON): Inuit Tapiriit Kanatami.

Related resources

Tags: Assess and report, Community engagement, Indigenous health , Mental Health, Community Organization, Link

Building organizational capacity for health equity action: A framework and assessment tool for public health – Summary report

This resource is available in English only.

Public health’s ability to address the social determinants of health (SDH) and health equity at a population level is complex and extends far beyond individual practitioner skills and knowledge. Recognizing this, Lambton Public Health developed a framework and assessment tool to identify key elements of public health organization-level capacity for action on health equity. 

Framework

The Conceptual framework for health equity action in public health (p. 11) describes both internal and external drivers that influence capacity for action on health equity at an organizational level. Internal drivers (p. 11-12) include leadership, formal and informal systems, resources, accountability, partnerships and governance structures. External drivers (p. 14) include policies, health threats, data, public interest, political will and “best evidence.”

The framework further explores how the internal drivers that influence how individuals take action play out within the broader organization, which functions within a dynamic and complex array of system level influences. For example, individual practitioner knowledge, skills and values are influenced by organizational processes and structures, including standards of practice, internal work culture and professional competencies. In turn, public policies, threats to health, epidemiological evidence, political will and public interest influence where organizations focus attention, which also framed how individuals can take action.

Assessment tool

As part of the same document, Lambton Public Health also created an assessment tool (p. 17) to support public health organizations as they identify existing components of organizational capacity and areas to be strengthened.

This resource includes checklists to identify elements of organizational capacity at the individual, organization and system levels, with the goal of developing “capacity-building action plans” in order to amplify action on health inequities.

A template for calculating and evaluating a team or department’s cumulative scores (p. 29) provides guidance in interpreting results and making recommendations for increasing capacity to address health equity.

Use this resource to

  • facilitate discussion with public health colleagues about organization level factors that influence practitioner action on health equity;
  • conduct an assessment of factors that currently exist and where there are gaps at the individual, organization, and system levels of the organization; and
  • develop an action plan to strengthen organizational capacity to take action on SDH and health equity.

Reference

Lambton Public Health. (2017). Building Organizational Capacity for Health Equity Action: A Framework and Assessment Tool for Public Health. Point Edward, ON; Lambton Public Health.

Related resources

Tags: Competencies & organizational standards , Leadership & capacity building, Public health unit / health authority, Public Health Organization, Document

Driving forward health equity – the role of accountability, policy coherence, social participation and empowerment

This resource is available in English and Polish only.

As part of the World Health Organization (WHO) European Health Equity Status Report initiative, this summary report presents the findings of a scientific expert review on the lack of progress in health equity in the region, despite significant investment to address individual determinants. Presenting their results in four related reports, the review panel found that accountability, policy coherence, social participation and empowerment were key drivers of health equity. In other words, when these drivers were present, there was greater action to reduce health inequities.

Corporate influence

The report considers the increasing effect of corporations on progress towards health equity, and discusses the importance of these key drivers in mitigating negative effects of the “commercial determinants of health.” The authors give equal attention to the idea that integrated governance is essential for policies that are coherent across levels of government and different sectors.

Throughout this work, accountability, policy coherence, social participation and empowerment are conceptualized as related and even synergistic “common goods.” This means that when accountability is ensured, when policy is aligned and coherent across governments and across sectors, when society is well represented and participates in decision-making and policy processes and when communities are empowered, human rights principles are at play.

As a result, there are multiple benefits (outlined in Table 1 on p. 7 of the summary report), and there is an overall positive effect on health equity. 

The following advice is given to those working in public health and policy:

  • Value the knowledge and experience of communities.
  • Make the most out of “empowering spaces” (e.g., community gatherings).
  • Stop using “stigmatizing narratives of disadvantage.”

Note that the WHO Regional Office for Europe has published three additional reports related to this summary:

Use these resources to:

  • reflect on the applicability of accountability, policy coherence, social participation and empowerment as drivers for health equity action in the Canadian context;
  • consider the multiple benefits of these key drivers; and
  • discuss, with your public health colleagues, how to better value the knowledge and experiences of communities, make the most of “empowering spaces”, and change stigmatizing narratives.

Reference

WHO Regional Office for Europe. (2019). Driving Forward Health Equity – the Role of Accountability, Policy Coherence, Social Participation and Empowerment. Copenhagen (Denmark): WHO Regional Office for Europe.

Related resources

Tags: Community engagement, Healthy public policy, Key concepts, Public Health Organization, Link

Achieving health equity for LGBT people

This resource is available in English only.

Achieving Health Equity for LGBT People is an interactive online module developed by the National LGBT Health Education Centre, an organization working to address healthcare disparities that affect LGBTQ (lesbian, gay, bisexual, transgender, queer) people. The module explores health inequities experienced by the LGBTQ community, deepens understanding of core concepts and definitions, and identifies strategies to improve health care for LGBTQ people.

Support for LGBTQ health

Components of the module include the importance of addressing LGBTQ health broadly, including aspects of stigma and discrimination as well as influence on life course trajectories for LGBTQ people. Definitions and core concepts are provided to identify common terminology and increase understanding across sectors and groups.

The resource also offers strategies for supporting LGBTQ people in a clinical setting, including clinical education for culturally sensitive care for LGBTQ communities and a focus on specific issues, such as HIV, smoking/tobacco use and preventive cancer care.

Relevant to public health practice

The module houses segments on LGBTQ youth and creating sensitive and caring environments to serve LGBTQ communities that draw attention to the context of family dynamics and acceptance by healthcare providers.

While the content is largely clinical in focus, there are components that are particularly pertinent to public health practice, such as:

  • information about connecting to services across sectors,
  • advice about collecting and presenting data about LGBTQ populations; and
  • context around the socioeconomic factors that affect health disparities among LGBTQ people.

A glossary of terms related to LGBTQ health provides an opportunity to create common understanding and strengthen communications.

Online modules

Users can access the interactive online module, as well as download PPT slides for later reference. The data and terminology are U.S. based, though core concepts apply to the Canadian context.

Users will need to register with the National LGBT Health Education Centre by creating a username and password to access the modules. Users can opt out of continuing education credits and for receiving e-mail notifications. If the modules do not function in one internet browser, open them in a different browser for full functionality.

Use this resource to:

  • deepen understanding of core concepts related to inequities experienced by LGBTQ communities;
  • facilitate a cross-sector discussion about how public health and primary care can collaborate to reduce LGBTQ health inequities; and
  • initiate discussion with organizations to develop and sustain meaningful engagement with LGTB communities.

Reference

National LGBT Health Education Centre. (n.d.). Achieving Health Equity for LGBT People [Online module]. Retrieved from: https://www.lgbthealtheducation.org/learning-module/achieving-health-equity/.

Related resources

Tags: Access to health services, Community engagement, Sex & gender, Community Organization, Link

Learning Essentials for Advancing Health Equity series

This resource is available in English and French.

The Learning Essentials to Advance Health Equity series is a collection of resources developed as part of the Building Capacity for Equity-Informed Planning and Evaluation Project, a partnership between the Alliance for Healthier Communities and Access Alliance Multicultural Health and Community Services.   

The goal of this project was to develop tools and resources that support organization-level capacity for community health centres (CHCs) to address inequities in healthcare access, healthcare quality and health outcomes.

The series includes a number of health equity learning modules on the basics of health equity concepts, using data to advance health equity efforts and evaluating improvements to health equity. It also offers tools to assess baseline health equity status, data collection and analysis to assess client needs, and planning tools such as a project charter and evaluation guide.

Additional tools for planning evidence reviews, employment surveys and other information gathering and analysis to support organization level capacity building are also offered.

Resource inventory

A resource inventory for healthcare organizations (available in English only) offers a framework to guide capacity-building to address health equity at multiple levels of a community health organization.

 It includes tools mapped onto each domain of the framework and subject area. The framework, tools and concepts can be adapted to various organizations and areas of public and community health practice.

Use this resource to

  • facilitate discussion about what components of organization-level capacity for health equity action are strong or need improvement in your organization;
  • assess how current programs and approaches address health equity and where they could be improved; and
  • develop a professional development plan to strengthen knowledge about organizational capacity to take action on health inequities in healthcare access and outcomes.

Reference

Alliance for Healthier Communities. (2018). Learning Essentials for Advancing Health Equity Series. Alliance for Healthier Communities and Access Alliance Multicultural Health and Community Services; Toronto (Ont).

Related resources

Tags: Leadership & capacity building, Methods & tools, Modify & orient, Public Health Organization, Link

Social determinants of health: Know what affects health

This resource is available in English only.

This website from the Centers for Disease Control and Prevention (CDC) provides links to CDC resources, tools and evidence to support public health, community organizations and healthcare professionals in taking action to address the impact of social determinants of health (SDH).

Resource groupings

Resources are offered in several groupings that align with the delivery public and community health services to facilitate uptake into both responsive and long-term practice:

  • “Know What Affects Health”: A broad overview of how SDH influence health, as well as a link to health system transformation and community wide approaches to show positive health outcomes and economic benefits.  
  • “Sources of Data on SDOH,” including disease rates and vulnerability indicators
  • “CDC Research on SDOH,” including the influence of economics, education, socioenvironmental context, healthcare and built environment on health outcomes  
  • “Tools for Putting SDOH into Action,” including best practices, data set directory, toolkits and program-specific guides to addressing SDH.
  • “CDC Programs Addressing SDOH,” such as built environment, lead poisoning, leadership, partnership, violence and race-based disparities in health.
  • “Policy Resources to Support SDOH,” such as chronic disease tracking, health impact assessment and intersection with non-health-specific policy approaches
  • Additional links to further resources and FAQs are also provided

While many of the tools and data sources are US based, most can provide a template for strategies and approaches that could be applied to the Canadian public health context, including place-based framework and research on social and community context.  

Use this resource to

  • initiate discussion about reorienting community and public health programs and services to address the impact of SDH on health outcomes; and
  • support reorienting non-health-specific policy approaches to better address the impact of SDH on health outcomes

Reference

Centers for Disease Control and Prevention. (2018). Tools for Putting Social Determinants of Health into Action. Centers for Disease Control and Prevention, Social Determinants of Health; US Department of Health and Human Services.

Related resources

Tags: Healthy public policy, Methods & tools, Modify & orient, Public Health Organization, Link

Towards a social justice approach to comprehensive tobacco control

This resource is available in English only.

Eliminating differences in tobacco use between different groups negatively affected by the social determinants of health can help achieve health equity. The development and adaptation of tobacco control policies has influenced health inequities among populations that have the highest rates of smoking.

The Propel Centre for Population Health Impact and the Program Training and Consultation Centre have compiled literature to guide strategy and intervention development to reduce health inequities in community and population health tobacco control initiatives.

Policy intervention

This evidence review identified taxation on tobacco products as the policy intervention with the greatest potential to reduce inequities in tobacco use based on socioeconomic status. Other strategies commented on include smoking bans, retail outlets, mass media campaigns, school-based interventions, multijurisdiction policies and cessation supports.

Implications of the evidence

The implications of this evidence for research, policy and practice support the use of tobacco control policies grounded in social justice principles as a strategy to reduce tobacco use among populations who live in low socioeconomic contexts.

Separate recommendations for researchers, practitioners and policy-makers are outlined to guide their work towards addressing inequities in tobacco use. An appendix describing six examples of tobacco control interventions with a social justice perspective is also included.

Use this resource to:

  • facilitate discussion about unintended impact of tobacco control programs that may actually increase or worsen health inequities;
  • support programs and interventions on tobacco control that directly address the social determinants of health and health inequities at a community and population level; and
  • develop a tool that identifies areas within tobacco programs and policies that can be improved to address the socioenvironmental conditions of tobacco users.

Reference

Hyndman, B., Corvaglia-Douglas, O., Lambraki, I., Honsberger, N., Garcia, J. (2018). Towards a Social Justice Approach to Comprehensive Tobacco Control. Toronto: Program Training and Consultation Centre and the Propel Centre for Population Health Impact, University of Waterloo.

Related resources

Tags: Knowledge translation , Modify & orient, Policy analysis, Public Health Organization, Link

National Inuit climate change strategy

This resource is available in English and French.

This informative strategy asks readers to ethically partner with Inuit communities while contributing to climate policy at all levels.

Situating climate change as a current crisis with health equity impacts

Canada’s 51 Inuit communities are already experiencing and responding to significant climate change impacts. Projections for further changes are dire, including further loss of sea ice and thawing permafrost. Graphics on pages 11-14 help illustrate the interaction of these changes with existing inequities such as access to traditional foods, cultural practices, safe and affordable housing, and health services. The relationship between climate change, health and wellness is further explained on page 22.

Drawing on Indigenous knowledge and resilience

In his opening letter, Natan Obed, president, Inuit Tapiriit Kanatami, highlights the resilience and strength that has been required to deal with the lasting impacts of colonialism, and notes that this same resilience will continue to be key in addressing the current climate emergency affecting Inuit Nunangat. Self-determination is central to this strategy, with particular attention to Inuit-led research, action and partnerships driven by Inuit needs. Case studies of Inuit-led climate initiatives are effectively used throughout the document.

Five priority climate actions

The strategy identifies five interrelated priorities for climate action, including “improv[ing] Inuit and environmental health and wellness outcomes through integrated Inuit health, education and climate policies and initiatives” (p. 22). Each priority area is accompanied by a clearly stated objective and related actions. The report is also accompanied by a framework for collaborating with Inuit on climate actions (p. 28) and a strategy implementation guide (p. 37).

Use this resource to:

  • increase your understanding of how the changing climate compounds health inequities for Inuit;
  • reflect on how the recommended priority climate actions relate to your public health work;
  • review examples of Inuit-led climate action; and
  • learn how to work with Inuit communities and participate in policy development related to climate action.

Reference

Inuit Tapiriit Kanatami. (2019). National Inuit Climate Change Strategy. Ottawa: Inuit Tapiriit Kanatami.

Related resources

Tags: Assess and report, Climate change, Environmental health, Indigenous health , Key concepts, Link

Health Inequities Series fact sheets

This resource is available in English only. Click here to access the printable version.

The Core Competencies for Public Health in Canada include the requirement that public health practitioners demonstrate knowledge and understanding of the social determinants of health (SDH) and health inequities. The Health Inequities Series, developed by Kingston, Frontenac, Lennox and Addington Public Health (KFLAPH), is a set of fact sheets designed to support professional development and competence in understanding and applying the underlying concepts related to SDH and health inequities and how they relate to public health program standards.

The fact sheets (available in interactive PDF and printable form) are designed for use by formal leadership as well as staff in programs, communications, evaluation, research and data, as well as anyone who wants to gain a better understanding of concepts related to health equity.

Based on the four public health roles

Content includes definitions of key terms such as structural and intermediary determinants, socioeconomic position and context, social hierarchies and working upstream. A series of fact sheets is divided into four sections —Assess and Report, Modify and Orient, Engage with Other Sectors, and Participate in advancing healthy public policies — which align with requirements within the Ontario Public Health Standards (OPHS) Health Equity Guideline, based on the NCCDH resource Let’s Talk: Public health roles for improving health equity.

Each section outlines ways that various public health practitioners at different levels of the public health system can use the resources, tailoring the application of the concepts to specific roles. Links to additional resources within each section/role are also provided, including an extensive list of citations and glossary of key terms.

Use this resource to:

  • facilitate discussion with colleagues about health equity requirements within public health standards, and how these influence program planning, implementation and evaluation;
  • develop a plan for professional development to strengthen knowledge of health equity concepts on an individual or organizational level, including quality improvement plans; and
  • identify areas for practitioner training and education as a way to build organization-level capacity to address health equity.

Reference

Kingston, Frontenac, Lennox and Addington Public Health. (2019). The Health Inequities Series. Kingston: Kingston, Frontenac, Lennox and Addington Public Health.

Related resources

Tags: Communicate, Competencies & organizational standards , Public health unit / health authority, Public Health Organization, Document

Just societies: Health equity and dignified lives

This report is available in English and Spanish only.

This report by the Pan American Health Organization’s Commission on Equity and Health Inequalities in the Americas examines social and economic inequalities in the regions, and considers several related factors such as gender, sexuality, ethnicity, disability and daily living conditions. An expanded list of the structural drivers of inequities also play prominently into the analysis.  

Conceptual framework

The conceptual framework presented in this report (p. 9) builds on the work of the previous World Health Organization Commission on the Social Determinants of Health, making several important additions:  

  • The list of structural drivers expands beyond the political, social, cultural and economic, emphasizing the natural environment and climate change and the ongoing impact of colonialism and structural racism.
  • Intersectionality is shown at the top of the framework as an ever-present frame, and sexuality, disability and migration are explicitly named.
  • Governance and human rights action on both structural drivers and the conditions of daily life are named as pathways to health equity

In sections three to five, the report makes 12 recommendations, presenting each with a table of specific objectives and concrete actions.

  1. Achieving equity in political, social, cultural, and economic structures
  2. Protecting the natural environment, mitigating climate change, and respecting relationships to land
  3. Recognize and reverse health equity impacts of ongoing colonialism and structural racism
  4. Equity from the start––early life and education
  5. Decent work
  6. Dignified life at older ages
  7. Income and social protection
  8. Reducing violence for health equity
  9. Improving environment and housing conditions
  10. Equitable health systems
  11. Governance arrangements for health equity
  12. Fulfilling and protecting human rights.

Case stories

The report is made more readable by the inclusion of case stories and highlights from initiatives across the Americas. Readers will also find the connections drawn between the information in the report and other agreements useful (e.g., United Nations Sdustainable Development Goals and relevant PAHO resolutions).

Use this resource to:

  • reflect on an updated conceptualization of the structures that drive inequities in the Americas;
  • consider the 12 recommendations and their related actions as you engage in health equity–related policy and program development; and
  • design related continuing professional development opportunities for your team.

Reference

Pan American Health Organization. (2018). Just Societies: Health Equity and Dignified Lives. Executive Summary of the Report of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas. Washington, D.C.: PAHO.

Related resources

Tags: Assess and report, Critical works in health equity, Key concepts, Racism/racialization, Public Health Organization, Link

Place standard: How good is our place?

This resource is available in English only.

The Place Standard Tool is a planning tool from NHS Scotland that supports organizations, businesses and citizens to work together to identify assets and opportunities for improvement in communities. It considers the relationship between place development, well-being and health inequities, asking whether the development has a positive, negative or neutral effect on social, physical and cultural well-being of a community.

This tool can be applied to places that are already established, experiencing change or are in the early stages of being planned and developed. The tool provides a framework for facilitating community engagement, providing prompts for discussion to consider the physical and social aspects of place-based planning.

Rating the quality of spaces

The tool can be completed as an individual or on behalf of a collaborative process both online or on paper. A series of 14 questions (complemented by prompts) guide the user to rate the quality of place-based aspects such as transportation, active and natural spaces, facilities, structures, and social inclusion. Ratings are plotted on a diagram, resulting in a visual representation of where a place is “performing well” and where improvements are needed.

When completed, the discussion moves to agreeing on priority areas and actions to improve social and physical conditions of the place being discussed.

Applications

The website provides a detailed guide outlining purpose, audiences, contexts of use and types of places for which the tool can be used. In addition, there is a description of practical applications of the tool, such as materials, timing and other steps for implementation as part of groups, surveys and workshops.

Currently applied across municipalities in Scotland and in 11 European countries, the tool is transferable to other communities and relates to broader strategic directions including Health 2020 and the United Nations Sustainable Development Goals.

Use this resource to

  • involve community citizens directly in healthy physical and social environment planning;
  • facilitate collaborative discussion among stakeholders at multiple levels about priorities for physical and social environments;
  • assess strengths and opportunities in places where people live as a way to bring divergent views together; and
  • develop a plan for advocacy efforts to improve social and physical environments in places where people live.

Reference

NHS Scotland. (2015). Place Standard: How Good Is Our Place? Retrieved from: https://www.placestandard.scot/.

Related resources

Tags: Assess and report, Community engagement, Healthy public policy, Link

Building Healthy, Equitable Communities series

This resource is available in English only.

ChangeLab Solutions is an interdisciplinary organization that works to address structural inequities through policy development in communities where residents are at risk of health inequities. Their focus is on how a combination of policy and community power can give rise to new and innovative opportunities to address health inequities.

One of their key resources is the Building Healthy, Equitable Communities series, which focuses on identifying actionable areas to build healthy, equitable communities. Geared towards government and community leaders, each of the six training modules includes a blog post, a webinar and a recorded expert panel conversation.


Topics include:

An additional “bonus” training discusses policies at upper levels of government that override state (provincial) policies, and the search for local solutions to public health equity issues.


Catalogue of tools

ChangeLab Solutions also offers a catalogue of tools that highlights policy solutions in community and public health, including governance, neighborhoods, food, childcare/school, tobacco and healthcare. Numerous resources are linked that relate to key areas for action on health equity, including health in all policies, built environment, food security, early childhood and access to healthcare.


Use this resource to

  • facilitate discussion about public health policy solutions to community level health inequities;
  • plan continuing professional development opportunities around health equity for yourself and others in your organization; and
  • consider how current public health efforts in built environment, food security, early childhood and tobacco can engage community members in decision-making program development to address inequities.


Reference

ChangeLab Solutions. (2018). Building Healthy, Equitable Communities Series. Retrieved from: http://www.changelabsolutions.org/publications/building-healthy-equitable-communities-series


Related resources

Tags: Community engagement, Healthy public policy, Leadership & capacity building, Partnership , Community Organization, Link

Public Health Speaks: Equity and the built environment

This product is also available in French.

