Resource Library

Working for Health Equity: The Role of Health Professionals

Published by the University College London’s Institute for Health Equity in 2013, this report  builds on a number of international resources, including Fair Society, Healthy Lives.  While the findings are specific to the United Kingdom, and focus on individuals working in the health care sector, they may also be useful for those working within public health in Canada.  

The authors avoid focusing simply on improving access to health services, and emphasize the need to ameliorate the broader social context for patients and providers. They suggest several potential levers for action within the health care system to do so, including: effective workforce education and training; relationships with patients and communities; partnerships within and outside the health care system; and advocacy strategies. The analysis focuses on six areas for the UK and includes key recommendations, case studies, and a description of next steps. 

The report includes commitments for action by several UK-based organizations and institutions, including the British Medical Association and the Academy of Medical Colleges. These commitments provide practical information for a number of health professions and include a rationale for action, case studies and further reading.

The report describes cases in which health professionals (such as nurses, social workers, midwives, dentists, doctors, and dieticians) are taking action to improve health equity and suggests practical ways to alleviate health inequalities through clinical practice.  The case studies are also available as a separate document.

Use this resource to

• Strengthen collaborative action between those working in the formal public health sector and those working in healthcare
• Discuss practice examples, and reflect on how health professionals can influence the broader social context
• Develop statements of action for your professional organization

Allen M., Allen, J., Hogarth, S., & Marmot, M. (2013). Working for health equity: The role of health professionals. London: UCL Institute of Health Equity. Retrieved from: https://www.instituteofhealthequity.org/projects/working-for-health-equity-the-role-of-health-professionals

Tags: Community engagement, Competencies and organizational standards , Intersectoral action, Public health leadership , Link

Physicians and health equity: Opportunities in practice

This 2013 report was written to support the Canadian Medical Association’s efforts to transform healthcare and help their members alleviate inequities in health status and improve the health of Canada’s most vulnerable populations.

This report draws upon 29 interviews with 32 physicians from across Canada. Interviewees identified areas of intervention for addressing health equity within their own practices. These included:

• Linking patients with supportive community programs and services
• Asking questions about a patient’s social and economic circumstances
• Integrating considerations of social and economic conditions into treatment planning
• Advocating for changes to support improvements in the social and economic circumstances of the community
• Undertaking advocacy on behalf of individual patients
• Adopting equitable practice design
• Providing practical support to patients to access the federal and provincial/territorial programs for which they qualify

The physicians interviewed identified a number of barriers and facilitators to integrating health equity work in their practice setting.  Further, they suggested potential actions in five main areas of interest: clinical practice, advocacy and communications, education, compensation, and research. 

The report also includes examples of health equity work among Canadian physicians and provides tools and resources for physicians interested in addressing the determinants of health. 

Use this resource to

• Learn about knowledge and service gaps identified by Canadian physicians and reflect on their implications for health equity and public health practice in Canada
• Facilitate discussion about the role of physicians in advancing health equity
• Reflect on the implications of health inequities and the determinants of health for the health care sector

Canadian Medical Association. (2013). Physicians and health equity: Opportunities in practice. Ottawa: Health Care Transformation in Canada.  Retrieved from:  http://healthcaretransformation.ca/2013/03/physicians-and-health-equity-opportunities-in-practice/

Tags: Access to health services, Competencies and organizational standards , Public health leadership , Link

Engaging with impact: Targets and indicators for successful community engagement by Ontario’s Local Health Integration Networks. A citizens’ report from Kingston, Richmond Hill and Thunder Bay

Engaging with Impact was commissioned in response to a growing need for Ontario’s Local Health Integration Networks (LHINs) to better engage communities in the design and delivery of integrated health services.  The author, MASS LBP, is a Toronto-based advisory firm specializing in public consultation.

The report advocates for the need to foster “a culture of engagement” in Ontario’s public health system, and proposes a series of targets and indicators to help Ontario LIHNs evaluate their public engagement strategies.

It describes three citizens’ workshops —in Thunder Bay, Richmond Hill, and Kingston —that brought together randomly-selected community members to learn about and contribute ideas for improving engagement.  The authors used the outcomes of these workshops to develop an engagement scorecard for LHINs, and a set of principles, recommendations and indicators for community engagement, all of which are included at the end of the report.

Other highlights include

• An essay by Professor John Gastil, Head of Communication Arts at Penn State University, examining the challenges associated with evaluating deliberative engagement.
• A comparison of community engagement approaches used in the Canadian and British health systems, by the Wellesley Institute and Involve (a UK-based think-tank).
• Interviews with LHIN directors who are engaging local communities in their operations and governance.

Use this resource to

• Explore ways to use community engagement approaches in integrated health care systems (e.g., regional health authorities)
• Review a set of indicators that measure how well your organization is engaged with stakeholders and community members
• Learn how to evaluate the impact of community engagement approaches
• Understand the challenges of evaluation, and learn about ways to address those challenges

MASS LBP. (2009). Engaging with impact: Targets and indicators for successful community engagement by Ontario’s Local Health Integration Networks: A citizens’ report from Kingston, Richmond Hill and Thunder Bay. Toronto, ON: Author. Retrieved from: http://www.masslbp.com/journal_detail.php/ontario-health-public-engagement.html

MASS LBP (commissioned by the Ontario Ministry of Health and Long Term Care, Health System Strategy Division, and the Central, North West and South East LHINs)

Tags: Access to health services, Community engagement, Evaluation, Intersectoral action, Knowledge translation , Methods & tools, Program planning, Reporting & measurement, Link

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

The second release in our “Let’s Talk” series offers public health organizations a framework for reflection and action.  The public health roles speak to four categories of action that can guide an organization’s efforts to reduce disparities in health.  This resource offers examples of effective action in each of the roles, from organizations across the country.

Use this resource to:

• Build a strategic framework for your organization’s health equity work
• Assess the areas of action where your organization is strong, and where it could devote more attention
• Encourage public health employees to look at the broad range of activities that can help reduce social inequities in health
• Spark dialogue and action in lunch room and staff meeting settings

For more information on the "Let's Talk" series, click here.

National Collaborating Centre for Determinants of Health. (2013). Let’s talk: Public health roles. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Intersectoral action, Program planning, National Collaborating Centre for Determinants of Health, Document

The Community Tool Box

The Community Tool Box is a website created by the University of Kansas’ Work Group for Community Health and Development, a research group that has been investigating ways to improve health through community action for more than 35 years.

The website states that it is the “world’s largest resource” for information about community health and development, with more than 7,000 pages of step-by-step guidance.

Resources are organized into four categories. The how-to-guidance page lists 46 ‘chapters’ of guidance in community-building skills. The toolkits page lists resources to guide you through assessing your community’s needs through to evaluating your strategies and outcomes.  The troubleshooting resources help readers work through common problems, such as those related to leadership, conflict, and unintended outcomes. The evidence-based practice page links to external databases — both comprehensive and category-based — of promising practices for promoting community health and development. These include the Cochrane Collaboration and the Public Health Agency of Canada’s Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention.

Online opportunities to connect with others, including experts and experienced community members, are also available.

For more information about the University of Kansas Work Group for Community Health and Development visit http://www.communityhealth.ku.edu.

Use this resource to

• Find step-by-step guidance to improve your community’s well-being through capacity building and health promotion
• Overcome obstacles in your own community engagement initiatives using topic-specific trouble-shooting guides
• Build your networks by connecting with experts and colleagues engaged in community mobilization and health promotion

University of Kansas’ Work Group for Community Health and Development. (1994). The Community Toolbox: Bringing solutions to light. Retrieved from: ctb.ku.edu/en/default.aspx.

Tags: Community engagement, Evaluation, Knowledge translation , Methods & tools, Program planning, Reporting & measurement, Link

Critical examination of knowledge-to-action models and implications for promoting health equity

Knowledge translation (KT) is about closing the gap between knowing and doing.  Public health has been particularly interested in finding effective models for moving research into action. This resource is the result of an extensive literature search for knowledge to action models, followed by an assessment of each model’s ability to effectively guide the introduction of equity-focused knowledge into public health practice.

Based on their “health equity scores,” six models were identified as promising. These models:

• identify equity as a goal
• ensure that stakeholders are involved in substantial ways
• prioritize multisectoral engagement
• draw knowledge from multiple sources
• recognize the importance of the social, physical, political, and economic context
• take a proactive, problem-solving approach

Use this resource to

• Facilitate discussion about the factors that make for effective knowledge translation related to health equity
• Select a KT model that can effectively guide your work in translating research for decision makers and practitioners

A summary is available here.

Davison, C.M., & National Collaborating Centre for Determinants of Health. (2012). Critical Examination of Knowledge to Action Models and Implications for Promoting Health Equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Community engagement, Critical works in health equity, Evaluation, Intersectoral action, Knowledge translation , Methods & tools, Program planning, National Collaborating Centre for Determinants of Health, Document

Let’s Talk… Universal and targeted approaches to health equity

The third release in our “Let’s Talk” series explores the approaches public health organizations use to close the gap between the most and least healthy, and reduce disparities all along the  socio-economic status gradient.  This resource is designed as a discussion guide for decision makers and practitioners who want to talk about when and why to use a universal, targeted, targeted universal, or proportionate universal approach—or some combination.  The document includes definitions (e.g. health gap and health gradient), examples and questions to guide group discussion.

