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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: Assess and report, Communicate, Evaluation, Intersectoral action, Leadership & capacity building, Public health unit / health authority

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: http://www.globalhealthaction.net/index.php/gha/article/view/29034

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, Socioeconomic status

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, Partner, 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: Aboriginal health , Early childhood development, Environmental health, Healthy public policy, 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.

Tags: Aboriginal health , 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, Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partner, 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.

Tags: Aboriginal health , 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, Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partner, 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. 

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: Aboriginal health , 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, Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partner, 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: Aboriginal health , 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, Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partner, Policy analysis, Public health unit / health authority, Racism/racialization, Sex & gender, Socioeconomic status , Working conditions

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: Aboriginal health , 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, Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partner, 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: Aboriginal health , 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, Infectious disease, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Partner, 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

Collaborative decision-making with communities (US) – Online course

This course is one of a series from the Evidence Based Behavioural Practice (EBBP) website that looks at shared decision-making in a variety of settings, from working with individual clients to implementing programs for entire communities.

This online module is unique in that it uses scenario-based training to guide participants through a case, from the point of view of a public health program manager working in a local health department. Using this scenario, participants learn about the collaborative decision-making process as a public health practitioner working with communities.

This online course is intended for a wide-ranging audience, including health and public health practitioners.  It provides a safe environment to apply and refine your decision-making skills by implementing the Evidence-Based Practice “Three Circles” model. By the end of the course you should be able to: define collaborative decision-making; describe the rationale for collaborative decision-making in evidence-based practice; and balance the three circles of evidence-based practice when applying collaborative decision-making with a community.

For more information on evidence-based practice, or to sign-up for this online training module, visit www.ebbp.org/training.html

Reference:

Evidence-Based Behavioural Practice. (2007). Collaborative decision-making with communities [online course]. Retrieved from http://www.ebbp.org/training.html

Tags: Community engagement, Key concepts, Methods & tools, Public health unit / health authority

The social determinants of health: A toolkit for collaboration

The Association of Academic Health Centers’ (AAHC) “Toolkit for Collaboration” is a website comprised of reports and resources for academic health centers (AHCs) to assess and enhance their ability to address social determinants of health. The toolkit includes: a report synthesizing the challenges and opportunities for AHCs to address social determinants of health; a scorecard for member organizations to assess their current efforts; AAHC meeting minutes; and a series of interviews exemplifying cross-sectoral approaches to improving health.

The toolkit is part of the AAHC’s Social Determinants of Health Initiative that seeks to improve academic health centers’ ability to respond to social determinants of health in their education, research, and clinical programs. Acknowledging that academic health centers have traditionally focused on medical care, AAHC’s “Toolkit for Collaboration” is a response to the growing interest in strengthening academic health center leadership to “further develop approaches to individual and population health that include underlying social determinants.” As institutions that educate new medical professionals, operate a range of health facilities, and lead in medical research, AHCs are “uniquely positioned to have a significant and positive impact on the determinants of health and the health of their communities.”

A key component of the toolkit is a consensus document synthesizing discussions held at an AAHC conference in 2014. The report “identifies challenges and barriers to addressing social determinants of health, proposes a variety of responses and solutions, and focuses in particular on the role of academic health centers working in collaboration with other stakeholders.”  To access and read the full report, click here.

For more information about the structure and work of the Association of Academic Health Centers, click here.

Use this resource to:

  • Assess how your organization is addressing environmental and social factors that affect health
  • Find tools to help promote the importance of working to improve the environments that determine health
  • Learn about the preoccupations, and the achievements, of other organizations that want to move further upstream in their health care work

Reference:

Association of Academic Health Centers. (2010-2014). Association of Academic Health Centers and the Determinants of Health: A Toolkit for Collaboration. Retrieved from wherehealthbegins.org.

Link where full text can be located (English)
www.wherehealthbegins.org/index.php

Other documents that should be linked to this document
“Academic Health Centers and the Social Determinants of Health: Challenges & Barriers, Responses & Solutions" www.wherehealthbegins.org/pdf/AAHC-SDOH-Report-Final.pdf

Tags: Competencies & organizational standards , Evaluation, Healthy public policy, Intersectoral action, Knowledge translation , Leadership & capacity building, Methods & tools

Inequalities in health: Definitions, concepts and theories

This review article seeks to “create a centralized resource for understanding methodological, theoretical, and philosophical aspects of health inequalities research” while highlighting previously under-discussed aspects of health disparities research, such as the distinction between measuring disparities by two different geographic parameters of space and place. The authors begin by making the important distinction between unavoidable health inequalities (the differences amongst individuals or groups) and health inequities that denote unjust, preventable, and systemic differences in health.

Next, the article introduces key concepts for gathering and interpreting information on health inequalities and the parameters by which health inequalities are commonly examined within and between populations, including: group-level differences versus overall health distribution; social group health inequalities and the difficulties of defining groups; absolute versus relative social position (particularly important when considering poverty’s impact on health); geographic health inequalities of both space and place; and the complexities of tracking and reporting health inequalities throughout the life course. This discussion then broadens into frameworks and theories for understanding health inequalities and the causal mechanisms and conditional health effects that link geographic and social factors to health.

The article concludes by asking a series of contextual and ethical questions on designing, executing, and using research of health inequalities to best set priorities, benchmarks, and corresponding policy agendas to address health inequalities.

Use this resource to:

  • Strengthen your understanding of the core measurement and assessment concepts associated with health equality research
  • Improve your ability to critically assess population health status reports and research findings associated with health equity outcomes
  • Integrate health equity measures into your program planning and evaluation approaches

Reference:

Arcaya, MC, Arcaya, AL, Subramanian, SV (2015).  Review Article.  Inequalities in health: definitions, concepts and theories.  Global Health Action, 8: 27106.  Accessed: http://www.globalhealthaction.net/index.php/gha/article/view/27106

Link where full text can be located (English):
http://www.globalhealthaction.net/index.php/gha/article/view/27106

Link where full text can be located (French):
Available in English only

Related Documents:

  1.  Population health status reporting: the learning together series (2012). http://nccdh.ca/resources/entry/population-health-status-reporting
  2. The Public Health Observatory handbook of health inequalities measurement (2005). http://nccdh.ca/resources/entry/the-public-health-observatory-handbook-of-health-inequalities-measurement
  3. Promoting health equity – Choosing appropriate indicators: literature scan (2013). http://nccdh.ca/resources/entry/promoting-health-equity-choosing-appropriate-indicators-literature-scan
  4. Reducing gaps: using area-based socio-economic measures to explore population health – online course (2012). http://nccdh.ca/resources/entry/reducing-gaps-online-course
  5. Une stratégie et des indicateurs pour la surveillance des inégalités sociales de santé au Québec (2013). French only: http://nccdh.ca/resources/entry/une-strategie-et-des-indicateurs-pour-la-surveillance-des-inegalites-social

 

Tags: Assess and report, Key concepts, Methods & tools

Do public health discipline-specific competencies provide guidance for equity-focused practice?

Building on an earlier analysis by NCCDH, Core competencies for public health in Canada: An assessment and comparison of determinants of health content, this document seeks to understand how different public health disciplines have incorporated growing knowledge about determinants of health and health equity into their discipline-specific competencies by analyzing the inclusion of health equity and social justice language in their competency frameworks.

The report first considers the state of public health competencies outside our borders, describing the status and content of selected international competency frameworks (general and discipline-specific), paying specific attention to the concepts of determinants of health, health equity and social justice.

Then, turning its attention to the Canadian context, the report provides a content analysis of the competencies developed by various public health discipline-specific professional bodies, describing how each competency-set addresses the concepts of determinants of health, health equity, and social justice.

Use this resource to:

  • Become familiar with the current competencies of public health practitioners across various disciplines in Canada and beyond
  • Identify opportunities to revise discipline-specific competencies to be more reflective of the principles of social justice and health equity

Reference:
National Collaborating Centre for Determinants of Health. (2015). Do public health discipline-specific competencies provide guidance for equity-focused practice? Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
 

Tags: Competencies & organizational standards , Public health unit / health authority

Pathways to health equity and differential outcomes: A summary of the WHO document Equity, social determinants and public health programmes

In 2010, one of nine knowledge networks of the World Health Organization (WHO) Commission on Social Determinants of Health published a report entitled, Equity, social determinants, and public health programmes. The report examines interventions and implementation approaches that address inequity and makes a strong plea to re-focus public health efforts toward societal-level healthy public policy.

The full WHO report includes findings from a literature review about interventions that address 12 key public health conditions, as well as 14 case studies of SDH implementation approaches in different countries. A chapter is devoted to each public health condition and includes analysis that looks upstream to investigate the condition’s causal pathway, along with
promising entry points and interventions.

The National Collaborating Centre for Determinants of Health (NCCDH) has summarized Equity, social determinants and public health programmes to help public health organizations and practitioners plan and deliver more nuanced interventions to advance health equity. 

Using the chapter on cardiovascular disease as an exemplar, the summary illustrates how the report’s conceptual framework for understanding health inequities applies to a major Canadian health challenge. In addition, the summary synthesizes some of the key lessons learned from the research findings to identify commonalities that public health can draw upon across health conditions. 

Use this resource to:

  • Facilitate discussion about how exposure to risk conditions by dissimilar populations leads to varied health outcomes
  • Inform development of a range of ‘intervention packages’ within individual public health programs
  • Shift public health practice towards more intersectoral, development-oriented upstream approaches that complement existing service models.

Reference:
National Collaborating Centre for Determinants of Health. (2015). Pathways to health equity and differential outcomes: A Summary of the WHO document Equity, social determinants and public health programmes. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
 

Tags: Access to health services, Assess and report, Critical works in health equity, Healthy public policy, Knowledge translation , Socioeconomic status

Advancing provincial and territorial public health capacity for health equity: Proceedings

The proceedings from the Advancing provincial and territorial public health capacity for health equity event provide an overview of a May 2014 pan-Canadian meeting of senior leaders and decision-makers in public health.

This two-day workshop gave participants an opportunity to learn together, by sharing new research and exchanging promising practices, as well stimulating more integrated provincial/territorial action to address inequities. Findings from the event are being used to facilitate further conversations about developing a common agenda for equity in public health.

Use this resource to:

  • Learn what other provinces and territories are doing to narrow the gap between the most and least healthy
  • Gain insight into the kinds opportunities and challenges seen by provincial/territorial health leaders
  • Learn what potential next steps and priority actions were identified by participants

Reference:
National Collaborating Centre for Determinants of Health. (2015). Advancing provincial and territorial public health capacity for health equity: Proceedings. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Healthy public policy, Knowledge translation , Leadership & capacity building, National Collaborating Centre for Determinants of Health, Document

Make food matter

Are you interested in learning how Nova Scotians are “making food matter” for their families’, communities, and province?  This online resource is a research and action initiative designed to support moving knowledge into action to build community food security in Nova Scotia. Although the website is designed around food security issues in Nova Scotia, the toolkit and resources can be adapted for use across Canada.

The ‘Make Food Matter’  website is a project of the Food Action Research Centre  at Mount St Vincent University in Halifax.  It identifies five research-based areas for action and provides a model highlighting approaches to move us to a healthy, just, and sustainable food system. In addition, citizens from across Nova Scotia share what is important to them about food through engaging and interactive photos, videos, and quotes.  You can find evidence on a range of community food security measures, including the results of community-based participatory research projects and reports from organizations doing similar work.

To support action, the site includes a toolkit organized under five action streams:  building community dialogue, developing policy action, social innovation approaches, advocacy strategies, and effective communication.  You can register as a member of the Make Food Matter community to be kept up to date on new resource additions, and build a personalized “action portfolio” of bookmarked resources to support your food security work.

Use this resource to

  • identify the multiple approaches needed to achieve community food security;
  • build a collection of action-oriented tools for moving knowledge into action about healthy, just, and sustainable food systems;
  • develop an action plan to influence decision-making and policy around social justice and food issues.

Reference

FoodARC.  Make Food Matter [Internet].  Nova Scotia:  FoodARC; 2015.  [updated 2015 October 22; cited 2015 October 22].  Available from:  http://foodarc.ca/makefoodmatter

Other resources

Large forces affecting health equity: How health equity is affected by societal shifts such as home ownership, rising energy costs, and pension http://nccdh.ca/resources/entry/large-forces-affecting-health-equity

A practitioner’s guide for advancing health equity: Community strategies for preventing chronic disease http://nccdh.ca/resources/entry/a-practitioners-guide-for-advancing-health-equity-community-strategies#sthash.Z2ckuv4J.dpuf

Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity http://nccdh.ca/resources/entry/community-based-participatory-research-contributions-to-intervention-resear#sthash.IdGkkZC6.dpuf

Community-based participatory research: A strategy for building healthy communities and promoting health through policy change http://nccdh.ca/resources/entry/community-based-participatory-research#sthash.p1DxKFeb.dpuf

Review summary: Community engagement to reduce inequalities in health http://nccdh.ca/resources/entry/review-summary-community-engagement-to-reduce-inequalities-in-health#sthash.XXUAvwkX.dpuf

Let’s Talk:  Moving Upstream http://nccdh.ca/resources/entry/lets-talk-moving-upstream

Let’s Talk:  Public Health Roles for Improving Healthy Equity http://nccdh.ca/resources/entry/lets-talk-public-health-roles

Tags: Community engagement, Food security, Health Impact Assessment, Health literacy, Healthy public policy, Knowledge translation , Methods & tools, Policy analysis, Public health unit / health authority, Socioeconomic status

Local action on health inequalities.  Introduction to a series of evidence papers

This series is designed for local authorities in England, particularly Directors of Public Health and their teams, and for Health and Wellbeing Boards. However, practitioners in Canada who have responsibility for work that has implications for health—like children's services, housing and education services—will also find the information useful.

The topics covered relate to policy objectives in the Marmot Review that are considered amenable to action by local authorities.  Each topic focuses on a social determinant and is addressed in an Evidence Review and a Briefing.  The Evidence Reviews, ranging from 30 to 90 pages, includes key messages and references.  The Briefing documents describe the issues in popularized language and offer actions and examples of actions by local authorities.

Two additional evidence papers focus on implementation and impact issues.  One addresses understanding the economics of investments in the social determinants of health, and the other focuses on general lessons related to tackling health inequalities through action on the social determinants of health.

Use this resource to

  • Find evidence and practice examples to prioritize local action on the social determinants
  • Drive innovation by combining evidence and the experience of others with local knowledge and expertise
  • Explore opportunities with community partners to develop new approaches to addressing the social determinants of health
  • Make the case for local action on the social determinants of health

Reference

Institute of Health Equity (2014).  ‘Local Action on Health Inequalities' - A Series of Reports.  University College London.

Other documents

  1. Fair Society, healthy lives: The Marmot survey – strategic review of health inequalities in England post-2010.  http://nccdh.ca/resources/entry/fair-society-healthy-lives/
  2. Learning from practice: targeting within universalism.  http://nccdh.ca/resources/entry/learning-from-practice-targeting-within-universalism
  3. A practitioner’s guide for advancing health equity: community strategies for prevention chronic disease.  http://nccdh.ca/resources/entry/a-practitioners-guide-for-advancing-health-equity-community-strategies
  4. Reduire les inegalites sociales en sante.  http://nccdh.ca/resources/entry/reduire-les-inegalites-sociales-en-sante
  5. Learning from others: comprehensive health equity strategies from Europe.  http://nccdh.ca/resources/entry/learning-from-others
  6. Tackling health inequities through public health practice: a handbook for action. http://nccdh.ca/resources/entry/tackling-health-inequities
  7. Better health: an analysis of public policy and programming focusing on the determinants of health and health outcomes that are effective in achieving the healthiest populations. http://nccdh.ca/resources/entry/better-health

 

Tags: Critical works in health equity, Early childhood development, Environmental health, Healthy public policy, Income inequality, Intersectoral action, Working conditions

Rio political declaration on social determinants of health: A snapshot of Canadian actions 2015

The World Health Organization’s Rio Declaration on the Social Determinants of Health  (WHO Rio Declaration) was adopted at the 2011 World Conference on Social Determinants of Health.  It outlines the commitment of United Nations Member States to addressing health equity through a social determinants approach.