The built environment encompasses all the man-made surroundings where we live, work, study and play. [1,2] In September 2018, The National Collaborating Centre for Determinants of Health (NCCDH) brought together three leaders in public health practice and research to share their experiences and reflections on public health practice and action to advance health equity through the built environment. [3]

This resource summarizes that conversation, facilitated by Dr. Teri Emrich, knowledge translation specialist at the NCCDH.


Expert panel on the built environment

The conversation included the following participants:

  • Claire Gram, population health policy and projects lead, Vancouver Coastal Health
  • Dr. Nazeem Muhajarine, professor, Community Health and Epidemiology, College of Medicine, University of Saskatchewan, and director, Saskatchewan Population Health Evaluation Research Unit (SPHERU)
  • Dr. Lisa Richards, medical officer of health, Winnipeg Regional Health Authority

The contributors discuss their experiences bringing an equity lens to work in the built environment. They identify opportunities for public health to promote equity through the built environment, who to partner with and how to ensure public health has a seat at the planning table.

Practical actions and roles for public health in shaping a healthy, equitable built environment are also identified.

Use this resource to:

  • identify potential partners for public health to collaborate with to promote equity through the built environment; and
  • identify practical actions and roles for public health practitioners to promote equity through the built environment.

Reference:

National Collaborating Centre for Determinants of Health. Public Health Speaks: Equity and the Built Environment. Antigonish (NS): NCCDH, St Francis Xavier University (CA); 2018.

References:

[1.] Public Health Agency of Canada. The Chief Public Health Officer’s Report on the State of Public Health in Canada 2017: Designing Healthy Living [Internet]. Ottawa (ON): PHAC; 2017 [cited 2018 Nov 14]. Available from: https://www.canada.ca/en/public-health/services/publications/chief-public-health-officer-reports-state-public-health-canada/2017-designing-healthy-living.html

[2.] Healthy Canada by Design CLASP. Health equity and community design: What is the Canadian evidence saying? Planning Healthy Communities Fact Sheet Series, No. 3. [Internet]. Healthy Canada by Design CLASP; [cited 2018 Nov 14]. Available from: https://www.cip-icu.ca/Files/Healthy-Communities/FACTSHEETS-Equity-FINALenglish.aspx

[3.] National Collaborating Centre for Determinants of Health. Public Health Speaks: Equity and the Built Environment [Internet]. Antigonish (NS): NCCDH, St Francis Xavier University (CA); 2018. Available from:

Tags: Environmental health, Intersectoral action, National Collaborating Centre for Determinants of Health, Document

A Reclamation of Well Being: The Story of the Toronto Indigenous Health Advisory Circle

This product is in the final stages of production. Please check back soon.

This document shares the story of the Toronto Indigenous Health Advisory Circle (TIHAC). Formed in January 2015, TIHAC represents a collaboration between Toronto Indigenous leaders and non-Indigenous health-focused organizations, including Toronto Public Health and the Toronto Central Local Health Integration Network.

TIHAC provides recommendations on how to improve health outcomes for Indigenous Peoples in Toronto and offers broader policy and advocacy direction to improve the social determinants of Indigenous health. This case story details TIHAC’s work over a period of 15 months, during which it created Toronto’s first self-determined Indigenous health strategy, released in 2016 – A reclamation of well being: Visioning a thriving and healthy urban Indigenous community.

This case story focuses on TIHAC’s work up to the release of the strategy, highlighting how TIHAC was formed, and identifying mechanisms leading to its success. Its purpose is to share TIHAC’s experience as a template for:

  • Indigenous and non-Indigenous co-learning and partnership
  • design and delivery of Indigenous self-determined public and acute health services and practices; and
  • policy development to improve the conditions of Indigenous Peoples’ daily lives


Use this resource to:

  • identify good practices for working to improve Indigenous health opportunities and outcomes;
  • foster Indigenous-determined approaches to strengthening and indigenizing health systems;
  • support the creation of self-determining Indigenous health advisory bodies to work in partnership with non-Indigenous government health agencies; and
  • deepen your understanding of the social determinants of Indigenous health.


Reference

Toronto Indigenous Health Advisory Circle, National Collaborating Centre for Determinants of Health, MUSKRAT Media. (2019). Advancing self-determined Indigenous health: The story of the Toronto Indigenous Health Advisory Circle. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags:

Organizational Capacity for Health Equity Action Initiative: A brief description

This product is also available in French.

This document provides an overview of the National Collaborating Centre for Determinants of Health (NCCDH)’s Organizational Capacity for Health Equity Action Initiative (OCI). The OCI was launched in 2018 to help organizations develop their capacity for health equity action by offering relevant frameworks, strategies and organizational conditions for this work.


Introducing the organizational capacity initiative

The resource outlines the objectives of the project and anticipated outcomes, as well as its long-term goals. These goals include providing models for action on health equity that can be used by all public health organizations – not just the two sites in this pilot.

The description also provides a definition of what organizational capacity means for the NCCDH and offers an explanation for the various elements of the program:

  • The learning circle format
  • The practice sites
  • The literature scans
  • The advisory group

The Brief description is the first in a series of knowledge products to be written to support the OCI, which is the second iteration of the NCCDH’s Learning Together series. The first Learning Together series offered resources related to population health status reporting and was released in 2012.


Use this resource to

  • familiarize yourself and your team with the goals of the OCI;
  • consider whether organizational capacity for health equity is a goal you can introduce at your public health organization; and
  • learn more about the process for conducting your own learning circle groups regarding organizational capacity, which will be addressed in future knowledge products in this series.


Reference

National Collaborating Centre for Determinants of Health. (2019). Organizational Capacity for Health Equity Action Initiative: A Brief Description. Antigonish, NS: NCCDH, St. Francis Xavier University.

Tags: Leadership & capacity building, Organizational Capacity Initiative (OCI), Racism/racialization, National Collaborating Centre for Determinants of Health, Document

Local resources and health: Overview of knowledge synthesis

These fact sheets summarize the findings of a literature review on the relationship between health and the availability of local resources (e.g., parks, supermarkets, community centres, etc.) that impact our daily life. The fact sheets were created as part of an initiative by La Chaire de recherche du Canada Approches communautaires et inégalités de santé (CACIS) and funded by the Canadian Institutes of Health Research (CIHR) and l’Université de Montréal.

This series of resources presents an overview of evidence on the relationship between the physical, social, and mental health of urban populations in four distinct areas:

  • Housing
  • Food environment
  • Community life
  • Sustainable mobility
Local resources and health:
Overview of knowledge
synthesis — Housing
(2018)
Local resources and health:
Overview of knowledge
synthesis — Food environment
(2018)
Local resources and health: 
Overview of knowledge
synthesis — Community life
(2018)
Local resources and health:
Overview of knowledge
synthesis — Sustainable mobility
(2018)


The fact sheets include results from evidence reviews with moderate or high impact only. The full literature review results will be available in upcoming academic journal articles.


Use this resource to

  • facilitate a discussion with elected officials and decision-makers to develop, adopt and implement public policies promoting the health impacts of built environments, food security and community life;
  • support participatory action research to assess community-level factors that influence social determinants of health such as food access and housing; and
  • inform discussions regarding the use of evidence-based data to inform public health priorities and resource allocation.


References

Boyer, G. & Ducrocq, F. (2018). Local Resources and Health: Overview of Knowledge Synthesis – Housing. Montreal (QC): Chaire de recherche du Canada Approches communautaires et inégalités de santé.

Boyer, G. & Ducrocq, F. (2018). Local Resources and Health: Overview of Knowledge Synthesis – Food Environment. Montreal (QC): Chaire de recherche du Canada Approches communautaires et inégalités de santé.

Boyer, G. & Ducrocq, F. (2018). Local Resources and Health: Overview of Knowledge Synthesis – Community Life. Montreal (QC): Chaire de recherche du Canada Approches communautaires et inégalités de santé.

Boyer, G. & Ducrocq, F. (2018). Local Resources and Health: Overview of Knowledge Synthesis – Sustainable Mobility. Montreal (QC): Chaire de recherche du Canada Approches communautaires et inégalités de santé.

Tags: Community development, Food security, Housing, Methods & tools, National Collaborating Centre for Determinants of Health, Public Health Organization, Link

Simcoe Muskoka District Health Unit’s approach to addressing the determinants of health: A health equity framework

This resource is only available in English.

Integrating concepts around social determinants of health into organization-level plans is considered a strategy for establishing organizational commitment to taking action on health equity. The Simcoe Muskoka District Health Unit’s (SMDHU) approach to addressing the determinants of health: A health equity framework provided the foundation for the SMDHU 2012-2016 strategic plan, which cited a commitment to reducing health inequities among population groups. This, in turn, has informed the development of the SMDHU 2019–2022 strategic plan, which continues this direction through stated values including equity, and a priority area to enhance relationships with priority populations to address the social determinants of health.


Anatomy of the framework

This framework was developed to support public health staff at the SMDHU to support outcomes including:

  • priority populations at risk of health inequities being prioritized for comprehensive agency response; and
  • implementation of an action plan to address risk conditions to meet their public health needs.

A glossary of common terminology related to addressing health equity is included, as well as information and references for understanding various models on the social determinants of health, and the theoretical bases for the framework.

A section to guide the identification of priority populations identifies key terminology, data sources and methods for determining priority populations that are at greater risk of health outcomes due to socioeconomic circumstances. The resource also provides background information on the political and governmental influences on public health system priorities. In addition, it addresses how to determine need, impact, capacity and partnership collaboration opportunities.


Applications to NCCDH resources

Examples of how SMDHU actions apply to the NCCDH’s Public health roles for action on health equity and capacity-building strategies illustrate the application of these principles to public health programs and priorities. A series of recommendations for public health action by SMDHU staff are included, as well as several appendices outlining key organizational documents, data describing the area’s population health status and examples of external tools for use in planning and prioritization. 


Use this resource to

  • facilitate discussion about how public health organizational documents can integrate health equity as a key area of focus;
  • develop a framework for addressing health inequities through program development and prioritization; and
  • consider how public health actions align with the NCCDH public health roles and capacity building strategies to identify areas for further development to address health equity.


Reference

Simcoe Muskoka District Health Unit. (2012). Simcoe Muskoka District Health Unit’s Approach to Addressing the Determinants of Health: A Health Equity Framework. Simcoe Muskoka District Health Unit. Barrie (ON).

Tags: Competencies & organizational standards , Leadership & capacity building, Public health unit / health authority, Public Health Organization, Link

Canada communicable disease report: Social determinants of health

This resource is also available in French.

Some population groups are more likely than others to be exposed to and experience infectious disease, thereby experiencing a higher burden of disease. Groups who are more vulnerable due to structural inequities are more likely to contract infectious disease, get sicker, and take longer to recover.

Public health efforts to prevent and control infectious disease can consider existing health inequities and underlying social determinants of health in all aspects including surveillance, access to services, prioritization, training, mitigation and prevention.

Social determinants of health and infectious disease

The Canada Communicable Disease Report (CCDR) is a peer-reviewed scientific journal of the Public Health Agency of Canada (PHAC). The CCDR 2016 supplement titled Social determinants of health is a full issue of this journal dedicated to examining the association of the social determinants of health and health equity with infectious disease and the implications for population health.

In addition to a brief overview of the importance and opportunity for public health to address health equity, this supplemental journal provides several articles that can inform public health priorities and planning, including:

  • the economic burden of communicable disease inequalities;
  • what public health can do to address inequities in infectious disease rates; and
  • the importance of intersectoral action to address the complex web of social determinants of health related to infectious disease.

Examples of research/program trials are profiled, as well as useful links for public notifications and best practices in addressing the social determinants of health.

Use this resource to

  • facilitate discussion about how socioenvironmental conditions create unequal risk and burden of infectious disease;
  • explore how to shift public health workplans to address inequities in infectious disease rates for populations who experience structural marginalization; and
  • identify intersectoral partners that can facilitate engagement with communities disproportionately affected by infectious disease.

Reference

Public Health Agency of Canada. (2016). Canada Communicable Disease Report: Social Determinants of Health. CCDR Supplement; 42:S1.

Related resources

Tags: Healthy public policy, Infectious disease, Intersectoral action

Climate change, health, and equity: A guide for local health departments

This resource is available in English only.

While climate change affects the whole population, groups that are already at a disadvantage due to structural inequities are more vulnerable and may have fewer resources to respond to the negative impacts of climate change on their physical and social environments. For the same systemic reasons, marginalized populations are more likely to already have poorer health, thereby experiencing more severe negative health effects and weakened ability to recover from events related to climate change.

This intricate intersection of climate change and health inequities points to a necessary and integral role for public health to address these complex issues at the local level.

Climate change as a public health issue

Climate change, health, and equity: A guide for local health departments has recently been released through the Public Health Institute Center for Climate Change and Health and the American Public Health Association.

This guide provides an overview of the following topics:

  • What climate change is
  • How it influences health
  • The equity perspective of specific climate change outcomes
  • How public health programs can overlap with climate change initiatives
  • Core public health actions at the local level that integrate addressing climate change and population health inequities.

The guide is designed to allow public health practitioners at all levels to identify their own work as it relates to this issue, providing a variety of entry points for public health into climate change work. An intersectoral Health in all Policies approach is reinforced as the main strategy through which to achieve climate mitigation through public health programs.

Use this resource to:

  • deepen your knowledge about the effects of climate change on population health and health inequities;
  • facilitate discussion about how existing public health programs can impact and be impacted by climate change;
  • identify multisectoral approaches and core public health functions that relate to addressing health inequities impacted by climate change; and
  • develop strategies to address the disproportionately high negative impacts of climate change experienced by populations who are disadvantaged due to structural inequities.

Reference

Rudolph, L., Harrison, C., Buckley, L. & North, S. (2018). Climate Change, Health, and Equity: A Guide for Local Health Departments. Oakland, CA, and Washington, D.C., Public Health Institute and American Public Health Association.

Related resoureces

Tags: Climate change, Environmental health, Intersectoral action, Public health unit / health authority, Public Health Association, Link

Establishing a holistic framework to reduce inequities in HIV, viral hepatitis, STDs, and tuberculos

This resource is available in English only.

Populations who live in situations of low socioeconomic status; unequal access to health services; lack of education; and stigmatization due to racism, homophobia and other forms of systemic discrimination are both at higher risk of a number of infectious diseases and underserved by preventive and treatment efforts.

In this document, the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCCHHSTP), part of the Centers for Disease Control and Prevention (CDC) in the United States, outlines its strategy to reduce the incidence of these infectious diseases among groups experiencing a disproportionate burden of disease risk and rates. The strategy attempts to address the imbalance through action on socioenvironmental roots on disease transmission and health.

Priority action areas

This report describes which population groups are disproportionately affected by HIV, viral hepatitis, STDs and tuberculosis and how this relationship intersects with the social determinants of health (SDH).
Six priority action areas for the NCCHHSTP are outlined based on the World Health Organization (WHO) theoretical framework for how the social determinants of health influence health inequities. These include:

  • research and surveillance;
  • health communication;
  • health policy;
  • prevention programs;
  • capacity-building; and
  • partnership activities.

Actionable priorities are outlined for each of these areas, including tasks related to program development and implementation, surveillance to inform policy priorities and resource allocation strategies. Monitoring and evaluation activities are also discussed, as well as how partnership activities can incorporate a social justice lens into their work.

Audience

The intended audience for this document includes public health practitioners, community organizations, health professionals across disciplines and other research and government agencies working towards the elimination of HIV, viral hepatitis, STDs and tuberculosis.

Use this resource to

  • facilitate discussion about intersectoral approaches to address inequities in rates of HIV, viral hepatitis, STDs and tuberculosis;
  • develop actions based on the six priority areas to address SDH that affect infectious disease;
  • incorporate monitoring and evaluation components to programs designed to eliminate infectious disease among populations negatively affected by SDH; and
  • advocate for resource reallocation and reprioritization to address inequities in disease.

Reference

Centers for Disease Control and Prevention. (2010). Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Atlanta, GA.

Tags: Infectious disease, Public Health Organization, Link

Proportionate universality

This resource is available in English only.

Experiences in early childhood have a direct effect on both a child’s health and their health and well-being at later stages of life. Children who experience marginalization in these early years are at greater risk for lifelong health challenges, including irreversible negative impacts to their ongoing development.

Addressing risks to a child’s developmental health at all levels of the social gradient, including strategies specifically designed for the most vulnerable children, is important for improving population health.

Research on child health outcomes

The Human Early Learning Partnership (HELP) research network at the University of British Columbia (UBC) looks at early childhood development through an interdisciplinary lens centered around three main areas of focus:

  • The relationship between biology and development
  • The influence of early childhood on development over time
  • Policy and program monitoring to address child vulnerability

This policy brief provides an overview of the concepts of proportionate universality and the social gradient, the relationship of socioeconomic status to early childhood development and the importance of shifting the social gradient to improve child health outcomes.

A brief discussion of the importance of including both universal and targeted strategies is included, as well as an example of what a proportionately universal family policy framework would look like.

Use this resource to

  • facilitate a discussion about the difference between universal and targeted programs in public health;
  • initiate planning strategies for programs to reach children and families at all levels of the social gradient; and
  • advocate for changes in program implementation towards a proportionate universal approach.

Reference

Human Early Learning Partnership (HELP). (2015). Proportionate universality. University of British Columbia. Vancouver, BC.

Related resources

Tags: Early childhood development, Key concepts, Public Health Organization, Link

Toward health equity: A tool for developing equity-sensitive public health interventions

This resource is also available in French.

The Public Health Agency of Canada (PHAC) has developed this practice tool for public health professionals to support them in developing equity-sensitive public health interventions [1]. The tool outlines five evidence-based elements to consider in order to integrate health equity into new and existing public health interventions [1].

The tool describes the five equity elements and the relevant considerations related to each one and prompts the user to consider which equity elements are relevant to their intervention and identify ways to address them [1].

The five elements for consideration include the following [1]:

  1. Equity objectives: Is the intervention based on structure, environment, behaviour or health-care/service.
  2. Social determinants: What is/are the entry point(s) to intervention across the spectrum from socioeconomic and political context to the individual level.
  3. Mediating factors: What are the health-enabling or -limiting conditions?
  4. Engagement strategies: How are those with a vested interest in the intervention being involved?
  5. Equity targeting: How is the intervention targeted to improve health equity outcomes?

Key operational definitions are provided, as well as a visual summary of the evidence related to the development of equity-sensitive public health interventions.

Use this resource to

  • integrate equity into the design of existing and new public health interventions; and
  • consider the equity elements of interventions and how they might be addressed.

Reference

Public Health Agency of Canada. Toward Health Equity: A Tool for Developing Equity Sensitive Public Health Interventions [Internet]. Ottawa (ON): PHAC; 2015 Dec 1 [cited 2018 Nov 13]. Available from: http://publications.gc.ca/collections/collection_2015/aspc-phac/HP35-64-2-2015-eng.pdf

References

[1] Public Health Agency of Canada. Toward Health Equity: A Tool for Developing Equity Sensitive Public Health Interventions [Internet]. Ottawa (ON): PHAC; 2015 Dec 1 [cited 2018 Nov 13]. Available from: http://publications.gc.ca/collections/collection_2015/aspc-phac/HP35-64-2-2015-eng.pdf

Tags: Leadership & capacity building, Methods & tools, Public Health Agency of Canada, Link

Achieving health equity: A guide for health care organizations

This resource is available in English only.

The Institute for Healthcare Improvement wrote this white paper to provide health care organizations with guidance on how they can reduce health inequities related to characteristics linked to discrimination and social exclusion. [1] The white paper provides a business case for accelerating action to achieve health equity on the basis that the disease burden brought on by inequities increases costs to the health care system, insurers, employers, patients and families. [1]

The white paper describes a five-part framework to guide health care organizations in making health equity a system-level priority. [1]

Key framework components include the following [1] p. 11:

  • Making health equity a strategic priority
  • Developing structures and processes to support health equity work
  • Deploying specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact
  • Decreasing institutional racism within the organization
  • Developing partnerships with community organizations to improve health and equity

Also included in the white paper is a case study featuring a health care organization with a history of health equity integration at the system level, as well as a health equity self-assessment tool for health care organizations.

Use this resource to

  • guide the integration of health equity across your health care organization and
  • conduct an organizational health-equity self-assessment.

Reference

Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. IHI White Paper [Internet]. Cambridge (MA): Institute for Healthcare Improvement; 2016 [cited 2018 Nov 11]. Available from http://www.ihi.org/resources/Pages/IHIWhitePapers/Achieving-Health-Equity.aspx

References

[1] Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. IHI White Paper [Internet]. Cambridge (MA): Institute for Healthcare Improvement; 2016 [cited 2018 Nov 11]. Available from http://www.ihi.org/resources/Pages/IHIWhitePapers/Achieving-Health-Equity.aspx

Tags: Methods & tools, Racism/racialization, Link

Towards healthy homes for all: What the RentSafe findings mean for public health in Canada

This document is also available in French.

Housing is considered to be a core social determinant of health (SDH) and intersects with a number of other SDH — including food insecurity and inadequate income — to create population health inequities. While housing is considered important to health outcomes, it may not be clear to public health practitioners if action on unhealthy housing as part of social and built environments is part of their scope or role.