Use this resource to

• Reflect on the values, assumptions, and evidence underlying public health programs and policy decisions
• Consider how the design of a public health intervention can narrow or widen the health gap
• Consider the strengths and challenges of targeted, universal, targeted universal, and proportionate universal approaches to public health interventions
• Spark dialogue and action in lunch room and staff meeting settings

For more information on the "Let's Talk" series, click here.

National Collaborating Centre for Determinants of Health. (2013). Let’s talk: Universal and targeted approaches to health equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Program planning, National Collaborating Centre for Determinants of Health, Document

Community-Based Participatory Research: A strategy for building healthy communities and promoting health through policy change

The authors of this report are convinced that effective, community-based, participatory research (CBPR) is a change strategy and that it can shape social policy.  They designed this document—which contains sample resources and tools—for community members, public health practitioners and researchers who want to use participatory research to advocate for healthy public policies.  The report was co-produced by Policy Link (an American research and action institute that advocates for economic and social equity) and the School of Public Health, University of California, Berkeley. 

CBPR is a change strategy that involves citizens and researchers equitably in a research process. It begins with a research topic that the community says is important, and combines knowledge and action, through a variety of approaches, to address that topic. For the authors, the goal of CBPR is always to “improve community health and eliminate health disparities.” (p. 10) 

The toolkit highlights eight promising practices drawn from American experiences, including 

• Build on partners’ strengths in studying and addressing shared concerns
• Use local approaches and processes, even if this slows down the process
• Engage children and youth by using visual and social media to document, study, and effect change
• Bring communities together on a regional level to improve health and the environment

The report’s six case studies from California show how CBPR can be tailored for different geographic settings and desired outcomes. The evaluation section recommends that partners take a long view on policy, asking “how did the [partnership’s] work improve the policy environment for this issue?” rather than “has the policy changed?” (p. 45).  The additional resources section contains dozens of references, grouped by topic and promising practice.  One frequently referenced resource is the Community-Campus Partnerships for Health.

Use this resource to
• Learn about tools that can guide community-based, participatory research
• Learn from the stories of community partnerships that have used a process, built commitment to it, and seen results
• Learn how to find and sustain both project partners and funding

Minkler, M., Garcia, A.P., Rubin, V. Wallerstein, N. (2012).  Community-based participatory research: A strategy for building healthy communities and promoting health through policy change.  A report to the California Endowment.  Berkeley, CA: Policy Link, University of California Berkeley. Retrieved from: http://www.policylink.org/atf/cf/%7B97C6D565-BB43-406D-A6D5-ECA3BBF35AF0%7D/CBPR.pdf

Tags: Community engagement, Healthy public policy, Intersectoral action, Knowledge translation , Methods & tools, Program planning, Link

A new way to talk about the social determinants of health

In 2006, the Robert Wood Johnson Foundation (RWJF), a philanthropic institution dedicated to improving health and health care, embarked on four years of research and message development around the question: “how do we find a common language that will expand Americans’ views about what it means to be healthy – to include not just where health ends but also where it starts?” (p.3) The result is this readable 37-page report.  In it, the authors outline their methodology, then present seven lessons for using language to frame the social determinants of health (p. 4), and six ways to talk about the social determinants of health (p. 7). They offer definitions for terms such as “poverty” and “health disparities” (p. 8).

Within the broad spectrum of this research, the authors keep returning to the very different, “deep metaphor frames” held by Democrats and Republicans.  Strikingly, researchers found that the term “the social determinants of health” did not resonate with audiences, regardless of their political affiliation or educational background.  However, when the core concept was re-phrased using emotional, “values driven” language, it was found to be more convincing.  Other findings include: “use one strong and compelling fact” rather than two or three, and “prime audiences […] with messages they already believe” to make the new message more credible.

More information about the Robert Wood Johnson Foundation and its work is available on their website, www.rwjf.org, where you can also find an hour-long webinar and accompanying slides based on this report.

Use this resource to:

• Engage others in a dialogue about the social determinants of health, regardless of their political beliefs, cultural background or educational attainment
• Reflect on the differences in how messages about the social determinants of health and health equity are received in the US and Canada
• Get your health equity message across to policy-makers, as well as to people working at the community level

Robert Wood Johnson Foundation. 2010. A new way to talk about the social determinants of health

Tags: Knowledge translation

Let’s Talk… Health Equity

Download the first in the “Let’s Talk” series, a small collection designed to promote discussion and understanding of how key concepts in health equity apply in public health practice. 

This document explores the concept of health equity and how it applies to public health practice, offering explanations to clarify the meaning of related terms, such as health inequity and health inequality. The discussion questions at the end were designed to spark dialogue, reflection, and action—in lunch room and staff meeting settings—to address the social determinants of health.

Use this resource to:

• Learn how terms like health inequalities, social inequalities in health, and health inequities are used in public health practice
• Initiate discussions about how social justice values apply to public health work
• Explore key health equity concepts with your colleagues

For more information on the "Let's Talk" series, click here.

National Collaborating Centre for Determinants of Health. (2013). Let’s talk: Health Equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: National Collaborating Centre for Determinants of Health, Document

CRICH Knowledge Translation Toolkit

This collection of tools and tips is designed to help researchers and community workers identify health equity research needs and communicate more effectively with decision-makers and the public.  The authors are scientists at the Centre for Research on Inner City Health (CRICH) at St. Michael’s Hospital in downtown Toronto.  The mission of CRICH is “to reduce health inequities through innovative research that supports social change.” 

The tools—which include reflection questions, exercise sheets, brainstorming lists and checklists—are divided into two sections:   1) tools for researchers; and 2) tools for using research in policy, planning and advocacy.

The tools for researchers help scientists reflect on the change they want to make, frame their research to support that goal, and communicate their findings.  This section includes tips for writing and report preparation, as well as the use of online media. 

The tools for using research include tips for engaging researchers in specific issues, assessing the relevance of research, and deciding whether or not to participate in research.

Use this resource to:

• Strengthen evidence-informed decision-making within your organization
• Consider your audience and the context in which you are communicating
• Reflect on the intent of your health equity goals
• Expand the audiences you are reaching with your message

Murphy, K., Holton, E. (2011). CRICH Knowledge Translation Toolkit. Toronto: Centre for Research on Inner City Health.

Tags: Knowledge translation , Methods & tools, Research

Exploring Action on the Social Determinants of Health in Canada’s Health Regions

The author of this Master’s thesis (produced for the School of Public Administration, University of Victoria) scanned Canadian health region websites to find references to health equity, and to identify interventions that address a social determinant of health. Eighty-nine health regions yielded 2,200 interventions. These were assessed using health equity and structural intervention lenses.

The author found that while 42% of the 89 health regions gave “equity” as a goal in the vision, mission and values section of their website, only 25% of the 2,200 interventions addressed equity.  Most of the interventions that sought to address health equity were designed to target vulnerable groups or to reduce barriers to services.

Only 15% of the interventions could be classified as “structural,” meaning they targeted an entire population.  Most commonly, these structural interventions addressed systematic barriers to accessing services, or they focused on building community capacity to promote wellness through an understanding of the social determinants.

The project was completed for the Canadian Population Health Initiative (CPHI), a division of the Canadian Institute for Health Information.  A 4-page summary is available on the CPHI website.

Use this resource to:

• Learn about innovative health region interventions that address the social determinants of health and health inequity
• Increase your understanding of structural interventions
• Identify gaps in your health service programming and evaluation
• Reflect on how to improve the evidence-base of social determinants of health interventions

MacNeil, A. (2012). Exploring Action on the Social Determinants of Health in Canada’s Health Regions (Master’s thesis). Retrieved from http://hdl.handle.net/1828/4409 

Tags: Key Concepts

How are Canadians Really doing? The 2012 CIW Report

The Canadian Index of Wellbeing (CIW) initiative at the University of Waterloo is an ambitious project that tracks the overall wellbeing of Canadians using 64 indicators within eight domains: 1) arts, culture and recreation; 2) civic engagement; 3) community vitality; 4) education; 5) environment; 6) healthy populations (health status indicators); 7) living standards; and 8) time use.

This is the CIW’s second report, and it reveals the inadequacy of using gross domestic product (GDP) as an indicator of wellbeing.  Between 1994 and 2010, Canada's GDP grew by almost 30%, while our quality of life improved by less than 6%.  Also, when the economy faltered between 2008 and 2010, Canadian wellbeing dropped by 24% and has not recovered, even while the economy has.

The primary goal of the CIW is to monitor trends within and among the eight domains of well-being.  Although only one domain deals directly with people’s health, all domains relate to people’s abilities to access the conditions that lead to good health.The report concludes with ideas about how people can use the data to promote and support social justice and equity work.  It also provides examples of how data from the previous CIW report has been used by individuals, and private and public sector organizations to work for change.

Use this resource to:

• Bring people from other sectors together with public health to talk about trends in Canadians’ wellbeing.
• Strengthen your regional health authority’s or health unit’s internal and external health equity work.
• Start a health equity conversation with elected representatives in your region.

Canadian Index of Wellbeing. (2012). How are Canadians really doing? The 2012 CIW report. Waterloo, ON: Canadian Index of Wellbeing and University of Waterloo.