This report, Rio political declaration on social determinants of health: A snapshot of Canadian actions 2015, outlines Canadian actions that align with the five main themes of the WHO Rio Declaration.  These themes, which reflect key areas in a comprehensive approach to improving health across populations, include:

  1. Adopt better governance for health and development
  2. Promote participation in policy-making and implementation
  3. Further orient the health sector towards reducing health inequities
  4. Strengthen global governance and collaboration
  5. Monitor progress and increase accountability

This report provides a summary and web links for initiatives and tools, from across Canada.  The Canadian examples are listed under “activity type” groupings within each theme area.  The intent is to show the diversity of activity happening across Canada that contributes to the Rio Declaration commitments.

Use this resource to:

  • Consider the breadth of initiatives and tools being used to improve health equity through work on the social determinants of health
  • Learn about intersectoral, community-engaged work that addresses the social factors that influence health
  • Investigate factors that contribute to organizational capacity to sustain initiatives designed to advance health equity

Reference

Public Health Agency of Canada (2015).  Rio political declaration on social determinants of health:  A snapshot of Canadian actions 2015.  Ottawa, ON:  Public Health Agency of Canada.

 

Tags: Aboriginal health , Access to health services, Community engagement, Healthy public policy, Intersectoral action, Leadership & capacity building, Modify & orient, Policy analysis, Public health unit / health authority, Public Health Agency of Canada, Document

Overcoming Poverty Together:  The New Brunswick economic and social inclusion plan 2014-19

The New Brunswick Economic and Social Inclusion Corporation  (NBESIC) has a mandate “to develop, oversee, coordinate and implement strategic initiatives and plans to reduce poverty and assist thousands of New Brunswickers to become more self-sufficient.”  This report, Overcoming poverty together:  The New Brunswick economic and social inclusion plan 2014-19 , builds on the momentum of New Brunswick’s initial economic and social inclusion plan launched in 2009 , and was created based on a significant public engagement process, as well as meetings with stakeholders from many sectors.  The goal of the plan is to reduce poverty and improve the quality of life for New Brunswick citizens.

The NBESIC also published an evaluation of its efforts to fulfill the 2009-2014 plan:  The impact of New Brunswick’s 2009-2014 Economic and Social Inclusion Plan.

The updated plan emphasizes community capacity-building, and includes 28 priority actions under four pillars:

  1. Community empowerment:  actions addressing community development, communication, networking, and volunteerism.
  2. Learning: actions addressing child, youth and adult education and training, and preparation for work.
  3. Economic inclusion: actions addressing participation in the labour market and business activity.
  4. Social inclusion: actions addressing food security and healthy food availability, housing, and transportation.

Community Inclusion Networks, with coordinators who work directly with the Corporation, ensure that the voices and needs of the community are integrated into actions.  The collaborative approach helps ensure that the voices of people with experiences of poverty—aboriginal communities, youth, seniors, immigrants, and persons living with disabilities and mental health issues—are reflected in the implementation and fulfillment of the plan.

Use this report to

  • earn about a public engagement process designed to take a broad economic and social inclusion approach to poverty and health
  • investigate how to build on the momentum of a first phase of public engagement and cross-sectoral collaboration
  • learn about ways to involve community members, province-wide, in decision making around poverty reduction

Reference

New Brunswick Economic and Social Inclusion Corporation (2015).  Overcoming poverty together:  The New Brunswick economic and social inclusion plan 2014-19. Fredericton, NB: Economic and Social Inclusion Corporation.

Other resources

Empower the community: New Brunswick’s approach to overcoming poverty

Tags: Access to health services, Communicate, Community engagement, Healthy public policy, Income inequality, Intersectoral action, Knowledge translation , Leadership & capacity building, Policy analysis, Promising practices , Socioeconomic status , Working conditions

Key public health resources for advocacy and health equity: A curated list

Public health advocacy is a critical population health strategy that emphasizes collective action to effect systemic change.  Advocacy influences decision-making to create positive change for people and their environments.
We’ve selected a number of tools and resources that public health practitioners can use in fulfilling their advocacy roles to help create healthier environments and policies.  These roles are described in more detail in “Let’s Talk: Advocacy and Health Equity ” They are:

  1. Framing the issue;
  2. Gathering and disseminating data;
  3. Working in collaboration and developing alliances; and
  4. Using the legal and regulatory system.

This curated list is not meant to be comprehensive, but to point to key resources to support advocacy for health equity by public health practitioners.

Tags: Assess and report, Collaboration, Communicate, Community engagement, Intersectoral action, Leadership & capacity building, Partner, Policy analysis, Document

Unnatural Causes: Is inequality making us sick?

A seven-part documentary series, Unnatural Causes explores various elements of racial and socioeconomic determinants of health across the US. The series and accompanying impact campaign aim to enlarge the public discourse about health by increasing awareness of how social inequities, racism and disempowerment influence health outcomes and have real associated costs. Unnatural Causes also emphasizes a population health framing, illustrating health and well-being is more than a matter of making good choices and access to quality care. The series contends that solutions need to be sought through broader equitable social policies.

The opening episode, In Sickness and In Wealth (approx. 1 hour), presents the series’ overarching themes. Each subsequent half-hour episode, set in a different ethnic community (e.g. Bad Sugar connects diabetes, oppression and empowerment in two Native American communities), provides deeper insight into how social conditions affect population health and how some communities are working to improve health and health policies.

As part of larger impact campaign, the documentary is accompanied by various tools including: a discussion guide for public screenings and community events; a policy guide to support organizations to plan and implement strategies for policy change; and an action toolkit to use the series to advance a health equity agenda. 

Use this resource to

  • link health discussions to social and economic policies.
  • support communities and organizations with examples of policies that have positively effected health equity
  • provide communities and organizations with tools to emulate these successful approaches
  • catalyze community discussions around policy initiatives related to health equity and the social determinants of health

Reference

National Association of County & City Health Officials. 2008. Unnatural Causes. Retrieved from www.unnaturalcauses.org

Tags: Community engagement, Health literacy, Healthy public policy, Income inequality, Key concepts, Knowledge translation , Racism/racialization, Socioeconomic status , Video

Population Health: The new agenda

Population Health: The New Agenda is a 15 minute video introducing the broad concepts of population health and the social determinants of health. The video includes vignettes from North Vancouver residents of varying economic situations discussing how their employment and economic stability, access to affordable housing, childcare, health care and community programs have each effected their overall health. The video also includes commentary from Vancouver Coastal Health staff offering analysis of city-wide data on rates of chronic disease and perceptions of health with a focus on health equity.

Use this resource to

  • Initiate discussion about how public policy can effect health.
  • Raise awareness about the social determinants of health.
  • Connect population health concepts to lived experiences.

Reference

Vancouver Coastal Health. (2009). Population Health: The New Agenda. Retrieved from: <https://vimeo.com/12167810>

Other Documents

VCH Population Health (web page where videos are linked)

Towards a Health Promotion Approach: A Framework and Recommendations for Action

Tags: Access to health services, Healthy public policy, Income inequality, Public health unit / health authority, Socioeconomic status , Video

Our Life: A new wave of public health

Building from the Marmot Review’s work on health inequalities and living well, Our Life examines how public health can address the basic causes of ill health, to shift the priority from living longer to living better. In addition to being a knowledge translation tool to illustrate the impact of the social determinants of health, this video is also designed to help public health professionals think through what is needed to re-conceptualize and shift the system. 

This seven minute illustrated video uses the International Futures Forum’s Three Horizons Model to outline strategies to realize a new wave of public health. The first of the three horizons addresses today’s issues with our best knowledge and ideas, and represents the currently predominant way of working in public health. The second horizon recognizes the mid-term perspective that new ways of working are needed. Our Life proposes strategies such as asset-based approaches, empowered consumerism (“from working with people as passive recipients of services to active, informed and empowered consumers or indeed producers of services”), advocacy, and integrated wellness services. The third horizon is the long-term vision, based on fringe innovations and the framing of a clear goal for the future direction of public health. Here the video asks, “Is what we envision [for public health] appropriate given the cultural and global changes?” The video further proposes that, rather than the goal being life expectancy alone, the goal could be “to create an equitable, fair, well and just environment that is sustainable for our locale and the wider world, to leave it in a better state.” Our Life ambitiously places public health and health equity at the center of these larger shifts. 

Use this resource to

  • facilitate discussion about how public health systems can address or lead long-term change.
  • initiate discussion among public health professionals and authorities about re-energizing, and re-directing public health work, issue framing and goals.
  • develop tools for conceiving and developing public health strategies.
  • initiate discussions about the societal shifts needed to support a new wave of public health.
  • catalyze community discussions around policy change related to health equity and the social determinants of health.

Reference

NHS NW England. 2013. Our Life: A New Wave of Public Health. Retrieved from <https://vimeo.com/55925174>

Other documents

A New Wave of Public Health Workbook,” Jude Stansfiled. 2012

Fair Society, Healthy Lives,” The Marmot Review

Three Horizons Thinking, International Futures Forum

Tags: Assess and report, Critical works in health equity, Healthy public policy, Intersectoral action, Key concepts, Knowledge translation , Methods & tools, Public health unit / health authority, Video

Making the Connections: Our city, our society, our health

This four minute video by the Wellesley Institute makes the connections between health, and the broader social factors that have a significant impact on health: income, housing, education, food, neighbourhood, sense of community and access to health care. Through this graphically engaging presentation, Making Connections introduces systems thinking and illustrates how our health is shaped by a complex web of interconnected and dynamic social factors. The video closes with the optimism that the “possibilities are endless;” from small neighbourhood changes to larger government policy, “we can start making the connections to a healthier community, a healthier city, a healthier society, a healthier you.”

The video is part of the Wellesley Institute’s popular education exhibit by the same name that aims to “engage communities across the Greater Toronto Area by identifying what the social determinants of health are, their interconnections, how they impact our health, and what we can do to address them.” The exhibit includes a poster/panel series and the Making Connections video.

Use this resource to

  • initiate community discussion on social determinants of health and thinking about the interconnecting factors that affect health.
  • illustrate the health benefits of improving a diverse range of social factors

Reference

Wellesley Institute. 2012. Making the Connection: Our City, Our Society, Our Health. Retrieved from http://www.wellesleyinstitute.com/topics/healthy-communities/making-the-connections/

Other documents 

Making the Connections Booklet: http://www.wellesleyinstitute.com/wp-content/uploads/2013/09/MakingTheConnections-Booklet-Wellesley.pdf

Tags: Community engagement, Health literacy, Healthy public policy, Income inequality, Intersectoral action, Key concepts, Socioeconomic status , Video

Introduction to upstream

This one minute film was created as an introduction to Upstream, an organization that works to “create a healthy society through evidence-based, people-centred ideas.” The animated video introduces the concept of upstream thinking through the example of saving drowning children in a river. Rather than putting all our effort into pulling children out of the water as they come downstream, we should ask “who keeps chucking these kids in the river?” and head upstream to find out. Introduction to Upstream outlines the various ways we are currently suffering from downstream thinking and offers that thinking upstream can lead to improved health policies and general health. The film asks “what better goal could Canada have than creating the conditions for all people to enjoy true health and experience physical, mental, and social well-being?” This statement proposes that healthy equity is the best way to measure our success and upstream thinking is the best way to achieve that success.

Use this resource to

  • initiate discussion about upstream thinking and how to address the social determinants of health.
  • illustrate how current approaches to health and well-being can be considered reactive rather than proactive or preventative.

Reference

Upstream: Institute for a Healthy Society. (2013). Introduction to Upstream. Retrieved from http://www.thinkupstream.net/about_upstream

Tags: Community engagement, Healthy public policy, Key concepts, Video

Unequal: Social inequalities in health

Unequal: Social Inequalities in Health is a short video illustrating the effects of social inequalities on the life-long health of Montrealers. Using clear graphics, the video depicts evident health disparities between the underprivileged and the affluent.  Each of these two socioeconomic groups comprises approximately 1/5 of Montreal’s population.

Overall, the underprivileged group has higher infant mortality rates, more frequent and longer hospital stays, and contains more single-parent households.  Members of this group are more likely to experience developmental delays in childhood, food insecurity, and have lower self-perceived mental and physical health. The underprivileged group also contains fewer high school graduates and consequently holds slimmer job prospects, lower salaries, and harsher working conditions. The narrator explains “Thus, the socioeconomic status in which Montrealers are born and grow up largely explain why not everyone is equal in sickness and in health.”  The unequal social factors accumulate over time, creating ever-increasing health disparities. Unequal closes by imagining the unmet potential of the underprivileged group brought on by the social inequalities outlined in the video. 

The video is a project of Santé Montréal, part of their Vivre une île en santé campaign. The video’s webpage includes additional findings and actions related to social inequality in Montreal and across Canada.

Use this resource to

  • initiate public discussion on what social inequalities are and how they affect health.
  • illustrate the accumulated effects of health disparities over a lifetime.
  • demonstrate how city-level socioeconomic data can support public health projects?

Reference

Santé Montréal. (2014). Unequal: Social Inequalities in Health. Retrieved from http://www.santemontreal.qc.ca/iss/en/

 

Tags: Income inequality, Key concepts, Methods & tools, Modify & orient, Policy analysis, Public health unit / health authority, Socioeconomic status , Video

Hurdles to health

Hurdles to Health follows the day-to-day life of a woman and her family in Saskatoon. Through Della’s descriptions of her struggles to provide for her family, the film illustrates how poverty affects health and wellbeing. She talks about her concerns around housing, childcare, diabetes, access to nutritious and affordable food and social supports. The film also interviews Saskatoon’s Chief Medical Health Officer, the Tribal Chief of the Saskatoon Tribal Council, and the Executive Director of the Saskatoon Friendship Inn; who each articulate the challenges of people living in poverty and the need to address health through a broader framework. The film ends with a note from Dr. Cory Neudorf, Chief Medical Health Officer, who says, “The biggest thing you could do to improve people’s health is to spend a little less on healthcare and more on education, employment, social services and support.”

Hurdles to Health is part of the partnership Promoting Health Equity Project being led by Saskatoon Regional Health Authority. 

Use this resource to

  • facilitate discussion about how poverty affects health and well-being
  • initiate discussion on the broader ways in which we can work to improve people’s health
  • be introduced to the ongoing challenges of working-poor individuals and families

Reference

Saskatoon Health Region. 2012. Hurdles to Health. Retrieved from: https://www.youtube.com/watch?v=gLKpywfFD4c&feature=kp


Other documents

Saskatoon Poverty Reduction Partnership

Release

http://www.hpclearinghouse.ca/wp-content/uploads/2012/11/DellaHurdlestoHealth.pdf

Tags: Aboriginal health , Access to health services, Food security, Health literacy, Healthy public policy, Income inequality, Knowledge translation , Leadership & capacity building, Public health unit / health authority, Socioeconomic status , Video

Healthy Living: Public policy makes a difference

Healthy Living: Public Policy Makes a Difference is a seven minute film that describes how good public policy can support healthy living and healthy communities. The video features the stories of two women in Vancouver who face challenges that have make it difficult for them and their families to lead healthy lives. They discuss how these challenges permeate their day-to-day lives and how the affects go beyond the inability to make ends meet. Both women share highlights of local public policies that have made a positive difference to their health and well being.