Recommendations to inform public health action on housing in Canada

The National Collaborating Centre for Determinants of Health (NCCDH) has worked with the director of RentSafe, a program under the Canadian Partnership for Children’s Health and the Environment (CPCHE), to summarize and present RentSafe’s recent findings and recommendations to inform public health action on housing. This summary document provides an overview of the RentSafe program, including provincial- and local-level work looking at unhealthy housing conditions for low-income tenants. An overview of findings from baseline research is provided, indicating lack of service coordination, weak intersectoral networks and uncertainty of how to address concerns about environmental health issues in low-income housing. The document also describes public health’s involvement in community-engaged research activities, including both primary and supportive intersectoral roles. Findings drawn from RentSafe’s work are framed as areas of potential action by public health practitioners at multiple levels. The authors place emphasis on the importance of participatory practice and direct engagement of those with lived experience of unhealthy housing to participate in intersectoral spaces and inform public health action.

Use this resource to:

  • initiate a discussion with municipal partners on opportunities to include the social determinants of health in the creation and updating of bylaws on housing, and ways that public health can support this work;
  • explore opportunities for community-engaged research to address the health impacts of inadequate and unaffordable housing; and
  • bring together multiple partners from the community and both health and non-health sectors for collaborative advocacy and action on unhealthy housing.

Reference

Phipps, E., and the National Collaborating Centre for Determinants of Health. (2018). Towards healthy homes for all: What the RentSafe findings mean for public health in Canada. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources

Tags: Community engagement, Environmental health, Housing, National Collaborating Centre for Determinants of Health, Document

Positive mental health and well-being across the life course: Concepts and social determinants

Positive mental health and well-being across the life course: Concepts and social determinants

This resource is available in English only.

Dr. Heather Orpana’s (Public Health Agency of Canada) presentation titled “Positive mental health and well-being across the life course: Concepts and social determinants” was co-hosted at St. Francis Xavier University on October 10, 2018, by the National Collaborating Centre for Determinants of Health, St. Francis Xavier University’s Faculty of Education and Department of Psychology, the Mulroney Institute of Government and the Maple League of Universities.

Promoting mental health for Canadian youth

Orpana’s talk addresses the concept of positive mental health, the positive mental health status of Canadian youth and adults, and how positive mental health is related to the social determinants of health. The three-factor model of mental health and dual-continuum framework for mental health are explored, defining the difference between positive mental health and mental illness.

Orpana also discusses an ecological approach to positive mental health. In addition, she provides some context for the measurement and surveillance of positive mental health across the population, as well as how this intersects with income, sex, urban/rural residence and other risk and protective factors. The recording also outlines how — for youth — autonomy, competence and relatedness are associated with prosocial and negative behaviours, bullying, being bullied and school connectedness.

Use this resource to

  • facilitate a discussion about positive mental health for children and youth;
  • discuss measurement and reporting of mental health status among Canadians; and
  • explore the social determinants of positive mental health and their contribution to health inequities.

Reference

Orpana, H. Positive mental health and well-being across the life course: concepts and social determinants. Lecture presented at: St. Francis Xavier University; 2018 Oct 10; Antigonish, NS, Canada.

Related resources

Tags: Assess and report, Mental Health, Public Health Agency of Canada, Video

Health equity 101: Videos for environmental health

This resource is available in English only.

Public health inspectors (PHIs), also known as environmental health officers (EHOs), are professionals with expertise in health protection, including inspections, enforcement of regulations and education/training roles. PHIs are the only professional discipline with training that is explicitly rooted in public health, though the intersection between environmental public health (EPH) practice and the social determinants of health (SDH) is not always recognized or obvious.

Building equity into the public health inspector role

As a way to encourage PHIs to look more closely at how their practice can impact population health inequities, the British Columbia Centre for Disease Control (BCCDC) has developed a resource to explore how EPH practice can address health equity as part of the existing mandate and scope of the PHI role. This series of five short videos presents key concepts related to how health equity applies to the daily practice of PHIs/EHOs and other environmental health practitioners at all levels of the public health system. Each of the videos is four-and-a-half to six minutes in length and presented in whiteboard video style.

Individual video topics include:

  1. Health equity and how it relates to EHO practice
  2. Social determinants of health and how they impact EHO practice
  3. How social determinants arise across different EHO practice settings
  4. How health authorities can integrate a health equity lens to environmental health
  5. Concrete actions that individuals EHOs can take to support health equity

The videos have been approved for PDH (professional development hour) credits through the CIPHI Continuing Professional Competency program. Practitioners may view the videos in succession or any order, in one sitting or spread out over several sessions, alone or with a group, as a way to explore how their work may impact health equity beyond individual client circumstances.

Use this resource to

  • facilitate a discussion with EPH peers on how to shift organizational practices to address the SDH;
  • develop a continuing education plan to improve knowledge in health equity concepts as applied to EPH; and
  • advocate for policy changes to basic income, housing and working conditions as SDH factors impacting health equity.

Reference

British Columbia Centre for Disease Control. (2018). Health equity 101: Videos for environmental health. British Columbia Centre for Disease Control; Vancouver, BC.

Related resources

Tags: Communicate, Environmental health, Public Health Organization, Video

The social determinants of mental health: An overview and call to action

This resource is available in English only.

In recent years, much attention has been given to the social determinants of health (SDH) and how they impact disparities in illness/disease rates among population groups who experience marginalization. Though the social determinants of mental health (SDMH) are comparable to those related to physical health, the former deserve particular attention related to both the prevention of mental illness and the promotion of positive mental health through changes to the socioeconomic environment.

The social determinants of mental health in relation to mental illness

This commentary article begins with a brief history of theories surrounding the roots of mental illness, originating in environmental public health areas and shifting toward “biological psychiatry” and attention to genetic factors. The importance of a population-based approach to mental health promotion is presented, including the dual importance of risk factors and protective factors, drawing attention to the role of the SDH in both the causes and course of mental illness. Several roots of population mental health are noted, such as policies that determine the distribution of wealth, power and resources, in addition to lack of societal supports to provide adequate care.

Options to address the SDMH are described, including actions for clinicians working with individuals, advocacy and political discourse, and policy development that improves living conditions. Collaboration across sectors to address population-level inequities and training in medical and psychiatry programs are also suggested. Addressing social determinants of physical and mental health creates environments that can both support positive mental health and mitigate the impact of mental illness.

Use this resource to

  • deepen understanding of how physical and social environments impact mental health of individuals and populations;
  • initiate a discussion about the roots of positive mental health promotion and prevention of mental illness, as well as the distinction between them; and
  • advocate for policies that improve living conditions as a way to promote positive mental health. 

Reference

Shim, R., Koplan, C., Langheim, F.J.P., et. al. (2014). The social determinants of mental health: An overview and call to action. Psychiatric Annals; 44(1): 22-26.

Related resources

Tags: Healthy public policy, Leadership & capacity building, Mental Health, Link

Health equity and the built environment: A curated list

This resource is also available in French.

The NCCDH has collected a list of resources that public health can use to inform and support action on the built environment as a determinant of health inequities. The document includes nine resources organized around the four public health roles for improving health equity [1], which are as follows:

  • Assess and report on (a) the built environments contribution to health inequities and (b) effective strategies to reduce inequities through the built environment
  • Modify and orient built environment interventions to reduce inequities
  • Partner with other sectors to identify ways to improve health equity through the built environment
  • Participate in policy development for improvement in health inequities through the built environment

Links to additional resources are provided to further inform and support action related to the built environment. This curated list is not a comprehensive collection of research related to health equity and the built environment; rather, the purpose is to support public health action on the built environment with their four roles for improving health equity.

Reference

National Collaborating Centre for Determinants of Health. (2018). Health equity and the built environment: A curated list. Antigonish, NS: National Collaborating Center for Determinants of Health, St. Francis Xavier University. 

References

[1] National Collaborating Centre for Determinants of Health. (2013). Let’s Talk: Public Health Roles for Improving Health Equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Environmental health, Reading list, National Collaborating Centre for Determinants of Health, Document

Self-Evaluation Tool for Action in Partnership

Cette ressource est aussi disponible en français.

The Canada Research Chair in Community Approaches and Health Inequalities (CACIS) (French) conducts research inform and support practices to improve health equity. [1] CACIS developed this Self-Evaluation Tool for Action in Partnership to allow partners working collaboratively on a specific project to evaluate their partnership with respect to six conditions necessary for effective partnership work [2]:

  1. Inclusion of a range of perspectives relevant to the issue;
  2. Stakeholder involvement in strategic decisions early on;
  3. Stakeholder engagement in negotiating and influencing decisions;
  4. Stakeholder commitment to the project;
  5. Equal distribution of power among stakeholders in the partnership; and,
  6. Arrangements that help build collective action.

CASIS designed the tool so that partners can complete the 18-item self-evaluation individually for later discussion and/or compilation of group results, complete as a group. [2] Users compile their results themselves, though there is also an online, French-language tool that compiles results automatically. 

The tool can be completed as a one-time evaluation to identify the strengths and weaknesses of a partnerships and areas where consensus is lacking, or longitudinally to track the amelioration or deterioration of the partnership over time. [2

Use this resource to

  • evaluate the effectiveness of you action partnerships. 

Reference

Bilodeau, A., Galarneau, M., Fournier, M., Potvin, L., Sénécal, G. & Bernier, J. (2017). Self-Evaluation Tool for Action in Partnerships. Toronto, ON: Health Nexus. Retrieved from: https://en.healthnexus.ca/sites/en.healthnexus.ca/files/resources/selfevaluationtool.pdf

References

[1] Chaire de recherche du Canada Approches communautaires et inégalités de santé (CACIS). (2018 Sept. 7). http://chairecacis.org/ 

[2] Bilodeau, A., Galarneau, M., Fournier, M., Potvin, L., Sénécal, G. & Bernier, J. (2017). Self-Evaluation Tool for Action in Partnerships. Toronto, ON: Health Nexus. Retrieved from: https://en.healthnexus.ca/sites/en.healthnexus.ca/files/resources/selfevaluationtool.pdf

Tags: Leadership & capacity building, Methods & tools, Partnership , Public Health Organization, Link

Housing as a focus for public health action on equity: A curated list

The NCCDH has collected a list of resources that public health can use to support action on housing as a determinant of population health equity. The document includes 10 resources organized around three themes:

  • Housing as a health issue in Canada: Strategies and calls to action that can position housing as a priority area for public health action
  • The impact of housing on health equity: Sources that describe the impact of housing on health in a way that supports action on housing as a public health equity issue
  • Housing as a focus of public health action: Resources that position housing as being within the scope of public health practice at multiple levels of the system

Links to additional resources that support action are also provided. This curated list is not meant to be a comprehensive collection of research that describes how housing is a social determinant of health; instead, the purpose is to point to housing as a focal point for action on population health equity regardless of whether housing is an explicit focus of the public health mandate.

Reference

National Collaborating Centre for Determinants of Health. (2018). Housing as a Focus for Public Health Action on Equity: A Curated List. National Collaborating Centre for Determinants of Health. Antigonish, NS: St Francis Xavier University.

Related resources

Tags: Community engagement, Healthy public policy, Intersectoral action, National Collaborating Centre for Determinants of Health, Document

The Built Environment: Understanding how physical environments influence the health and well-being of First Nations peoples living on-reserve

Built environments are defined in this resource as the “human-made or modified physical surroundings in which people live, work and play,” a definition taken from the work of Cheadle & Tugwell. [1] This study, published by the National Collaborating Centre for Aboriginal Health (NCCAH) explores how the built environment influences the health and well-being of First Nations peoples living on reserve.

The document provides a historical analysis of how Indigenous populations altered their surrounding physical and built environments to promote holistic well-being and protect the natural ecosystem. Author Roberta Stout describes how colonialism and forced relocation interrupted all aspects of Indigenous peoples’ lives, produced profound inequities, and resulted in multiple negative health outcomes for Indigenous peoples. Five elements of the built environments of First Nations peoples living on reserve that have a negative impact on residents’ health and well-being are explored:

  1. Housing
  2. Water and wastewater management
  3. Food security
  4. Active living
  5. Transportation

In her analysis, the author describes how elements such as poor ventilation and mould contribute to tuberculosis risk, how poor food access contributes to obesity, and how inadequate road maintenance in “special access” communities results in a greater number of multivehicle collisions. She highlights the lack support from government and health agencies regarding the built environment have contributed to these negative health outcomes. The article also addresses how the forced use of Eurocentric housing models that are not always suited for the geography and weather conditions of reserves has contributed to this problem.

Strategies are offered for countering the issues caused by chronic underfunding and inattention to the five aspects of the built environment listed above. These strategies include the incorporation of Indigenous planning principles in the design of the built environment on reserves, the prioritization of safe drinking water and proper wastewater management for all reserves, and encouraging the teaching traditional food-harvesting skills to younger generations.

Use this resource to:

  • facilitate discussion between Indigenous communities and public health colleagues about the built environment and its influence on health outcomes for First Nations peoples living on reserves;
  • locate the opportunities for action in policy development regarding built environments on reserves; and
  • serve as a starting point for engaging with Indigenous leaders and communities to provide space so their perspectives guide plans for built environments for Indigenous people living off reserves.

Reference

Stout, Roberta (2018). The built environment: Understanding how physical environments influence the health and well-being of First Nations peoples living on-reserve. National Collaborating Centre for Aboriginal Health. Retrieved from: https://www.ccnsa-nccah.ca/495/The_built_environment__Understanding_how_physical_environments_influence_the_health_and_well-being_of_First_Nations_peoples_living_on-reserve_.nccah?id=236

Related resources

References

[1] Cheadle, T., and A. Tugwell. (2014). Healthy built environment linkages: A toolkit for design, planning, health, Version 1.1. Vancouver: Provincial Health Services Authority.

Tags: Community engagement, Food security, Housing, Indigenous health , Public Health Organization, Link

Health Promotion in Canada: New perspectives on theory, practice, policy, and research, 4th edition

This resource is available in English only.

Far beyond the limited concept of individual healthy lifestyles, health promotion practice is a key part of public health efforts to address population health inequities. Health promotion work happens across sectors, recognizing the socioeconomic roots of health and the impact of policy development to shape the environments in which health is determined. The book Health Promotion in Canada: New perspectives on theory, practice, policy, and research, Fourth edition  brings together provincial, national and international perspectives to help inform emerging opportunities in health promotion practice to address health in new and innovative ways.

A three-part analysis

The authors of the book’s chapters include voices from a variety of provinces, including both Anglophone and Francophone writers, as well as Indigenous contributors. The first of the book’s three parts describes the context and foundations for health promotion in Canada and offers a historical analysis of health promotion, a review of key concepts including social and behavioural theory, and consideration of ecological health promotion interventions.

The second part provides an overview of health promotion in Canada, with chapters on gender-transformative practice, intervention entry points, inequities in health, mental health, Indigenous community engagement, immigrant health promotion, urban governance, education and human development, social innovation, clinical care, and digital media.
The third part centers around critical reflective practice in health promotion with content related to health in all policies, intervention research, ethics, participatory practice, population health promotion, globalization, and reflections on the future of health promotion in Canada.

Each chapter concludes with critical thinking questions to encourage thoughtful analysis and application of the content to health promotion practice. The chapters also include further readings, relevant websites and complete references. Those who purchase the book also receive an instructor’s manual with learning objectives, discussion questions and student assignments to facilitate the book’s use as a teaching tool across disciplines and institutions.

Use this resource to

  • explore the application of core health promotion principles to address population health inequities;
  • support critical self-reflection on current and potential focus for health promotion practice;
  • advocate for strengthening the application of health promotion to empower and engage with communities; and
  • develop professional education resources and academic lesson plans for educating current and emerging professionals about health promotion.

Reference

Rootman, I., Pederson, A., Frohlich, K.L.,, Dupéré, S. (Eds). (2017). Health promotion in Canada: new perspectives on theory, practice, policy, and research.  Fourth edition. Toronto, ON: Canadian Scholars Press.

Related Resources

Tags: Healthy public policy, Key concepts, Key Historical Documents, Public Health Organization, Link

Policy avenues: Interventions to reduce social inequalities in health

Public policies contribute to the creation of social inequalities in health, and can serve as critically important levers to reduce health inequities. This paper from the Institut national de santé publique du Québec (INSPQ) reviews comprehensive approaches to reducing health inequities, as well as policy interventions on specific determinants of health implemented in Quebec, Canada, Europe and elsewhere in the world. The report discusses intersectoral action, Health in All Policies and health impact assessments as relevant approaches for use by government organizations.

Differing intervention strategies: comprehensive and determinant specific

Comprehensive interventions such as intersectoral coordination led by government institutions and mechanisms that have built in accountability for the implementation of specific policies are identified in Norway, Finland, New Zealand and the United Kingdom. In circumstances like those in Australia, Sweden and the United Kingdom, there are organizations that are responsible for knowledge translation, monitoring and evaluation of interventions. Comprehensive interventions in these regions were usually led by departments of health. Some enablers of these approaches are political will, justice and equity values and intersectoral governance. The report also notes a few challenges, such as lack of evaluation of the interventions and the struggle to balance of universal and non-stigmatizing targeted interventions.

Interventions on specific determinants, such as early childhood and education, employment and land use planning, are typically sector-led, including health. In these interventions, citizen participation and mobilization around existing priorities (e.g., sustainable development) have been beneficial. As is the case with comprehensive policy interventions, the impact of determinant-specific policies is not always present and the most marginalized groups may not benefit.

The report notes the absence of specific public policies on reducing social inequalities in health in Quebec. However, there are numerous government and local public health initiatives which can impact that goal. Examples include the National Strategy to Combat Poverty and Social Exclusion at the government level and equity oriented public health monitoring and reporting by departments of public health.  

Reference:

Lambert, R., St-Pierre, J., Lemieux, L., Chapados, M., Lapointe, G., Bergeron, P., Choinière, R., Leblanc, M.-F., Trudel, G. (2014). Policy Avenues: Interventions to Reduce Social Inequalities in Health. Montreal, QC: Institut national de santé publique du Québec.

Use this resource to:

  • Identify specific policy interventions to reduce health inequities
  • Compare and contrast comprehensive and determinant-specific approaches to addressing health equity

Tags: Policy analysis, Public Health Organization, Link

Healthy built environment linkages toolkit: Making the links between design, planning and health, version 2.0

This resource is available in English only.

The physical surroundings made or modified by humans — the spaces in which we live, work and play — are known as the built environment[1]. Core features of the built environment include neighbourhood design, transportation networks, natural environments, food systems and housing. In order to help health professionals promote healthier built environments, the British Columbia Centre for Disease Control (BCCDC) led the development of the Healthy Built Environment Linkages Toolkit (HBE Linkages Toolkit) in collaboration with the British Columbia Healthy Built Environment Alliance Steering Committee.

Initially launched in 2014, with this updated version released in 2018, the HBE Linkages Toolkit provides an evidence-based conceptual framework and communication tool for conducting HBE work and supporting research and education in the field.1 The initial HBE Linkages Toolkit was developed following a scoping review, and both the 2014 and 2018 versions draw on extensive literature review and input from content experts. Findings were graded based on a weighted assessment criteria. 

For each of the core features of the built environment described above, the HBE Linkages Toolkit includes the following[1]:

  • Fact sheets with evidence-based key messages and suggestions for improving population health through healthy planning and design
  • Summaries of research links highlighting relationships between built environment features, intermediate impacts and health outcomes found in the literature
  • Health evidence diagrams that graphically depict the research evidence, indicating where strong, moderate or newly emerging impacts and outcomes exist
  • Broader considerations for practice including economic co-benefits, social well-being outcomes and small and medium-sized community contexts

Use this resource to

  • identify and communicate evidence-based messages on how appropriate planning and design of the built environment promote population health;
  • inform input into community projects, plans, and strategies; and
  • support research and education related to healthy built environments. 

Reference

British Columbia Centre for Disease Control. (2018). Healthy Built Environment Linkages Toolkit: Making the Links Between Design, Planning and Health, Version 2.0 [Internet]. Vancouver, BC: Provincial Health Services Authority. Available from: http://www.bccdc.ca/health-professionals/professional-resources/healthy-built-environment-linkages-toolkit

Reference list

1. British Columbia Centre for Disease Control. (2018). Healthy Built Environment Linkages Toolkit: Making the Links Between Design, Planning and Health, Version 2.0 [Internet]. Vancouver, BC: Provincial Health Services Authority. Available from: http://www.bccdc.ca/health-professionals/professional-resources/healthy-built-environment-linkages-toolkit

Tags: Environmental health, Public Health Organization, Link

Toward healthy homes for all: RentSafe summary and recommendations

This resource is available in both English and French.

Housing is a key social determinant of health (SDH) and a component of healthy built environments and social environments. For this reason, housing is a critical point of action for public health to work towards health equity. However, due to lack of capacity and clarity on the role and scope of public health to address housing, it is often an area that is lost when it comes to advocacy and policy-making. For this reason, having an understanding of the underlying circumstances that contribute to unhealthy housing can help practitioners identify solutions and potential actions for public health.

RentSafe is a research initiative of the Canadian Partnership for Children’s Health and the Environment (CPCHE), a partnership that works collectively to address the environmental issues that influence the health of children across Canada. The RentSafe initiative seeks to address unhealthy housing conditions faced by low-income tenants in rural and urban communities in Ontario.

This summary document provides an overview of RentSafe research findings from focus groups with low-income tenants and surveys of public health units, legal aid clinics, by-law enforcement officers, landlords and direct-service providers to residents. Resources for intersectoral service providers are provided, as well as an overview of key intersectoral initiatives of the research program. For public health practitioners thinking about addressing housing as a social determinant of health inequity on a population level, the report has a set of recommendations related to intersectoral capacity, strengthening legal bases, knowledge, empowerment and collective vision.