Tags: Reporting & measurement

The Chief Public Health Officer’s Report on the State of Public Health in Canada. Influencing Health - The Importance of Sex and Gender

This is the fifth, mandated, theme-based annual report published by the Chief Public Health Officer of Canada; it focuses on sex- and gender-rooted health inequalities and what can be done to address them.  The report elaborates on the definitions of “sex” as biological characteristics, and “gender” as socially and culturally constructed roles.  Dozens of graphs and tables present Canadian statistics on the interplay between the social determinants and health, with a focus on how sex and gender affect health across age, income and cultural background.

The report is organized into three sections: 1) the state of public health in Canada; 2) sex, gender and the health of Canadians; and 3) a path forward. Section 1 provides a demographic profile of the physical, mental, and sexual health of Canadians, and how these relate to a range of socio-economic determinants of health.  Section 2 describes how sex and gender interact with other determinants of health to increase inequalities, and highlights examples of successful efforts to incorporate sex and gender awareness into public health research, policies and programs.  Section 3 sets priority areas for action, and identifies strategies to better incorporate sex and gender into public health policy and practice.

In his preface to the report, Dr. David Butler-Jones offers a quote from science fiction writer William Gibson: “The future has already arrived. It’s just not evenly distributed yet.”  The report notes that while the overall health of Canadians is improving, this trend is not true for everyone.

Use this resource to:

• Find data describing the health of Canadians, across many determinants, in 2011
• Understand how sex and gender affect mental, physical and sexual health
• Develop sex- and gender-sensitive criteria for policy and program development and implementation
• Provide a rationale for sex and gender-focused public health interventions

Public Health Agency of Canada. (2012). The Chief Public Health Officer’s report on the state of public health in Canada, 2012: influencing health – the importance of sex and gender (Catalogue No. HP2-10/2012E). Ottawa, ON: Public Health Agency of Canada.

Tags: Sex & gender

What Types of Interventions Generate Inequalities? Evidence from Systematic Reviews

This study sought to understand which types of non-health-care interventions are likely to increase or reduce health inequalities.  Using a “rapid overview of systematic reviews” method, the researchers looked for studies that showed a change in health status, or health behaviour, between groups of lower and higher socioeconomic status (SES), following a non-health-care intervention.  All of the studies were conducted in high income countries.  The researchers found an increase in health status inequalities for two types of interventions:  media campaigns and workplace smoking bans.  They found a reduction in health inequalities, across the SES spectrum, for three types of interventions: ones that offered employees increased control or participation in the workplace (e.g. changes to working hours), ones that adjusted prices (e.g. tobacco), and ones that provided resources (free folic acid supplements).

The authors note that their findings are consistent with research showing that upstream interventions (pricing and working conditions) are more likely to reduce SES inequalities than are downstream approaches (media campaigns), but caution that their conclusions are provisional.

Use this resource to:

• Initiate a discussion in your health unit or regional health authority about the effect of particular types of interventions on health inequity between SES groups.
• Develop a better understanding of how some public health interventions can unwittingly increase health inequities.
• Learn about the evidence pointing to types of interventions that reduce health inequities.

This report does not have open access.

Lorenc, T., Petticrew, M., Welch, V. & Tugwell, P. (2012). What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health, 67(2), 190-3. Doi: 10.1136/jeck-2012-201257

Tags: Socioeconomic status

The Role of Public Health Agencies in Addressing Child and Family Poverty: Public Health Nurses’ Perspectives

This study, by two public health nursing faculty from the University of Winnipeg, is a first in Canada.  It examined, from the perspective of PHNs themselves, the role of both public health nurses (PHNs) and organizations in addressing child and family poverty. The study is a qualitative analysis of focus group conversations with 23 PHNs working in an urban Canadian setting.

PHNs described feeling impotent and frustrated in the face of systemic barriers to meaningful action (e.g., a lack of accountability for poor housing conditions, and inefficient or inappropriate responses to issues related to child poverty).  They also identified constraints at an organizational level that resulted in a significant gap between their current role and what they perceived they were capable of achieving.  One significant constraint is an organizational focus on individual responsibility rather than on the social determinants of health.  Participants identified the following ways to overcome these constraints: expand PHN roles to include monitoring, advocacy, and community development; include service providers and recipients in needs assessments and program evaluations; and expand the mandate of health organizations to include community development, and advocacy for the social determinants of health.

Use this article to:
• Learn about the impact of poverty on child and family health.
• Review potential organizational strategies to maximize the expertise of PHNs in reducing health inequities experienced by children and families.
• Better understand the potential role of a practitioner in helping to reduce the impact of poverty on the health of children and families

Reference: Cohen, B., & McKay, M. (2010). The role of public health agencies in addressing child and family poverty: Public health nurses’ perspectives. The Open Nursing Journal, 4, 60-71.

Tags: Early childhood development, Income inequity

Building community and public health nursing capacity: A synthesis report of the National Community Health Nursing Study

Recent widespread changes to the health care system, and growing evidence related to the social determinants of health, prompted a consortium of Canadian university researchers and decision makers to investigate the following questions: what does the Canadian community health workforce look like?  and What makes for effective community health nursing?

The result is a mixed methods study that includes an analysis of Canadian Institute for Health Information databases (1996-2007), a pan-Canadian survey of over 13,000 community health nurses, and 23 focus groups with public health policy-makers and front-line nurses.

The study found that in 2007, 16% of the nursing workforce, or over 53,000 nurses, worked in the community.  This number had not changed, as a percentage of all nurses, for the past 5 years.  Community nurses were older and more educated than the nursing average, more than 50% worked full-time, and more than 95% were female. 

The researchers also identified organizational attributes that support the effectiveness of public health nurses (the largest subset of community nurses). These attributes include “flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; [and] coordinated public health planning across jurisdictions.” 

The nurses surveyed identified leadership attributes that support their ability to perform effectively: vision; empowering and motivational behaviours; and support for the time-consuming work of building relationships and teams with community organizations and their clients, and other professionals.  They said that leaders who respect and understand public health had  a positive effect on public health nurses’ abilities to work to full scope. 

Community nurses emphasized that they need more access to continuing education, policies, evidence, and debriefing sessions to sustain their competencies, and their professional confidence.

Use this article to:

• Learn how to adjust community health programs, HR policies, and management processes so that they enhance community nurses’ ability to improve health outcomes in their communities
• Learn about the methodology of the National Community Health Nursing Study, the first of its kind in Canada
• Rekindle your sense of mission as a community or public health nurse, manager, or policy maker

Underwood, J. M., Mowat, D., Meagher-Stewart, D., Deber, R. B., Baumann, A. O., MacDonald, M. B., & ... Munroe, V. J. (2009). Building community and public health nursing capacity: A synthesis report of the National Community Health Nursing Study. Canadian Journal of Public Health, 100(5), I1-11.

Tags: Public health leadership

Appreciative inquiry: a strength-based research approach to building Canadian public health nursing capacity

This study—conducted by a team of researchers from across Canada—is an assessment of a research protocol that led to hard-hitting policy recommendations related to public health nursing practice for provincial and federal leaders.  In this study-of-a-study, the authors evaluated the effectiveness of two group process methods (appreciative inquiry and nominal group process) used to generate experience-based policy recommendations.  The methods were used in 23 focus groups with public health nurses, managers, and policy makers from rural and urban settings across Canada.

This paper describes the impact of using appreciative inquiry methods to collect data, rather than the traditional problem orientation methods used in most social research.  In the appreciative inquiry groups, participants were asked to identify characteristics of organizations that best support public health nursing.  In the data analysis stage of the research, focus groups used nominal group technique to analyse the data and formulate policy recommendations. The participatory research methods were considered to be enormously successful: 93% of participants responded to a post-focus group survey, and the processes led to solution-focussed results that are now being addressed by policy makers.  The authors theorize that “success” is partly due to the “philosophical congruence” between public health nursing practice and these strength-based, group decision-making processes.

Use this article to:

• Rekindle your sense of mission as a public health nurse, manager, or policy maker
• Learn about the appreciative inquiry and nominal group technique approaches and how they can be used for research and policy-making purposes
• Learn how these focus group techniques can help communities anywhere develop policy recommendations

Knibbs, K., Underwood, J., MacDonald, M., Schoenfeld, B., Lavoie-Tremblay, M., Crea-Arsenio, M. …. Ehrlich A. (2010).  Appreciative inquiry: a strength-based research approach to building Canadian public health nursing capacity.  Journal of Research in Nursing.  doi: 10.1177/1744987110387472.

Tags: Methods & tools, Research

Tools and Approaches for Assessing and Supporting Public Health Action on the Social Determinants of Health and Health Equity

This quick-reference guide, co-produced by the National Collaborating Center for Healthy Public Policy (NCCHPP) and the National Collaborating Centre for Determinants of Health (NCCDH), offers a condensed description of tools and approaches that can be used to 1) assess the conditions that create health inequities and 2) develop services designed to reduce these inequities.

The guide includes general evaluative information (e.g., objectives, sources of evaluation data, drawbacks and benefits), and examples for three categories of tools and approaches: 

1) Checklists and lenses
2) Processes such as health impact assessments, and equity-focused health impact assessments 
3) Support structures such as health equity offices

The document’s table formatting lets you quickly see similarities and differences among the tools and approaches, so you can find one best suited for a particular context. While the guide focuses on regions and authorities in Canada, it includes some international resources. 