The video makes the case that healthy housing policy, healthy early childhood policy, and building healthy communities are pivotal components for local governments to improve population health. The video is accompanied by a discussion guide

Use this resource to

  • initiate discussion about how public policy effects health
  • raise awareness about how the social determinants of health—housing, early childhood development, and social cohesion—effect health
  • acquaint yourself with the circumstances and real-life consequences of earning a low income

Reference

Vancouver Coastal Health; Lemongrass. 2009. Healthy Living: Public Policy Makes a Difference. Retrieved from https://www.youtube.com/watch?v=nH-iAXEnb5k

Other documents 

Video Discussion Guide
 

Tags: Early childhood development, Environmental health, Food security, Healthy public policy, Income inequality, Policy analysis, Public health unit / health authority, Socioeconomic status , Working conditions, Video

Connie Clement interview: Components of a national health equity agenda

In this video, Connie Clement, Scientific Director of the National Collaborating Centre for Determinants of Health, gives a three minute overview of the fundamental components needed for a Canada-wide, healthy equity agenda.

The video was taped during the 2013 conference Developing a Health Equity Agenda: From a Shared Vision to Policy and Practice Summit, hosted by the NCCDH, the University of Saskatchewan, and the Canadian Council on Social Determinants of Health (CCSDH). The event brought together researchers, public health practitioners, policy makers and sector leaders in an effort to further advance healthy equity in Canada. This is one of eight interviews from the gathering. 

Connie stresses the need for building a health equity agenda that is shaped at different governance levels: national, provincial/territorial, local, and First Nations.  She emphasizes that the agenda needs to address large-scale structural and societal issues (such as income inequality), as well as the daily conditions that lead to health differences; housing, education, employment and social interaction. Thinking about these factors can move the conversation from “an individual framework to a collective or societal way of thinking.”

Use this resource to

  • facilitate conversation about the need for a common agenda for health equity in Canada, and what that agenda might look like
  • learn about potential elements of a common agenda

Reference

Saskatoon Health Region. (2013). Health Equity Summit: Connie Clement. Retrieved from https://www.youtube.com/watch?v=wSmRMZgT6nM&list=PLtpygcPUjlJ4ygPVkCbsoxGSFelEKUNs3&index=3

Other documents 
Saskatoon Health Region has all 8 videos grouped on their Youtube Channel

Tags: Healthy public policy, Leadership & capacity building, Policy analysis, Video

Public Health Speaks: What is social media, and how can it support knowledge exchange on the social determinants of health and health equity?

In July 2014, the NCCDH hosted an online conversation to discuss questions related to the use of social media for knowledge exchange on the social determinants of health and health equity.

Participants in the conversation talked about using social media to:

  • increase the visibility, accessibility, and transparency of SDOH issues and practice
  • share information and links to online resources such as reports and articles
  • expand their reach from their local context to beyond the ‘usual suspects’
  • crowdsource answers to public health questions
  • adopt a user-centred approach to gain input for planning processes, policies, and/or services


Use this resource to: 

  • identify strategies for using social media in public health
  • identify organizational supports for the use of social media
  • discover resources to facilitate the inclusion of social media in public health practice


Reference

National Collaborating Centre for Determinants of Health. (2014). Public Health Speaks: What is social media, and how can it support knowledge exchange on the social determinants of health?  Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

 

Tags: Communicate, Community engagement, Knowledge translation

Review summary: Community engagement to reduce inequalities in health

Broad-scale evidence as to the effectiveness and cost-effectiveness of community engagement is limited. This document summarizes a systematic review by O’Mara-Eves et al (2013) that aimed to: i) identify community engagement approaches that can improve the health of disadvantaged groups and/or reduce health inequalities; ii) describe the populations and contexts in which such approaches are effective; and iii) understand the costs associated with implementing these approaches.

This summary presents key implications for community engagement research and practice that follow from the author’s findings. It emphasizes that future work must prioritize mixed-method evaluations, community-lead and defined engagement activities, and critical analysis as to the multi-level factors shaping engagement and inequalities.

The review used four strategies to do this: a) theoretical synthesis of community engagement models; b) meta-analysis of effectiveness studies; c) thematic synthesis of process evaluations; and d) economic analysis of costs and resources data.

Despite indication of the effectiveness of community engagement on health outcomes, a limited evidence base made it difficult to say whether certain approaches were more effective and/or cost-effective than others. Based on their findings, the authors proposed a conceptual framework for community engagement, highlighting how engagement approaches can vary from theory to practice.

Based on: O’Mara-Eves A, Brunton G, McDaid D, Oliver S, Kavanagh J, Jamal F, et al. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Res 2013; 1(4).

Use this resource to

  • learn about current evidence and evidence gaps in the area of community engagement in public health
  • consider how  your research or practice can contribute to strengthening the evidence base and promote meaningful engagement
  • initiate discussion on the connections between engagement models and frameworks on research and practice

Reference

National Collaborating Centre for Determinants of Health. (2015). Review Summary: Community engagement to reduce inequalities in health. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related Resources:

 

Tags: Community development, Community engagement, Evaluation

The path taken: Developing organizational capacity for improving health equity in four Ontario health units

This case study profiles the experience of integrating a health equity approach in four Ontario public health units: Niagara Region Public Health, Ottawa Public Health, Simcoe Muskoka District Health Unit, and Sudbury and District Health Unit.  Each health unit has taken a different path to developing organizational capacity for improving health equity.

Each health unit is harnessing leadership, taking advantage of supportive organizational structures, using local evidence, training staff, and forging deeper partnerships in the community.  The diversity of paths taken and lessons learned provide tangible examples for other public health organizations working to strengthen their own health equity-focused approach.

The NCCDH used the framework for Organizational Capacity for Public Health Equity Action (OC-PHEA) to organize this case study along with the roles and strategies for public health action to reduce health inequities described by the NCCDH.

Use this resource to:

  • explore the variety of paths that have been taken to build health equity capacity within public health organizations in Ontario
  • enhance your understanding of the OC-PHEA Framework and the public health roles for action on health inequities
  • consider the tensions experienced in doing this work and reflect on ways to build the capacity of your organization to do health equity work

Check out our previous five case studies profiling public health leadership and community action on the social determinants of health. 

Reference:

National Collaborating Centre for Determinants of Health. (2015). The path taken: Developing organizational capacity for improving health equity in four Ontario health units.  Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

 

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

Let’s Talk: Advocacy and health equity

The sixth release in our “Let’s Talk” series highlights the importance of advocacy as a strategy and practice within public health, and describes the different ways advocacy can contribute to addressing the social determinants of health and improving health equity.  It acknowledges the challenge of engaging in advocacy within the Canadian public health context and provides a framework for situating a variety of approaches and resources that could be of help to public health practitioners in their particular context.

Four roles for public health are described, including:

  • Framing the issue
  • Gathering and disseminating data
  • Working in collaboration and developing alliances
  • Using the legal and regulatory system

The case is made for shifting the advocacy focus in public health from individuals and groups to upstream policy and structural changes.
The resource includes discussion questions to help public health staff examine their work and consider whether they have the skills to participate in advocacy, how they can create safe spaces to engage in advocacy, and how to address policy and social change at the structural level.

We’ve selected a number of tools and resources that public health practitioners can use in fulfilling their advocacy roles.  These can be found in the resource library document “Key public health resources for advocacy and health equity: A curated list”

Use this resource to:

  • explore how the type of advocacy action selected is related to the focus and goal
  • reflect on how the concepts of “market justice” and “social justice” provide a tension in public health advocacy
  • learn about the elements related to the four public health roles within an advocacy strategy
  • support a conversation in your organization about how to create a safe space for moving your advocacy actions further upstream toward structural change

Reference:

National Collaborating Centre for Determinants of Health. (2015). Let’s talk…Advocacy for health equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
Other documents in this series:

Let’s Talk: Health equity 
Let’s Talk: Public health roles for improving health equity
Let’s Talk: Universal and targeted approaches to health equity 
Let's Talk: Populations and the power of language 
Let’s Talk: Moving upstream

 

 

Tags: Community engagement, Healthy public policy, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Partner, Policy analysis, National Collaborating Centre for Determinants of Health, Document

Equity-integrated population health status reporting: Action framework

Population health status reporting (PHSR) is a dynamic tool for addressing the social determinants of health and improving health equity. This resource presents an accessible action framework for people who are creating community health status reports, as well as people interested in learning how to use PHSR to drive action on improving health equity. 

Actors at all levels of the health system— including senior leaders, medical health officers, epidemiologists, managers and front-line staff—are well-positioned to use PHSR processes as a call to action for interventions that address the social determinants of health and improve health equity.  

The action framework includes

  • the roles and expected outcomes for public health actors, researchers and community stakeholders
  • how to communicate, collaborate and apply a health equity values lens, including key questions to ask and examples of promising practices
  • seven steps of a population health status reporting process and examples of potential actions/promising practices for each

The document concludes with examples of ways to apply the framework to your own practice and how to use it as a conversation starter.  Readers are encouraged to examine the framework through the lens of their own role in the system and think about what they can do within their circle of influence.

Use this resource to:

  • start a conversation at a regular meeting with your supervisor, team or unit, or at the next strategic planning session
  • invite other teams or units doing PHSR work in your organization to explore whether there are opportunities to apply components of this Action Framework to influence an existing PHSR process
  • explore the opportunity for a new PHSR process if you do not currently have one in your organization or community.

Download the summary document:

Equity-integrated population health status reporting - Action framework: Summary

Reference:

National Collaborating Centres for Public Health (NCCPH) and the National Collaborating Centre for Determinants of Health (NCCDH). (2015).  Equity-Integrated Population Health Status Reporting: Action Framework.  Antigonish, NS:  National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Assess and report, Methods & tools, National Collaborating Centre for Determinants of Health, Document

Equity in environmental health practice: Findings of a pilot study

Public health inspectors (PHIs) are environmental health professionals who carry out inspections, enforce health protection regulations, and provide environmental health education and training. This qualitative study explored the role of environmental public health practitioners in addressing the social determinants of health (SDH) and health equity related issues that may present as barriers to compliance with public health protection regulations. These barriers align with the social determinants of health (SDH).

National Collaborating Centre for Determinants of Health and the National Collaborating Centre for  Environmental Health worked together to conduct focus groups with PHIs in British Columbia and Nova Scotia.  Discussions revealed that business or facility operators experience equity issues that affect their ability to comply with environmental health regulations. These equity-related issues include socioeconomic status, differences in practices or knowledge associated with cultural background, limited English language or literacy skills, psychosocial stressors, and geographic isolation.

Participants discussed organizational factors such as limited time or resources, inflexible policies, insufficient managerial support, and departmental silos as compounding issues to PHIs’ challenges in dealing with clients facing inequity-related challenges. Because of these restraints, PHIs used ad hoc strategies to help clients overcome barriers related to SDH, such as borrowing multi-lingual tools, using co-worker or family as translators, and referring clients to social services or external funding sources when possible. They focused on relationship-building and open communication to work with clients who were facing barriers to compliance with public health protection regulations.

The study concludes that support for PHIs’ ability to address health equity in environmental health practice could include:

  • training on SDH, health equity, and risk assessment/communication for PHIs
  • scaling up ad hoc strategies shown to be effective;
  • improving cross-jurisdictional collaboration
  • clarifying roles and responsibilities could help support PHIs’ ability to address health equity in environmental health practice 

Use this resource to:

  • deepen your understanding of how SDH and health equity related barriers impact environmental health protection
  • consider strategies that environmental health practitioners can use to support clients facing health equity related barriers with respect to compliance with regulations
  • contemplate organizational factors that can help public health inspectors respond to these issues

For more evidence-based resources for public health inspectors and environmental health practitioners, visit National Collaborating Centre for  Environmental Health.

Reference:

Rideout, K. and National Collaborating Centre for Determinants of Health. (2014). Equity in Environmental Health Practice: Findings of a Pilot Study. 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: Environmental health, National Collaborating Centre for Determinants of Health

Public Health Speaks: Public Health Roles for Improving Health Equity

In September 2013, the NCCDH hosted an online conversation to discuss the four-role model for public health action to improve health equity that we described in one of our Let’s Talk series.  Participants in the conversation talked about:

  • which role areas they were working in and what activities they were involved in with that role,
  • which role areas they would like to do more work in, and
  • what was getting in the way of doing more work in a particular role area

Participants identified a number of conditions that support public health staff in their ability to act within the four roles:

  • Assess and report
  • Modify and orient
  • Partner with others
  • Participate in policy development

Use this resource to

  • Discover resources that related to the four-role model
  • Learn how others in the public health community are working in each of the role areas
  • Identify enabling organizational factors that make working in the four role areas possible
  • Discover new programs and initiatives that public health staff are involved in, within the four role areas.

Citation:

Related resources:

Let’s talk … Public health roles for improving health equity

 

Tags: Assess and report, Community engagement, Competencies & organizational standards , Healthy public policy, Intersectoral action, Leadership & capacity building, Modify & orient, Policy analysis, Public health unit / health authority

An environmental scan and assessment of online learning opportunities related to health equity and social determinants of health, for public health practitioners in Canada

The NCCDH commissioned and guided this 2013 scan and assessment of online courses (in French and English) with the intent to increase public health staff awareness and use of effective e-learning opportunities related to health equity.  In addition, we wanted to contribute to a coordinated, high-quality approach to online learning across the National Collaborating Centre program.

Our consultant and writer, Jacques LeCavalier, who has over 25 years of experience in workplace education and e-learning, created the assessment tools, and conducted the scan and initial assessment of the online courses.  Our advisory group of online learning and public health specialists guided us in the scan methodology and course assessments.

This report describes our methodology: the sources we searched, the best practice screen used to determine quality, and how the final assessments were done.  This work identified 38 online courses related to the social determinants and health equity.  The quality assessment resulted in 12 recommended courses.  The report contains summary information on all 38 courses, and detailed assessment information for the 12 recommended courses.

Use this resource to:

  • Select on online course for yourself or your staff
  • Use established criteria to evaluate an online course you think could help build your, or your teams skills and knowledge about health equity
  • Find out what other organizations are doing to build their staff’s knowledge and skill about health equity work

Reference

LeCavalier, J. (2015). An environmental scan and assessment of online learning opportunities related to health equity and social determinants of health, for public health practitioners in Canada. Antigonish, NS: National Collaborating Centre for Determinants of Health

Other Links:

Twelve recommended online courses:

Partly as a result of this research, the NCCDH is currently developing a health equity course for public health practitioners in partnership with Skills Online, a service of the Public Health Agency of Canada.

Tags: Competencies & organizational standards , Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools

Public Health Speaks: Where are the resources to “move upstream” in Public Health work?

In July 2014, the NCCDH hosted an online conversation to discuss questions related to finding the resources to move public health work upstream, work that we described in one of our Let’s Talk Moving upstream publication.  Participants in the conversation talked about

  • how public health could better focus on work that has broad, longer-term impact
  • who public health competes to get resources for upstream work
  • whether public health has to transfer the delivery of some services to other health sectors to make it possible for it to do upstream work, and
  • how to make sure public health is sitting at resource allocation tables

Participants shared their experiences of finding resources to do more upstream work in the areas of

  • reframing and political advocacy
  • collaboration and community engagement
  • reallocation of services and resources

Use this resource to

  • Identify strategies for the public health community to move more upstream in its approach
  • Identify enabling ideological and organizational factors that make finding resources to move upstream possible
  • Discover new programs and initiatives that public health staff and intersectoral partners are involved in that are helping to advance efforts toward a more upstream approach
  • Discover resources related to moving upstream

Citation:
National Collaborating Centre for Determinants of Health. (2015). Public Health Speaks: Where are the resources to “move upstream” in Public Health work? Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

Let’s Talk: Upstream


 

Tags: Assess and report, Community engagement, Competencies & organizational standards , Healthy public policy

Public Health Speaks: Public health leadership for health equity

Leadership is often cited as critical to public health action on the social determinants of health to advance health equity.

The National Collaborating Centre for Determinants of Health hosted an online conversation in the Health Equity Clicks online community to explore questions of leadership and health equity, specifically:

What does effective public health leadership for the social determinants of health and health equity entail and how can it be developed?