Use this resource to

  • facilitate a discussion with public health colleagues about the role of practitioners to take action on unhealthy housing conditions for low-income tenants;
  • develop an approach that meaningfully engages community members who have lived experience of unhealthy housing with public health planning and policy development; and
  • explore intersectoral partnerships to address housing needs, including current collaborative groups that gather around other health equity issues.

Reference

RentSafe. (2018). Towards healthy homes for all: RentSafe summary and recommendations. Canadian Partnership for Children’s Health and the Environment, Ottawa.

Related resources

Tags: Community engagement, Environmental health, Housing, Intersectoral action, Community Organization, Link

The SDH impacts of resource extraction and development in rural and northern communities

The “boom and bust” cycles associated with natural resource extraction have a significant impact on the social, cultural and economic determinants of health for both individuals and communities. While many resource extraction projects may undertake an environmental impact assessment, the population health inequities that result from these projects are often not accounted for in their design and implementation. There is a need to account for the impact of these projects on the social determinants of health (SDH) so that the resulting health inequities and associated healthcare costs are reduced.

The Northern Health region collaborated with the British Columbia Observatory for Population and Public Health and the BC Centre for Disease Control to produce a report that explores how resource extraction and development in rural and northern communities can influence SDH. This report serves to inform how SDH considerations are incorporated into the assessment and monitoring of natural resource extraction and development projects. Based in a holistic and First Nations perspective on health and wellness, the literature scan and summary of evidence was conducted in consultation with stakeholders for to identify both common impacts of resource development projects on SDH and measures that can be used to assess and monitor these impacts. The literature reported summarizes SDH impacts related to 15 sociocultural determinants of health, including those related to Indigenous self-determination and connections to the land. Environmental, social impact, health impact, socio-ecological, and cumulative assessment frameworks are reviewed, with consideration for common themes and their application to public health. A number of promising principles for the assessment, measurement, and monitoring of impacts on SDH are offered, including the selection of appropriate indicators, qualitative and quantitative methods, and the importance of community involvement in all phases.

Use this resource to

  • facilitate a discussion among PH and other colleagues about the impacts of resource extraction on SDH in rural and northern communities;
  • support a relationship with resource development stakeholders in your community to consider assessment and monitoring processes specific to the SDH; and
  • deepen your understanding of the social impacts of resource development, and how pre-existing inequities can be worsened when these impacts are not accounted for.

Reference

Northern Health. (2018).The social determinants of health impacts of resource extraction and development in rural and northern communities: a summary of impacts and promising practices for assessment and monitoring. Northern Health, British Columbia Observatory Population and Public Health, BC Centre for Disease Control. British Columbia, Canada.

Related resources

Tags: Assess and report, Environmental health, Healthy public policy, Link

Protéger les plus vulnérables, un impératif de santé publique

This resource is only available in French.

Employment and income are important social determinants of health [1]. In November 2016, the Québec government adopted a new act to better align training and jobs to facilitate entry into the labour market (Bill 70) [2]. This reform requires new social assistance applicants to enroll in a labour market integration program known as Objectif Emploi (French only) or face financial penalties in the form of reduced social assistance rates.

In this memorandum to the Québec Government, Montreal and Montérégie’s public health directors advocate for the removal of the financial penalties from the program, noting that their implementation has the potential to increase food insecurity and homelessness in their regions [3]. In the memorandum, the public health directors use local surveillance data, evidence from the literature and their knowledge from working with intersectoral partners to develop seven recommendations for improving the Objectif Emploi program. 

Recommendations in the report include not only the removal of the of the financial penalties associated with the program but also call for a health impact assessment; ongoing evaluation of the program; provisions for the quality of jobs included under the program; and accessible health care, childcare and public transportation for program participants regions [3].

Use this resource to

  • see an example of upstream public health action to reduce health inequities; and
  • see public health advocacy for policy change to improve the social determinants of health action. 

Reference

Direction régionale de santé publique du CIUSSS du Centre-Sud-de-l’Île-de-Montréal et Direction de santé publique du CISSS de la Montérégie-Centre. (2017). Protéger les plus vulnérables, un impératif de santé publique. Montréal and Longueuil, QC: Bibliothèque et Archives nationales du Québec. Available from: http://www.dsp.santemontreal.qc.ca/fileadmin/documents/dossiers_thematiques/Autres_thematiques/Inegalites_sociales_de_sante__ISS_/12092017_Mem_Proteger_les_plus_vulnerable_final.pdf

Related resources

References

[1] National Collaborating Centre for Determinants of Health. (2014). Glossary of essential health equity terms. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

[2] Assemblée Nationale du Québec. (2016). An Act to allow a better match between training and jobs and to facilitate labour market entry. Available from: http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=5&file=2016C25A.PDF.

[3] Direction régionale de santé publique du CIUSSS du Centre-Sud-de-l’Île-de-Montréal et Direction de santé publique du CISSS de la Montérégie-Centre. (2017). Protéger les plus vulnérables, un impératif de santé publique. Montréal and Longueuil, QC: Bibliothèque et Archives nationales du Québec. Available from: http://www.dsp.santemontreal.qc.ca/fileadmin/documents/dossiers_thematiques/Autres_thematiques/Inegalites_sociales_de_sante__ISS_/12092017_Mem_Proteger_les_plus_vulnerable_final.pdf.

Tags: Fair society, Income inequality, Public health unit / health authority, Public Health Association, Link

Leadership competencies for public health practice in Canada

Community Health Nurses of Canada, in partnership with Canadian Institute of Public Health Inspectors and Manitoba Public Health Managers Network, have developed Leadership Competencies for Public Health Practice in Canada. The leadership competencies are to be used by public health practitioners at all levels of an organization and across all disciplines. They represent skills, knowledge and attributes that are considered foundational to supporting public health leadership practice in Canada.
The leadership competencies are intended to complement the Core Competencies for Public Health in Canada and discipline specific competencies for public health nurses, dietitians, public health inspectors, dentists, physicians, health promoters and epidemiologists. Competency statements are outlined for five main areas of public health leadership practice including systems transformation, achieve results, lead self, engage others and develop coalition. These leadership competencies will serve to strengthen public health leadership practice based on core values of health equity and social justice in the achievement of population health goals.

Use this resource to

  • facilitate a discussion about essential knowledge, skills, and attributes of leaders at multiple levels of the public health system;
  • develop a continuing education plan for the enhancement of public health leadership skills; and
  • support the enhancement of competence among public health leaders in the pursuit of population health equity.

Reference

Community Health Nurses of Canada. (2015). Leadership Competencies for Public Health Practice in Canada: Leadership competency statements version 1.0.  Community Health Nurses of Canada.

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Health equity indicators for Ontario local public health agencies

Where health status indicators measure the level of health inequity in a population, the “organizational action indicators” mentioned in this report measure the process of health equity work happening within a public health agency (but not the impact on population health). The goal of this user guide is to support organizations in assessing how well they are meeting their health equity mandate through identifying equity related activity in programs and services, where gaps in action are and improvements made over time.

The document is presented in five sections that align with the four public health roles for improving health equity developed by the NCCDH, in addition to a fifth role developed by the research team.

  1. Assessing and reporting on health status
  2. Modifying and re-orienting public health programs
  3. Engaging in community and multi-sector collaboration
  4. Leading, supporting and participating with others to address policies
  5. Developing organizations and systems

Each indicator is accompanied by resources and references.  A glossary of terms is included, along with a series of worksheets to support the practical application of the indicators.
This document was developed by Public Health Ontario’s Locally Driven Collaborative Project (LDCP) to support public health organizations in Ontario in taking action to address the health equity mandate outlined in the Ontario Public Health Standards (OPHS). Use of these indicators can support public health practitioners across Canada to assess and improve actions at an organizational level to address population health inequities.

Use this resource to

  • facilitate a discussion about how health equity is placed as a priority in your public health organization;
  • determine current health equity actions being taken in your organization and where improvements can be made;
  • develop program and evaluation plans to assess steps being taken to address population health inequities; and
  • identify facilitators and barriers to health equity work in your public health organization.

Reference

Public Health Ontario. (2016). Health equity indicators for Ontario local public health agencies: User guide. Public Health Ontario.

Related resources

Tags: Assess and report, Competencies & organizational standards , Intersectoral action, Leadership & capacity building, Modify & orient, Public Health Organization, Document

Building your capacity to facilitate health equity action: Learning pathways for public health middle managers

Middle managers (directors, managers and supervisors) play an important role in facilitating and supporting the innovative health equity work that public health organizations undertake. Consequently, the NCCDH developed this self-directed learning tool to facilitate and support the professional development of public health directors, managers and supervisors.

Understanding a learning pathway

Learning pathways are a form of self-directed learning that includes self-assessment and learning task selection, and should end in practice or behavioural change. [1] The learning strategies and design elements of these learning pathways were informed by a brief literature search and review [1] (the findings of which are available upon request from the NCCDH – in English only). The learning pathways include selected readings and videos from the NCCDH Resource Library, categorized into introductory resources and resources for additional learning. The learning pathways also include learning tools such as quizzes for middle managers to self-assess their knowledge, as well as questions and thinking activities to help middle managers take away practical lessons from each resources they review in the pathway.

Key competencies

This learning pathways build the knowledge, skills and attitudes (i.e., competencies) public health middle managers require to be successful at facilitating the development and implementation of public health strategies and interventions that reduce health inequities. Resources and tools are clustered into learning pathways according to five middle management competency domains adapted to the public health context from the Government of Canada’s Key Leadership Competency Profile. [2] This competency set was selected following a brief literature review to identify existing middle management competencies [3], the results of which are available upon request from the NCCDH – in English only.  The five middle management competency domains include [2.3]:

  1. Create vision and strategy
  2. Mobilize people and achieve results
  3. Uphold integrity and respect
  4. Collaborate with partners and stakeholders
  5. Promote innovation and guide change

Using competencies to cluster tools and resources allows middle managers to clearly see how the knowledge gained from using the learning pathways can be used to build the skills and attitudes needed to succeed in their roles.

Time commitment

It should take approximately one hour to review the introductory resources and complete the tools clustered under one competency domain. Reviewing the additional learning resources should take no more than an additional 45 minutes for each competency domain.

Use this resource to

  • Develop the middle management competencies needed to support health equity work in public health

Reference

National Collaborating Centre for Determinants of Health. (2018). Learning pathway for public health middle managers. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources

References

[1] Meighoo, P. (2018). Learning Pathways. Brampton, ON: Durlaksar Inc.
[2] Government of Canada. (2015). The Key leadership competency profile [Internet]. Available from: https://www.canada.ca/en/treasury-board-secretariat/services/professional-development/key-leadership-competency-profile.html
[3] Meighoo, P. (2018). Middle Management Competencies. Brampton, ON: Durlaksar Inc.

This product is in the final stages of production. Please check back soon.

Tags: Competencies & organizational standards , Key concepts, Leadership & capacity building, National Collaborating Centre for Determinants of Health, Online Course

A gaps analysis to improve health equity knowledge and practices

As part of its mandate, the National Collaborating Centre for Determinants of Health (NCCDH) uncovers and responds to gaps that influence the public health sector’s capacity to improve or mitigate social determinants of health. Given the complexity of addressing SDH to advance health equity, the NCCDH approaches gaps broadly. This analysis identifies gaps in research on public health systems and practices relating to health equity, weaknesses and inconsistencies in practitioner knowledge and skills, and barriers to accessing and applying knowledge.

The NCCDH identifies evidence and knowledge gaps through multiple means, including secondary research and synthesis of literature; consultation with its audiences, partners and other stakeholders; direct requests for information from users, researchers and other stakeholders; and evaluation and environmental scanning reports.

This gap analysis was designed as a resource to focus attention on the most pressing needs in advancing health equity. It is structured to identify gaps and actions by three key audiences:

  • Researchers - Primarily academics outside of the formal public health system (or co-appointed) who have some capacity to undertake independent research
  • Policy-makers and government decision-makers - Those with the authority to generate changes in the conditions and context within the public health system, influencing both how practitioners work and how public health departments and institutions are organized.
  • Public health practitioners – Those who practice in the formal public health sector, including formal leaders (senior management), middle management and front-line, across programs and disciplines.

Use this document to

  • to undertake independent research
  • to generate changes in the conditions and context within the public health system, influencing both how practitioners work and how public health departments and institutions are organized

Reference

National Collaborating Centre for Determinants of Health. (2018). A Gaps Analysis to Improve Health Equity Knowledge and Practices. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources

Tags: Gaps, Knowledge translation , Promising practices , National Collaborating Centre for Determinants of Health, Document

Building a culture of equity in Canadian public health: An environmental scan

This is the third environmental scan undertaken by the National Collaborating Centre for Determinants of Health (NCCDH) since 2010. It responds to recent concerns about the significant decline in commitment to public health programs and services in the Canadian health sector. The scan explores implications for the public health sector in undertaking effective action to address the social determinants of health and improve health equity in this context.

The four public health roles to address health equity are revisited and the essential resources for undertaking these roles are explored further, along with the implications for how these resources can be used for organizational and system development. The resulting framework uses “resources for action” to bridge public health action (the four roles) and organizational and community change processes focused on supporting health equity.

The resources for action provide the information and tools public health practitioners need to fulfill the four roles and build a culture of equity:

  1. Leadership – formal leadership and systems leadership (transformational)
  2. Evidence - research and evaluation to guide decision-making
  3. Communication – to frame, educate, and inform internally and externally
  4. Training – skill development and partnership development

Five action areas for building organizational and leadership capacity to improve health equity in the context of the current health system are distilled from the findings. These recommendations include the following:

  1. Incorporate health equity as a foundational value for the health system
  2. Support a values-reflection process for leaders
  3. Prepare public health leaders to advocate for health equity work across the health system
  4. Support use of an equity lens in evidence-based decision-making
  5. Support grounded community engagement as a foundation for health equity work

The potential strategies described under each action area have been selected to align with the knowledge translation role of the NCCDH. However, each action area (and resources for action) is equally applicable across public health and the wider health system at all levels (local, provincial/territorial, national).

Use this document to

  • learn about the challenges and opportunities from across the country for public health to take action to improve health equity;
  • explore ways your organization can strengthen resources for action to support change processes; and
  • identify possible strategies and next steps to guide your health equity work and build a culture of equity.

Reference

National Collaborating Centre for Determinants of Health. (2018). Building a culture of equity: 2017 environmental scan. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources

Tags: Assess and report, Knowledge translation , National Collaborating Centre for Determinants of Health, Document

Key public health resources for Master of Public Health students: A curated list

This curated list from the National Collaborating Centre for Determinants of Health (NCCDH) outlines key resources to support Master of Public Health (MPH) students looking to incorporate health equity action into their career in Canadian public health. The resource draws from documents and tools available from the NCCDH website.

The resources are organized into three main categories:

  • Introductory resources: For those needing an introduction to the concept of health equity or to the social determinants of health
  • Online tools: For those seeking opportunities to connect with fellow practitioners or with organizations demonstrating a commitment to health equity
  • Guidance documents: For those orienting their future work in the field towards action that promotes health equity

Use this resource to

  • direct your own learning as an MPH student seeking a better understanding of health equity and the social determinants of health (SDH)
  • guide and support student discussion on the application of health equity and SDH to public health practice in Canada
  • gain insight from working public health practitioners on the most pressing issues facing health equity promoters today

Reference

National Collaborating Centre for Determinants of Health. (2018). Key public health resources for Master of Public Health students: A curated list. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Promising practices , Reading list, Students, National Collaborating Centre for Determinants of Health, Document

Public health leadership to advance health equity: A review summary

Cette ressource est aussi disponible en français

In 2016, Betker (2016) completed a dissertation titled Public health leadership to advance health equity: A scoping review and metasummary that reviewed research on health equity interventions and identified outcomes. The NCCDH has collaborated with Dr. Betker to produce an overview of the key findings of the scoping review and metasummary. It covers such topics as:

  • the status of the existing evidence base;
  • the essential attributes of public health leaders;
  • the importance of relationships in leading public health action for health equity;
  • the types of knowledge needed by leaders;
  • the essential nature of value when making decisions as a public health leader
  • the bridging and enabling role of leaders;
  • the levels at which leadership occurs; and
  • the tools and mechanisms to support leadership development.

To facilitate the application to public health practice, the resource aligns activities to support leadership development with core public health roles and leadership competencies. It also includes key messages for practice and research.

Use this resource to

  • facilitate a discussion about the importance of key attributes and values, as well as how to support these notions among current and emerging public health leaders;
  • identify actions that can be taken at each of the three levels of leadership to advance health equity within public health practice;
  • develop a professional development plan to strengthen the essential types of knowledge, relational aspects and bridging/enabling roles of public health leaders; and
  • consider activities within core public health roles that support the development of leadership for health equity action.

Reference

Betker, RC and the National Collaborating Centre for Determinants of Health (2018). Public health leadership to advance health equity: A review summary. Antigonish, NS: National Collaborating Centre for Determinants of Health.

Related resources

Tags: Competencies & organizational standards , Key concepts, Leadership & capacity building, Public health unit / health authority, National Collaborating Centre for Determinants of Health, Document

The health of Canada’s children and youth: A CICH profile

Cette ressource est aussi disponible en français.

The Canadian Institute of Child Health (CICH) has developed a series of topic-specific modules that consolidate over 400 indicators on the health and well-being of children aged 0 to 5 and their families. The modules compile data on a variety of child- and youth-related topics, including:

  • the context of children’s lives, including demographics, family composition, health outcomes, economic inequities and international comparisons;
  • genetics and pediatric health;
  • primary health services; and
  • the health profile of immigrant children and youth in Canada.

Two of the modules have an emphasis on the social determinants of health. Module 7 (English only at this time) is specific to Indigenous early childhood development and was developed using a determinants of health model. Module 8 (English only at this time) is more broadly applicable to early childhood development and includes an early childhood partnership tool that can be customized to identify partnership opportunities for particular program needs. Both modules feature innovative examples of intersectoral initiatives that show how data have been used to lead action on early childhood development.

This project is a collaboration between the Canadian Council on Social Determinants of Health (CCSDH), the Canadian Institute for Child Health (CICH) and the Public Health Agency of Canada (PHAC). The modules will be useful for anyone working with children or designing interventions to support children’s growth and development.

Use this resource to

  • develop intersectoral partnerships to address early child development in public health programs;
  • identify opportunities to share resources, expertise and ideas among partners in early childhood health and well-being;
  • support the development of interventions promoting action to address social determinants such as Indigeneity, income inequity, inadequate housing and food insecurity; and
  • advocate for early-childhood resources and programs by demonstrating where health inequities exist.

Reference

Canadian Institute of Child Health (2018). The health of Canada’s children and youth: A CICH profile. Canadian Council for Social Determinants of Health and Canadian Institute for Child Health: Canada.

Related resources

Tags: Assess and report, Early childhood development, Intersectoral action, Partnership , Public Health Organization, Link

Public health leadership for action on health equity: A literature review

Cette ressource est aussi disponible en français.

In 2016, Dr. Claire Betker completed a scoping review and metasummary on public health leadership for action on health equity as a PhD dissertation research project. The dissertation included a comprehensive literature review, which revealed that there is very little theoretical and empirical literature examining public health leadership to take action on health inequities. The lack of literature makes the definition, development and support of leadership in this area very challenging.

This summary highlights key concepts from the general leadership literature that are transferrable to public health action on health equity, including:

  • elements and theories of leadership;
  • distinguishing followers and leaders;
  • differentiating leadership and management; and
  • considering leadership at multiple levels of the health system.

Key learnings from the literature are explored, such as the empowerment of leaders at multiple levels, relational aspects of leadership, the use of data to demonstrate inequities and the interdependence of leaders and followers. Research gaps and areas for further development highlight opportunities to enrich the field of public health leadership to address inequities.

Use this resource to

  • discuss the relationship between management and leadership, and between leaders and followers;
  • explore opportunities to develop leadership knowledge and skills at multiple levels of the public health system;
  • identify research projects that consider elements of public health leadership that specifically aim to advance health equity; and
  • consider leadership development within the community, organizations and civil society in partnership with public health.

Reference

Betker, RC and the National Collaborating Centre for Determinants of Health (2018). Public health leadership for action on health equity: A literature review. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources

Tags: Leadership & capacity building, Promising practices , National Collaborating Centre for Determinants of Health, Document

Key public health resources for anti-racism action: A curated list

Cette ressource est aussi disponible en français.

Racism and racialization are important considerations in public health work because of the documented impact each has on the health outcomes of Indigenous Peoples and people of colour. Action on racism requires an understanding of both its structural implications and the tools available to promote anti-racist action at the individual, organizational and system levels.

The purpose of this reading list is to offer a starting point for public health practitioners hoping to deepen their understanding of the causes and implications of structural racism. In addition, the collection highlights different strategies for dismantling racist systems and offers examples of communities that have experience success with these aims.

The resources and tools selected address four main areas for promoting anti-racist action in public health:

  1. Building capacity: Supports systems and organizations that are considering how to analyze and act on the structural forces that drive racial inequities
  2. Taking action: Includes resources for assessing and reporting on the impacts of racialization and racism
  3. Case examples: Offers practice-based examples of system- and organization-level action on racism
  4. Tools to support planning and implementation: Showcases organizations that have enacted strategies and guidance that can be applied to their own contexts

This curated list is not meant to be comprehensive but to showcase key considerations for addressing the systemic and structural causes of racism.