Use this resource to:

• Compare and contrast resources available to support public health action to advance health equity
• See, at a glance, whether a tool has been used in Canada or whether it has been evaluated (two of numerous criteria listed in the tables)
• Find the sources and download the tools and guides for local adaptation and use

National Collaborating Centre for Determinants of Health (NCCDH) & National Collaborating Centre for Healthy Public Policy (NCCHPP). (2012).  Tools and approaches for assessing and supporting public health action on the social determinants of health and health equity: Comparative tables, November 2012. Montreal, QC & Antigonish, NS:  Mendell, A.,  Dyck, L., Ndumbe-Eyoh,  S., & Morrison, V.

Tags: Evaluation, Methods & tools, National Collaborating Centre for Determinants of Health

Fair Society, Healthy Lives: The Marmot Survey – Strategic Review of Health Inequalities in England post-2010

This 2010 Marmot Review proposes a series of evidence-based policies and a monitoring framework to address health inequalities in England.  It summarizes the findings of a two-year independent review, chaired by Sir Michael Marmot, head of the University College London (UCL) Institute of Health Equity,  and former Chair of the WHO Commission on Social Determinants of Health, which published Closing the gap in a generation: Health equity through action on the social determinants of health in 2008.

The report gathers evidence on the state of health inequality in England and evaluates the policies, approaches, and delivery systems currently in place to address the gap between the healthiest and least healthy. Based on this evidence, the authors recommend six policy objectives, including 1) give every child the best start in life; 2) create fair employment and good work for all; and 3) create and develop healthy and sustainable places and communities.  These policy objectives are further broken down into 20 recommendations.

The authors take the view that action to reduce health inequalities must involve organizations and governing structures outside the health sector, and be included in policies at all levels of government.  This report will be of interest to policy makers at local, regional, and national levels who are creating their own evidence-based strategies to achieve a fairer distribution of health. 

Since the review’s publication, the UCL Institute of Health Equity has supported the implementation of its recommendations across England, including  contributing to the Mayor of London’s health inequalities strategy, and working with the London Health Observatory to monitor the key indicators that were suggested in the review. 

Use this resource to:

• Better understand how evidence related to health inequality can be translated into policy recommendations and concrete actions at all levels of government and across sectors
• Access a framework for delivering and monitoring reductions in health inequalities along the social gradient, including a list of process indicators, output indicators, and examples for each of the 20 policy recommendations

The Marmot Review (2010). Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post-2010, February 2010. UCL Institute of Health Equity.  http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report 

Tags: Healthy public policy, Intersectoral action

The Spirit Level: Why Equality is Better for Everyone

Wilkinson and Pickett contend that people in more equal societies live longer, have better mental health and are more socially mobile.  In this book they present the relationship between income inequality and a range of health and social issues, using data from the 23 richest countries and 50 US states. Using 11 measures of health and social development—among them physical and mental health, drug abuse, teenage pregnancies, and child wellbeing—the authors use scatter graphs to demonstrate that people are significantly worse off in more unequal countries or states. Importantly, the observed relationship is with economic inequality, not total wealth or average per-capita income.

Wilkinson and Pickett argue that income inequality affects everyone in society. Their analysis shows that people at all levels of the social hierarchy do better in more equal societies.

The Spirit Level was published in conjunction with the launch of the Equality Trust website which conducts campaigns based on the authors’ research. The website hosts videos and presentations designed to educated and mobilize support for efforts aimed at reducing economic inequality.
The book was published in the UK under the title The Spirit Level: Why More Equal Societies Almost Always Do Better, and in the US under the title The Spirit Level: Why Greater Equality Makes Societies Stronger. It won the 2010 Bristol Festival of Ideas Prize, and the 2011 Political Studies Association Publication of the Year Award.

Use this resource to:

• Explore a method for assessing income inequality
• Access data on the relationship between income inequality and social outcomes
• Review potential policy options for reducing income inequality

Wilkinson, R.G., & Pickett, K. (2009). The spirit level: Why equality is better for everyone. London: Penguin Books.

Tags: Income inequity

Ontario Population Health Index of Databases

The Ontario Population Health Index of Databases (OPHID) offers open access to an online, searchable index of databases and other quantitative information sources.  It is not a data-access platform, but rather an index of a wide variety of data sources.  A key word search brings you to a list of data sources, with a description of the data available in each source and how to contact the data provider to request clarification and access.  The 275 plus databases can be searched by topic, key word or series.
 

OPHID is a service of the Population Health Improvement Research Network (PHIRN), created with funds from the Ontario Ministry of Health and Long Term Care to support high-quality applied population health research. Although the primary focus of the resource is Ontario databases, many of the information sources are Canada wide.

Use this resource to:

• Find population health data, particularly for Ontario
• Learn who is gathering data in a particular area
• Find statistical evidence to support your work in health equity and the social determinants of health

Population Health Improvement Research Network (2012, June 27). The Ontario Population Health Index of Databases (OPHID).

Retrieved from http://www.rrasp-phirn.ca/index.php?option=com_content&view=article&id=215&Itemid=64&lang=en

Tags: Reporting & measurement

Equity in public health standards: a qualitative document analysis of policies from two Canadian provinces

To understand how health equity is conceptualized in public health systems, this research team analyzed public health documents from British Columbia (BC) and Ontario (ON). The team focused on standards of practice, which many public health organizations are developing or re-visiting as a mechanism for system renewal. The analysis compared the conceptualization and integration of health equity in key documents related to the public health renewal process of each province.

The two provinces’ approaches were similar in key ways:  their understanding of health equity, their focus on reducing health inequities, and their naming of health equity as a goal.  However, the researchers describe different circumstances surrounding each province’s renewal process. For example, conducting an evidence review on equity and using an equity lens during the development of the BC standards appears to have resulted in specific and robust processes to address health inequities. In contrast, the Ontario public health standards were not developed to be legislated, enforceable, or have financial implications for the Boards of Health.

The authors conclude that activities of public health organizations are influenced by how health inequities are understood and described in standards of practice.

This research is part of a Canadian Institutes of Health Research (CIHR) funded project entitled Renewal of Public Health Services in BC and Ontario . The results of this project seek to inform system renewal in BC, ON and Canada. 

Members of the research team presented their work at a Public Health Ontario Round table on September 4, 2012.

Use this resource to:

• Learn how health equity is conceptualized and incorporated into standards for public health organizations in BC and Ontario
• Consider the roles played by public health organizations in addressing health inequities
• Find guidance to incorporate equity considerations into local and regional public health programs and services
• Reflect on how terminology (e.g., “priority populations” vs. “vulnerable populations”), and public health paradigms can influence public health activities

Pinto, A., Manson, H., Pauly, B., Thanos, J., Parks, A., & Cox, A. (2012). Equity in public health standards: a qualitative document analysis of policies from two Canadian provinces. International Journal of Equity in Health, 11(1), 28. doi: 10.1186/1475-9276-11-28

Tags: Competencies and organizational standards

Core Competencies for Public Health in Canada: An Assessment and Comparison of Determinants of Health Content

The explicit inclusion of determinants of health in public health competency statements ensures that action on the determinants is a visible and concrete part of public health practice. This assessment explores how and to what extent the determinants of health are reflected in Core Competencies for Public Health in Canada: Release 1.0, made available by the Public Health Agency of Canada (PHAC) in 2007. The National Collaborating Centre for Determinants of Health reviewed the PHAC document and compared it with four sets of competencies for public health from the United States, United Kingdom, and Australia.

Use this resource to:

• Understand how the determinants of health are reflected in Core Competences for Public Health in Canada: Release 1.0
• Learn how the determinants of health are integrated in public health competencies from other countries
• Discuss how public health competencies support practice to address the determinants of health
• Contribute to the use of competencies and organizational standards as a promising practice to advance health equity
• Explore other competencies and standards relevant to public health practice (e.g., Public health nursing, discipline-specific competencies ; Continuing professional competencies program: Reference guide)

National Collaborating Centre for Determinants of Health. (2012). Core Competencies for Public Health in Canada: An assessment and comparison of determinants of health content.  Antigonish, NS: Author, St. Francis Xavier University.

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

An Inter-sectoral Approach for Improving Health Literacy for Canadians: A discussion paper

 “To be health literate is to be able to access and understand the information required to manage one’s health on a day-to-day basis” (p. 3). According to the Canadian Council on Learning, an estimated 60% of Canadian adults (ages 16 and older) and 88% of seniors (age 65 and older) have limited health literacy. As the population ages and the incidence of chronic disease increases, the financial impact of these statistics is likely to grow. In addition, low health literacy is more common among some population groups: older adults, Aboriginal peoples, recent immigrants, people with lower levels of education and/or low English or French proficiency, and people on social assistance. Improving health literacy for those with the worst health outcomes reduces health inequities.
 

Health literacy is about the abilities of individuals and systems.  The authors challenge service providers of all kinds to offer people accessible, useful, plain-language health information, and to encourage people to be proactive and ask for what they need. This discussion paper presents a comprehensive framework for improving health literacy in Canada, with action recommendations for five key partners—governments, the health sector, the education sector, workplaces and businesses, and community organizations—at the local, provincial/territorial, and national levels. The three components of the framework are 1) develop knowledge about effective ways to improve health literacy, 2) raise awareness and build  the capacity of partners at all levels to support health literacy, and 3) build the infrastructure and partnerships needed to implement the action recommendations.
 