The conversation took place in January 2013, and was moderated by Sume Ndumbe-Eyoh, Knowledge Translation Specialist. Guest contributors Monika Dutt, Trevor Hancock, and Jane Underwood kicked-off the conversation, and were soon followed by other members of the Health Equity Clicks community.

This summary includes the conversation highlights, and practice examples and resources shared by participants.

Use this resource to:

  • Identify leadership approaches that support action on health equity
  • Identify actions that demonstrate public health leadership
  • Discover resources related to public health leadership

Reference:

National Collaborating Centre for Determinants of Health. (2015). Public Health Speaks: Public Health Leadership for Health Equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

Public Health Speaks: Leadership for health equity [video]
Leadership for health equity: Working intersectorally and engaging the community in Western Health
Public health leadership development in Canada
What contributes to successful public health leadership for health equity? An appreciative inquiry
Fostering health through healing: engaging the community to create a poverty reduction strategy in Nunavut
Alberta Health Services: Establishing a province-wide social determinants of health and health equity approach

 

Tags: Leadership & capacity building

Public Health Speaks: The Power of People and Systems

In order for public health to help bring greater equity in the distribution of health, staff need to develop a specific set of skills and competencies, and organizational systems need to be put in place to support an equity-oriented culture.

The National Collaborating Centre for Determinants of Health hosted an online conversation to explore the following questions:

  • What are the knowledge, skills and attitudes practitioners need to influence the social determinants of health?
  • How do we develop, implement and sustain an equity-oriented organizational culture in public health?
  • What role does public health leadership play in supporting organizational capacity for equity action?

This summary includes conversation highlights, practice examples and resources shared by participants.

Use this resource to
Consider how to integrate health equity into your organizational culture, processes and priorities

  • Identify practitioner skills and competencies needed to address health equity
  • Learn from examples of how health equity is currently embedded in public health standards and practice
  • Start a discussion on the role of advocacy and the integration of health equity training for public health professionals

Reference
National Collaborating Centre for Determinants of Health (2014).  Public Health Speaks:  The power of people and systems. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related work

Public Health Speaks: Organizational standards as a promising practice for health equity

  • Public Health Speaks:  Leadership
  • Public Health Speaks:  Social Media
  • Public Health Speaks:  Public Health Roles

 

Tags: Competencies & organizational standards , Leadership & capacity building

Communicating the social determinants of health: Income Inequality and Health

It is challenging to communicate effectively about the everyday factors that affect health. This document applies strategic advice from Communicating the social determinants of health common messaging guidelines, published by the Canadian Council on the Social Determinants of Health, to a contemporary communications challenge of great interest and importance. 

The document shows you how to create effective, targeted messages, using the topic example of making the connection between income inequality and health inequality.  The text demonstrates how to take into consideration the worldviews and values of the people you are trying to communicate to.  It includes examples of effective messages for three audiences: health practitioners, private sector leaders and the media. 

Use this resource to:

  • Create effective messages on income inequality and health that resonate with specific audiences
  • Gain insights into the perspectives of your audiences
  • Identify and use worldviews and frames related to the social determinants of health and health equity

Reference:

National Collaborating Centre for Determinants of Health & Canadian Public Health Association. (2014). Communicating the social determinants of health: Income inequality and health. Antigonish, NS & Ottawa, ON: Author

Tags: Assess and report, Communicate, Health literacy, Income inequality, Knowledge translation , Document

Social Media in Public Health

Social Media in Public Health summarizes the findings of a systematic review of research into the potential for using social media to promote and track public health events, and spread public health messages. The “briefing note,” compiled by the National Collaborating Centre for Healthy Public Policy, looks at evidence about the effectiveness of social media in relaying public health messages and changing people’s behaviours, and whether its effectiveness is the same for all population groups. 

It is unclear how the public reacts to social media messages and how or if social media messages affect behaviour.  Even though public health units use social media to share evidence, the public does not yet view social media as a source of reliable health information. The fact that multiple users can contribute to social media sites detracts from the reliability, and therefore the effectiveness, of social media messages.

The literature is mixed as to who uses social media, but it is known that remoteness and low incomes are barriers to use.  Other barriers include geography, knowledge of computing, low education and literacy.

The document contains a list of the most common social media platforms and how each can be used to disseminate public health messages. Best practice guidelines are outlined, including the organizational practices of having “clearly identified objectives, resources, target audiences, and key messages before starting any campaign,” and using social media to complement other dissemination approaches.

Use this resource to

  • Understand the range of ways social media can be used for public health messaging.
  • Facilitate a discussion on how to incorporate social media into your communication strategy.
  • Investigate how to reach different kinds of audiences with a public health message

Reference

Newbold, B. (2015). Social Media in Public Health. National Collaborating Centre for Healthy Public Policy.

Related Resources 

Public Health Speaks: What is social media, and how can it support knowledge exchange on the social 
Communicating the social determinants of health common messaging guidelines

Tags: Communicate, Health literacy, Knowledge translation , Methods & tools

Learning to work differently: implementing Ontario’s Social Determinants of Health Public Health Nurse Initiative

As a part of our Public Health leadership initiative, the NCCDH produces a series of case studies exploring leadership to advance health equity in Canada. These documents are learning tools; they are designed to help public health staff reflect on the role of leadership in advancing health equity, as well as on the strategies and conditions that develop and support leaders at all levels.

In 2012, the Ministry of Health and Long Term Care (Ontario) provided funding for 2 new full-time equivalent positions for all 36 public health units in the province. This case study explores the development and implementation of social determinant of health public health nurse (SDH PHN) positions across local public health agencies. Using case study methodology the authors interviewed 42 participants and reviewed over 200 documents to understand the factors that influenced the implementation of these positions at the local level. The findings indicate that the following themes were important for implementation:

  • Learning to work differently
  • Shifting organizational practice environments
  • Aligning policy expectations with implementation

The case study found that leadership played an important role in the implementation of the SDH PHN positions and in an organization’s health equity work more broadly. It highlights supports and barriers and concludes with recommendations for policy, practice, education and research.

Use this resource to

  • enhance your understanding of the supports and barriers for the implementation of health equity positions in your organization
  • facilitate a discussion about the role of leadership in supporting health equity action
  • learn the importance of systems guidance for local action
  • identify components for building the capacity for public health organizations to act on the social determinants of health and health equity

Download the summary documents

Reference

National Collaborating Centre for Determinants of Health. (2015). Learning to work differently: implementing Ontario’s Social Determinants of Health Public Health Nurse Initiative. Antigonish, NS: National Collaborating Centre for Determinants of Health.

Related resource

 

Tags: Competencies & organizational standards , Intersectoral action, Leadership & capacity building, Modify & orient

The town with no poverty: Using health administration data to revisit outcomes of a Canadian guaranteed annual income field experiment

While income security is a well-known determinant of health, the precise correlations are less documented. This study re-visits the outcomes of a guaranteed annual income (GAI) field experiment (MINCOME) carried out in Dauphin, Manitoba in the mid-1970s. As no final report and little data analysis came out of the federally-sponsored MINCOME experiment, Forget instead analyzed routinely collected health administrative data of both Dauphin residents and a well-matched comparison group to examine the health and social impacts of GAI. MINCOME was unique in having a “saturation site,” meaning every family in Dauphin who met the income guidelines was eligible for a supplement relative to Statistics Canada’s low-income cut-off, a factor which both increased the health and social impacts of the experiment as well as making it easier to retrieve and analyze data. 

Forget found an overall decline in hospitalizations and physician contacts – specifically hospitalizations for accidents, injuries and mental health diagnoses – for participants in the MINCOME experiment, relative to the comparison group. Given that only a third of families qualified for GAI support at any one time during the MINCOME experiment, and many of these supplements were small, the overall community impact was larger than expected. The study attributes this wider impact to a social multiplier effect: because Dauphin was a “saturation site,” recipients would have helped change overall social attitudes and behaviors of individuals and families not receiving a supplement.

Additionally, Forget notes the GAI supplements offered economic stability and predictability for an agriculturally dependent town with high levels of self-employment. This social benefit resulted in a greater proportion of high school students continuing their studies rather than going directly into paid work.

The results of this study indicate the potential for a relatively modest GAI to improve population health, as well as the value of historical health administrative data.

Use this resource to

  • Learn more about an unusual social experiment that set out to track the impacts of stable income within a community on health
  • Facilitate a discussion about the correlation between income security and health
  • Demonstrate the potential for a GAI to improve population health

Reference

Forget, E. (2011). The Town With No Poverty: Using Health Administration Data to Revisit Outcomes of a Canadian Guaranteed Annual Income Field Experiment. University of Manitoba. Retrieved from?

Tags: Critical works in health equity, Income inequality, Intersectoral action, Key concepts, Knowledge translation , Methods & tools, Policy analysis, Public health unit / health authority, Socioeconomic status

Health for All: Building Winnipeg’s Health Equity Action Plan

Health for All is a report created by the Winnipeg Regional Health Authority to build a foundational understanding of existing health gaps in Winnipeg and to facilitate collaborative conversations in creating a health equity action plan.  

The report first envisions what a vibrant, healthy Winnipeg would look like, and emphasizes the value of creating a shared vision to work towards. Using some of the most telling local indicators, the report then outlines the nature and scale of existing health gaps in Winnipeg, making clear the connection between social and economic circumstances and health.

This framework for understanding and addressing health equity is organized into principles, strategies, and areas for action depicted as layers around the desired outcome of “health for all.” The principles represent a basic set of intentions, and the strategies—knowledge, governance, and participation—describe different approaches for sustained action; together, the principles and strategies provide a context for 12 areas of action to improve health equity.

The areas for action described in Health for All are similar to the social determinants of health, yet the frame of reference used in the report is “geared towards motivating enhanced action going forward rather than explaining causation looking backwards” (p.22).

While this foundational report acknowledges the need for a diversity of approaches from many sectors, it concludes by identifying common components of effective action for all equity promotion work: reaching out; dignity, respect and cultural proficiency; integrated services; locally-based services; and equity impact assessment.

Use this resource to

  • Learn about ways to begin the work of developing a health equity action plan within a health unit or authority
  • Review the foundational principles adopted by another health authority for its health equity work
  • Design a statement of purpose for health equity work in your health unit
  • Initiate multi-sector discussions about how to address health gaps.

Reference

Winnipeg Regional Health Authority. 2013. Health for All: Building Winnipeg’s Health Equity Action Plan.

Tags: Assess and report, Community engagement, Healthy public policy, Intersectoral action, Key concepts, Methods & tools, Policy analysis, Public health unit / health authority, Socioeconomic status

Health equity assessment: facilitators and barriers to the application of health equity tools

The authors of this document analysed the application of health equity assessment tools (HEATs) in Australia, New Zealand, United Kingdom and Canada to identify facilitators and barriers to success.  The analysis is intended to help Canadians conduct effective health equity impact assessments and, in particular, using the Health Equity Impact Assessment tool now used in Ontario. HEATs provide systematic steps for health policy makers, program planners, and researchers to assess their initiatives through the lens of health equity.

The findings of these researchers are relevant to the application of other types of health equity tools in other contexts. The report has two parts:

  • Part 1 - Summary of facilitators and barriers that help or hinder the application of HEATs and the uptake of recommendations resulting from the assessments
  • Part 2 - Case studies describing  practices in the application and evaluation of HEATs, from the UK, Canada, Australia and New Zealand

Use this resource to:

  • Identify facilitators and barriers to the of application of HEATs
  • Learn from the experiences of organizations that have conducted HEATs
  • Anticipate issues that may arise when planning to incorporate HEATs into practice

Citation:

Tyler, I., Amare, H., Hyndman B., Manson, H. & Public Health Ontario. (2014) Health equity assessment: facilitators and barriers to the application of health equity tools. Toronto, ON: Queen’s Printer of Ontario.

Tags: Competencies & organizational standards , Evaluation, Healthy public policy, Leadership & capacity building, Methods & tools, Modify & orient, Policy analysis

Learning from practice:  Equity in influenza Prevention in Saskatoon

This is the story of Saskatoon Health Region’s (SHR) work to improve immunization rates and reduce the spread of influenza in the city’s six core neighbourhoods.  It is a continuation of our 2012 case study  about Saskatoon’s broad health equity work.  This story focuses on the region’s equity work related to influenza prevention through to 2014.

The story is framed using the four roles framework for action to reduce health inequities.

Role #1  Assess and report on health inequities and effective strategies.  As a result of their thorough prior research and “on-the-ground” experience, SHR set the goal of raising influenza vaccination rates in the six core neighbourhoods to a level comparable to other areas of the city.

Role #2   Modify and orient interventions.  In order to remove barriers and make services more accessible, immunization clinics were held in elementary schools, social housing, the food bank and the Sexual Health Clinic. Vaccination clinic times were set to accommodate clients’ work shifts and childcare responsibilities.

Role #3  Partner with other sectors.  Each member of the Building Health Equity (BHE) team was assigned to a school in order to form direct relationships with staff, students and parents. Partnerships were formed with the Saskatoon Tribal Council and the Central Urban Métis Federation.

Role #4    Participate in policy development.  The BHE team has achieved policy changes such as 2)  bus tickets for clients to get to public health programs and services; 2) immunization for newcomers who are awaiting a provincial health card; and 3) integrated influenza immunization and childhood vaccination clinics.

Use this resource to

  • Develop an equity-focused influenza prevention strategy
  • Use data to argue for an equity-focused influenza prevention strategy
  • Blend equity considerations into all immunization programs.

Reference
National Collaborating Centre for Determinants of Health. (2015). Learning from Practice: Using data and building relationships in the Saskatoon Health Region. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

 

Tags: Aboriginal health , Access to health services, Assess and report, Community engagement, Competencies & organizational standards , Infectious disease, Intersectoral action, Leadership & capacity building, Methods & tools, Modify & orient, Policy analysis, Public health unit / health authority, Racism/racialization

Learning from practice:  Equity in influenza prevention in Manitoba

During the 2009 H1N1 influenza pandemic, the need for an equity approach came sharply into focus for Manitoba Health, Healthy Living and Seniors (MHHLS).  With the support of its Health Equity Unit, Manitoba’s response was unique among Canadian provinces in identifying Aboriginal peoples as a distinct equity group related to H1N1 exposure.

This story is framed using the four roles framework for action to reduce health inequities.

Role #1  Assess and report on health inequities and effective strategies .  Due to the ready availability of epidemiological data, described in this section, MHHLS was able to quicly implement measures to address inequities.

Role #2   Modify and orient interventions .  Manitoba used epidemiological evidence to prioritize First Nations, Northern and isolated communities for early distribution of the H1N1 vaccine, post-exposure anti-viral medication and infection prevention and control supplies.  The province also adapted and used a Health Equity Assessment Tool to review influenza response planning throughout the province.

Role #3  Partner with other sectors .  Partners were engaged at governance, policy and technical levels.  Partnership forums included a Tri-Partite Table with members from federal and provincial government departments, the Assembly of Manitoba Chiefs, the Manitoba Métis Federation, and representatives of regional health authorities; a policy-level Equity and Ethics Table, and appointment of a Aboriginal Health Advisor.

Role #4    Participate in policy development .  A number of significant policy changes grew out of Manitoba’s influenza experience, including the Health Equity Action Tool that is now used in the design of all new MHHLS initiatives.

Use this resource to

  • Develop an equity-focused influenza prevention strategy
  • Put in place conditions that enhance the likelihood of success for such a strategy
  • Find epidemiological data systems and a health equity tool that can assist in the selling and implementation of such a strategy.