Reference

National Collaborating Centre for Determinants of Health. (2018). Public health resources for anti-racism action: A curated list. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Other related resources

Tags: Racism/racialization, Reading list, National Collaborating Centre for Determinants of Health, Document

Pan-Canadian Health Inequalities data tool, 2017 edition

Cette ressource est aussi disponible en français.

This data tool from the Pan-Canadian Health Inequalities Reporting Initiative is designed to help program analysts, policy analysts and public health practitioners to identify which health issues and populations are experiencing the greatest level of inequity. Once such areas have been identified, the resource is meant to inform priorities for action. Partners in this initiative include the Public Health Agency of Canada (PHAC), the Pan-Canadian Public Health Network (PHN), Statistics Canada and the Canadian Institute for Health Information (CIHI).

The Pan-Canadian Health Inequalities data tool includes over 70 indicators of health outcomes and determinants drawn from 13 national data sources, including indicators for health status and health determinants (daily living conditions and structural drivers). The data is disaggregated by 14 social and demographic stratifiers meaningful to health equity, including socioeconomic status, Indigeneity and place of residence, as well as demographics such as age, racial background and sexual orientation. Various effect measures and population impact measures can be accessed, allowing a deeper interpretation of the data. Chosen data can also be displayed visually in the form of charts, which can be downloaded for incorporation into other products or for further dissemination.

An accompanying report on Key Health Inequalities in Canada describes 22 of the most widespread health inequalities in Canada. This report also identifies priority areas for federal and provincial/territorial action and monitoring, including data on Indigenous Peoples living on reserve and in northern communities. Together, the data tool and health inequalities report can inform how public health research, programs and services can better address health inequities. 

Use this resource to

  • generate research questions about the relationships between indicators of health status and how they can be stratified to indicate inequities in health outcomes;
  • facilitate a discussion about which populations are experiencing which types of health issues and inequities;
  • inform public health prioritization and program planning activities; and
  • support and inform surveillance activities when planning health status reporting.

Reference

Public Health Agency of Canada, the Pan-Canadian Public Health Network, Statistics Canada and the Canadian Institute of Health Information. (2017). Pan-Canadian health inequalities data tool, 2017 edition. Public Health Agency of Canada (PHAC): Canada.

Related resources

Tags: Assess and report, Socioeconomic status , Public Health Agency of Canada, Link

What Is Health Equity? And What Difference Does a Definition Make?

This report from the Robert Wood Johnson Foundation aims to stimulate discussion and promote greater consensus about the meaning of health equity and the implications of acting on it. The goal of the report is to identify essential elements to guide effective action rather than to encourage all practitioners to use the same words to define health equity.

The report notes that definitions can matter and that, in the case of health equity, clarity is important, especially given that working towards equity is a struggle that must engage diverse stakeholders with varied agendas. Clarifying the meaning of health equity can bring actors a step closer to identifying and promoting policies and practices that are likely to reduce inequities.

What is health equity? includes a general definition of health equity, a definition that is relevant for measurement and short, audience-specific definitions. In addition, the report presents guiding principles for action to achieve health equity, examples of organizations advancing health equity and resources for further exploration and learning.

A brief version of the report can be found here.

Use this resource to

  • facilitate discussions on the meaning of health equity;
  • identify a process and principles to guide health equity action; and
  • generate actionable ideas to achieve health equity.

Reference

Braveman P, Arkin E, Orleans T, Proctor D, and Plough A.  (2017). What Is Health Equity? And What Difference Does a Definition Make? Princeton, NJ: Robert Wood Johnson Foundation.

Tags: Critical works in health equity, Public Health Organization, Document

Austerity and the embodiment of neoliberalism as ill-health: Towards a theory of biological sub-citi

This theoretical article from Matthew Sparke sheds light on the growing global health inequities that he argues are a direct consequence of the austerity policies of neoliberal governments. In this resource, Sparke, a professor of politics at the University of California Santa Cruz, shows how austerity creates “radically unequal health risks and risk management options” and extends beyond national borders. Referencing Canadian academics Ronald Labonté and Ted Schrecker, Sparke refers to his work as a theory of biological sub-citizenship where people are “actively prevented from becoming fully enfranchised biological citizens.”

Sparke divides his argument into three categories:

  1. Health disenfranchisement through exclusion and conditionalization refers to national health service cuts, user fees and privatization plans.
  2. Biological sub-citizenship through biovalue extraction and exploitation refers to the growing inequity between those who benefit from biomedical advances and those who are used in the process.
  3. Disenfranchisement through financialized experimentation refers to pro-market efforts to correct injustices in specific disease streams and in specific locations, leaving millions of people either “fleetingly enfranchised” or further non-enfranchised.

Use this resource to

  • deepen your understanding of the multiple pathways to health inequity;
  • find counter-arguments for government austerity measures; and
  • learn about the inequitable global health impacts of austerity and pro-market policies.

Reference

Sparke, M. (2016). Austerity and the embodiment of neoliberalism as ill-health: Towards a theory of biological sub-citizenship. Social Science and Medicine 187 (2017) 287-295. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0277953616307079.

Tags: Critical works in health equity, Healthy public policy, Income inequality, Key concepts, Policy analysis, Socioeconomic status , Document

Public Health: A Conceptual Framework, 2nd Edition

Cette ressource est disponible aussi en français.

To define what is meant by a public health “lens” or “perspective,” the Canadian Public Health Association (CPHA) developed a working paper that outlines a conceptual framework for public health.  This framework offers two things:

  1. A structure for the foundations of public health
  2. A model for the essential components of population health strategies

The CPHA plans to use elements of this framework to define its policy options in the coming years.

The framework starts with the foundations of public health practice and moves on to the amalgamation of activities that constitute the field.

The three foundations that guide public health action include social justice, health equity and the social and ecological determinants of health.

The key activities that stem from the foundation fall into one of five connected areas:

  1. Evidence base: Research (qualitative and quantitative), community consultations and surveillance/epidemiology
  2. Risk assessment: Informed by the evidence base and includes hazard identification and characterization, exposure assessment and estimate of risk on a population level
  3. Policy: Informed by the evidence base and risk assessment, with considerations for financial, economic, social and legal/jurisdictional issues
  4. Program: If or when the policy is put into action, which is most often implemented through multisector collaboration and includes those who are directly affected by the health issue
  5. Evaluation: Critical to assessing whether the program is meeting its goals, based on qualitative and quantitative data that can inform further public health program development

Though this framework was developed to guide CPHA policy options, it is also meant to capture the complex and dynamic nature of the public health system and, more broadly, the populations it serves. The working paper can be used in its current form by public health practitioners to give context to the complexity of their work and the elements needed to enact change. 

Use this resource to

  • facilitate discussion about public health practice that is rooted in social justice and health equity;
  • explore the role of public health in contributing to the evidence base that informs the other building blocks of public health practice;
  • compare current public health actions with the framework and identify areas for change; and
  • support the shifting of public health attention away from lifestyle and charity based strategies and towards addressing root causes of health inequities.

Reference

Canadian Public Health Association (2017). Public Health: A Conceptual Framework, 2nd Edition. Canadian Public Health Association: Ottawa.

Tags: Key concepts, Public Health Association, Document

Health Equity Tools 2.0

The University of Victoria’s Equity Lens in Public Health project created an inventory of health equity tools to help people working in public health make sense of the growing number of resources available. The 2016 inventory includes 112 tools, an update of the 2013 iteration that comprised 36 resources.

The research team combed through peer-reviewed and grey literature for tools that clearly identify the improvement of health equity as a goal. The search also included any content that described itself as a guide, resource, audit or framework for health equity. The documents were screened for relevance to public health and for their inclusion of steps or a process to follow. Each entry in the inventory is designed to help the reader find specific categories of information, including objectives, intended users, content, type, how it can be used and information about the application and evaluation of the tool.

The inventory has been organized into nine major categories reflecting broad areas of application, with an appendix that includes a list of practical and theoretical criteria to consider when determining if the tool is useful for you and your organization. There are also a number of additional resources on the ELPH website, including a detailed description of their research program and a list of publications and presentations.

Use this resource to

  • assess the degree to which health equity is integrated into a public health program or policy;
  • measure the impact of a program or policy on the distribution of health outcomes; and
  • promote the inclusion of health equity in public health policies and programs.

Reference

Pauly, B., MacDonald, M., Hancock, T., O'Briain, W., Martin, W., Allan, D., Riishede, J., Dang, P., Shahram, S., Strosher, H., & Bersenev, S. on behalf of the ELPH Research Team (2016). Health Equity Tools 2.0. Victoria, BC: University of Victoria.

Related resources

Tags: Communicate, Knowledge translation , Methods & tools, Modify & orient, Knowledge Translation Organization , Document

Health inequities in the age of austerity: The need for social protection policies

In this commentary, Arne Ruckert and Ronald Labonté of the University of Ottawa’s School of Epidemiology and Public Health synthesize research on the impact that the 2008 global financial crisis had on social policy and health equity. The researchers focus on the connection between social austerity measures — the social spending restraints adopted by governments around the world in response to slowing economic growth — and health equity measures.

The report lists studies from around the globe that link austerity policies with health outcomes. While some studies show health improving in times of recession (more home-cooked meals, less stress), the authors focus on how austerity affects the pathways to health inequities. For example:

  • people with higher levels of formal education tend to emerge from recessions in better health;
  • people earning lower incomes experience significantly greater barriers to accessing health care once “user fees” are introduced; and
  • people facing protracted employment caused by austerity measures have a higher propensity towards depression and suicide.

Ruckert and Labonté conclude that social protection spending is key to mitigating the negative effects on health, and particularly health equity, during times of government austerity. They argue that the Sustainable Development Goals offer a strong anti-austerity agenda and can be shortened from 17 goals to three:

  1. Quality education
  2. A reduction of inequality
  3. The development of environmentally sustainable consumption and production

They critique the SDGs’ contradictory support of a “business-as-usual” model of economic growth, which they say is irrefutably linked with growing income, wealth and health inequality.

Use this resource to

  • find research support for arguments that cuts in social spending aggravate health inequities
  • better understand the impacts of a neoliberal economic worldview on health and well-being; and
  • incorporate Sustainable Development Goal–oriented thinking in public health programming and policy

Reference

Ruckert, A. & Labonté, R. (2017). Health inequities in the age of austerity: The need for social protection Policies. Social Science and Medicine 187 (2017) 306-311. Retrieved from:  https://www.sciencedirect.com/science/article/pii/S0277953617301752.

Tags: Access to health services, Healthy public policy, Income inequality, Key concepts, Policy analysis, Link

Basic income: Rethinking social policy

There is growing momentum in Canada for a government-supported basic income guarantee (BIG). Ensuring a minimum level of income is thought to provide a way to address income inequities and the resulting health, social and economic impacts they have. Edited by Alex Himelfarb and Trish Hennessy, this compendium of short essays considers the implications of basic income as a policy option to address income and social inequities. This collection explores whether basic income represents an alternative way of investing in social justice and equity.

The publication offers many varying perspectives on basic income that may be considered as part of policy implementation. These include the following:

  • Social and economic conditions for implementation of basic income and the impact on health and housing outcomes
  • How basic income contributes to poverty reduction, including effects on marginalized groups such as Indigenous peoples
  • Alignment of basic income with employment standards and family supports
  • Considerations related to essential labour market policies and other social service/public programs 
  • Historical controversies surrounding the idea of a BIG

This report refrains from offering a blanket endorsement of basic income, nor does it present a full argument against the strategy. Rather, it recognizes the potential for a BIG to help transform welfare policies, working to move BIG into the realm of realistic solutions to current policy problems regarding social inequities.

Use this resource to

  • facilitate a discussion about how basic income could impact social determinants of health including housing, food insecurity, employment conditions, income inequity and socioenvironmental conditions of living;
  • explore how basic income could additionally influence social inequities related to racism and colonialism;
  • support the work of poverty reduction groups with evidence-based perspectives on basic income; and
  • inform advocacy activities for basic income as a provincial and federal policy option to address health and social inequities.

Reference

Canadian Centre for Policy Alternatives Ontario (2016). Basic income: Rethinking social policy. Alex Himelfarb & Trish Hennessy, eds. Canadian Centre for Policy Alternatives Ontario Office: Toronto.

Related resources

Tags: Access to health services, Income inequality, Key concepts, Policy analysis, Socioeconomic status , Working conditions, Public Health Organization, Link

Handbook of Health Equity in Environmental Public Health Practice

Environmental public health (EPH) can promote health equity by identifying populations at risk, working toward equity-promoting solutions and advocating for changes to address inequities. The traditional model of EPH practice focusing on the impact of programs at an individual level is shifting to an emerging style of practice that considers population-level impacts and solutions. This English-language resource from the British Columbia Centre for Disease Control offers a collection of tools that describe how EPH intersects with the social determinants of health and health equity, as well as strategies for EPH practitioners to integrate these issues into their work. 

This handbook includes resources for exploring health equity in the context of EPH through an overview of concepts, as well as descriptions of facilitators, barriers and policy levers. It incorporates approaches for including health equity in EPH such as practice scenarios, strategies for examining organizational capacity and tools for EPH practitioners to use in their daily practice. A section on the built environment provides specific approaches for EPH practitioners working with local governments and offers context for the importance of addressing the socioenvironmental influences on health. This resource will be useful to EPH practitioners at all levels of public health (including frontline public health inspectors/environmental health officers), as well as those in management and supervisory positions (including Medical Officers of Health who have a focus in EPH programming).

Use this resource to:

  • explore how EPH and health equity intersect in public health programs;
  • support the development of skills and knowledge among EPH practitioners to address health equity;
  • examine how public health programs can address health equity within regulatory protocols and standards for EPH; and
  • advocate for services and policies to address the environmental sources of health inequities.

Reference:

British Columbia Centre for Disease Control (2017). Handbook of health equity in environmental public health practice. British Columbia Centre for Disease Control: Vancouver, BC.

Related resources:

Tags: Environmental health, Methods & tools, Public health unit / health authority, Socioeconomic status , Public Health Organization, Document

Implications of a Basic Income Guarantee for Household Food Insecurity

The Northern Policy Institute (NPI) is an independent policy institute that works to identify policy opportunities to support the sustainable growth of Northern Ontario communities. The document, titled Implications of a basic income guarantee for household food insecurity, was created as part of the NPI's series exploring basic income guarantee as a policy option for addressing income-related health inequities. This paper supports the notion that food insecurity is centrally connected to inadequate and insecure incomes. 

Household food insecurity is an indicator of material hardship that extends beyond the issues of food access and skills. Food insecurity is a social determinant of health as well as a determinant of health care spending, with the probability of food insecurity increasing as household income decreases across the population. In this paper, basic income guarantee (BIG) is discussed in relation to affordable housing, food programs, improved wages, as well as BIG's potential to reduce the incidence and severity of household food insecurity. One of the report’s recommendations for addressing food insecurity is to develop a basic income policy strategy that can be applied to a variety of household compositions and locations.

Use this resource to:

  • facilitate discussion about basic income guarantee as a policy option to address food insecurity at the population level;
  • explore the differences between policy options to food insecurity and access and charity-based strategies;
  • support program development that shifts public health action towards income-based policy solutions to food insecurity; and
  • advocate for BIG.

Reference:

Tarasuk, V. (2017). Implications of a basic income guarantee for household food insecurity. Northern Policy Institute: Thunder Bay, ON.

Related resources:

Tags: Food security, Healthy public policy, Income inequality, Policy analysis, Socioeconomic status , Community Organization, Document

PROOF – Research to identify policy options to reduce food insecurity

PROOF is an interdisciplinary research project that investigates food insecurity in Canada. The project examines the material conditions that determine food insecurity at a household level, costs to the healthcare system and policy interventions to address inadequate income as a source of food insecurity. PROOF has published reports on a basic income guarantee to address food insecurity, as well as several documents on research indicators of food insecurity. The team has developed fact sheets to explore the process of monitoring food insecurity, its impact on children and overall health, its relationship to food access and public policy, and its intersection with social assistance. Digital versions of previous presentations and webinars offered by PROOF are available, as well as links to external research publications.

There is a symbiotic relationship between food insecurity and adequate income: food insecurity is a lens through which to advocate for basic income guarantee, and a basic income guarantee will, in turn, facilitate action on reducing food insecurity in Canada.

Use this resource to:

  • facilitate discussion about the difference between food access and food insecurity;
  • explore policy options to address food insecurity; and
  • advocate for a basic income guarantee.

Related resources:

  • Public Health Speaks: Upstream action on food insecurity
  • Upstream action on food insecurity: a curated list
  • Learning from practice: advocacy for health equity – food security

Reference:

PROOF. PROOF – Research to identify policy options to reduce food insecurity [Internet]. Toronto (ON): University of Toronto; 2017 [cited 2017 Sept 19]. Available from: http://proof.utoronto.ca/.

Tags: Assess and report, Food security, Healthy public policy, Income inequality, Policy analysis, Socioeconomic status , Community Organization, Link

Innovative approaches to promoting population mental health and well-being

Innovative approaches to promoting population mental health and well-being

Dr. Margaret Barry’s lecture, titled “Innovative approaches to promoting population mental health and well-being: Who needs to be engaged for effective action?,” addresses the need for innovative policies and approaches to address the social determinants of mental health (SDMH) and considers what it means to adopt whole-of-government and whole-of-society approaches to promoting population mental health and well-being. Frameworks for implementation, evidence-based strategies and consideration of a “mental-health-in-all-policies” approach are explored. The link between mental health promotion and primary prevention is touched on, including the SDMH and how population mental health promotion (PMHP) intersects with public health practice. Evidence-based actions for implementing a PMHP approach are presented, with a focus on mental health promotion in children and youth through multi-sectoral collaboration and engagement of the wider community.

This live stream event was co-presented by the National Collaborating Centre for Determinants of Health and St. Francis Xavier University’s Department of Education and Office of the Associate Vice-President of Research. It was made possible by a Dobbin Atlantic Scholarship from the Ireland Canada University Foundation, provided with support from the Government of Ireland.

Use this resource to:

  • facilitate a discussion about population mental health promotion for children and youth;
  • identify multi-sectoral partnerships to promote mental health across society; and
  • explore the social determinants of mental health and their contribution to health inequities.

Related resources:

Reference:

Barry, M. Innovative approaches to promoting population mental health and wellbeing. Lecture presented at: St. Francis Xavier University; 2017 Jun 1; Antigonish, NS, Canada.

Tags: Mental Health, Policy analysis, National Collaborating Centre for Determinants of Health, Video

Trends in Income-Related Health Inequalities in Canada: Summary Report

The Trends in Income-Related Health Inequalities in Canada project examines whether the health gaps between lower- and higher-income individuals have changed over the past decade. The summary report is an easy to access overview of the findings. It is supported by the Health Inequalities Interactive Tool, which provides a series of visualizations representing inequalities related to nine health indicators, by sex and by province or territory. The technical report provides additional analysis, interpretation and contextual information for 16 health indicators.

The evidence in this report indicates that inequalities are persistent in Canada. Over the past decade, little or no progress has been made in reducing inequalities in health by income level in Canada. Since the early 2000s, inequalities widened for three of the 16 health indicators studied (smoking, COPD hospitalization and self-rated mental health) and did not change for 11 of them. While inequalities did narrow for the remaining two indicators, this was the result of an undesirable “levelling down” effect — in other words, health worsened among the richest Canadians while there was no change among the lowest income group.

The report concludes that while specific policies and programs can be implemented to mitigate health inequalities, major progress is unlikely without addressing the broader array of social determinants of health.

To support exploration and use of the data, CIHI has created a number of tools that can be accessed from their site:

  • Health inequalities interactive tool — to help you explore the data for your region and compare changes with other regions over time
  • Data tables — in Excel format that you can download and use for your own analysis
  • Info graphics — to help communicate the data on smoking, COPD and self-rated mental health
  • Companion products — including provincial and territorial highlights, methodology notes and indicator definitions


Reference:

Canadian Institute for Health Information. Trends in Income-Related Health Inequalities in Canada: Summary Report. Ottawa, ON: CIHI; 2015.


Related resources:

Tags: Assess and report, Communicate, Methods & tools, Document

Taking stock of the social determinants of health: A scoping review

The authors of this scoping review argue that there has been a dramatic increase in focus on the social determinants of health (SDH) in recent years and that it is time to build on earlier attempts to synthesize the literature on SDH. The review included academic and grey literature from the fields of population health, public health and health promotion.

The paper describes the ways the SDH have been presented and communicated in grey and peer-reviewed literature, including:

  • A list of influential factors
  • Conceptual models
  • Stories or narratives
  • Different epistemologies

The authors describe one theme that emerged prominently during their analysis: health equity as an overarching theme and binding concept for the SDH. They describe how equity is conceptualized in different ways, depending on whether it is intended to align with more upstream or downstream orientations for action. Conceptualizations of equity also influence how ideas associated with the social gradient and socioeconomic position are used.

The authors note a significant gap in the literature for articles published outside of the global north, and recommend that the importance of global justice and fairness in relations between wealthy and poor nations be recognized and this gap in SDH literature addressed.

This review is intended to support those working and studying in the areas of population health, public health, and health promotion.

Use this resource to:

  • Identify the different ways the SDH are presented and communicated in the literature
  • Explore the impact of how the SDH are conceptualized and thereby influence resulting actions and interventions
  • Strengthen the link between proposed actions on the SDH and health equity in public heath practice

Reference:

Lucyk K, McLaren L (2017). Taking stock of the social determinants of health: A scoping review. PLoS ONE 12(5): e0177306. https://doi.org/10.1371/journal.pone.0177306.