Use this resource to:
 

• Facilitate conversations, and encourage cross-sectoral health literacy initiatives, among practitioners, researchers and policy makers
• Identify priorities for improving health literacy in Canada
• Discuss the applicability of the this framework to your context
• Contribute to research and practice in the area of health literacy by sending your comments and ideas to Dr. Irving Rootman

Public Health Association of British Columbia. (2012). An inter-sectoral approach for improving health literacy for Canadians: A discussion paper. Victoria, BC: Author. Retrieved from http://www.phabc.org/userfiles/file/IntersectoralApproachforHealthLiteracy-FINAL.pdf

Tags: Health literacy, Intersectoral action, Public Health Association

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

This review of Canadian literature assesses the statistical links between health outcomes and four social determinants of health: income, food security, housing, and social exclusion. The authors found 109 studies that met their inclusion criteria, three-quarters of which showed that the incidence of poor health increased as the value of the determinant decreased (negative association).  The review is one of three studies commissioned for the Canadian Nurses Association’s National Expert Commission. 
 

The authors conclude that this evidence presents new opportunities for the nursing profession to expand its role to include advocacy, policy analysis, and political action. The recommendations include policy changes such as increasing minimum wage to a “living wage,” and political action such as supporting campaigns, social movements, and political parties that advocate for progressive taxation.

The appendix includes a table profiling each study by its objectives, design, conceptual definition, groups compared, and findings.
 

Use this resource to
 

• Become familiar with the Canadian empirical literature on the social determinants of health
• Consider policy changes and advocacy aimed at reducing health inequalities by improving income, food security, housing, and social inclusion
• Learn about the work of the Canadian Nurses Association in addressing social inequalities linked with poor health outcomes
   

Muntaner, C., Ng, E., & Chung, H. (2012). 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. Retrieved from Canadian Health Services Research Foundation website: http://www.chsrf.ca/publicationsandresources/ResearchReports/ArticleView/12-06-18/dced281f-7884-4d36-8b0f-a797aa7eec41.aspx
 

Tags: Food security, Income inequity, Intersectoral action, Socioeconomic status

Concepts and Principles for Tackling Social Inequities in Health.  Levelling Up.  Part 1

Between 1992 and 2002, the gap between Europe’s healthiest and least healthy citizens widened, creating challenges for policy makers working for greater social and health equity. The World Health Organization’s Collaborating Centre for Policy Research on Social Determinants of Health asked Whitehead and Dahlgren to revisit ground-breaking work they did in the early 90s to raise awareness and stimulate public debate on the elusive topic of health equity. 

This discussion paper translates complex concepts for non-technical audiences. It describes the difference between “variations in health” and “social inequities in health”; it distinguishes between what equity in health care looks like, versus the look of broader, socially-based health equity.  The authors propose 10 principles for policy action to advance health equity, and in the process clarify key concepts like “social gradient” and “levelling up.”  In principle #2, they present the three main approaches to addressing health inequities‒‒1) focusing only on people in poverty (targeting); 2) focussing on the health of disadvantaged populations relative to that of other groups (narrowing the health divide); and 3) reducing inequities throughout the whole population‒‒and argue that these approaches are interdependent and should be addressed sequentially.  They conclude that “… to make it absolutely clear, … the only way to narrow the health gap in an equitable way is to bring up the level of health of the groups of people who are worse off to that of the groups who are better off. Levelling down is not an option.” (p. 14) 

Use this report to:

• Improve your understanding of key concepts in health equity and how these concepts relate to action
• Explain health inequity to people new to the concept
• Explore core principles that provide a values base for strategies and actions aimed at reducing health inequity

The authors have written a companion document - European strategies for tackling social inequities in health: Levelling up Part 2 (2006) in which they present evidence about the nature and extent of health inequities in Europe, and offer policy options to tackle the problems. 

Whitehead, M. & Dahlgren, G.  (2006). Concepts and principles for tackling social inequities in health: Levelling up part 1. University of Liverpool: WHO Collaborating Centre for Policy Research on Social Determinants of Health. Retrieved from the WHO website: www.who.int/social_determinants/resources/levelling_up_part1.pdf

Tags: Income inequity, Key Concepts

The Ontario Women’s Health Equity Report.  Chapter 13.

The POWER Study  (Project for an Ontario Women’s Health Evidence-based Report), a multi-year investigation of women’s health status, has produced a 13-chapter Ontario Women’s Health Equity Report. The report examines gender differences on a comprehensive set of evidence-based, health-related indicators. 
 

Chapter 13 presents the key lessons from the study and recommends policy directions for improving health equity.  For example, the finding that inequities in health, and a person’s ability to perform normal daily activities, are much larger than inequities in access to and quality of care, argue for focusing on the social determinants of health.  Also, the gender differences found in health outcomes is strong evidence for gender-sensitive solutions. The authors propose redesigning Ontario’s health care system to prioritize 1) upstream interventions that address the social determinants of health; 2) chronic disease prevention and management; 3) patient-centred care; 4) service integration and care coordination; and 5) innovation, learning, and research.
 

The authors propose 27 indicators to monitor health equity, and to guide and evaluate interventions. They also discuss opportunities for improving organizations’ capacity for collecting health equity data. The chapter concludes with a 10-step road map for achieving health equity in Ontario.
 

Use this resource to:

• Learn about the importance of collecting both measurement and monitoring data to inform and support the policy and practice changes needed to improve health equity
• Review a Leading Set of Health Equity Indicators‒in the areas of prevention and population health, chronic disease management, access to care, reproductive health, and the social determinants of health‒that can be used to guide interventions, evaluate their effectiveness, and monitor progress
• Study a 10-point plan designed to lead a province toward greater health equity (also included in Chapter 12)
   

Bierman, A.S., Shack, A.R., Johns, A. for the POWER Study. (2012) Achieving Health Equity in Ontario: Opportunities for Intervention and Improvement. In A. Bierman, (Ed). Project for an Ontario Women’s Health Evidence-Based Report: Volume 2: Toronto. Retrieved from: http://www.powerstudy.ca/the-power-report/the-power-report-volume-2/achieving-health-equity-in-ontario  In French: http://www.powerstudy.ca/l-tude-power/volume-2/r-liser-l-quit-en-mati-re-de-sant-en-ontario
 

Tags: Healthy public policy, Reporting & measurement, Sex & gender

Health Equity Impact Assessment (HEIA) Tool

The Health Equity Impact Assessment (HEIA) Tool was designed to help organizations both inside and outside the health care system predict the impact of their work on the health of Ontarians. The Ontario Ministry of Health and Long-Term Care created the tool to help decision makers amplify the positive impacts and reduce the negative impacts of organizational decisions on health disparities.  Its use can raise awareness of, and capacity for, health equity approaches throughout an organization, by prompting planners to ask questions like, “How can we include more people in this program, especially those often missed?” and “What are the barriers to accessing this service?”

The tool has two components: a workbook that explains the five steps of an HEIA; and a template for users to record the results of each step.  The five steps of the HEIA process are 1) scoping, 2) identifying potential impacts, 3) mitigation, 4) monitoring, and 5) dissemination.

The HEIA tool has a public health unit supplement with special considerations for this group, and a French language supplement for staff with distinct language responsibilities.

Use this resource to

• Help identify possible unintended health equity impacts of decision making (positive and negative) on specific population groups
• Support equity-based improvements in policy, planning, program or service design
• Embed equity in an organization’s decision-making processes, and
• Build capacity and raise awareness about health equity throughout the organization

Ministry of Health and Long-Term Care. (2012). Health Equity Impact Assessment Tool. Toronto, ON: Author. Retrieved from the MOHLTC website: http://www.health.gov.on.ca/en/pro/programs/heia/tool.aspx. In French: http://www.health.gov.on.ca/fr/pro/programs/heia/tool.aspx

Tags: Methods & tools

Early Child Public Health Home Visiting Annotated Bibliography

This bibliography offers brief annotations for 147 articles related to early child development and public health home visiting.  The articles were drawn from 61 peer-reviewed, refereed journals from Canada, Australia, the Netherlands, New Zealand, Sweden, Syria, the United Kingdom, and the United States.  The majority were published between 1993 and 2008, but some older key references are included.  A significant proportion of the literature was produced by Dr. David Olds and colleagues, and describes the work of his Nurse-Family Partnership.

Use this resource to:

• Find articles related to early child development and public health home visiting
• Learn about the research, debate, and contradictions in the early child development and public health home visiting literature

National Collaborating Centre for Determinants of Health. (2008). Early child public health home visiting annotated bibliography.  Antigonish, NS: Author.
 

Tags: Early childhood development, National Collaborating Centre for Determinants of Health

The Ontario Women’s Health Equity Report. Chapter 12: SDOH and Populations at Risk

The POWER Study (Project for an Ontario Women’s Health Evidence-based Report) is a multi-year investigation of women’s health status and has produced a 13-chapter Ontario Women’s Health Equity Report. The report examines gender differences on a comprehensive set of evidence-based, health-related indicators. 

Chapter 12 looks at how low income, education, race/ethnicity and where one lives affect the health of women and men differently. The chapter is divided into three sections: 1) how Ontario women and men compare across a range of determinants of health; 2) how low income women and men compare, looking at the POWER Study indicators from other chapters (health status, risk factors, access to services, and health outcomes); and 3) how immigrant and minority population women and men compare on these same indicators.  In addition, the authors analyse the data for immigrant women using three new indicators: the prevalence of diabetes, cervical cancer screening, and pre-term births.