Reference
National Collaborating Centre for Determinants of Health. (2015). Learning from Practice: Prioritizing populations for influenza prevention at Manitoba Health, Healthy Living and Seniors
Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

 

Tags: Aboriginal health , Access to health services, Assess and report, Community engagement, Competencies & organizational standards , Infectious disease, Intersectoral action, Leadership & capacity building, Methods & tools, Modify & orient, Policy analysis, Public health unit / health authority, Racism/racialization

The equity action spectrum: Taking a comprehensive approach. Guidance for addressing inequities in health.

This document is proposed as guidance for European nations in moving towards meeting the goals of Health 2020, which is the European policy framework for health and well-being endorsed by the World Health Organization (WHO) European region in 2012.  Identifying health as a human right, Health 2020 calls for joint action across multiple sectors including government, health, and non-health partners. The equity action spectrum consists of four key stages essential to building a comprehensive approach and action plan at a national, regional, or local level: 

  1. securing political commitment and multi-sectoral action;
  2. assessing the problem and possible intervention points;
  3. deciding on optimum organizational and accountability arrangements; and
  4. drawing up a strategy and action plan. 

Recognizing the need for a combination of universal and targeted approaches to reduce inequities in health, the report stresses that inequities affect every segment of the population and therefore require a universal approach. The case is made that reducing the health equity gap is achieved by improving the health of those who are worse off faster than those who already have better health, meaning that additional effort over and above the population health approach is needed to improve the health of disadvantaged groups. 

This policy brief also offers an overview of eight system components outlined by the WHO, including a list of tools, resources and examples that support action on the framework components discussed in the document.  As well, 10 specific examples from countries across Europe are offered as demonstrations of how the principles described in the report have been applied successfully to address inequities in health.

Use this resource to

  • consider how the framework applies to a local or Canadian context
  • review steps that can be taken to address the social determinants of health in public health policy-making
  • explore policy intervention options to address health inequities

Reference

Whitehead, M., Povall S., Loring, B. The equity action spectrum:  taking a comprehensive approach.  Guidance for addressing inequities in health [Internet]. Geneva: World Health Organization: 2014. [cited 2014 Nov 04] 40 p. Available from: http://www.euro.who.int/__data/assets/pdf_file/0005/247631/equity-action-090514.pdf

A summary of this document has been prepared by NCCDH as a tool to highlight the four stages of the framework and various projects in Canada that can be considered examples of the framework stages in action.

Tags: Access to health services, Evaluation, Healthy public policy, Intersectoral action, Leadership & capacity building, Modify & orient, Policy analysis

English glossary of essential health equity terms

This glossary contains 21 core terms used internationally by public health staff in their health equity work.  Each term is accompanied by a sentence, illustrating how it could be used in day-to-day practice with colleagues and partners.

The NCCDH team developed the glossary in response to requests from our public health audience:  we were asked to help practitioners develop a clearer and more consistent understanding of health equity terms.  The glossary project began with a literature search, included focus groups with practitioners and NCCDH staff, and ended with an external review. 

The glossary is available as a pdf document, and as an interactive page on our website.  It is currently available in English and French.  The definitions are intended to both support and create dialogue among our colleagues and associates.  To this end, our website includes a comment box at the bottom of each definition and example sentence.  Visitors can leave comments for us; with your input, the glossary will develop and change over time.

Use this resource to

• Promote a clear and effective use of language among members of your team

• Explore ways of talking about core health equity concepts to clarify and enrich discussions with your partners and audiences

• Challenge yourself to integrate health equity terms into your core communication tools and strategies

Reference

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.


Link where glossary webpage is located (English)
   

Link where glossary webpage is located (French)

 

Related Work 

1. Vancouver Coastal Health Population Health: Advocacy guideline and resources
2. Communicating the social determinants of health common messaging guidelines
3. Let’s talk … populations and the power of language
4. Let’s talk … health equity
5. What are the social determinants of health?  
6. An inter-sectoral approach for improving health literacy for Canadians: a discussion paper
7. A new way to talk about the social determinants of health

 

Tags: Communicate, Health literacy, Key concepts, Knowledge translation , Document

Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity

A core concept of community based participatory research (CBPR) is that traditional research trials need to be adapted to local settings and ever-changing systems in order to address health equity and social determinants of health in a meaningful way.  CBPR can build a bridge between science and community-based practice, as well as balance the power relationship between academic and community research partners.   This includes, but is not restricted to, the difference between quantitative vs. qualitative research methods.

In addition to working with a dynamic and complex local setting, the challenges of CBPR include how it applies to other settings, defining what is “evidence”, choosing a mutually understood language and discourse, moving academics out of “business as usual”, the ability to sustain change, and lack of trust between researchers and under-represented communities.  The authors make the case that CBPR builds community capacity, develops trust and long-term relationships, emphasizes accountability, and supports adapting interventions to suit the local context (e.g., cultural relevance and project language).

The authors use the term “knowledge hybridity” to describe the integration of knowledge from different sources into a community partnership.   They also describe a model of community-based participatory research (from one of their previous publications) that illustrates the multiple dimensions of CBPR.

Use this resource to

  • understand how CBPR applies to program design for public health practice
  • deepen your understanding of the challenges of applying traditional research in a dynamic local context
  • challenge your assumptions about what forms of research are useful to public health practitioners, and how various forms of research can complement each other

 

Reference

Wallerstein, N. & Duran, B.  (2010). Community-based participatory research contributions to intervention research:  The intersection of science and practice to improve health equity.  American Journal of Public Health 100(1):S40-S46.

 

Available at:  http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.184036  

Tags: Community engagement, Critical works in health equity, Evaluation, Healthy public policy, Knowledge translation , Leadership & capacity building

Thirteen public interventions in Canada that have contributed to a reduction in health inequalities

This report from the National Collaborating Centre for Healthy Public Policy examines 13 programs or policies that have had some success in reducing health inequalities in Canada. The report is a summary of a longer document prepared by the Centre de recherche Léa-Roback sur les inégalités de santé de Montréal.

All of the selected governmental interventions had an explicit goal to act on the social determinants of health to address health inequities, and they had been evaluated using current medical evidence-based standards. “The 13 programs … demonstrate that efforts made to reduce health inequalities are not simply expenses, but indeed represent investments from which the whole of society benefits. The evaluated programs presented here convincingly show that social determinants, ill health, and health inequalities are linked in inextricable and complex ways.” (p. 2)

The 13 cases are summarized under two broad categories: 1) revenue support programs and 2) reducing exposure to health damaging conditions and behaviours. The programs and policies were implemented at the local, provincial/territorial and national level.

Examples of interventions include

  • An income supplement program in British Columbia and New Brunswick
  • Recreational and skill-development for children living in social housing in Ottawa
  • Recreational, skill development and social supports for single mothers on social assistance in Ontario

The report notes that very few policy/program initiatives have been systematically studied, particularly over a long period of time. This is not surprising given that the evaluations must take place in dynamic social contexts, where it is challenging to isolate variables that can be measured over time.

Use this resource to

  • Identify Canadian policies and programs that have been shown to reduce health inequities
  • Review research designs that include high caliber evaluations
  • Find evidence for the cost effectiveness of policy/program interventions designed to improve the health of people living in difficult socio-economic conditions

 

Citation

National Collaborating Centre for Healthy Public Policy. (2010). Thirteen public interventions in Canada that have contributed to a reduction in health inequalities. Montreal, QC: National Collaborating Centre for Healthy Public Policy.

 Link: http://www.ncchpp.ca/141/publications.ccnpps?id_article=314

 Available in French: http://www.ccnpps.ca/102/publications.ccnpps?id_article=399

 

Tags: Access to health services, Assess and report, Early childhood development, Evaluation, Healthy public policy, Methods & tools, Modify & orient

Public Health Speaks: Advancing health equity through targeted universality [video]

In this video, Dr. Pat Martens and Dr. Sande Harlos describe the theory and practice of targeted universalism as an approach to reducing health inequities across the entire population. Targeted universalism focuses on improving the health of everyone in the population, with additional attention placed on specific populations that are socially or economically disadvantaged. Public health organizations deliberately design targeted universalism interventions to reduce health inequities.

This video was filmed at the Researcher-practitioner workshop on health equity: Bridging the Gap  held in February 2012.

Speakers include

  • Dr. Sande Harlos, Medical Officer of Health, Winnipeg Regional Health Authority
  • Dr. Pat Martens, Professor, Department of Community Health Sciences, University of Manitoba

Use this resource to

  • Increase your understanding of targeted universalism as an approach to reducing health inequities while improving the health of everyone
  • Consider how the design of public health interventions can reduce inequalities in health

National Collaborating Centre for Determinants of Health. (2013). Public health speaks: Advancing health equity through targeted universality [video]. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources

Tags: Key concepts, Leadership & capacity building, Modify & orient, National Collaborating Centre for Determinants of Health, Video

Public Health Speaks: Social determinants of health [video]

“Language is a powerful tool… it is very important to describe what we do in everyday language.” Connie Clement

“… historical factors have created some of the power dynamics, class and racial issues that [communities] continue to experience.” Nancy Edwards

This video features reflections from public health decision-makers and researchers in Canada on what health equity and the social determinants of health mean to them, and how they talk about these concepts with others. Health equity is often described in terms of fairness, “allowing to live,” and creating the social and economic conditions that support health. Some key points in unpacking health equity include getting to the root causes of inequities, asking why differences in health outcomes exist, being attentive to the deep historical roots of contemporary inequities, and talking about the societal benefits of a more equal society.

This video was filmed at the Researcher-practitioner workshop on health equity: Bridging the Gap  held in February 2012.

Speakers include

  • Connie Clement,  Scientific Director, National Collaborating Centre for Determinants of Health
  • Gail Turner, Director of Health Services, Health and Social Services, Nunatsiavut
  • Dr. Gaynor Watson-Creed, Medical Officer of Health, Capital Health, Halifax
  • Nancy Edwards, Scientific Director, Canadian Institutes for Health Research, Institute for Population and Public Health
  • Dr. Colleen Dell, Associate Professor, University of Saskatchewan
  • Dr. Jocelyne Sauvé, Medical Officer of Health, Montérégie Regional Health Authority, Québec

Use this resource to

  • Learn how terms like health inequalities, health inequities and social determinants of health are used in public health practice
  • Explore the underlying premises of health equity
  • with your colleagues

National Collaborating Centre for Determinants of Health (2013). Public Health Speaks: Social determinants of health [video]. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

Tags: Healthy public policy, Key concepts, National Collaborating Centre for Determinants of Health, Video

Public Health Speaks: Purposeful reporting for health equity [video]

“What we don’t monitor, what we don’t study, we can’t improve. Things never just spontaneously improve…” Dr. Marie-France Raynault

Purposeful reporting involves deliberately asking questions about health inequities and the social determinants of health in the way that health and sociodemographic data is collected, analyzed, interpreted and shared. Purposeful reporting is often the first stage of action, and it also provides an opportunity to take stock of progress towards greater health equity and.  Working with other sectors to collect data pulls in information that public health may not have available. Organizations need people with skills to understand the data, and share it effectively (i.e., in a way that leads to action). In addition to trigger action, population health status reports provide recommendations for modifying or initiating programs and policies.

This video was filmed at the Researcher-practitioner workshop on health equity: Bridging the Gap  held in February 2012.

Speakers include

  • Jean Harvey, Director, Canadian Population Health Initiative, Canadian Institute of Health Information
  • Dr. Marie-France Raynault , Professor, Department of Social and Preventive Medicine, Université de Montréal; Director, Léa-Roback Research Centre
  • Dr. Gaynor Watson-Creed, Medical Officer of Health, Capital Health, Halifax
  • Connie Clement,  Scientific Director, National Collaborating Centre for Determinants of Health

Use this resource to

  • Consider how data can be used to support action on health equity
  • Identify potential data partners for public health
  • Learn about the components of purposeful reporting

National Collaborating Centre for Determinants of Health. (2013). Public Health Speaks: Purposeful reporting for health equity [video]. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Related resources:

Tags: Assess and report, Community engagement, Evaluation, Key concepts, Methods & tools, Modify & orient, National Collaborating Centre for Determinants of Health, Video

Public Health Speaks: Leadership for health equity [video]

“Leadership is not a function of organizational position.” Dr. Jeff Masuda, University of Manitoba

“Leadership is really throughout systems—health systems and other systems—so really almost everybody brings some element of leadership to their role in participating in health equity.” Dr. Sande Harlos, Winnipeg Regional Health Authority

This video features reflections from Canadian public health leaders on the characteristics underlying effective leadership for health equity. The speakers share their understanding of leadership, its importance to advancing health equity, and what it looks like in practice.

Some key skills for leaders include strategic analysis, advocacy, a socio-ecological analysis of health and society, and relationship-building with internal and external stakeholders. Effective public health leaders also set priorities, making hard choices about what to give up in order to create space and time for health equity priorities.

While leadership at the top of an organization is needed to support health equity action, champions in other parts of the organization need to be supported when they assume leadership in their management of health equity projects and programs.  

This video was filmed at the Researcher-practitioner health equity workship: Bridging the Gap held in February 2012.

Speakers include

  • Gail Turner, Director of Health Services, Health and Social Services, Nunatsiavut, (retired)
  • Connie Clement,  Scientific Director, National Collaborating Centre for Determinants of Health
  • Dr. Nancy Edwards, Scientific Director, Canadian Institutes for Health Research, Institute for Population and Public Health
  • Dr. Jocelyne Sauvé , Medical Officer of Health, Montérégie Regional Health Authority
  • Dr. Sande Harlos, Medical Officer of Health, Winnipeg Regional Health Authority
  • Dr. Jeff Masuda, Assistant Professor, Department of Environment and Geography, University of Manitoba
  • Dr. David Mowat, Medical Officer of Health, Peel Region
  • Dr. Patricia Martens , Professor, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba
  • Dr. Cory Neudorf, Medical Officer of Health, Saskatoon Regional Health Authority
  • Dr. Marie- France Raynault , Professor, Department of Social and Preventive Medicine, Université de Montréal; Director, Lea-Roback Research Centre

Servez-vous de cet outil pour:

  • identify characteristics of public health leadership for health equity
  • explore how to develop the skills required for effective leadership of health equity initiatives

Centre de collaboration nationale des déterminants de la santé. (2013). La santé publique a la parole : leadership pour l’équité en santé [vidéo]. Antigonish (N.-É.), Centre de collaboration nationale des déterminants de la santé, Université St. Francis Xavier.

Related resources:
What contributes to successful public health leadership for health equity? An appreciative inquiry http://nccdh.ca/resources/entry/leadership-app-inquiry

Tags: Key concepts, National Collaborating Centre for Determinants of Health, Video

Leadership for health equity: Working intersectorally and engaging the community in Western Health

As a part of our Public Health leadership initiative, the NCCDH produced a series of case studies profiling instances of leadership to advance health equity in Canada. These documents are learning tools; they are designed to help Public Health staff reflect on the qualities of effective leadership in advancing health equity, as well as on the strategies and conditions that develop and support these qualities in Public Health leaders at all levels. 

This case study profiles the work of Western Health, which provides health services to 78,000 residents of Western Newfoundland.

Western Health’s work to address health inequities builds on a long history of intersectoral collaboration and community engagement. Senior representatives from education, child, youth and family services, and advanced education and skills meet quarterly, on the Linkages Committee, to share ideas and solve problems. The committee’s efforts are “at the core…. about maintaining relationships,” according to a senior manager.

Western Health engages directly with communities through Local Community Advisory Committees that make decisions based on data from a tri-annual community needs assessment.

Interviewees said their success results from supportive leadership, positions dedicated to community engagement, and a history and culture of collaboration. Their challenges relate to protecting the time needed to collaborate effectively, finding common language to describe inequities and the responses needed, evaluating program impacts, and build organizational capacity. 

Use this resource to

  • enhance your understanding of the conditions and systems that nurture intersectoral action and community engagement
  • facilitate a discussion about the factors that create strong organizational support for leadership and health equity work
  • learn how evidence can be used to favour a health equity approach to health priorities
  • support the work of community partners doing social determinants work

National Collaborating Centre for Determinants of Health. (2014). Working intersectorally and engaging the community in Western Health. Antigonish, NS: National Collaborating Centre for Determinants of Health.