Related resources:

Tags: Critical works in health equity, Key concepts, Knowledge translation , Document

Let’s talk: Racism and health equity

The seventh release in our Let’s Talk series discusses racism as a critical factor that impacts health and wellbeing. It describes the concepts of race, racism and racialization and emphasizes settler colonialism and structural racism as the root causes of health and social inequities experienced by Indigenous and racialized peoples in Canada.

The resource includes discussion questions designed to help public health staff examine their work and consider how they can orient practice towards critical, decolonizing and anti-racist approaches. In addition, the questions ask practitioners to consider how beliefs and stereotypes may influence their practice.

This Let’s Talk provides tips for embracing critical, decolonizing and anti-racist approaches in public health practice and discusses roles public health can engage in to address racism.

We’ve selected a number of tools and resources that public health practitioners can use in acting to eliminate racism.  These can be found in “Key public health resources for racism and health equity: A curated list” (in publication)

Use this resource to:

  • describe key concepts related to race and racism;
  • explain the relationship between racism and wellbeing;
  • identify entry points for anti-racism work in public health; and
  • support a conversation in your organization about how to develop strategies to eliminate racism.

Related resources:

The Let’s Talk Series is a collection of resources designed to promote discussion and understanding of how key concepts in health equity apply in public health practice. Each resource contains discussion questions to spark dialogue, reflection, and action to address the social determinants of health. 

Other documents in this series

Tags: Community engagement, Cultural competency, Healthy public policy, Income inequality, Indigenous health , Key concepts, Leadership & capacity building, Partnership , Racism/racialization, National Collaborating Centre for Determinants of Health, Document

Public health leadership to advance health equity: A scoping review and metasummary

This research responds to the challenge that little consensus and evidence are available about factors that support public health leaders to effectively advance health equity. It was initiated by Betker as part of her work as a Senior Knowledge Translation Specialist at the National Collaborating Centre for the Determinants of Health. The dissertation is comprised of a scoping literature review, a survey of public health leaders to validate and deepen findings, and a metasummary of the most relevant literature that includes thematic analysis and data visualizations.

Betker’s analysis found that three aspects are essential for public health leaders to advance health equity: 1) leadership occurs simultaneously at the organizational, community and societal level; 2) the leader bridges between community and her/his organization and functions ‘in between’ spaces; and 3) leadership is grounded in a specific set of values (equity, social justice, solidarity).

Sections regarding findings and discussion will be of most use to practitioners. Readers will find:

  • summary descriptions of the key concepts of health equity, social determinants of health, public health, leadership;
  • attributes of leaders and analysis of relational skills/practices and types of knowledge required by public health leaders who seek to advance health equity;
  • distinguishing characteristics between leadership and management, ways of developing leadership, and how to apply leadership theory to public health, especially drawing upon very limited research about health equity as a driver or result of public health leadership;
  • descriptions of tools, strategies and mechanisms that contribute to public health leadership development; and
  • recommendations for further research to address gaps uncovered or confirmed by her research.

Use this resource to:

  • ​Understand leadership capacities and requirements to advance health equity.
  • Plan organizational and professional development.
  • Consider and plan one’s personal knowledge, skill and career path.

Reference:

Betker, R.C. (2016). Public health leadership to advance health equity: A scoping review and metasummary (Doctoral dissertation). University of Saskatchewan, Saskatoon, Saskatchewan. Retrieved from: https://ecommons.usask.ca/xmlui/bitstream/handle/10388/7642/BETKER-DISSERTATION-2016.pdf?sequence=1&isAllowed=y

Related resources:

Tags: Leadership & capacity building

Honouring the truth, reconciling for the future

“Residential schools are a tragic part of Canada’s history. But they cannot simply be consigned to history. The legacy from the schools and the political and legal policies and mechanisms surrounding their history continue to this day. This is reflected in the significant educational, income, health, and social disparities between Aboriginal people and other Canadians. It is reflected in the intense racism some people harbour against Aboriginal people and in the systemic and other forms of discrimination Aboriginal people regularly experience in this country. It is reflected too in the critically endangered status of most Aboriginal languages.” (p. 135)

After six years of study, and hearing from more than 6,000 witnesses, the Truth and Reconciliation Commission of Canada (TRC) released its findings with 94 calls to action aimed at building Indigenous culture and self-determination, and reconciliation between Canadian governments and Aboriginal societies. 

The summary includes a well-informed account of what happened to Indigenous children who were physically and sexually abused in government boarding schools, where an estimated 3,200 children died from diseases resulting from poor living conditions.

The calls to action urge all levels of government—federal, provincial, territorial and Aboriginal—to work together to repair the harm caused by residential schools (legacy recommendations 1 to 42) and move forward (reconciliation recommendations 43 to 94).

Some key recommendations in the area of health are:

  • Acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies. Recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties (all governments).
  • Increase the number of Aboriginal professionals working in the health-care field, ensure retention of Aboriginal health-care providers in Aboriginal communities and provide cultural competency training for all healthcare professionals.
  • Provide sustainable funding for new and existing Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools. Ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.
  • Recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.

Use this resource to:

  • Deepen your understanding of the impact of the residential school legacy on Indigenous people today
  • Develop your organization’s response to the TRC calls to action
  • Choose one or more calls to action that you can commit to contributing to, either personally or organizationally

Reference:

Truth and Reconciliation Commission of Canada. (2015). Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada. Canada : McGill-Queen’s University Press.

Related resources: 

 

Tags: Cultural competency, Indigenous health , Racism/racialization

Policy approaches to reducing health inequalities

This briefing note from the National Collaborating Centre for Healthy Public Policy, one of five sister centers of the NCCDH, introduces public health stakeholders to eight broad approaches to reducing health inequalities. The authors discuss the theoretical foundations of different policy approaches to acting on health inequities and how they might produce different effects based on their approach to reduce health inequalities.

Three ways of thinking about health inequalities are described; targeting disadvantaged groups, closing gaps, and addressing the gradient. The authors explain the difference between determinants of health and determinants of health inequalities including which policy approaches are most likely to address the various determinants. To explore the different potential effects, the authors discuss how the various approaches address social stratification, exposure to risk factors, the vulnerability of certain groups to particular conditions and the inequitable consequences as a result of specific conditions.

The approaches described are:

  • Political economy,
  • Macro social policies,
  • Intersectionality,
  • Life course approach,
  • Settings approach,
  • Approaches that aim at living conditions,
  • Approaches that target communities, and
  • Approaches aimed at individuals.

Use this resource to:

  • Identify and distinguish between policy approaches that can be used to improve health equity
  • Identify the potential impacts of different approaches to improving health equity and align your approach with the desired impact
  • Describe the differences between the social determinants of health and the social determinants of health inequalities

Reference:

Mantoura, P. & Morrison, V. (2016). Policy Approaches to Reducing Health Inequalities. Montréal, Québec: National Collaborating Centre for Healthy Public Policy.

Related resources: 

  • Public Health Speaks: Intersectionality and health equity
  • Common agenda for public health action on health equity
  • Pathways to health equity and differential outcomes: A summary of the WHO document Equity, social determinants and public health programmes

Tags: Critical works in health equity, Healthy public policy, Leadership & capacity building, Modify & orient, Policy analysis

Foundations: Definitions and concepts to frame population mental health promotion for children and youth

The work of promoting population mental health for children and youth is already happening in many public health settings in Canada. However, practitioners have told us that they still feel uncertain about how to most effectively integrate population health promotion in their practice. 

The six NCCs for Public Health collaborated on a project to increase understanding of population mental health promotion for children and youth. Together, they developed a collection of documents  to mobilize knowledge, clarify key concepts, and strengthen public health practice in this area.

This paper by the NCCDH contributes to the collection by providing definitions and background on key concepts, including the determinants of positive mental health for children and youth. A population approach to mental health promotion, as well as a description of setting and public health roles are also included as foundational concepts.

Reference:

National Collaborating Centre for Determinants of Health (2017). Foundations: Definitions and concepts to frame population mental health promotion for children and youth. Canada: National Collaborating Centres for Public Health.

Tags: Collaboration, Competencies & organizational standards , Early childhood development, Environmental health, Healthy public policy, Indigenous health , Infectious disease, Intersectoral action, Methods & tools, Sex & gender, Socioeconomic status , National Collaborating Centre for Determinants of Health

Public health use of digital technology to advance health equity

Social media has become an ever-present aspect of life. Public health can increase its influence and impact on the social determinants of health and health equity by harnessing social media.

The NCCDH conducted surveys in 2012 and 2016 to assess how public health used social media and other digital tools for knowledge translation, relationship building, and specific public health roles to advance health equity.

Highlights:

  • Most participants thought social media had an important role in public health and were generally comfortable in online spaces.
  • Half of respondents were satisfied with their ability to use social media.
  • Social media was used more frequently for personal purposes, and was less present in professional settings.
  • More than one in five of those surveyed used Twitter or Facebook at least weekly for knowledge exchange.
  • Social media is being used to address public health equity roles.

These findings indicate that there is room to enhance the use of social media in public health practice. Capacity building and organizational policies that support social media use may help achieve this.

A version of this report is also published in the Journal of Public Health Policy: Ndumbe-Eyoh, S. & Mazzucco, A. Social media, knowledge translation, and action on the social determinants of health and health equity: A survey of public health practices. J Public Health Pol (2016) 37(Suppl 2): 249.

Use this resource to:

  • Describe how and why public health professionals use social media and other digital tools
  • Identify which social media platforms are most relevant for public health professionals
  • Explore areas for developing capacity for social media use

Reference:

National Collaborating Centre for Determinants of Health. (2017). Public health use of digital technology to advance health equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Assess and report, Communicate, Community development, Knowledge translation , Leadership & capacity building, Methods & tools, Partnership , National Collaborating Centre for Determinants of Health

Collective impact and public health: An old/new approach — Stories of two Canadian initiatives

Collective impact (CI) is a collaborative community development approach that “brings people together, in a structured way, to achieve social change.” Collective impact  is built on the premise that organizations can be more successful in achieving large-scale social change if they coordinate their efforts across sectors, rather than working in isolation on interventions with similar aims.

This blended case story describes two CI initiatives in which public health is significantly involved: London Ontario’s Child & Youth Network (with 170 member organizations) and The Child & Youth Health Network on Vancouver Island.  This document describes why and how the two networks came together, their current status and future goals. From these stories, the authors identify seven strategic lessons:

  1. Allow for a lot of time to build and change community/institutional relationships
  2. Align organizational staffing with new structures
  3. Work for worldview, policy and organizational alignment
  4. Find adequate funding, particular for the initial years
  5. Pay attention to continuous network communications and education
  6. Integrate evaluation with CI network development
  7. Involve people with lived experience

This document also summarizes the foundational and evolving CI framework, and offers advice on how to get started on a CI initiative.

Use this resource to: 

  • Review the evolving framework of the CI approach
  • Deepen your understanding of how the mandate of a Public Health unit can be served by involvement in a CI initiative
  • Guide your efforts to instigate or participate in a CI initiative

Reference: 

National Collaborating Centre for Determinants of Health. (2017). Collective impact and public health: An old/new approach - Stories of two Canadian initiatives. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

 

Tags: Assess and report, Community engagement, Early childhood development, Evaluation, Intersectoral action, Leadership & capacity building, Methods & tools, Partnership , Public health unit / health authority, National Collaborating Centre for Determinants of Health

Learning from Practice: Advocacy for health equity - Environmental racism

This case story describes the experience of the Nova Scotia-based Environmental Noxiousness, Racial Inequities and Community Health (ENRICH) project in advocating against environmental racism that impacts Mi'kmaq and African-Canadian communities.

"Environmental racism refers to the disproportionate location of industrial polluters such as landfills, trash incinerators, coal plants, toxic waste facilities and other environmentally hazardous activities near to communities of colour and the working poor.” (ENRICH project website: http://www.enrichproject.org/)

The ENRICH project uses the range of public health advocacy roles described in Let’s Talk: Advocacy and health equity.

Role 1 Framing the issue of environmental racism in the community and through media advocacy

Role 2 Gathering and disseminating data using a community based research approach to conduct and disseminate research on the causes, effects and solutions to environmental racism

Role 3 Working in collaboration and developing alliances by establishing a multidisciplinary and multi-sectoral project team

Role 4 Using the legal and regulatory system: The ENRICH project team has worked with a sitting politician to submit Bill 111: An Act to Address Environmental Racism in the Nova Scotia Legislature.

Use this resource to:

  • Integrate an advocacy approach into your health equity activities
  • Develop a health equity framework or strategy for your organization
  • Support a conversation in your organization on approaches to address racism and identify potential partners in addressing environmental racism

Reference:

National Collaborating Centre for Determinants of Health. (2017). Learning from Practice: Advocacy for health equity - Environmental racism. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

Tags: Collaboration, Communicate, Community engagement, Environmental health, Healthy public policy, Indigenous health , Intersectoral action, Racism/racialization, National Collaborating Centre for Determinants of Health

Learning from Practice: Advocacy for health equity - Generation Squeeze

This case story describes the experience of Generation Squeeze in advocating for increased investment in people in their 20s, 30s and 40s and their children. Generation Squeeze is a national, non-partisan, science-based political voice for the interests of Canadians in their 20s, 30s and 40s, and their children. It was founded in 2011 by Dr. Paul Kershaw, a professor at the School of Population and Public Health at the University of British Columbia, in response to a variety of issues that disproportionately affect younger generations. Examples include the difficulty of finding a good job, the rising cost of owning a home and increased student debt—as well as, critically, a lack of government support to help address these problems. Generation Squeeze refers to the combination of these factors as “the squeeze.”

Generation Squeeze uses the range of public health advocacy roles described in Let’s Talk: Advocacy and health equity to address the squeeze.

Role 1 Framing the squeeze using plain language to focus directly on specific issues like earnings, education, housing and child care

Role 2 Gathering data generated in-house and by others and disseminating directly to politicians

Role 3 Working in collaboration and developing alliances: Generation Squeeze has built a coalition that now surpasses 26,000 people and a variety of organizational allies

Role 4 Using the legal and regulatory system: Generation Squeeze uses its research to directly influence government budget decisions to invest in social policy for younger generations

Use this resource to:

  • Integrate an advocacy approach into your health equity activities
  • Develop a health equity framework or strategy for your organization
  • Identify policy solutions to improve the living and working conditions for younger generations

Reference:

National Collaborating Centre for Determinants of Health. (2017). Learning from Practice: Advocacy for health equity - Generation Squeeze. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

Tags: Communicate, Community engagement, Evaluation, Healthy public policy, Income inequality, Intersectoral action, Knowledge translation , Leadership & capacity building, Partnership , Policy analysis, Socioeconomic status , Working conditions, National Collaborating Centre for Determinants of Health

Learning from Practice: Advocacy for health equity - Food security

Food insecurity is a growing concern for many households with clear impacts on health and wellbeing. Across Canada, many organizations are taking new approaches to improve food security. This paper highlights the experience of the Ontario Association of Public Health Nutrition Professionals and Food Secure Canada in advocating to improve food security focusing on three advocacy roles in public health (these roles are described in Let’s Talk: Advocacy and health equity).

Role 1 Framing food security as being related to inadequate income and advocating for a move away from charity-based approaches (e.g. food banks) to a focus on income related solutions.

Role 2 Both organizations supported the generation and use of data needed to move forward the policy agendas

Role 3 Working in collaboration and developing alliances with a broad range of partners

Use this resource to:

  • Integrate an advocacy approach into your health equity activities
  • Develop a health equity framework or strategy for your organization
  • Support a conversation in your organization on policy approaches to improving food security

Reference:

National Collaborating Centre for Determinants of Health. (2017). Learning from Practice: Advocacy for health equity - Food security. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

Tags: Communicate, Food security, Income inequality, Intersectoral action, Partnership , Policy analysis, National Collaborating Centre for Determinants of Health

Upstream action on food insecurity: A curated list

We have selected a number of tools and resources that public health practitioners can use to design program and policy interventions to act on food insecurity. A total of 13 resources are organized around the NCCDH’s Public Health Roles for Improving Health Equity

  1. Assess and report – Evaluating outcomes of community food programs, indicators and monitoring of food insecurity
  2. Modify and orient interventions – Position statements on upstream solutions to food insecurity, recommendations for strategies and interventions
  3. Partner with other sectors – Intersectoral initiatives, collaborative partnership projects
  4. Participate in policy development – Policy options to address poverty as the predictor of food insecurity, recommendations for broader policy change to address inequities as they influence food insecurity

Additional resources to support action related to the public health roles are also included. A final section offers documents that explore the unique issues related to northern food insecurity. This curated list is not meant to be comprehensive, but to point to key considerations for addressing the root causes of food insecurity.

Reference

National Collaborating Centre for Determinants of Health (2017). Upstream action on food insecurity: A curated reading list. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University

Tags: Assess and report, Food security, Healthy public policy, Income inequality, Indigenous health , Modify & orient, Partnership , Policy analysis, Public health unit / health authority, Reading list, National Collaborating Centre for Determinants of Health, Document

Public Health Speaks: Upstream action on food insecurity

Food insecurity affects over four million Canadians and yet is not an explicit goal of public policies in Canada. Public health practice has long been focused on supporting charitable and community food programs which, while beneficial for food access and skills development, do not address poverty as the biggest predictor of food insecurity. The NCCDH brought a small group of researchers and practitioners together to discuss inadequate income as the root cause of food insecurity, and what is needed to support a shift in public health practice towards income-based policy solutions.

This resource summarizes an October 2016 discussion facilitated by Dianne Oickle, Knowledge Translation Specialist at NCCDH, with:

  • Catherine Mah, Assistant Professor of Health Policy, Memorial University
  • Melanie Kurrein, Provincial Manager of Food Security, Provincial Health Services Authority British Columbia
  • Lyndsay Davidson, Public Health Dietitian, Chatham-Kent Public Health

Contributors discuss food insecurity as a determinant of health equity, shifting public health practice towards upstream solutions, and practical actions that public health practitioners can take to address food insecurity. Suggestions for actions to address the root causes of food insecurity are organized by the NCCDH’s Public Health Roles for Improving Health Equity.

Use this resource to:

  • Facilitate discussion about what public health interventions to address the root causes of food insecurity look like
  • Identify opportunities in day-to-day practice for action to address material deprivation as a cause of food insecurity
  • Design program and policy interventions around public health roles to act on food insecurity as a determinant of health equity

Reference:

National Collaborating Centre for Determinants of Health. (2017). Public Health Speaks: Public health action to address food insecurity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
 

Tags: Food security, National Collaborating Centre for Determinants of Health

Intersectoral collaboration to address health equity: A curated list

Bringing partners together to work collectively on a common issue is a key strategy to address health equity. Addressing the dynamic and inter-dependent nature of the social determinants of health requires multi-sectoral partnerships that cross geographical and organizational boundaries in an effort to engage both stakeholders and the community at large.

We have selected a number of tools and resources that public health practitioners can use at various stages of developing and sustaining collaborative partnerships. Eight resources are organized as they related to the following five action points in the intersectoral collaboration process.

  1. Think purposefully
  2. Consider enablers and barriers
  3. Build partnerships with key stakeholders
  4. Implement an intersectoral approach
  5. Contribute to the evidence base

This curated list is not meant to be comprehensive or to represent a step-by-step process, but to point to key considerations at critical points of multi-sectoral action.

Reference

National Collaborating Centre for Determinants of Health. (2015). Intersectoral collaboration to address health equity: A curated list. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Access to health services, Assess and report, Evaluation, Intersectoral action, Key concepts, Partnership , Public health unit / health authority, Reading list, National Collaborating Centre for Determinants of Health, Document

Foundational documents in health equity: A curated list

NCCDH staff chose seven documents that have contributed nationally and globally to an understanding of how social, political and economic power structures determine the distribution of wealth, income and other resources that have a direct impact on people’s health. This curated list provides short descriptions of and links to publications that have influenced the strategic direction of many Canadian public health actions, and continue to fuel our efforts to reduce health inequities. These documents provide an excellent starting point for people wanting to learn more about the broad context of health equity work, in Canada and globally.

Reference

National Collaborating Centre for Determinants of Health (2014). Foundational documents in health equity: A curated list. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Critical works in health equity, Key concepts, Policy analysis, Racism/racialization, Reading list, National Collaborating Centre for Determinants of Health, Document

Income-related policy recommendations to address food insecurity

This document was created and published by the Ontario Society of Nutrition Professionals in Public Health (OSNPPH) , an independent, non-profit body that represents over 200 registered dietitians working in public health in Ontario. OSNPPH’s food security working group reviewed and compiled research to support implementation of income-based policy approaches to reduce poverty as the most effective way to address food insecurity.

Three areas to address food insecurity are highlighted, including potential impacts and recommended actions:

  • Prioritize investigation into a basic income guarantee;
  • Increasing social assistance rates to reflect actual costs of nutritious food, housing and inflation rates;
  • Revisions to employment standards legislation and health benefits for low income Ontarians.

Recommendations for action by public health practitioners include advocacy for policy change and addressing poverty as the root cause of food insecurity. These policy recommendations are complementary to a position statement on responses to food insecurity, which describes food insecurity as an urgent human rights and social justice issue, and can be used to support action by public health practitioners on income-based policy solutions. As well, a food insecurity infographic for use in advocacy and educational work is available that represents the information in both the position statement and the policy recommendations.