The chapter concludes with a health equity road map to move Ontario towards greater health equity.

Use this resource to:

• Read a clear and well-referenced summary of the social determinants of health and key indicators
• Learn how to use data from the Canadian Community Health Survey (CCHS), the Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD), and Landed Immigrant Data System (LIDS) to graphically reveal health inequities in other provinces
• Study a ten-point plan designed to lead a province toward greater health equity

Bierman AS, Johns A, Hyndman B, Mitchell C, Degani N, Shack AR, Creatore MI, Lofters AK, Urquia ML, Ahmad F, Khanlou N, Parlette V. Social Determinants of Health and Populations at Risk In: Bierman AS, editor. Project for an Ontario Women’s Health Evidence-Based Report: Volume 2: Toronto; 2012.

Tags: Income inequity, Race, Sex & gender, Socioeconomic status

Population Health Status Reporting:  The Learning Together Series

Increasingly, population health status reports are key evidence in the creation and realignment of public and population health policies.  The resources in this Learning Together series summarize the NCCDH Population Health Status Reporting Initiative, which is working to strengthen the integration of social determinants and health equity in population health status reporting processes. 

The NCCDH is using a learning circle approach to bring together health sector stakeholders from across Canada. Through a series of discussions, demonstrations, and presentations, the learning circle offers advice and skills to support Capital Health in Halifax, the practice hub, as they work to integrate health equity into their first population health status report, to be released in 2013.

Read about the work of this initiative in the following documents:

1. Learning Together: Collaborating to Improve Population Health Status Reporting presents the rationale, objectives and methods of NCCDH’s Public Health Status Report Initiative.
2. Learning Together: A Learning Circle Approach describes how the NCCDH is bringing people together to share evidence and experience, and to support a practice hub that is working to integrate health equity into its first population health status report.
3. Learning Together: What is a Population Health Status Report and Why is it Important? summarizes what population health status reports cover, the challenges in creating them, and the opportunities they offer for improving health equity.
4. Learning Together: Reviewing Evidence on the Purpose of Population Health Status Reports presents the highlights of the March 2012 Learning Circle discussion about the purpose of population health status reporting in Canada, and the evidence supporting its use to increase health equity. 
5. Learning Together: Selecting Population Health Status Indicators to Advance Health Equity summarizes the May 2012 Learning Circle discussion on how indicators are selected.
6. Learning Together: Population Health Status Reporting Ethics and Best Practices for Access and use of External Data synthesizes the discussion at the July 2012 Learning Circle. This meeting focused on the use of data from outside the public health sector for assessing and taking action on the social determinants of health.
7. Learning Together: Representing the Data and Telling the Health Equity Story in Population Health Status Reporting summarizes the October 2012 Learning Circle discussion on effective ways to frame, report, and display data in population health status reports.
8. Learning Together: Knowledge Translation Methods and Tools for Population Health Status Reporting synthesizes the November 2012 Learning Circle discussion on the methods and tools that best support the iterative process of knowledge translation in communicating population health status findings.

Use these resources to:

• Learn about the importance and mechanics of population health status reporting.
• Propose evidence-informed options for integrating health equity indicators into population health status reporting in your organization.
• Discover how to use the learning circle approach to share experience, use evidence, and inform new ventures.

Tags: Reporting & measurement, National Collaborating Centre for Determinants of Health

Colour Coded Health Care: The Impact of Race and Racism on Canadians’ Health

Colour Coded Health Care reviews the Canadian literature (1990-2010) on the impact of race and racism on health. Nestel explores the construct of race, and urges health service providers to move beyond biology and genetics‒which have little bearing on racial differences in health outcomes‒to understanding the social norms and structures that produce unequal healthcare experiences and health outcomes for racialized Canadians. The impact of these norms and structures are revealed in numerous studies: for example, studies found statistically significant associations between people’s self-assessed poor or fair health and their experience or perception of racism.   Other researchers found health care providers unconsciously racialized patients’ explanations by applying cultural or overly-simplified characteristics.  The author emphasizes that racism transcends socioeconomic and educational status in its impact on health, and introduces epidemiologist Nancy Krieger’s six pathways through which racism harms health.

Use this resource to:

• Gain an understanding of the construction of race, and the pathways through which racism impacts health
• Review empirical evidence showing the impact of racism on health conditions such as cardiovascular disease, cancer, occupational and environmental illness, diabetes, mental health, HIV/AIDS, and intimate partner violence
• Learn about the need to disaggregate, or tease apart, data based on race

To download the flip sheet for this document, click here. 

Nestel, S. (2012). Colour coded health care: The impact of race and racism on Canadians’ health. Toronto, ON: Wellesley Institute.  Retrieved from Wellesley Institute website:  http://www.wellesleyinstitute.com/health-care/colour-coded-health-care-the-impact-of-race-and-racism-on-canadians-health/

Tags: Race

Antoinette’s Story: An Introduction to an Early Child Development Model of Care and Post-natal Home

The Total Environment Assessment Model for Early Child Development (TEAM-ECD) is a framework for understanding how the socioeconomic environment is a fundamental determinant of early child development. The model was developed by the Knowledge Network for Early Child Development as part of the WHO Commission on Social Determinants of Health. Antoinette’s Story uses the TEAM-ECD model to guide problem-based learning.

Use this resource to:

• Understand the social determinants of early child development
• To influence practice, policy and programming in this area

MacLeod, A., & Betker, C. (2012). Antoinette’s story: An introduction to an early child development model of care and post-natal home visiting scenario. Vancouver, BC: Human Early Learning Partnership with the National Collaborating Centre for Determinants of Health. Retrieved from http://earlylearning.ubc.ca/media/uploads/publications/hvscenario_final.pdf

Tags: Early childhood development, Socioeconomic status , National Collaborating Centre for Determinants of Health

Scan of Family Literacy and Health: Final Report

A scan of the literature was conducted to answer the research question, “Does family literacy have a measurable outcome impact on health?” The purpose of the scan was to identify resources and literature for the development of a training module on family literacy and health, a joint venture of the NCCDH and the Centre for Family Literacy (Edmonton, AB). The findings indicate limited research on the topic has been conducted in Canada, and therefore most of the resources described in the report are from the United States. 

Use this resource to:

• Become familiar with the literature that describes how family literacy influences health
• Identify topics for future Canadian research
• Evaluate current family literacy programs

National Collaborating Centre for Determinants of Health. (2007). Scan of family literacy and health: Final report. Antigonish: NS: Author.

Tags: Health literacy, National Collaborating Centre for Determinants of Health

Pan-Canadian Inventory of Public Health Early Child Home Visiting

This document summarizes the key facts and terms of a pan- Canadian environmental scan conducted by the NCCDH on public health early child home visiting programs.
 

The purposes of the environmental scan were to:

• Identify the provincial/territorial similarities and differences in public health early child home visiting programs across Canada
• Illuminate the evidence that early child home visiting improves the health equity and health outcomes of children and their families

This summary provides insight on topics such as: key practitioners involved, preferred curricula used to guide practice, professional development practices, evidence-informed screening and assessment tools, evaluation, and how the social determinants of health are incorporated within Canadian programs.

Use this resource to:

• Gain insight into the status of Canadian early child home visiting programs
• To become familiar with the terms frequently used in this context

National Collaborating Centre for Determinants of Health. (2009). Pan-Canadian inventory of public health early child home visiting: Key facts and glossary. Antigonish: NS: Author.

Tags: Early childhood development, National Collaborating Centre for Determinants of Health

Beyond Descriptions: Fostering Action to Improve Social Determinants of Health

This video presentation is part of the Health Promotion Seminar Series offered by de Souza Institute and the Community Health Nurses Initiatives Group (CHNIG) of the Registered Nurses' Association of Ontario. Connie Clement  describes 10 principles for action on how public health and other community nurses can improve social determinants of health and advance health equity.

Use this resource to:

• Learn about the social determinants of health and health equity
• Guide public health action to advance health equity
   

Clement, C. (2012).  Beyond descriptions: Fostering action to improve social determinants of health. Health Promotion Seminar Series: de Souza Institute and the Community Health Nurses Initiatives Group (CHNIG) of the Registered Nurses' Association of Ontario. Available from http://www.chnig.org/Resources/78/76

Tags: Key Concepts

10 Promising Practices to Guide Local Public Health Practice to Reduce Social Inequities in Health

The reports describe the process and findings of the Sudbury & District Health Unit (SDHU) Canadian Health Services Research Foundation (CHSRF) Executive Training for Research Application (EXTRA) Fellowship. The project sought evidence to guide the health unit to orient programs and services to reduce social inequities in health. Through an extensive literature review process, the project identified 10 local public health practices that have potential to reduce social inequities in health.

The technical report (2011) summarizes the 10 practices: 1) Targeting with universalism, 2) Purposeful reporting, 3) Social marketing, 4) Health equity target setting/goals, 5) Equity-focused health impact assessment, 6) Competencies/organizational standards, 7) Contribution to evidence base, 8) Early childhood development, 9) Community engagement, and 10) Intersectoral action. These practices have also been presented with related tools and resources in a series of fact sheets, designed for public health practitioners and community partners.