Tags: National Collaborating Centre for Determinants of Health, Document

Public Health Speaks: Advancing health equity through public health competencies

“If you are serious about practicing modern public health as indicated by the core competencies, you have to make the investment.” Dr. David Mowat

“My hope with organizations looking at core competencies is that they continue to be forward thinking in that approach.” Dr. Nancy Edwards

To make a significant contribution to improving health equity, public health practitioners require competencies—knowledge, skills and attitudes—to address the social determinants of health. In this video, Canadian public health practitioners and researchers reflect on what competencies public health staff need so that they can work effectively on creating a more equal society, and on how public health organizations can support the use of competencies.

Competencies help clarify the practice of public health by identifying a set of basic requirements. These competencies include leadership, communication, advocacy, collaboration and negotiation skills, as well as evidence-informed decision-making.

Organizations that are committed to building staff competencies dedicate resources to adequately support staff development. They remain forward-thinking and focused on the end result of improving health equity.

This video was filmed at the Researcher-practitioner workshop on health equity: Bridging the Gap held in February 2012.

Speakers include

  • Dr. Sande Harlos, Medical Officer of Health, Winnipeg Regional Health Authority
  • Dr. Nancy Edwards, Scientific Director, Canadian Institutes for Health Research, Institute for Population and Public Health
  • Dr. David Mowat, Medical Officer of Health, Peel Region
  • Dr. Patricia Martens, Professor, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba

Use this resource to

  • identify skills required by public health practitioners to move their communities, regions and provinces towards greater fairness and equity
  • learn how competencies can guide staff knowledge and skill development to address health equity
  • improve your work effectiveness and the effectiveness of your staff and colleagues


National Collaborating Centre for Determinants of Health. (2013). Advancing health equity through public health competencies [video]. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Competencies & organizational standards , National Collaborating Centre for Determinants of Health, Video

Public health speaks: Intersectoral action for health equity

“People need to believe that you have their interest at heart as much as your own. A big piece has been us being willing not just to take but also to give.” Dr Gaynor Watson-Creed


To effectively take action to improve access to the social determinants of health, public health is called to work with other sectors. In this video, public health decision-makers and researchers reflect on the necessity for intersectoral action, and share tips for successfully working with others. They discuss 1) examples of intersectoral action, 2) structures that support intersectoral action and 3) the importance of staying open to different perspectives and recognizing mutual priorities.

This video was filmed at the Researcher-practitioner workshop on health equity: Bridging the Gap held in February 2012.

Speakers include

  • Dr. Gaynor Watson-Creed, Medical Officer of Health, Capital Health, Halifax
  • Dr. Marjorie MacDonald, Professor, Faculty of Nursing, University of Victoria
  • Dr. Cory Neudorf, Medical Officer of Health, Saskatoon Regional Health Authority
  • Althea Arsenault, Manager of Resource Development, New Brunswick Social and Economic Inclusion Corporation
  • Stéphane Leclair, Executive Director, New Brunswick Social and Economic Inclusion Corporation
  • Dr. Sande Harlos, Medical Officer of Health, Winnipeg Regional Health Authority
  • Gail Turner, Director of Health Services, Health and Social Services, Nunatsiavut (retired)

Use this resource to

  • refine your rationale for putting resources into intersectoral collaborations
  • learn from the experiences of other public health actors about how to work effectively with non-health partners

National Collaborating Centre for Determinants of Health. (2013). Public Health Speaks: Intersectoral action for health equity [video]. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

 

Tags: Community engagement, Intersectoral action, Leadership & capacity building, National Collaborating Centre for Determinants of Health, Video

Public health speaks: Community engagement for health equity

“It’s a long process and it’s about developing trust.” Dr. Colleen Dell

Community engagement is an essential part of public health practice. In this video, public health decision-makers and researchers reflect on the importance of involving communities in research and practice. They share examples of community engagement initiatives, and identify tensions that can be addressed through genuine engagement. Authentically involving communities requires placing community voices and perspectives at the centre of the process.

This video was filmed at the Researcher-practitioner workshop on health equity: Bridging the Gap held in February 2012.

Speakers include

  • Dr. Colleen Dell, Associate Professor, University of Saskatchewan
  • Connie Clement,  Scientific Director , National Collaborating Centre for Determinants of Health
  • Alicia Fridkyn, PhD Candidate, University of British Columbia
  • Althea Arsenault, Manager of Resource Development, New Brunswick Social and Economic Inclusion Corporation
  • Gail Turner, Director of Health Services, Health and Social Development, Nunatsiavut

Use this resource to

  • learn about the importance of relationship building in community engagement from researchers and public health managers
  • identify examples of effective community engagement initiatives involving public health

National Collaborating Centre for Determinants of Health. (2013). Public Health Speaks: Community engagement for health equity [video]. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Community engagement, Video

Public health leadership development in Canada

This report investigates leadership development issues and opportunities for PH nurses wanting to work for greater health equity through the social determinants of health. It is based on a literature scan, a survey of community health nurses in leadership positions, and Community Health Nurses of Canada  (CHNC) workshop participation. The report is a joint project of the National Collaborating Centre for Determinants of Health and the CHNC, and the research was supported by Dr. Ardene Robinson Vollman.

The report offers innovative examples of leadership development, with references. It states that roles and scope of practice must be clarified as a starting point for developing the leadership potential of PH nurses at the front line. The literature identifies political and social politicization (understanding of big P and little p politics), and a valuing of knowledge gained through practice, as a key elements of leadership training for health equity work.  

Factors that impact effective public health nursing leadership include

  • Front line management support
  • An organizational culture that values health equity and social justice, and frontline experience
  • Intersectoral/interprofessional relationships (vertical networks)
  • Access to data
  • Support for innovation and creativity

The research included a print survey of 46 nurses on the CHNC Board and standing committees, and a summary of contribution to a 2013 CHNC workshop, both of which identified leadership characteristics/qualities, actions, and skills.

The report calls for PH leadership frameworks that imbed transformational, political, trans-organizational and team-building competencies. Other recommendations call for the establishment of a Centre of Excellence for PH nursing leadership.

The report contains a summary of all the literature reviewed.

Use this resource to

  • Investigate research focused on PH nursing leadership for health equity
  • Identify leadership competencies for health equity
  • Investigate mechanisms and curriculums developed to build leadership skills and attitudes among PH nurses

Community Health Nurses of Canada & National Collaborating Centre for Determinants of Health (2013). Public health leadership development in Canada.

Related resources

National Collaborating Centre for Determinants of Health (2013) What contributes to successful public health leadership for health equity? An appreciative inquiry
National Collaborating Centre for Determinants of Health (2012) Capitalizing on change: Building leadership competency in public health in Quebec
National Collaborating Centre for Determinants of Health (2014) Boosting momentum: applying knowledge to advance health equity - 2014 Environmental scan
 

 

Tags: Competencies & organizational standards , Intersectoral action, Document

Tackling the wider determinants of health and health inequalities: evidence from systematic reviews

The authors conducted a review of systematic reviews, or “umbrella review,” to identify and synthesize evidence about the impact of non-healthcare interventions on health outcomes and health “inequalities.” The review, which was commissioned by England’s Department of Health, identified 30 systematic reviews of interventions involving the social determinants of health in North America, Europe, Australasia, and Japan. All of the included reviews investigated links between health outcomes and 1) housing and living environment, 2) work environment, 3) transport, 4) health and social care services, 5) unemployment and welfare, 6) agriculture and food, and 7) water and sanitation.

Only three of the 30 reviews included data about the health impacts on different social groups. No reviews were identified that focused on interventions relating to macroeconomic, cultural and environmental conditions.  The researchers found some evidence that housing and work environment interventions have the potential to tackle health inequalities.  The authors conclude that evidence supporting social determinants interventions is weak, despite the presence of sector-wide policies aimed at improving health through social interventions.

Health Evidence rated the quality of this research

Use this resource to

  • facilitate discussion about which determinants have been shown, through research, to improve health.
  • become familiar with the current state of research evidence on social interventions, health and health equity
  • identify research gaps and opportunities to strengthen the evidence base on the health equity impact of social determinants of health interventions

Bambra, C., Gibson, M., Sowdon, A., Wright, K., Whitehead, M., & Petticrew, M. (2010). Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews. Journal of Epidemiology and Community Health, 64, 284-291

Tags: Evaluation, Healthy public policy, Income inequality, Intersectoral action, Knowledge translation , Working conditions, Document

A conceptual framework of organizational capacity for public health equity action (OC-PHEA)

The conceptual framework for organizational capacity that this article presents is grounded in the experiences of Canadian public health equity champions. The authors conducted interviews with key informants and a review of the literature to identify the core elements of the framework and the factors that enable or constrain health equity action.

The framework has two key domains: 1) the internal context, referring to dimensions within an organization that influence its capability to act, and 2) enabling external environment, representing dimensions of the local community and broader systems that influence the public health organization’s capability to act. Both internal and external domains are characterized by similar dimensions: shared values, demonstrated commitment and will, and a supportive infrastructure.

The authors argue that the framework identifies characteristics that together are necessary for public health to be fully functional as a societal driver toward the elimination of health inequities. 

Use this resource to

  • investigate what organizational characteristics underpin successful health equity initiatives
  • identify indicators of capacity within your organization
  • identify and address areas of weakness and barriers to implementing a health equity approach in your organization
  • reflect on how to monitor changes in organizational capacity over time

Cohen, B.E., Schultz, A., McGibbon, E., VanderPlaat, M., Bassett, R., GermAnn, K., Beanlands, H. and Fuga, L.A. (2013). Commentary: A conceptual framework of organizational capacity for public health equity action (OC-PHEA). Canadian Journal of Public Health, 104(3):262-266.

Tags: Document

Vancouver Coastal Health Population Health: Advocacy guideline and resources

The original purpose of this resource was to provide Vancouver Coastal Health (VCH) staff with guidelines, parameters and resources for undertaking population health advocacy. VCH has made it available on its website to support the advocacy work of public health practitioners in other jurisdictions. 

The guidelines present the principles of advocacy within VCH’s organizational and administrative policies. They propose that advocacy topics and activities should

  • provide a non-partisan viewpoint
  • adhere to the professional standards of your occupation
  • focus on the health impacts of an issue

The resources include an “advocacy in action” framework with a worksheet for starting your advocacy plan. The document has links to tools and materials from other organizations. 

The VCH population health webpage  offers a rich array of videos, strategic planning documents and key resources related to the work of improving population health.

Use this resource to

  • learn more about the concept and role of advocacy in creating positive change for people and their environments
  • plan and implement an advocacy initiative from within a health service organization
  • identify organizations that do advocacy work, and tools that can help you plan an advocacy campaign


Vancouver Coastal Health (n/d).  Advocacy guideline and resources.  Vancouver Coastal Health, Population Health.

Tags: Communicate, Competencies & organizational standards , Healthy public policy, Key concepts, Methods & tools, Document

Rising to the Challenge: Sex- and gender-based analysis for health planning, policy and research in Canada

This Canadian guide  is the result of more than a decade of work by the now defunct Atlantic Centre of Excellence for Women’s Health.  It demonstrates that sex- and gender-based analysis (SGBA) is an essential, “necessary and possible” (p. 2) process for addressing the social determinants of health and improving health equity in Canada.  It makes the point that equity is the ultimate driver for sex- and gender-based analysis.

The resource is divided into two sections. The first presents the origins of SGBA, and how its key concepts relate to health. It includes guidance on how to conduct a SGB analysis; essentially the process involves asking new questions about existing evidence and identifying gaps in evidence. The second section presents over one dozen case studies that illustrate the power of SGBA to help planners and others understand different types of health research, health care and health policy issues. The authors make the point that SGBA can and should be applied to better understand men’s and boys’ health as well as women’s health.

The guide is supported by three sets of online, free tutorials —co-developed by the former network of Centres of Excellence for Women’s Health—to guide your learning.  The first set of modules provides an opportunity to explore core concepts, while the second set supports the process of doing SGBA.  The final set provides an opportunity to apply SGBA to your own work.

Use this resource to

  • better understand the inequities that result from sex and gender-based relations and interactions with other social factors
  • review tested methods for doing sex- and gender-based analysis (SGBA)
  • engage in a deeper discussion, beyond checklists, of the changing meaning of sex and gender in the context of your work
  • use SGBA as a practical and effective process to engage across sectors

Clow, B., Pederson, A., Haworth-Brockman, M. & Bernier, J. (2009). Rising to the Challenge: Sex- and gender-based analysis for health planning, policy and research in Canada. Atlantic Centre of Excellence for Women’s Health, Halifax, NS.

Tags: Assess and report, Evaluation, Healthy public policy, Key concepts, Methods & tools, Modify & orient, Policy analysis, Sex & gender, Document

Communicating the social determinants of health common messaging guidelines

Communicating about the everyday factors that affect health, especially those outside the health care system, can be challenging. This document provides information about how to create effective, targeted messages about the impact of factors like income and education on health. It explores common worldviews and metaphors that people hold and through which they filter and understand messages about health.

The document offers strategic advice for expressing concepts, and for using facts, stories and images.  It includes examples of effective messages for key audiences such as youth, parents, educators, health practitioners, private and public sector leaders and the media.  A practical list of “dos and don’ts” is also included.

“The Canadian Council on the Social Determinants of Health is a collaborative, multi-sectoral stakeholder group in Canada that aims to address the factors that shape health and wellbeing.” - CCSDH website

Use this resource to:

  • Create effective, targeted messages that resonate with different audiences
  • Gain insights into the needs of priority audiences
  • Identify and use worldviews and frames related to the social determinants of health and health equity


Canadian Council on the Social Determinants of Health. (2013). Communicating the social determinants of health guidelines for common messaging. Ottawa, ON: Canadian Council on the Social Determinants of Health

Tags: Communicate, Document

Fostering health through healing: engaging the community to create a poverty reduction strategy in Nunavut

As a part of our Public Health leadership initiative, the NCCDH produced a series of case studies profiling instances of leadership to advance health equity in Canada. These documents are learning tools; they are designed to help Public Health staff reflect on the qualities of effective leadership in advancing health equity, as well as on the strategies and conditions that develop and support these qualities in Public Health leaders at all levels.

Income is a widely recognized social determinant of health. To the Inuit of Nunavut (Nunavummiut), physical and mental health cannot be separated, and the relationship between poverty and physical and mental illness is circular, with each one building on the others. 

This case study looks at Nunavut’s shared leadership approach to developing a poverty reduction strategy.  It discusses why healing from the wounds inflicted by colonialism is an integral part of The Makimaniq Plan: A Shared Approach to Poverty Reduction.  In Inuktitut, Makimaniq means “empowerment” or “standing up for yourself.”  The strategy grew out of intense collaboration between government and Inuit organizations, and public and non-governmental organizations, and resulted in the Collaboration for Poverty Reduction Act, in 2013.

The case gives historical background, discusses what poverty means in Nunavut, and describes the four stages of the public engagement process:

  • community dialogues on poverty reduction (winter 2011)
  • regional roundtables for poverty reduction (May to June 2011)
  • poverty summit (November 2011)
  • program delivery (ongoing)

The case study concludes with how the community worked with challenges, and the successes and strengths of their approach.

Use this resource to

  • learn about the Nunavummiut concept of health
  • consider indicators that best reveal the issues related to poverty
  • build a collaborative approach to poverty reduction
  • reflect on how cultural beliefs affect poverty reduction and health equity work

Related Resources:

* Alberta Health Services: Establishing a province-wide social determinants of health and health equity approach
* Working intersectorally and engaging the community in Western Health - coming soon. 
* Our 2012 case studies  profiling health units and provincial departments that have taken action on the social determinants of health

National Collaborating Centre for Determinants of Health. (2014). Fostering health through healing: Engaging the community to create a poverty reduction strategy in Nunavut. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Aboriginal health , Community engagement, Intersectoral action, Leadership & capacity building, National Collaborating Centre for Determinants of Health, Document

Une stratégie et des indicateurs pour la surveillance des inégalités sociales de santé au Québec

This resource is available in French only.