Use this resource to:

  • Facilitate discussion about how to shift public health practice away from charity and food focused solutions to food insecurity and towards supporting income-based policy action;
  • Advocate for basic income guarantee and changes to legislation that will support addressing poverty as the underlying determinant of food insecurity;
  • Illustrate how food insecurity as a social determinant of health contributes to broader health inequities;
  • Support communications with stakeholders both internal and external to public health to encourage action on poverty.

Reference:

Ontario Society of Nutrition Professionals in Public Health Food Security Workgroup (2015). Income-related policy recommendations to address food insecurity. www.osnpph.on.ca/membership/documents.

Tags: Communicate, Food security, Healthy public policy, Income inequality, Intersectoral action, Methods & tools, Modify & orient, Policy analysis, Public health unit / health authority, Socioeconomic status

Paying for nutrition:  A report on food costing in the North

The Paying for Nutrition project is an academic and community partnership between Food Secure Canada and partners from four universities (Mount St. Vincent, Dalhousie, Lakehead, and University of Waterloo). This document was created to bring attention to the level of food insecurity in northern First Nations communities. The report describes challenges with food costing in remote locations and compares food costs between three communities. Concepts such as food sovereignty and the importance of foods from the land are explored; along with the incidence and consequences of food insecurity in First Nations communities and northern retail food environments.

The average monthly cost of feeding a family of four in the three communities examined is $1793.40, which includes subsidized food prices. The cost of items such as toilet paper, toothpaste, diapers, other household items as well as hunting supplies are additional and not included in this average monthly food cost. Northern food subsidies did not bring the cost of nutritious foods to an affordable level. Many households must spend at least 50% of household income to purchase a basic nutritious diet, compared to 15% in Thunder Bay and 11% in Toronto. Recommendations include expanded food costing in remote stores, increased local control over food retail, initiatives to increase access to local foods, and a broader comprehensive strategy to address food insecurity that includes guaranteed minimum incomes that are indexed to the higher cost of living in the provincial North.

Use this resource to:

  • Raise awareness about the cost of healthy eating and food insecurity in northern and remote Indigenous communities;
  • Advocate for policy changes to address Indigenous food insecurity such as basic income;
  • Support the development of tools to measure food costing in remote locations.

Reference:

Food Secure Canada (2016). Paying for nutrition: A report on food costing in the north. http://foodsecurecanada.org/sites/foodsecurecanada.org/files/201609_paying_for_nutrition_fsc_report_final.pdf

Tags: Assess and report, Food security, Healthy public policy, Income inequality, Indigenous health , Racism/racialization, Socioeconomic status

The REFLEX-ISS tool: Taking better account of social inequalities in health

The REFLEX-ISS tool was developed to support teams to engage in collective reflection about how to better address health equity in their project, with the aim of improving health equity or at least not increasing health inequities. The main goal of the tool is to promote ongoing discussion around social inequalities in health rather than to measure impact or effectiveness of an intervention. It complements other tools that you are likely to use to ensure the quality of your project. Important strategies within the tool include participation, action on social determinants of health, collaboration, intersectoral action and empowerment.

The tool is designed for public health actors involved in the planning, implementation and evaluation on of public health projects to be used in collaboration with partners in health and other sectors (e.g., ministries, school boards, municipalities, schools, community organizations).

Presented in five parts, all sections can be used independently at any stage in a project. The sections are:

  • Conducting joint planning,
  • Adjusting an existing plan or intervention,
  • Implementing a plan or intervention,
  • Evaluating a plan or intervention and/or
  • Planning for sustainability.

Each section has a set of questions with five responses that represent a level of progress as well as a space for written text.

There are two accompanying case studies demonstrating the application of the tool:

Use this resource to:

  • Analyze how your project can be designed to improve health equity
  • Identify and analyze strengths and areas for improvement
  • Engage in health equity dialogue with colleagues and partners

Reference:

Guichard, A., Ridde, V., Nour, K., & Lafontaine, G. (2015). REFLEX-ISS Tool - Taking better account of social inequalities in health. Longueuil, QC : CISSS de la Montérégie‐Centre, Direction de santé publique de la Montérégie. Retrieved from: http://www.equitesante.org/chair-realisme/tools/reflex-iss/ 

Related resources:

Tags: Healthy public policy, Intersectoral action, Leadership & capacity building, Partnership , Policy analysis

Taking action on the social determinants of health: Insights from politicians, policymakers and lobbyists

This report examines how changes to create a shift in the distribution of the social determinants of health and improve health equity were a fit in the Australian political context.

The team found that those interviewed (current politicians, senior bureaucrats and external lobbyists) were aware of evidence on the social determinants of health and assessed that evidence as accurate. However, participants thought that policies needed to change the distribution of the social determinants of health were not well-aligned with the ways the political process was structured and understood.

Structurally, silos between departments are not conducive to the large-scale social change. This reality is contrary to intersectoral and whole-of-government approaches being promoted by many organizations such as the World Health Organisation. Participants recommend that interventions be reduced to more manageable, solutions-focused interventions that fell within the mandates of specific departments.

Noting that moral and ethical arguments were at the centre of public policy, participants argued that advocates and researchers should embrace ideological debate and not rely solely on objective evidence-based approaches.

Use this resource to:

  • Identify how to better work with politicians and decision-makers in health and non- health sectors
  • Develop interventions which are aligned with departmental boundaries
  • Employ moral- and values-based arguments

Reference:

Carey, G. &  Crammond, B. (2014). Taking Action on the Social Determinants of Health: Insights from politicians, policymakers and lobbyists. Retrieved from: http://determinantsofhealthalliance-org.webs.com/140714Taking%20Action.pdf

Related resources:

Tags: Healthy public policy, Intersectoral action, Leadership & capacity building, Partnership , Policy analysis

Growing healthier: A health equity impact assessment for Saskatoon’s growth plan

[This report] will be of interest to policymakers and members of the public who want to understand how our built environments shape our health, and what we can do to ensure that growth does not come at the expense of wellbeing.”p3

The City of Saskatoon released its Growth Plan to Half a Million in early 2016. Recognizing the impact this initiative would have in the next three or four decades, Saskatoon Health Region – Population and Public Health and Upstream, a Saskatoon-based “movement to create a healthy society through evidence-based, people-centred ideas,” collaborated to conduct a health equity impact assessment (HEIA) of the plan.

The authors argue that in addition to achieving the objective of growth, the city can focus on residents’ quality of life and be proactive against the potential negative effects of growth. Examples are provided of how changes at the municipal level can have a direct effect on the health and wellbeing of all residents, in addition to deliberately enhancing the health of those in low-income areas.

The report proposes that implementation of the Growth Plan occur through a “health lens” and offers 13 recommendations that align with plan initiatives. The recommendations focus on changes that will happen over the next four years, and in the areas of public transit, infill development and active transportation. The report advises conducting more HEIAs as the Growth Plan is implemented, and suggests the inclusion of community engagement and monitoring components.

The recommendations include:

  • Ensure a mix of housing types, including “deliberate emphasis” on affordable housing
  • Increase green spaces and trees
  • Provide proportional discounts on bus passes based on income level
  • Raise intensity of public transit service in lower-income neighbourhoods
  • Encourage service development along bus and active transportation routes to improve access to services
  • Invest early and heavily in active transportation infrastructure planning, accessibility and year-round maintenance especially in low-income areas
  • Integrate active transport infrastructure with public transit

Use this resource to:

  • Enhance your knowledge about how built environments affect health and well-being
  • Design interventions related to infrastructure and health
  • Advocate for or conduct an HEIA of your municipality’s growth plan

Reference:

Sharpe, C., Janzen, C., Schwandt, M., Dunn-Pierce, T., Neudorf, C., & Meili, R. Growing Healthier: A Health Equity Impact Assessment of Saskatoon’s Growth Plan. Saskatoon Health Region and Upstream: Saskatoon, SK. October 2016. Retrieved from: https://drive.google.com/file/d/0B0U9o9nlpWKIQWp4RXNpNHYxclU/view

Related resources: 

Tags: Access to health services, Assess and report, Healthy public policy, Policy analysis

Oppression: A social determinant of health

“Oppression and health are intricately connected.”

This edited book presents analysis of oppression as a significant influence on health and wellbeing from leading experts in the field. Oppression is defined as “discrimination backed up by systemic or structural power, sometimes referred to as institutionalized power, including government, education, legal, and health system policies and practices” (pg. 30).

In 3 sections, critical social science perspectives and health systems/health sciences knowledge are used to argue we must consistently and explicitly integrate analysis of systemic forces such as capitalism, globalization, imperialism, medicalization, neo-colonialism and neoliberalism if we are to change the oppressive practices that cause ill health. This analysis frames health inequities within the context of systemic oppression through a focus on the differential health outcomes across age, gender, race, social class and sexual orientation. These health inequities are rooted in ageism, misogyny and patriarchy, racism, classism, heterosexism and homophobia (among others).

Part 1, Politicizing health, explains how systemic power structures are connected to health and provides an overview of oppression and its relationship to health across the lifespan. Intersectionality theory is introduced as a way of understanding how “isms” relate to the social determinants of health. This section closes with a discussion of the links between the social determinants, health outcomes and the systemic contexts which create and reproduce poor health.

Part 2, How oppression operates to produce health inequities, provides examples of how ageism, sexism, racism, colonialism, neocolonialism and social exclusion affect the health of older women, people of colour, Indigenous peoples and socially excluded groups. Additional chapters focus on mental health and links between oppression, migration and health.

The final section, Toward structural change, builds on the social change message through the exploration of public policy, political economy and human rights perspectives.

Use this resource to:

  • Explore how complex systemic forces shape health
  • Identify strategies to support action to intervene on large scale systems

Reference:

McGibbon, E. (Ed). (2012). Oppression: a social determinant of health. Fernwood Publishing.

Tags: Access to health services, Critical works in health equity, Indigenous health , Key concepts, Policy analysis, Racism/racialization, Sex & gender

Improving population health by working with communities: Action guide 3.0

The National Quality Forum (NQF) Action Guide is a framework to help multi-sector groups work together to improve population health by addressing 10 interrelated elements for success, using related resources as needed.

Much like a “how-to” manual, the Action Guide is organized by these elements and contains definitions, recommendations, practical examples, and a range of resources to help communities achieve their shared goals and make lasting improvements in population health.  Intentionally brief, it is written in plain language to be as accessible as possible for all types of stakeholders in the U.S. (at local, state, regional, and national levels) to take action.

Through the National Quality Strategy (NQS), the NQF prioritizes community efforts and interventions to improve social, economic, and environmental factors that impact health.  At the same time, they recognize that quality improvement and measurement have been overwhelmingly focused on the clinical care system. The purpose of this project was to better understand how communities can work with the public health and clinical care systems to collaboratively improve population health. Shared definitions and a common conceptual framework are intended to ensure better coordination and advance community partnerships.

The 3-year project was funded under NQF’s contract with the U.S. Department of Health and Human Services and explored questions such as:

  • How can individuals and multi- stakeholder groups come together to address community health improvement?
  • Which individuals and organizations should be at the table?
  • What processes and methods should communities use to assess their health?
  • What data are available to assess, analyze, and address community health needs, and measure improvement?
  • What incentives exist that can drive alignment and coordination to improve community health?
  • How can communities advance more affordable care by achieving greater alignment, efficiency, and cost savings?

Use this resource to:

  • Undertake a collaborative self-assessment of population health approaches
  • Find examples and resources to help with organizational planning and priority setting
  • Bring together stakeholders across the health sector and community to explore opportunities for collaboration

Reference:

National Quality Forum (2016). Improving Population Health by Working with Communities: Action Guide 3.0. Multistakeholder input on a national priority, August 2016.  National Quality Forum, Washington, DC: www.qualityforum.org.  Retrieved from: http://www.qualityforum.org/Publications/2016/08/Improving_Population_Health_by_Working_with_Communities__Action_Guide_3_0.aspx

Related resources:

Tags: Assess and report, Community engagement, Competencies & organizational standards , Intersectoral action, Leadership & capacity building

Doctors for health equity. The role of the World Medical Association, national medical associations and doctors in addressing the social determinants of health and health equity

This report explores evidence and case studies to highlight the ways in which doctors, national medical associations and the World Medical Association (WMA) can act on the social determinants of health and improve health equity. These actions include:

  • High level advocacy and advice,
  • Shaping policies at local, national, regional and international levels,
  • Partnering and collaborating with sectors outside health, and
  • Doctors’ individual interactions with patients during clinical encounters.

A strategy for the WMA and national medical associations is outlined, as well as practical approaches for medical professionals and their associations to incorporate the social determinants of health into their everyday practice and broader societal roles.

This report is part of Dr. Michael Marmot’s commitment to using his term as president of the WMA to advance action on improving health equity around the world.This included a number of initiatives:

Use this resource to:

  • Explore opportunities to partner with medical colleagues in other parts of the health sector on health equity initiatives (see additional Canadian resources at Canadian Medical Association).
  • Find case studies to explore physician engagement and action on the social determinants of health
  • Bring together stakeholders across the health sector to explore opportunities for public health collaboration

Reference:

Institute of Health Equity and World Medical Association (2016). Doctors for Health Equity. The role of the World Medical Association, national medical associations and doctors in addressing the social determinants of health and health equity.  Retrieved from: http://www.instituteofhealthequity.org/Content/FileManager/wma-ihe-report_-doctors-for-health-equity-2016.pdf.

Related resources:

Tags: Access to health services, Assess and report, Competencies & organizational standards , Intersectoral action, Leadership & capacity building, Public health unit / health authority

Health inequities in New Brunswick

In producing this report, the Office of the Chief Medical Officer of Health in New Brunswick set out to purposefully describe the inequalities in the distribution of the social determinants, and an overview of health inequities in the province. Data was taken from the 2011-2012 Canadian Community Health Survey, conducted by Statistics Canada, which could provide reliable data (despite standard population exclusions) at the health region level. 

Data were chosen to paint a picture of self-reported health and mental health, incidence of chronic diseases and distribution of the social determinants including household income (divided into quintiles), education and gender by health region. 

The key findings were:

  • Household food insecurity decreases with every increase in income quintile
  • Smoking, healthy eating and active living are correlated with income (higher income residents smoke less, eat healthier food and are more physically active)
  • Active living correlates with education (people with more formal education are more active)
  • Lowest income households were more likely to report having cancer, heart disease, chronic obstructive lung disease, diabetes, high blood pressure or being classified as obese
  • People with low income and education levels perceived their mental and physical health as poorer compared to the most affluent households and the more educated
  • Residents in the northern part of the province reported more limited access to the social determinants than did people living in the south

The report includes examples of promising practices adopted by the Office of the Chief Medical Officer of Health, and calls to action for Public Health organizations, individual staff and the non-health sectors.

Use this resource to:

  • Develop a purposeful health inequity report for your province or region
  • Explore how Statistics Canada data can be used to create a report on inequities
  • Better understand the distribution of social determinants in New Brunswick, and the relation of this distribution to health outcomes

Reference:

Office of the Chief Medical Officer of Health. (2016). Health inequities in New Brunswick. Department of Health, Fredericton, New Brunswick.

Related resources:

Tags: Assess and report, Communicate, Food security, Income inequality, Socioeconomic status

Advancing health equity: Case studies of health equity practice in four award-winning California health departments

The California Endowment recently honoured four California health departments – representing counties of varying size – for their work in advancing health equity. The awards were presented as part of a larger effort to recognize and further progress among local health departments – including the organizations and regional coalitions they work with – that are engaging in innovative work to address health inequities. The goal is to help set a new standard of health equity practice among health departments by showcasing effective initiatives that can serve as examples for others, as well as providing funds to bolster promising approaches. Three awards came with a companion grant of $25,000, and the Arnold X. Perkins Award for Outstanding Health Equity Practice had an accompanying grant of $100,000.

The case studies explore successes, challenges, visions for the future, and lessons learned in efforts to ensure health equity. Each case study includes a description of local partnerships, outcomes to date, and the role of the public health department. In addition to a written description of the projects, each case study has a video link to help tell their story. Projects include education, child care, community economic development, population health status reporting, accessible public health services, parks and recreation, and housing affordability.

The report ends with a summary of lessons learned, including:

  1. Name it – it’s important to describe work improving health outcomes for everyone as health equity work
  2. Build internal staff understanding of health equity and their capacity to address it – this includes breaking down silos, asking questions, learning from others and getting creative with funding
  3. Collaborate – by building relationships, by challenging the community but not trying to change them, showing how it’s a win-win, knowing when to lead and when to step back, bringing the data, keeping the community engaged, and being patient
  4. Engage the public through strategic use of media – by engaging journalists and finding ways to share “authentic voices” of people with lived experience.

Use this resource to:

  • Find examples of public health action to improve health equity to support their own planning and evaluation
  • Facilitate discussion about how to strengthen organizational capacity to engage the community
  • Bring together key stakeholders to explore opportunities for public health to support collaborative action to redress health inequities

Reference:

Gehlert, H. (2015). Advancing Health Equity: Case studies of health equity practice in four award-winning California health departments. Berkley Media Studies Group, a project of the Public Health Institute, and The California Endowment. Retrieved from: http://www.bmsg.org/resources/publications/health-equity-case-studies-california

Related resources:

Tags: Case study

Promoting health equity: WHO health inequality monitoring at global and national levels

Equity is a cross-cutting theme in the World Health Organization (WHO) Sustainable Development Goals (SDGs). The WHO has a number of products designed to help monitor health inequalities (which are defined as observed differences in health between subgroups) as a metric through which the normative concept of health equity can be evaluated.

The paper provides a framework to classify resources related to health inequality monitoring according to the component of monitoring (collection, analysis, reporting) and whether the level of monitoring occurs on a global or national level. Six different WHO products are categorized according to the framework and described using information on scope, contents and intended uses. A URL is provided for each of the six products. The paper concludes with recommendations to strengthen equity-oriented health information systems with respect to collection, analysis and reporting. Highlights on upcoming work by the WHO concerning health inequity monitoring on a global level are also included.

Use this resource to:

  •  Find national data to support planning and decision making
  • Access learning opportunities, including e-learning and workshops
  • Follow best practices in the design and development of local equity monitoring systems

Reference:

Hosseinpoor, A.R., Bergen, N., & Schlotheuber, A. (2015). Promoting health equity: WHO health inequality monitoring at global and national levels. Global Health Action, 8: 29034. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576419/pdf/GHA-8-29034.pdf

Related resources:

Tags: Assess and report, Evaluation, Methods & tools

Key resources for environmental public health practitioners to address health equity: A curated list

Public health organizations across Canada have highlighted health inequities as a priority area for action.  Environmental public health practitioners may be unclear of how to approach health inequities within their scope of practice because they have often not been included in discussions about how public health can do this work.

This list contains resources specific to environmental public health practitioners with respect to their roles in addressing the social determinants of health (SDH) and health equity in consultation, enforcement, and education. In order to explore their roles in this work more deeply, the resources are organized into three main themes:

  • The intersection of SDH and health equity with environmental public health practice
  • Facilitators and barriers to integrating SDH and health equity into individual and organizational practices to support a shift in practice focus
  • Taking action on SDH and health equity, including stories from the field and tools to provide practical considerations for how public health inspectors can address SDH and health equity

Use this resource to

  •  Facilitate a discussion with colleagues about the role of environmental public health practitioners in addressing health equity
  • Work with organizational leadership to integrate work on the SDH into the scope of environmental public health
  • Learn from other environmental health practitioners about how they address the SDH in their practice

Reference

National Collaborating Centre for Determinants of Health & Rideout, K. (2016). Key resources for public health inspectors (PHIs) on health equity: A curated list. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University; Vancouver, BC: National Collaborating Centre for Environmental Health, British Columbia Centre for Disease Control.

Tags: Environmental health, Intersectoral action, Leadership & capacity building, Methods & tools, Modify & orient, Public health unit / health authority, Reading list, Socioeconomic status , National Collaborating Centre for Determinants of Health, Document

Toward health equity: Practical actions for public health inspectors

Environmental health practitioners, including public health inspectors (PHIs) and environmental health officers (EHOs), have a role to play when it comes to addressing the social determinants of health (SDH) and working toward health equity, but that role is not always clear. Practitioners can use these two tools to reflect on their current practice and identify practical actions that can be taken in their day-to-day work or broader program planning.

This framework outlines 10 considerations for action by individual practitioners to help them apply the broader concepts of SDH and health equity to their practice, understand how health equity work fits into their own region or organization, and work with others to support health equity. The framework highlights points of action at different levels within a public health organization, and can be used by staff with any degree of knowledge or experience related to health equity.

The accompanying user guide identifies three main audiences and outlines potential points of influence for practitioners, who can use the tool in different ways depending on the scope and responsibilities of their position. Together, these tools encourage reflective practice, collaborative approach, and action at multiple levels.

Use this resource to:

  • Start a conversation about the role of environmental public health practitioners in building organizational capacity to address the SDH and health equity
  • Identify skills and knowledge necessary for PHIs and EHOs to support action on SDH and health equity
  • Consider points of influence to shift practice beyond day-to-day activities
  • Set tangible goals for shorter- and longer-term action on health equity


References:

User guide

Rideout, K., & National Collaborating Centre for Determinants of Health (2016). Toward health equity: Practical actions for public health inspectors – Framework for action on the social determinants of health and health equity. User Guide. Vancouver, BC: National Collaborating Centre for Environmental Health, British Columbia Centre for Disease Control; Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Framework

Rideout, K., & National Collaborating Centre for Determinants of Health (2016). Toward health equity: Practical actions for public health inspectors – Framework for action on the social determinants of health and health equity. Vancouver, BC: National Collaborating Centre for Environmental Health, British Columbia Centre for Disease Control; Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
 

Tags: Communicate, Environmental health, Healthy public policy, Intersectoral action, Key concepts, Leadership & capacity building, Methods & tools, Partnership , Policy analysis, Public health unit / health authority

Housing need in Canada: Healthy lives start at home

Despite the direct impact of housing conditions on the health of children and youth, Canada remains the only G8 country without a national housing strategy.  Substandard and insufficient housing impacts a family’s ability to access and engage with the healthcare system. Moreover, substandard living conditions can lead to a number of negative effects on mental health, the spread of communicable diseases, educational outcomes, and nutritional status, as well as children’s growth and development.