The full report (2010) describes the full methodology of the literature synthesis and provides details about the project.

The progress report (2009) describes early results of the project and explains how the group prioritized health unit initiatives.

Use these resources to:

• Guide local public health action in orienting programs and services to reduce social health inequities.
• Learn about the evidence supporting local public health action to reduce health inequities.

Sudbury & District Health Unit. (2011). 10 promising practices to guide local public health practice to reduce social inequities in health: Technical briefing. Sudbury, ON: Author. Retrieved from http://www.sdhu.com/uploads/content/listings/10PromisingPractices.pdf

Sutcliffe, P., Snelling, S., & Laclé, S. (2010). Intervention project final report: Implementing local public health practices to reduce social inequities in health. Sudbury, ON: Author. Retrieved from http://www.sdhu.com/uploads/content/listings/FINALIPPRSDHUMay2010.pdf

Sutcliffe, P., Snelling, S., & Laclé, S. (2009). Intervention project progress report 2: Research-oriented decision-making to guide local public health practice to reduce social inequities in health. Sudbury, ON: Author. Retrieved from http://www.sdhu.com/uploads/content/listings/EXTRAProgressReport2SDHUJuly2009_External.pdf

Documents available at: http://www.sdhu.com/content/healthy_living/doc.asp?folder=3225&parent=3225&lang=0&doc=11759  

Tags: Competencies and organizational standards , Early childhood development, Intersectoral action, Key Concepts, Reporting & measurement

Assessing the impact and effectiveness of intersectoral action on the social determinants of health

This expedited systematic review is part of the NCCDH’s effort to explores “what works” to improve health equity through action on the social determinants of health. The purpose of the review is to examine the question, “What is the impact and effectiveness of intersectoral action as a public health practice for health equity through action on the social determinants of health?”

Use this resource to:

• Gain an understanding of how public health works with other sectors to intervene on the social determinants of health and advance health equity.
• Become familiar with the current state of research evidence on the impact of intersectoral action on health equity  
• Identify research gaps and opportunities to strengthen the evidence base for intersectoral action on health equity and the social determinants of health

A summary statement of the report findings is available here.

“Health-evidence.ca has rated this review as methodologically strong. A summary of their quality assessment is available here.”

National Collaborating Centre for Determinants of Health. (2012). Assessing the impact and effectiveness of intersectoral action on the social determinants of health and health equity: An expedited systematic review. Antigonish, NS: Author.

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

Stepping It Up: Moving the Focus from Health Care in Canada to a Healthier Canada

The report summarizes key informant perspectives and experiences of intersectoral and whole-of-government approaches in Canada. The pre-conditions and factors that support the launch and success of such approaches are describe, including leadership, creation of a business case, and community engagement. The authors encourage collaborative intersectoral work and recommend policy action that alters the determinants of health to improve health equity. A useful checklist on page 25 synthesizes key pieces of information from the report.

Use this resource to:

• Learn how whole-of-government and intersectoral initiatives have been initiated and sustained in Canada
• Inform intersectoral partners about the importance of a population health approach to address the determinants of health
• Find out about ongoing efforts to reduce health inequities at federal and provincial levels in Canada (see Appendices)

Health Council of Canada. (2010). Stepping It up: Moving the focus from health care in Canada to a healthier Canada. Toronto, ON: Author. Retrieved from  www.healthcouncilcanada.ca

Tags: Community engagement, Intersectoral action, Public health leadership

Social Inequalities in Health in Montréal 2011: Progress to Date

This report highlights population health changes over a decade in Montreal. It focuses specifically on changes in health inequalities and discusses the impact of local interventions.  Evidence and recommendations are presented on a range of public health areas including early childhood interventions (e.g. breastfeeding, daycare policies), occupational health, access to services, housing, motor vehicles accidents and social determinants, nutrition, and neighbourhood design. The report closes with recommendations for public health and other sectors.

Use this resource to:

• Inform the development of policies, programs, and practices to improve health equity
• Identify potential indicators for health inequalities
• Identify actions which can be taken by public health and intersectoral partners

Le Blanc, M. F., Raynault, M. F., & Lessard, R. (2011). Report of the director of public health. Social inequalities in health in Montréal. Progress to date. Montréal, Quebec: Direction de santé publique de Montréal. Retrieved from http://www.dsp.santemontreal.qc.ca/espace_du_directeur/rubriques/le_directeur_et_son_mandat/rapports_sur_la_sante_de_la_population.html
 

Tags: Access to health services, Early childhood development, Environmental health, Food security

Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada

Using literature review and original data analysis this report investigates the relationship between health and socio-economic status (SES) in urban Canada and explores the associated costs. The original data analysis assesses the relationship between SES and health in 15 of Canada’s census metropolitan areas (CMAs). The assessment examines health service use and self-reported health status through stratification of low- , average-, and high-SES areas profiling differences within and across the 15 CMAs. The final section of the report discusses improving the evidence base for the development of actionable interventions to improve population health and reduce gaps in health linked to SES.

Use this resource to:

• Increase knowledge about SES and health in urban Canada
• Support the generation of solutions to address gaps in SES and health
• Learn about examples of universal and targeted policies and programs aimed at reducing SES gap in health in Canada and internationally 

Canadian Institute for Health Information. (2008). Reducing gaps in health: A focus on socio-economic status in urban Canada. Ottawa, ON: CIHI. Retrieved from https://secure.cihi.ca/free_products/Reducing_Gaps_in_Health_Report_EN_081009.pdf

Tags: Socioeconomic status

What are the Social Determinants of Health?

This factsheet describes the social determinants of health and references useful resources for public health practitioners and organizations.

Use this resource to:

• Learn about the social determinants of health.
• Spark discussion on health equity and public health practice in Canada.

National Collaborating Centers for Public Health & National Collaborating Centre for Determinants of Health. (2012). What are the social determinants of health? Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Key Concepts, National Collaborating Centre for Determinants of Health

Reducing Health Inequalities: A Challenge for our Times

Reducing Health Inequalities: A Challenge for our Times explains what health inequalities are and includes a glossary of relevant terms. It discusses what causes health inequalities and how they interact with the personal, social, economic and environmental determinants of health. It presents ‘snapshots’ of the five most vulnerable groups in Canada, and concludes with details about the Public Health Agency of Canada’s actions to reduce health inequalities.

Use this resource to:

• Gain greater understanding about health inequalities and how they affect vulnerable groups in Canada
•  Identify opportunities to support public health action to reduce health inequalities
• Access a glossary of terms relevant to the social determinants of health

Public Health Agency of Canada. (2011). Reducing health inequalities: A challenge for our times. Ottawa, ON: Author. Retrieved from http://publications.gc.ca/collections/collection_2012/aspc-phac/HP35-22-2011-eng.pdf
 

Tags: Key Concepts

Environmental Scan of School Readiness for Health

This environmental scan is a broad review of the scientific and gray literature pertaining to school readiness among young children. Using an ecological lens, the scan explored school readiness from a health perspective. The document includes descriptions of current monitoring systems used in Canada to assess factors related to school readiness among children. Evidence-informed interventions and promising practices for improving outcomes related to school readiness are also identified.
 

Use this resource to:

• Become more familiar with the assessment of school readiness as an early childhood development health outcome
•  Learn which interventions and promising practices are most effective at improving school readiness among children
   

Pivik, J. (2012). Environmental scan of school readiness for health: Definitions, determinants, indicators and interventions. Vancouver, BC: Human Early Learning Partnership with the National Collaborating Centre for Determinants of Health. 

Tags: Early childhood development, Reporting & measurement, National Collaborating Centre for Determinants of Health

Bridging the Gap between Research and Practice: Methodology for Case Study Development

This resource describes the methodology used to development a series of four case studies profiling public health action on the social determinants of health. The case studies were originally incorporated into a workshop hosted by the National Collaborating Centre for Determinants of Health and the Canadian Institutes of Health Research-Institute of Population and Public Health in Toronto, Ontario on February 14-15, 2012. For more information about this workshop, please refer to the event proceedings and highlights. 

National Collaborating Centre for Determinants of Health. (2012). Bridging the gap between research and practice: Methodology for case study development. Antigonish, NS: Author. 

Tags: Methods & tools, Research, National Collaborating Centre for Determinants of Health

Researcher-Practitioner Health Equity Workshop: Bridging the Gap - Proceedings & Highlights

The Canadian Institutes of Health Research-Institute of Population and Public Health (CIHR-IPPH), the National Collaborating Centre for Determinants of Health (NCCDH), and its partners hosted The Research-Practitioner Health Equity Workshop: Bridging the Gap that took place in Toronto on February 14-15, 2012. The purpose of the workshop was to strengthen relationships between researchers and practitioners to address health inequities. Descriptions of the presentations and discussions that took place during the workshop are included in this document.

Click here to download the Researcher-Practitioner Health Equity Workshop: Bridging the Gap – Proceedings

Click here to download the Researcher-Practitioner Health Equity Workshop: Bridging the Gap – Highlights

National Collaborating Centre for Determinants of Health & Canadian Institutes of Health Research-Institute of Population and Public Health. (2012). Researcher-practitioner health equity workshop: Bridging the gap- proceedings. Antigonish, NS: Author.