For two decades, reducing social inequalities in health has been a mainstay of political agendas and health policies in Quebec. Monitoring systems have been used to track social determinants of health, population health status, and the use of health and social services departments over time and space (regional). Despite this knowledge base, Quebec does not have a systematic plan for monitoring social inequalities in health, which exist nonetheless.

The purpose of this report is to propose a strategy and indicators for monitoring social inequalities in health. The result is a joint regional and provincial effort by professionals from the Table de concertation nationale en surveillance, the ministère de la Santé et des Services sociaux (Quebec’s department of health and social services), and the Institut national de santé publique du Québec (Quebec’s institute of public health).

The report is divided into three parts: the first describes context elements and useful concepts, the second reviews points of method, and the third recommends a strategy and indicators to adopt to systematically monitor social inequalities in health.

To initiate monitoring of inequalities, the report proposes 18 indicators covering population health status (10 indicators) and its determinants (8 indicators). These indicators will, for the most part, be cross-referenced with a deprivation index and monitored for about two decades, on a Quebec-wide and regional basis. The proposed indicators will be used to monitor social inequalities in health from a relative and an absolute perspective.

Use this resource to:

  • Identify the most important indicators to monitor social inequalities in health in Quebec
  • Identify methods to measure social inequalities in health
  • Learn about the components of an indicator of social inequality in health

Pampalon, R., Hamel, D., Alix, C., Landry, M. (2013). Une stratégie et des indicateurs pour la surveillance des inégalités sociales de santé au Québec. Institut national de santé publique du Québec

Tags: Assess and report, Methods & tools, Modify & orient, Socioeconomic status , Document

Comprehensive school health research: Evidence to action in PEI

Dr. Murnaghan began her career as a nurse. She describes her astonishment at meeting high numbers of patients with poorly managed chronic conditions that are preventable. Believing that many chronic conditions can be eliminated through prevention strategies for youth, Dr. Murnaghan used the SHAPES research framework (School Health Action, Planning and Evaluation System) to gather baseline data and develop strategies to improve youth’s physical, mental and sexual health. She and her team concluded that PEI youth were being underserved by their schools’ health initiatives, and created partnerships with the community to address how this could be changed. She highlights the importance of gathering local data to support the argument for new approaches that address students who are least healthy and improve the health conditions for all students. Visit the research team’s website at www.upei.ca/cshr/

Use this resource to

  • learn about a research framework for collecting and using data to address student health issues in schools
  • learn how this model can be used to facilitate partnerships between school teachers and administrators, youth and community organizations

Tags: National Collaborating Centre for Determinants of Health, Video

Large forces affecting health equity: How health equity is affected by societal shifts such as home ownership, rising energy costs, and pension

Dr. Lynn McIntyre, Professor and Chair of Gender and Health, University of Calgary discusses three research studies that reveal the impact of large forces on health equity in Canada. She uses food insecurity, which is defined as a lack of resources or insufficient funds to purchase food, as baseline data for observing the impact of these larger forces. The first study looked at the possible effects of proposed changes to the age of eligibility for Canada Pension, from 65 to 67. The study showed that food insecurity drops 50 per cent among Canadians once they receive their pensions. This provides evidence that increasing the age of pension eligibility will have negative impacts on older people’s health. The second study concerns the correlation between food insecurity and the jump in home heating costs in 1998-99. While food insecurity in Alberta rose more quickly among homeowners than renters, the federal government created an energy tax credit for low income renters, revealing the need for more evidence-based policy. The third study investigated rates of food insecurity among working people, showing that lone parents and people of African descent are most likely to experience food insecurity. Dr. McIntyre states that we can eliminate large public health concerns such as food insecurity through effective research and planning, and implementation of population-targeted interventions.

Use this resource to

  • Facilitate discussion about how larger societal forces affect people’s health, through the social determinants of health.
  • Learn how research can inform the creation of health-aware public policy.
  • Initiate discussion with community partners about the need to respond to broad public policy that impacts health.

Tags: Community engagement, Food security, Healthy public policy, Income inequality, Intersectoral action, Socioeconomic status , National Collaborating Centre for Determinants of Health, Video

Boosting momentum: Applying knowledge to advance health equity - 2014 Environmental scan

Since 2010, the NCCDH’s strategic direction has been informed by an environmental scan it conducted to assess public health sector practices, barriers, and opportunities to advance health equity. In 2013, we went back to see what had changed and what had stayed the same. Boosting momentum summarizes our findings from a review of grey and peer-reviewed literature, key informant interviews, focus groups, and written feedback.

The 2014 scan includes references to key documents, and identifies ways that the context and practice of health equity work in the public health domain have changed since 2010, including

  • an increase in the level of attention, interest, and dialogue devoted to health equity concepts—and voiced commitment to health equity action—in the Canadian public health community
  • more public health reports that apply a health equity lens to data and how it is reported 
  • more research into the factors that make public health action possible, and into the effectiveness of health equity interventions
  • increased health equity action from other sectors
  • many new structures and organizational supports for health equity work
  • great variance in the level of leadership support for health equity
  • a need for  skill and competency development in health equity assessment and surveillance, research and evaluation of interventions, policy analysis and advocacy, and community engagement.

Participants noted that there is still no significant, concrete action to reduce health inequities. Without these actions, many argued, public health interest in health equity may become a passing fad. As a framework that can help us keep an action focus, we found overwhelming support for the four roles framework for promoting action.

The scan concludes with eight recommendations for action for the NCCDH.

Use this document to

  • investigate ways your organization can strengthen its capacity for health equity action
  • learn about health equity commitments and priorities across the country
  • find support for community engagement and intersectoral work
  • identify skills needed for health equity work, and how other jurisdictions are helping people acquire those skills
  • find tools and resources related to many aspects of health equity action

A summary is available here.

For a copy of the PowerPoint presentation "Leveraging Opportunities for Public Health" click here

National Collaborating Centre for Determinants of Health. (2014). Boosting momentum: applying knowledge to advance health equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Integrating social determinants of health and health equity into Canadian public health practice - 2010 Environmental Scan

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

What does it mean to “mobilize” community health?

Dr. Louise Potvin teaches in the Department of Social & Preventative Medicine at the Université de Montréal.  In this talk, she discusses what it means to “mobilize health.”  She explains that health is a combination of two things: 1) a person’s capacity to transform resources into health, and 2) his or her access to health-protecting resources. To mobilize health means to create more equitable access to health protecting resources within communities, and ensuring that all individuals have the capacity to access those resources. The four types of access are proximity, economic domain, institutional domain, and informal reciprocity.  We must make it possible for people to work across these domains to create equitable access to health resources.

Dr. Potvin presents data from different Montreal neighborhoods that shows the correlation between education and access to health resources, with more highly educated people receiving the majority of the health-sustaining resources. She suggests that access can be achieved through population monitoring, supporting rich and diverse institutional environments, promoting regulation of the economic domain, and supporting vibrant community organizations. Mobilizing health means working with local actors from all domains to increase the correspondence between people’s capacities and entitlements, and the quality and quantity of local health resources.

Use this resource to

  • better understand how individual capacity and accessibility of the social determinants combine to affect health outcomes
  • initiate a discussion about community access to resources, rather than availability
  • consider new ways to partner with community organizations to achieve a more equitable distribution of health

Tags: National Collaborating Centre for Determinants of Health, Video

How public health in Nova Scotia is focusing on the social determinants of health and health equity

Following introductions by Dr. Sean Riley, President of St. Francis Xavier University, and Connie Clement, Scientific Director of the NCCDH, Dr. Strang emphasizes the difference between “disparities/ inequalities” and “inequities.” Disparities and inequalities are measureable, naturally-occurring differences between people, while inequities are avoidable and preventable, and are often unjust and unethical. A society that recognizes inequities, and initiates services and supplies resources to eliminate them, will be a healthier society. 

Strang argues that despite this powerful connection between income, education, housing and health, most people prioritize medical care spending over social supports. Dr. Strang quotes the former president of the Canadian Medical Association, Dr. Anna Reid, who, in a landmark initiative, called on governments to think outside the health system to improve the health of Canadians.

In 2006, Nova Scotia Public Health conducted a two-year review of its goals and activities, resulting in 21 recommendations. Since then, it has been working with communities and community health workers to create a collective vision for the future.

Use this resource to

  • learn about Nova Scotia’s public health renewal process and the centrality of health equity in its recently published standards
  • facilitate discussion about investments in health care vs. investments in the social determinants of health
  • initiate discussion with public health professionals about the impact of social disparities on health

Tags: National Collaborating Centre for Determinants of Health, Video

Grounded in our communities: 3/10 promising practices in Capital Health

Dr. Watson-Creed, Medical Officer of Health, Capital & District Health Authority (Halifax), discusses the evolution of health equity practice and policy within Capital Health’s public health system. The Chief Public Health Officer's 2008 Report on the State of Public Health in Canada prompted the health authority to think critically about the work it was doing. Through community engagement, a cohesive framework for the delivery of public health services in the city was created.

Dr. Watson-Creed explains how three promising practices identified by the Sudbury District Health Unit—purposeful reporting, community engagement and intersectoral action—guided their work. Purposeful reporting is key because understanding inequities and their causes drives the work, she says (Nova Scotia’s Public Health mission is: Public Health works with others to understand health of our communities and act together to improve health.  The job of public health is to bring the data to the table, critically evaluate it and engage with community actors to develop effective solutions. 

Use this resource to

  • Reflect on the value of data collection and analysis in health equity work
  • Learn how data can lead to shifts in policy and strategy
  • Learn about a public health renewal process

Tags: National Collaborating Centre for Determinants of Health, Video

A guide to community engagement frameworks for action on the social determinants of health and health equity

Public health is increasingly using community engagement strategies to close the gap between the most and the least healthy. This reference guide describes 16 community engagement frameworks that can be used in the development and implementation of public health interventions.

The frameworks were identified through a search of Canadian and international organizations, and assessed for their applicability to work on the social determinants of health (SDOH) and health equity. Priority was given to frameworks that referred to values and concepts related to health equity.

The guide contains a summary of key concepts related to community engagement, and a description of the search and assessment methodology. Each framework is described under the following headings: 1) area of focus, 2) relevance to the SDOH and health equity, 3) intended use, 4) principles and values, 5) community engagement strategies, 6) risks, 7) success factors, and 8) evaluation.

Use this resource to

  • learn about existing community engagement frameworks, and the strategies and approaches they contain
  • determine whether you need to create a new, context-specific community engagement framework to support your work, or adopt an existing framework
  • match your project to an appropriate community engagement framework
  • revise a community engagement strategy you are currently using


National Collaborating Centre for Determinants of Health (2013).  A guide to community engagement frameworks for action on the social determinants of health and health equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

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

A practitioner’s guide for advancing health equity: Community strategies for preventing chronic disease

The intention of A practitioner’s guide for advancing health equity is to help practitioners and leaders incorporate a health equity view  in their collaborations with community organizations. It offers ideas—with stories to illustrate— for how public health organizations can develop competency in the important work of building organizational capacity, engaging communities, developing partnerships and coalitions, and making the case for health equity.

Each of the four sections of the Practitioner’s guide (1. foundational skills, 2. tobacco-free living strategies, 3. healthy food and beverage strategies, and 4. active living strategies) offers examples and lessons learned from diverse communities and organizations. The guide focuses on how public health can improve the places where people live, learn, work and play through changes in three specific arenas:  policy, systems, and physical environments. Policy improvements are made through legislation, regulation, and administrative action. Systems improvements change the culture, or social norms, of an entire organization, institution, or system. Environmental improvements change the economic, physical, and social environment of a community. Each section includes a set of questions to stimulate reflection, discussion and ideas.

The guide cautions that without careful planning, design and implementation, interventions can widen health inequity.

Use this resource to:

  • Generate ideas and strategies for public health action to stimulate policy, systems, and environmental improvements
  • Learn from the experiences of others in a variety of settings and communities
  • Reflect on how health equity can be further integrated into your work and the priorities of your organization
  • Find checklists and other tools to help you integrate health equity in planning and strategy development processes

Reference:

Centers for Disease Control and Prevention, Division of Community Health. 2013.  A practitioner’s guide for advancing health equity:  Community strategies for preventing chronic disease. Atlanta, GA: US Department of Health and Human Services.

Tags: Community engagement, Competencies & organizational standards , Healthy public policy, Intersectoral action, Key concepts, Leadership & capacity building, Methods & tools, Modify & orient, Link

Social justice... A means to an end, an end in itself (2nd ed.)

This 2010 policy discussion paper was produced by the Canadian Nurses Association (CNA) following a review of their “social justice initiative,” which began in 2003. Through this text, the Association reaffirms its commitment to work for social justice, which is defined as “the fair distribution of society’s benefits, responsibilities, and their consequences.” (p. 10)

In addition to unpacking the concept of fairness, the updated definition of social justice focuses on the advantage that some groups or individuals have relative to others; the need to understand root causes of inequities; and the need to take responsible action to eliminate inequities. (p. 13)

Perhaps most useful to public health practitioners is an evolved version of the Social Justice Gauge (p. 19), designed to spark discussion and to support the development of more equitable programs, policies, and products. In contrast to the original version, the redesigned gauge is meant for broad application, both within and outside the nursing sector. The tool guides practitioners with three key questions about the program, policy, or product they have chosen to investigate. Practitioners are also asked to recognize where injustices exist, and to document the actions that should be taken to reduce these injustices.

Use this resource to

  • Initiate discussion in your workplace or your professional association about what social justice means
  • Assess a program, policy or product for its strengths and weaknesses in relation to social justice
  • Identify opportunities to strengthen the ability of a program, policy or product to address and even reduce social injustice

Canadian Nurses Association. (2010). Social justice... A means to an end, an end in itself. (2nd ed.) Retrieved from http://www.cna-aiic.ca/en/on-the-issues/better-health

Tags: Healthy public policy, Methods & tools, Modify & orient, Document

Building a business case for preventive home visiting for pregnant women and mothers of young children: A review of the literature

Home visiting programs across Canada seek to improve the immediate and long-term health outcomes of mothers and their young children. The purpose of this rapid review was to bring together the best available evidence on early child home visiting, with the goal of designing effective home visiting interventions.

The authors searched the Abstracts of Reviews of Effect (DARE) database and found 22 reviews that met the inclusion criteria, and two reviews that supported the business case for home visiting.

Use this resource to

  • Increase your understanding of the value of preventive home visiting programs
  • Identify knowledge gaps related to preventative home visiting
  • Create a business case for a preventative home visiting programs

National Collaborating Centre for Determinants of Health. (2010). Building a business case for preventive home visiting for pregnant women and mothers of young children: A review of the literature. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Early childhood development, Evaluation, Modify & orient, National Collaborating Centre for Determinants of Health, Document

Understanding Racism

Since their contact with Europeans, Aboriginal peoples in Canada have experienced different forms of racism which have negatively affected all aspects of their lives and well-being. This paper—which is an exploration of the concept of race, its history and contexts—is the first of three papers that will discuss forms of racism within societies.

In the 1600s scientists began investigating differences between groups and classifying them as different and distinct races.  By the 1800s, race was used to create social hierarchies. This paper describes a number of forms of racism: epistemic, relational, structural, symbolic, and embodied.  These ideological constructions of racial difference are frequently used to generate and reinforce structural inequities and a cycle of oppression. The authors emphasize that race is not a biological fact, but rather a socially constructed concept that was created—and is maintained—to justify disparities in the distribution of resources and power.