Housing need in Canada:  Healthy lives start at home is the position statement of the Canadian Pediatric Society (CPS) that also serves as a call to action. The statement provides an overview of housing need in Canada, while also reviewing literature on definitions of housing need, the health impacts of various types of housing, environmental and neighborhood influences, impacts on the health care system, populations at higher risk, and how health care providers can assess and address housing need among their patients. 

The CPS suggests that all levels of government need to develop and implement housing-supportive policies, informed by a national housing strategy, with the support and involvement of multiple partners, including housing authorities, communities and public health. Recommended roles for primary care providers include: advocating for improved housing, screening for housing status among patients, and connecting patients with local resources.  Students and training programs are encouraged to pursue research priorities related to identifying housing needs for populations, developing screening and assessment tools, and advancing knowledge of referral resources.

Use this resource to:

  • Improve your knowledge base on the impact of housing conditions on the health of children and youth
  • Consider how public health can support primary care providers in addressing patients’ housing needs
  • Support advocacy efforts for housing-supportive policies, including a national housing strategy
  • Facilitate discussion about how public health can collaborate with other partners to address housing as a component of health equity work

Reference:

Waterston, B.G., Grueger, B., and Samson, L.; Canadian Pediatric Society, Community Paediatrics Committee. (2015). Housing need in Canada: Healthy lives start at home. Paediatrics and Child Health, 20. Retrieved from http://www.cps.ca/en/documents/position/housing-need

Tags: Early childhood development, Environmental health, Healthy public policy, Indigenous health , Socioeconomic status

Maps to inform intersectoral planning and action

Mapping health indicators provides a visual display of geography linked with the social determinants of health (SDH) and can graphically illustrate areas and populations at risk, indicating where action is needed at the local level. Collaborative actions across sectors and the integration of information systems can support increased capacity to use evidence to inform planning and reduce duplication of efforts.

Maps to Inform Intersectoral Planning and Action is a technical report based on research commissioned by the Canadian Council on Social Determinants of Health (CCSDH). The report highlights the potential role of mapping technologies to support action on the SDH and health equity. Three different approaches to mapping data are highlighted, including geospatial data infrastructure, web mapping, and geographic information systems, while two case studies illustrate the use of these technologies. Espace Montréalais d’information sur la santé (EMIS) supports health surveillance, planning, and evaluation and disseminates data on population health and health services to inform a number of initiatives including policy design and action at the local level. Community View Collaboration (CVC) is a regional community information system that includes user-friendly tools to facilitate data sharing among jurisdictions through two levels of data access (partner and public) based on an SDH conceptual model. 

Increased availability and utility of data can improve an organization’s ability to plan, manage programs and services, and target programs. However, mapping data is not enough; mapping technologies must meet user needs and engage stakeholders in a meaningful way in the development and maintenance of systems throughout all phases.

Use this resource to:

  • Learn more about how mapping technology can inform public health planning
  • Consider ways to improve the usability and applicability of current mapping technologies in use by your organization
  • Facilitate a discussion about the ways that data sharing and mapping tools can contribute to evidence-based decisions for intersectoral action

Reference:

Canadian Council on Social Determinants of Health. (2014). Maps to inform intersectoral planning and action. Retrieved from http://ccsdh.ca/images/uploads/Maps_to_Inform_Intersectoral_Planning_and_
Action_Technical_Report.pdf

Maps to inform intersectoral planning and action: A summary

Tags: Assess and report, Evaluation, Intersectoral action, Knowledge translation , Public health unit / health authority

Does public health advocacy seek to redress health inequities? A scoping review

The public health (PH) sector is ideally situated to take a lead advocacy role in catalysing and guiding multi-sectoral action to address social determinants of health inequities, but evidence suggests that PH’s advocacy role has not been fully realised. The purpose of this review was to determine the extent to which the PH advocacy literature addresses the goal of reducing health and social inequities, and to increase understanding of contextual factors shaping the discourse and practice of PH advocacy.

This review collates and analyzes not only theoretical and conceptual literature, but also empirical literature, professional and education resources and standards, and secondary literature such as editorials and commentaries.  The authors have provided a comprehensive list of key documents to guide public health practitioners in developing their advocacy strategies to address health inequities.  They also make the point that if the PH sector is to fulfill its advocacy role in catalysing action to reduce health inequities, it will be necessary to address advocacy barriers at multiple levels, promote multi-sectoral efforts that implicate the state and corporations in the production of health inequities, and rally state involvement to redress these injustices.

The review notes the gap between theory and practice and suggests a few reasons for this: it could be because advocates focused on social action may be less inclined towards publication, or it could be that advocacy is taking place largely outside of the public health sector and that public health advocacy for social justice is not making significant headway.  Either way, the authors make the case for increased education of public health practitioners about public health advocacy in general, and advocacy for health equity in particular. They note that little attention has been given to organisational capacity for engaging in public health advocacy, specifically to redress health inequities. They conclude by calling for more applied research focused on strengthening this capacity and public health practitioners engaging in equity-focused advocacy and related evaluation research, even when advocacy efforts are unsuccessful at affecting change. 


Use this resource to:

  • Find examples of public health advocacy in action to support their own planning and evaluation
  • Facilitate discussion about how to strengthen organizational and education supports for public health advocacy in their communities
  • Bring together key stakeholders to explore ways for public health to support collaborative advocacy to redress health inequities


Reference:

Cohen, B.E., & Marshall, S.G. (2016).  Does public health advocacy seek to redress health inequities? A scoping review.  Health and Social Care in the Community.  Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/hsc.12320/epdf.


Related document:

Tags: Access to health services, Assess and report, Communicate, Community engagement, Competencies & organizational standards , Critical works in health equity, Early childhood development, Environmental health, Evaluation, Food security, Health literacy, Healthy public policy, Income inequality, Indigenous health , Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partnership , Policy analysis, Public health unit / health authority, Racism/racialization, Sex & gender, Socioeconomic status , Working conditions

Let’s start a conversation about health… and not talk about health care at all

“Let's Start a Conversation About Health … and Not Talk About Health Care at All” are social media videos that describe how social and economic conditions influence health. The video was first developed by Sudbury & District Health Unit (SDHU) and has been adapted by other regions (including Chatham-Kent Public Health Unit, Niagara Region Public Health Unit and Peterborough County-City Health Unit).  SDHU created a user guide (2011) to support and engage individuals and organization as they start their own conversations about health. These videos illustrate how public health organizations are engaging with community members, talking about the social determinants of health, and sharing innovative practices.

In 2011-12, the Health Equity Office of the SDHU carried out a process evaluation of the Let’s Start a Conversation resources. The evaluation findings were intended to guide SDHU’s future use of these resources as well as shape other ongoing efforts aimed at building understanding and action around the social determinants of health. 

Use this resource to:

  • Raise awareness about the social determinants of health
  • Develop common language with partners in other sectors
  • Inform the design of other multimedia ‘storytelling’ tools

Reference:
Sudbury & District Health Unit. (2011). Let’s start a conversation about health… and not talk about health care at all: User guide. Retrieved from https://www.sdhu.com/health-topics-programs/health-equity/health-equity-resources.

Tags: Communicate, Community engagement, Income inequality, Public health unit / health authority, Socioeconomic status

A review of frameworks on the determinants of health

Frameworks are used to visually represent complex ideas or concepts. Numerous frameworks exist to help explain the relationship between the social determinants and health experiences and outcomes. The Canadian Council on the Social Determinants of Health commissioned a review of these frameworks to identify those that best support action across multiple sectors.

This report provides a brief analysis of 37 frameworks on the determinants of health, and an in-depth analysis of seven frameworks deemed most useful for understanding and acting on the social determinants across sectors. The study and use of these frameworks can help shift public health practice towards more intersectoral, development-oriented, upstream approaches.

The frameworks were analysed to determine how well they:

  • reflect an intersectoral perspective;
  • identify points of entry for different sectors;
  • demonstrate how different sectors can take action to maximize impact; and
  • include ecological factors, the Canadian context, and Aboriginal health.

The frameworks are categorized as 1) explanatory, used to explain the concept of health determinants to uninitiated audiences; 2) interactive, identifying points of interaction and the relationships between them; or 3) action-oriented, focusing on the decision or policy-making process.


Use this resource to:

  • Understand the interaction between the determinants of health and health outcomes
  • Identify ways to influence the determinants of health and health equity
  • Shift public health practice towards more intersectoral, development-oriented, upstream approaches.


Reference:
Canadian Council on Social Determinants of Health. (2015). A review of frameworks on the determinants of health. Ottawa, ON: Canadian Council on Social Determinants of Health. Retrieved from http://ccsdh.ca/images/uploads/Frameworks_Report_English.pdf.


Related resource:

Tags: Access to health services, Assess and report, Communicate, Community engagement, Competencies & organizational standards , Critical works in health equity, Early childhood development, Environmental health, Evaluation, Food security, Health literacy, Healthy public policy, Income inequality, Indigenous health , Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partnership , Policy analysis, Public health unit / health authority, Racism/racialization, Sex & gender, Socioeconomic status , Working conditions

Common agenda for public health action on health equity

The National Collaborating Centre for Determinants of Health (NCCDH) collaborates with and engages public health practitioners, researchers, and decision-makers across Canada on the question of how to strengthen the social determinants of health and improve health equity. 

Through knowledge exchange, learning and networking activities, these stakeholders have identified challenges they face, priorities they are already engaged in, and areas for more focus and collaboration.  This common agenda was developed through a synthesis of documents from these activities (including past NCCDH event reports, environmental scans, and meeting notes), and staff observations during network development activities and consultations. These sources represent the voices of thousands of public health actors from every province and territory in Canada. 

A summary of this report is also available here.

The Common Agenda identifies eight priorities organized under three themes for public health stakeholders:

1. Build a foundation for action

a) Strengthen public health leadership

b) Increase social and political support (political will) and action

c) Build organizational and system capacity

2. Establish and use strong knowledge base

a) Act on existing evidence and strengthen the knowledge base to support concerted action

b) Incorporate equity considerations into regular monitoring, surveillance and reporting

3. Collaborate with non-health sector partners

a) Participate in long-term, multisectoral action

b) Advocate for policy and structural change

c) Allocate time and resources for meaningful sustained community engagement and political empowerment 

These priorities build on existing momentum to improve health equity in Canada and can support policy makers, practitioners and organizations at all levels to influence the social determinants of health. While this document was developed for public health, the priorities acknowledge that this work happens in collaboration with health and non-health partners, and community stakeholders. 


Use this resource to:

  • Identify approaches to guide organizational and systems action needed to improve health equity.
  • Facilitate discussions about common health equity action priorities with internal and external partners.
  • Evaluate current health equity activities and develop strategies to bridge gaps in action. 


Reference:

National Collaborating Centre for Determinants of Health. (2016). Common Agenda for Public Health Action on Health Equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.


Related resources:

Tags: Access to health services, Assess and report, Communicate, Community engagement, Competencies & organizational standards , Critical works in health equity, Early childhood development, Environmental health, Evaluation, Food security, Health literacy, Healthy public policy, Income inequality, Indigenous health , Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partnership , Policy analysis, Public health unit / health authority, Racism/racialization, Sex & gender, Socioeconomic status , Working conditions

Economic arguments for shifting health dollars upstream

For several decades, researchers and policy-change advocates have offered economic evidence that the health sector would better serve the population – and at less cost – if more of its dollars were spent facilitating improvements in people’s living and working conditions.  This discussion paper calls for a re-invigoration of this discussion, fueled by contemporary pressures: our expanding medical technical capabilities, our aging population, rising incidences of chronic disease, the skyrocketing wealth gap, and slowing economies.

The discussion paper provides 1) an overview to health system spending; 2) a discussion of the current drivers for looking at the economics of how we spend health care dollars; 3) a synthesis of existing economic arguments for moving dollars upstream; 4) examples of effective economic arguments in the areas of early child development and food security; and 5) actions we can take moving forward, with discussion questions.

Use this resource to:

  • Facilitate discussion about how we spend health care dollars, nationally and provincially
  • Explore recent research that links socioeconomic status, social determinants, interventions, health outcomes and health costs
  • Discuss the status and value of using economic arguments with government decision-makers

Reference:

National Collaborating Centre for Determinants of Health. (2016). Economic arguments for shifting health dollars upstream. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Assess and report, Evaluation, Healthy public policy, Leadership & capacity building, Policy analysis

Learning from Practice: Advocacy for health equity – Hamilton Public Health Services

In collaboration with other areas of local government and community groups, Hamilton Public Health has been advocating for health equity through its efforts to support initiatives such as basic income guarantee, food security and the Canada Learning Bond for low income residents.

This paper highlights three main roles that public health professionals at Hamilton Public Health took as part of their advocacy for health equity. These roles are described in Let’s Talk: Advocacy and health equity.

Role 1 Framing the issue:  In Hamilton Public Health, social determinants of health (SDOH) nurses used a framing strategy that targeted specific populations and issues.

Role 2  Gathering and disseminating data:  SDOH nurses used population health surveillance data to reveal where the inequities in the community existed.

Role 3  Working in collaboration and developing alliances: Hamilton Public Health worked closely with internal public health partners—including staff working directly with clients and Medical Officers of Health—as well as with community-based organizations and all levels of government.

Use this resource to:

  • Integrate an advocacy approach into your health equity activities
  • Develop a health equity framework or strategy for your organization
  • Support a conversation in your organization about how to create a safe space for moving advocacy actions further upstream toward structural change

Reference:

National Collaborating Centre for Determinants of Health. (2016). Learning from Practice: Advocacy for health equity – Hamilton Public Health Services. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

Tags: Access to health services, Assess and report, Communicate, Community engagement, Competencies & organizational standards , Critical works in health equity, Early childhood development, Environmental health, Evaluation, Event, Food security, Health literacy, Healthy public policy, Income inequality, Infectious disease, Intersectoral action, Key concepts, Leadership & capacity building, Methods & tools, Modify & orient, Partnership , Policy analysis, Public health unit / health authority, Sex & gender, Working conditions, National Collaborating Centre for Determinants of Health

Public Health Speaks: Intersectionality and health equity

In partnership with the National Collaborating Centre for Healthy Public Policy (NCCHPP), the NCCDH brought a small group of public health practitioners and researchers together to share perspectives on the relevance and application of intersectionality in public health. Intersectionality is an approach or lens that recognizes that health is shaped by a multi-dimensional overlapping of factors such as race, class, income, education, age, ability, sexual orientation, immigration status, ethnicity, indigeneity, and geography.

This resource summarizes an October 2015 conversation facilitated by Sume Ndumbe-Eyoh, Knowledge Translation Specialist at NCCDH with:

  • Anna Travers, Director, Rainbow Health Ontario
  • Samiya Abdi, Health promotion consultant, Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario
  • Dr. Olena Hankivsky, Professor & Director, Institute for Intersectionality Research and Policy, Simon Fraser University
  • Val Morrison, Research Officer, NCCHPP

The contributors discuss their understanding of intersectionality and how it is currently applied in public health practice, policy and research focused on the social determinants of health and health equity. They identify gaps and opportunities to better integrate an intersectional lens into various aspects of equity-oriented public health activity.

Use this resource to:

  • Identify opportunities to integrate intersectionality into public health practice, policy and research
  • Design program and policy interventions that address multiple structures of power and disadvantage
  • Develop training activities for staff

Reference:

National Collaborating Centre for Determinants of Health and National Collaborating Centre for Healthy Public Policy. (2016). Public Health Speaks: Intersectionality and health equity. Antigonish, NS and Montreal, QC: Author.

Tags: Access to health services, Assess and report, Communicate, Community engagement, Competencies & organizational standards , Critical works in health equity, Early childhood development, Environmental health, Evaluation, Food security, Health literacy, Healthy public policy, Income inequality, Indigenous health , Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partnership , Policy analysis, Public health unit / health authority, Racism/racialization, Sex & gender, Socioeconomic status , Working conditions

Multiple actors bringing diverse knowledge to improve health equity: Dialogue proceedings

In February, 2015, the Réseau de recherche en santé des populations du Québec (RRSPQ), the National Collaborating Centre for Determinants of Health (NCCDH), and the Institut national de santé publique du Québec (INSPQ) hosted a forum entitled Dialogue: Multiple actors bringing diverse knowledge to improve health equity. Seventy participants from nine Quebec regions gathered in Quebec City to reflect on the question: “What are the opportunities to reduce social inequities in health if we bring together knowledge gathered from experience, intervention, research, and decision-making?”

These proceedings summarize the process and discussions of the day as well as proposed follow-up actions. Through presentations and open-space technology methods , participants chose and attended discussions of greatest interest to them. Building on their diverse backgrounds, knowledge and expertise, participants created an agenda at the start of the meeting, with topics including: 

  • Gaining a better understanding of proportionate universality, intersectionality, and structural determinants of health;
  • Mitigating conditions leading to social inequalities for children;
  • Poverty in rural communities;
  • Early interventions in ethnically diverse settings;
  • Challenges related to social diversity, including in smaller communities;
  • Integrating social inequalities in health into public health planning processes and interventions;
  • Influencing decision-makers to take action to reduce health inequities

The forum closed with participants identifying areas of interest and follow-up activities.

Use this resource to:

  • Identify key health equity issues in  Quebec
  • Explore areas for joint problem-solving and collaboration
  • Learn about open space technology as a tool to support group collaboration and idea generation

Reference:

Réseau de recherche en santé des populations du Québec, National Collaborating Centre for Determinants of Health and the Institut national de santé publique du Québec. (2015). Multiple actors bringing diverse knowledge to improve health equity: dialogue proceedings.

Tags: Access to health services, Assess and report, Communicate, Community engagement, Competencies & organizational standards , Critical works in health equity, Early childhood development, Environmental health, Evaluation, Food security, Health literacy, Healthy public policy, Income inequality, Indigenous health , Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partnership , Policy analysis, Public health unit / health authority, Racism/racialization, Sex & gender

Equity action: Health equity tools for health system managers (Canada) – Online course

In the last few decades, health inequalities, health inequities and the social determinants of health have become increasingly popular topics, as health differences between socio-economic groups continue to persist and, in some cases, widen. This course is designed to provide health system managers with more information about approaches to health equity across the country.

The one-hour course uses simple animations, case study information and knowledge checks to relay different approaches to addressing health inequities at the regional level. Upon completion, you will be able to identify how Canadian health regions are using information, strategies, policies and programs to reduce health inequities and access tools and resources available to support the use of a health equity perspective in decision-making.

A written primer, “Equity action: A primer on health equity for health system managers,” is available for download.

The course was developed by the CIHI and the Canadian Population Health Initiative. To access the course, visit: https://learning.cihi.ca/users/index.aspx

Reference:

CIHI Learning Centre (2014). Equity action: Health equity tools for health system managers [online course]. Retrieved from https://learning.cihi.ca/users/index.aspx

Tags: Competencies & organizational standards , Leadership & capacity building, Methods & tools, Promising practices , Public health unit / health authority

Health promotion foundations (Canada) – Online course

Public health practitioners come to health promotion from a wide variety of career paths. This course is designed to provide foundational information about health promotion.

This series of interactive modules covers key concepts, milestones, models, theories, strategies, and more. The modules do not attempt to change intervention skills; they focus instead on awareness and how practice can be reframed in light of new perspectives.

Upon completing this 1-2 hour course, you will be able to: describe the features and values that shape health promotion practice; describe key milestones in the field; distinguish health promotion from related concepts such as disease prevention, population health and harm reduction; and identify strategies to take action on the health issues affecting individuals and communities.

For more information, or to sign-up, visit: http://www.publichealthontario.ca/en/LearningAndDevelopment/OnlineLearning/Pages/default.aspx

Reference:

Public Health Ontario. (2014). Health promotion foundations [online course]. Retrieved from http://www.publichealthontario.ca/en/LearningAndDevelopment/OnlineLearning/Pages/default.aspx
 

Tags: Key concepts, Public health unit / health authority

Introduction to population health (MOOC) (Europe) – Online course

The University of Manchester pioneered the online teaching of population health with one of the first distance learning programs in the world. The 2016 schedule for this free MOOC (massive online open course) has not been set; you can request notification for the next delivery dates.

This course is aimed at learners in the general public, but due to the quality of the video lectures and suggested readings, it would be useful for people working in health and social care who want to improve their understanding of population health. As is common with MOOCs, most of the content is in the form of video lectures and suggested readings, along with discussion activities, self-assessment, and other exploratory activities. 

The six week course (1-3 hours/week) covers the following topics:
Week 1 – An introduction to population health
Week 2 – An introduction to epidemiology
Week 3 – The state of the world’s health
Week 4 – Global influences on population health
Week 5 – Population health interventions
Week 6 – Reflection

For more information, or to sign-up, visit: https://www.coursera.org/course/population

Reference:

University of Manchester. (2014). Introduction to population health [online course]. Retrieved from https://www.coursera.org/course/population.

Tags: Key concepts, Knowledge translation , Promising practices

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