Use this resource to learn about the

  • historical construction of race.
  • different forms of racism.

Citation: National Collaborating Centre for Aboriginal Health. (2013). Understanding Racism. Prince George,  BC: National Collaborating Centre for Aboriginal Health.

Tags: Aboriginal health , Critical works in health equity, Key concepts, Racism/racialization, Document

Public Health Speaks: Tuberculosis and the social determinants of health

In partnership with the National Collaborating Centre for Infectious Diseases (NCCID), the NCCDH brought a group of public health practitioners together to share perspectives on the roles, actions and strategies that can be used to reduce inequities in the incidence of infectious disease. Using tuberculosis (TB) as the example, the practitioners discuss how public health can address the social determinants of the disease.

This resource summarizes a January 2014 conversation facilitated by Claire Betker, NCCDH’s Senior Knowledge Translation Specialist, with

  • Nash Dhalla, Tuberculosis Services for Aboriginal Communities, British Columbia Centre for Disease Control
  • Elizabeth Rea, Associate Medical Officer of Health, Tuberculosis Prevention and Control, Toronto Public Health & Adjunct Professor, University of Toronto
  • Gail Turner, Retired, Public Health Consultant, Happy Valley-Goose Bay, Labrador

Use this resource to

  • increase understanding of how infectious disease programming can be directed at improving the social determinants of disease
  • consider how public health activities to reduce TB fit within the four public health roles for improving health equity
  • reflect on the use of innovative partnership approaches by public health practitioners

National Collaborating Centre for Determinants of Health and National Collaborating Centre for Infectious Diseases. (2014). Public Health Speaks: Tuberculosis and the social determinants of health. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Aboriginal health , Access to health services, Assess and report, Infectious disease, National Collaborating Centre for Determinants of Health, Document

Learning from practice: Targeting within universalism

This series of short case descriptions, or practice examples, was created to demonstrate the application of targeting within universalism to achieve greater equity in Canadian public health service delivery.

As part of our “Let’s Talk” series, the NCCDH published a pamphlet that explores targeted, universal and blended approaches to public health interventions. In Let’s talk: Universal and targeted approaches to health equity a number of conceptual examples were given to help clarify the theory, but no real-world examples were provided.

The purpose of this series of real-world examples is to help public health staff better understand how targeted and universal approaches can be blended to achieve better population health outcomes. 

The three examples describe targeting within universalism at

Use this resource to

  • increase your understanding of the concept and application of targeting within universalism in public health practice
  • assess the strengths and challenges of using a targeting within universalism approach
  • investigate how others have blended universal and targeted services and initiatives to improve population health outcomes
  • reflect on how Canadian public health organizations incorporate research evidence, partnerships, and evaluations in implementing targeting within universalism programs

National Collaborating Centre for Determinants of Health. (2014). Learning from practice: Targeting within universalism. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Aboriginal health , Access to health services, Early childhood development, Environmental health, Evaluation, Modify & orient, National Collaborating Centre for Determinants of Health, Document

Let's Talk: Moving upstream

The fifth release in our “Let’s Talk” series defines and illustrates three levels where public health can intervene to reduce health disparities:

  • Downstream to address  immediate health needs
  • Midstream to address material circumstances such as housing and employment
  • Upstream to advocate for greater fairness in power structures and income

The four-page guide argues that we can adopt an upstream attitude by being alert to the causes-of-the-causes of poor health, whether we work in direct service, management or policy. It suggests ways that public health staff can contribute to an upstream shift:  among other things, we can challenge our assumptions about the causes of health and illness, and develop our skills in partnership building, advocacy, and community organizing.

The resource includes discussion questions to help public health staff examine their work in terms of its upstream, midstream or downstream placement, and think of ways to more fundamentally address why some populations are healthier than others.

Use this resource to

  • consider the breadth of  public health’s mandate to prevent disease
  • reflect on ways you and your organization can address the causes-of-the-causes
  • learn about ways that public health is working with organizations outside of health to improve the conditions that affect our health
  • spark dialogue and action in lunch room and staff meeting settings

National Collaborating Centre for Determinants of Health. (2014). Let’s Talk: Moving upstream. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Key concepts, Knowledge translation , Leadership & capacity building, National Collaborating Centre for Determinants of Health, Document

Pathways to improving well-being for Indigenous peoples: How living conditions decide health

This report provides an overview to how the socio-economic determinants of health are connected to health inequities for Aboriginal peoples in Canada. The authors draw attention to the social gradient in determinants like income, unemployment, and education: the higher your socio-economic level the healthier you tend to be. The authors draw on research and health status data to document what is known about the effects of the following determinants on the health of First Nations, Inuit, and Métis peoples in Canada. 

  • social/community supports and networks
  • housing
  • health care access
  • early life (prenatal influences and breastfeeding)
  • healthy living (affordable, nutritious food and active lifestyles)
  • substance use and misuse (tobacco, alcohol,  and drugs)
  • The authors explore how these determinants interrelate, why they are so powerful, and what can be done in these social-economic areas to improve health outcomes.

The main message of the report is that research and intervention strategies must adopt a holistic “life course approach from a social determinants of health perspective.”  We must not only consider the complex web of socio-economic determinants, but also the interactions that operate throughout an individual’s life and across generations.

The authors makes a strong case for paying attention to the foundational impacts of colonization, and for conducting research focused on finding and supporting interventions that make a difference.

Use this resource to

  • learn about the social gradient in health status between Aboriginal and non-Aboriginal populations in Canada
  • improve your understanding of how the social determinants of health impact the health status of Aboriginal people
  • identify interventions that show promise for improving the social determinants of health and health equity for Indigenous peoples

Reading, J. & Halseth, R. (2013). Pathways to improving well-being for Indigenous peoples: How living conditions decide health.  Prince George, BC: National Collaborating Centre for Aboriginal Health.

Tags: Aboriginal health , Access to health services, Assess and report, Critical works in health equity, Early childhood development, Food security, Income inequality, Racism/racialization, Document

Rio Political Declaration on Social Determinants of Health

The Rio Political Declaration on Social Determinants of Health was adopted in October, 2011 at the World Health Conference on Social Determinants of Health. Held over three days in Rio de Janeiro, Brazil, the conference brought together more than 1000 participants from 125 member states to spur global action on the social determinants of health.

The Rio Declaration builds on a series of seminal documents by the World Health Organization, including the 1978 Declaration of Alma-Ata, the 1986 Ottawa Charter, and the 2008 final report from the Commission on the Social Determinants of Health (Closing the gap in a generation). It was intended to help build the political momentum for national action plans and strategies devoted to reducing health inequities.

It touches on many familiar, but salient themes, including the need for

  • action across sectors and levels of government, including the adoption of a Health in all Policies approach
  • reorientation of the health sector (including public health) to reducing health inequities
  • research and other types of evidence to inform policy and action
  • action to improve health across the entire population, while paying special attention to vulnerable groups
  • cooperation between private and public sectors (e.g., in ensuring workplace safety)
  • inclusivity and participation in policy-making and implementation processes
  • a life-course approach with a special focus on promoting health and wellbeing in early childhood
  • monitoring and evaluation strategies
  • This call-to-action led to a resolution (“Reducing health inequities through action on the social determinants of health,”) signed by the World Health Assembly in 2012.

Use this resource to

  • learn the components of a comprehensive approach to improving health across populations, including those that are most vulnerable
  • advocate for comprehensive policies on regional, provincial and national levels to address the social determinants of health
  • better understand the history of global action on the social determinants of health

World Health Organization (2011). Rio Political Declaration on Social Determinants of Health.  Rio de Janeiro, Br: World Health Organization.

Tags: Access to health services, Community engagement, Critical works in health equity, Early childhood development, Healthy public policy, Income inequality, Intersectoral action, Key concepts, Leadership & capacity building, Socioeconomic status , Document

Alberta Health Services: Establishing a province-wide social determinants of health and health equity approach

This case study profiles Alberta Health Services (AHS). Formed in 2008, after a re-organization of provincial health services, AHS quickly identified health equity as a strategic priority and established targets to improve equity in the province’s population health outcomes. The speed and clarity of this direction was due to the leadership qualities of senior and frontline managers, strategic planners, practitioners, and community partners. 

The progress of AHS did not come without challenges, including one as fundamental as a common understanding of “health equity.” In the planning stages, the lack of (and need for) population health data at the local level became apparent. Other challenges related to the job of integrating a health equity approach across the diverse programs and service delivery locations of the health authority.

Use this resource to

  • Enhance your understanding of the factors that identify — and the conditions that nurture — leaders for health equity
  • Facilitate a discussion about the factors that create strong organizational support for leadership and health equity work
  • Reflect on ways to support and build the capacity of community partners doing and providing leadership to  equity work
  • Build and maintain motivation among Public Health staff for health equity work


Check out our previous four case studies profiling public health and community action on the social determinants of health.

National Collaborating Centre for Determinants of Health. (2013). Leadership for health equity. Alberta health services: Establishing a province-wide social determinants of health and health equity approach. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

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

Let's Talk: Populations and the power of language

The fourth release in our “Let’s Talk” series  explores the language public health practitioners and organizations use to label populations that are identified by their social, economic, geographic  or other demographic characteristics.  This four-page brochure examines how terminology influences how we frame problems and solutions, make decisions and implement activities that seek to reduce inequities between groups.

This resource is a discussion guide for practitioners who want to talk about choosing terms that positively describe and empower the population groups they refer to. The document includes a discussion of some widely-used terms (e.g., marginalized, vulnerable, priority population), principles and key considerations to guide the language we use, and questions for group discussion.

Use this resource to

  • Reflect on the values and assumptions underlying our choice of language in public health
  • Consider how the words we use can support or hinder our efforts to reduce health inequities
  • Consider the strengths and challenges of using specific terms to identify particular populations
  • Spark dialogue and action in lunch room and staff meeting settings

National Collaborating Centre for Determinants of Health. (2014). Let’s Talk: Populations and the power of language. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

 

 

Tags: Communicate, Key concepts, Knowledge translation , National Collaborating Centre for Determinants of Health, Document

The Public Health Observatory handbook of health inequalities measurement

Measuring and monitoring health inequalities is central to public health practice. By measuring health inequalities, or differences in health outcomes, we come closer to understanding the extent of health inequities, or those inequalities that are systematic, avoidable and unfair. With solid data about inequalities, public health is in a better position to design and implement interventions that reduce inequities.

Published in 2005 by the South East England Public Health Observatory (SEPHO), this book is designed to assist people who are working at the local level measure and monitor health inequalities in their regions. It provides methodological advice about different types of indicators (e.g., geography, socio-economic status), and data sources (survey data, administrative data), among other topics.

The book has 11 sections, which include: measuring inequality by social category; using administrative and survey data to measure inequality by health and disease categories; designing surveys to measure inequality; and understanding indexes of deprivation. While the content is England- focused, this resource has a wealth of information for those doing the same work in Canada.

The English Public Health Observatories were launched in 2000 with a mandate to support the availability and use of information about health by local public health organizations, a role similar to that of the National Collaborating Centres. More information about SEPHO is available on their website.

Use this resource to

  • Understand how to choose appropriate methods to measure health inequalities
  • Explore the pros and cons of various indicators and data sources to measure and monitor health inequalities
  • Learn how to design surveys and use survey data and indexes of deprivation to measure health inequalities

Carr-Hill, R., Chalmers-Dixon, P. (2005). The Public Health Observatory Handbook of Health Inequalities Measurement. Oxford, UK: South East England Public Health Observatory.

Tags: Assess and report, Competencies & organizational standards , Healthy public policy, Leadership & capacity building, Methods & tools, Modify & orient, Socioeconomic status , Document

Cross-country analysis of the institutionalization of health impact

This paper is the eighth in a series of papers produced by the World Health Organization’s (WHO) Commission on the Social Determinants of Health (CSDH). Paper #2 is also in our Resource Library. All of these papers are peer reviewed and intended to provide a forum for sharing knowledge on how to approach the inequitable distribution of health determinants in countries around the world.

The institutionalization of health impact assessment (HIA) is considered to be a clear indicator of a country’s implementation of a “health in all policies” agenda.  However, differences in political and socioeconomic conditions, and institutional settings, lead to substantial variations in the use and institutionalization of this process.  The authors of this review of the literature and analysis across countries set out to identify factors that enable or inhibit the development of effective strategies to institutionalization HIA more broadly.

Key factors that enable the institutionalization of HIA are identified as

  • Strong political will and support
  • Legislative mandate
  • International commitment to Health in All Policies and health promotion
  • Awareness and importance of intersectoral cooperation
  • Using the experience of other countries as a positive example
  • Involvement of research communities

Challenges to institutionalization include

  • lack of clarity around methodology and procedures
  • narrow definitions of health
  • lack of awareness of the relevance of health impacts in non-health sectors
  • insufficient funding and tools

Based on their experiences, the key informants propose the following core recommendations

  1. Embed HIA in national normative systems (e.g. in legislation and Public Health Acts)
  2. Clarify definitions and develop guidelines and methodological criteria to operationalize HIA
  3. Strengthen and build capacity for HIA practice
  4. Improve cooperation between sectors

Use this resource to

  • Learn about the approaches and resources used in other countries to support HIA
  • Develop a plan (which includes the development of academic and community partnerships) for your jurisdiction to increase the likelihood that HIA will be used
  • Introduce the benefits of HIA with your intersectoral partner to encourage a “health in all policies” approach.
     

Lee, JH, Robbel, N, & Dora, C. (2013).  Cross-country analysis of institutionalization of Health Impact Assessment.  Social Determinants of Health Discussion Paper Series 8 (Policy & Practice). Geneva, World Health Organization.

Tags: Community engagement, Environmental health, Healthy public policy, Intersectoral action, Methods & tools, Document

Promoting health equity - Choosing appropriate indicators: Literature scan

Promoting Health Equity -  Choosing Appropriate Indicators: Literature Scan is designed to support the British Columbia’s Provincial Health Services Authority (PHSA) and regional health authorities in selecting a common set of indicators and targets to measure the impact of activities designed to reduce health inequities. 

The impetus for this scan is found in the PHSA’s 2011 report, Towards Reducing Health Inequities:  A Health System Approach to Chronic Disease Prevention, which recommended that the province “Develop health equity targets and plans in consultation with communities and community members and actively monitor and measure their impact on health inequities.”

This literature scan lists a set of indicators and recommends options to support a decision-making process, by provincial and regional health organizations, to select common indicators. The project team chose to support the health system’s selection of indicators first, before expanding to include non-profits, community organizations and other stakeholders. The team recommends that future phases of the initiative involve engagement with members of these outside-the-health-system groups.

The PHSA scanned Canadian and international peer-reviewed and grey literature, gathered information on the current use of indicators by BC regional health authorities (Appendix A), and conducted key informant interviews. In addition, the report was informed by researchers and practitioners involved in a series of NCCDH initiatives, including our Population Health Status Reporting Learning Circle. Based on the scan, the Canadian Indicators of Health Inequalities framework was identified as most appropriate for adaption to the BC situation. 

The report suggests a six indicator selection criteria: feasible, understandable, relevant, valid, reliable and comparable. The authors recommend that selected indicators align with BC’s priorities and mandate, and that representatives from all parts of the health system be involved in identifying, defining and prioritizing the common indicators.

Use this resource to

  • Learn about the literature, tools and resources that can be used to help you select health equity indicators
  • Promote the use of appropriate indicators and targets to measure activities that seek to reduce health inequities
  • Support the selection of health indicators in local health unit and health authority settings 
     

Provincial Health Services Authority (2013). Promoting health equity - Choosing appropriate indicators: Literature scan. Vancouver, BC: Provincial Health Services Authority. Retrieved from: http://www.phsa.ca/HealthProfessionals/Population-Public-Health/Health+Equity.htm

Tags: Assess and report, Evaluation, Modify & orient, Document

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