Tags: Knowledge translation , National Collaborating Centre for Determinants of Health

Making the Case for Health Equity: Winnipeg’s Experience

The NCCDH produced a series of case studies that profile action on the social determinants of health in various setting. The cases are designed to help public health practitioners in a range of settings advance health equity within the scope of their practice.

Public health leaders took advantage of relevant, local and comparative health data – and a possible media interest – to focus regional managers’ attention on the health of people from Winnipeg’s poorest neighbourhoods. They were turning up in city hospitals at two or three – sometimes even five – times the rate of the city’s wealthiest residents. The data provided a catalyst for action that now involves managers from all areas of the health region and is strengthening ties with anti-poverty and other community organizations. Their approach casts a health equity lens over all aspects of the Winnipeg Regional Health Authority, including health services delivery and long-term care.

Use this resource to:

• Use local data to build a case for health equity issues.
• Gain the support of senior health managers on health equity initiatives.
• Find and nurture health equity champions, both internally and externally.
• Create links between evidence on health equity and existing health priorities.
• Support and build on the work of existing community partners.
• Build and maintain motivation.

For more information, download this case study, a related presentation, and a summary of the case study methods.

National Collaborating Centre for Determinants of Health. (2012). Making the case for health equity: Winnipeg’s experience. Antigonish, NS: Author.

Tags: Income inequity, Reporting & measurement, National Collaborating Centre for Determinants of Health

Improving Health in Saskatoon: From Data to Action

The NCCDH produced a series of case studies that profile action on the social determinants of health in various setting. The cases are designed to help public health practitioners in a range of settings advance health equity within the scope of their practice.

Detailed health information at the neighbourhood level in Saskatoon showed that data averaging was hiding serious health differences among city residents. People in the lowest income areas were many times more likely than their wealthier neighbours to be hospitalized, give birth while in their teens, or have an infant die in its first year of life. Dr. Cory Neudorf, Saskatoon’s Chief Medical Health Officer, used the data as a rallying point to engage citizens, community organizations, municipal departments and other levels of government to work together to address health inequities.

Use this resource to:

• Learn how to use local data to present health equity issues.
• Gain the support of citizens in health equity initiatives.
• Work effectively with a large number of community partners.
• Successfully communicate health equity issues to the public and the media.

For more information, download this case study, a related presentation, and a summary of the case study methods.

Other related links:

• From Poverty to Possibility… and Prosperity

National Collaborating Centre for Determinants of Health. (2012). Bridging the gap between research and practice: Improving health equity in Saskatoon: From data to action. Antigonish, NS: Author.

Tags: Community engagement, Income inequity, Intersectoral action, Reporting & measurement, National Collaborating Centre for Determinants of Health

Empower the Community: New Brunswick’s Approach to Overcoming Poverty

The NCCDH produced a series of case studies that profile action on the social determinants of health in various setting. The cases are designed to help public health practitioners in a range of settings advance health equity within the scope of their practice.

“Overcoming Poverty Together: The New Brunswick Economic and Social Inclusion Plan”, empowers communities to address poverty. Over 2500 New Brunswick residents contributed to the development of the plan, and were invited to join one of 12 Community Inclusion Networks across the province.  The plan is being implemented by engaging leaders and volunteers to identify community issues, and build momentum toward long-term solutions. This is a new approach that requires excellent collaboration among local organizations, and connections to relevant research to ensure that plans are based on the best possible evidence.

Use this resource to:

• Develop or support existing community-driven coalitions for poverty reduction
• Build on the knowledge inherent in communities
• Find and incorporate local research sources into planning, in the absence of formal research links
• Overcome challenges associated with community poverty reduction approaches, including the role of public health to ‘lead from behind’

For more information, download this case study, a related presentation, and a summary of the case study methods.

National Collaborating Centre for Determinants of Health. (2012). Bridging the gap between research and practice: Empower the community-New Brunswick’s approach to overcoming poverty. Antigonish, NS: Author.

Tags: Community engagement, Income inequity, National Collaborating Centre for Determinants of Health

Capitalizing on Change: Building Leadership Competency in Public Health in Quebec

The NCCDH produced a series of case studies that profile action on the social determinants of health in various setting. The cases are designed to help public health practitioners in a range of settings advance health equity within the scope of their practice.

Extensive changes to the health structure in Québec meant that public health risked being lost in the shuffle. Legislation in November 2005 merged public health services, traditionally provided through community service locations, into regional centres that included long-term care facilities and hospitals. Seizing the opportunity, Dr. Jocelyne Sauvé, Public Health Director for the region of La Montérégie, developed a detailed training program to embed a population health approach in the new managers, many of whom had little or no experience in public health. Her program was a resounding success, and is now being implemented province-wide, instilling a population-health perspective into all health service delivery.

Use this resource to:

• Develop leadership in public health and health equity.
• Make inroads into health care by capitalizing on public health successes.
• Make ‘systems change’ by building health equity into planning and performance indicators.

For more information, download this case study, a related presentation, and a summary of the case study methods.

National Collaborating Centre for Determinants of Health. (2012). Bridging the gap between research and practice: Building leadership competency in public health - Taking advantage of changes in health delivery in Québec. Antigonish, NS: Author.

Tags: Public health leadership , National Collaborating Centre for Determinants of Health

Integrating Social Determinants of Health and Health Equity Into Canadian Public Health Practice

This is a summary of Integrating Social Determinants of Health and Health Equity Into Canadian Public Health Practice: Environmental Scan 2010. The complete document is available here.
 

Tags:

Making Sense of it All: Conducting KSTE with Canadian Public Health

Participants in this event were representatives and stakeholders from the six National Collaborating Centres, and the Public Health Agency of Canada and key researchers, practitioners and policymakers. The conference involved discussions of the challenges and opportunities for knowledge synthesis, translation and exchange (KSTE) within public health in Canada, how to create change in programs and policies and what is considered evidence and how it can be applied. This report includes detailed overviews on the presentations and discussions that took place at the conference and includes ideas on how to increase and improve KSTE.
 

Use this resource to:

• Learn about knowledge synthesis, translation and exchange in the context of public health in Canada
• Reflect on the mandate, history, and progress of the National Collaborating Centres of Public Health Program

National Collaborating Centre for Determinants of Health. (2007). A report on the NCC’s 2nd annual summer institute: Making sense of it all: Conducting KSTE with Canadian public health. Antigonish, NS: Author.
 

Tags: Knowledge translation , National Collaborating Centre for Determinants of Health

Exploring the Contribution of Public Health Early Child Home Visiting

More than 125 participants from across Canada attended the NCCDH and NCCAH Early Child Development Forum in October of 2008. Participants, including frontline providers, policy and program planners, senior government officials, academics, and researchers, came together to share knowledge and experiences about the contribution of early child development to long-term health. The purpose of the forum was to profile selected home visiting programs, explore experiential knowledge from stories and to identify and prioritize policy and practice issues that could be addressed. Nine priority issues were identified by the forum participants and the NCCDH and NCCAH committed to addressing these issues.
 

Use this resource to:

• Learn about Canadian home visiting programs and explore the relationship between home visiting and health equity
• Explore knowledge from stories and scenarios to help apply “what works” to improve policy and practice
   

National Collaborating Centre for Determinants of Health & National Collaborating Centre for Aboriginal Health. (2008). A report on the proceedings of the early child development forum: Exploring the contribution of public health early child home visiting. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
 

Tags: Early childhood development, National Collaborating Centre for Determinants of Health

The Influence of Socio-economic Status and Ethno-racial Status on the Health of Young Children

This review discusses the research literature on the health impacts of low socio-economic status (SES) and the impact of ethno-racial status on child and family health. The document also describes the gaps in the research literature pertaining to the health impacts of poverty among Canadian children from ethno-cultural groups and how public policy has a role in addressing child poverty.
 

Use this resource to:

• Gain knowledge about the health impacts of low SES and ethno-racial status among young children and their families
• Identify research gaps and implications for public health policy and practice 

National Collaborating Centre for Determinants of Health. (2008). The influence of socio-economic status and ethno-racial status on the health of young children and their families. Antigonish, NS: Author.
 

Tags: Early childhood development, Healthy public policy, Race, Socioeconomic status , National Collaborating Centre for Determinants of Health

Adult Working Group: Cross-national Consultations on Health and Learning

The Report of The Adult Working Group, part of the Canadian Council of Learning, provides information on consultations in Vancouver, Regina, Toronto, Montreal and Nova Scotia in 2006- 2007. The consultations with individuals with low literacy skills, immigrants, and refugees and service providers who work with these groups were intended to identify themes, gaps, and needs related to health and learning among these target groups. The feedback was used by the Adult Working Group to develop a list of research and knowledge dissemination and mobilization priorities to better address health literacy issues experienced by vulnerable individuals in Canada.

Use this resource to:

• Gain insight into the experiences of those with low literacy skills and immigrants and refugees regarding access to health services and maintaining their heath
• Learn which strategies for improved learning and systemic changes to increase health outcomes were identified during the consultations
• Learn which research and knowledge dissemination and mobilization priorities were identified by the Adult Working Group (Canadian Council of Learning)

Adult Working Group. (2007). Adult working group: Cross-national consultations on health and learning. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
 

Tags: Health literacy, National Collaborating Centre for Determinants of Health

Working Poor Project, Sudbury and District Health Unit: A Case Study

This report presents interviews with key informants and low-wage workers, examining data from the 2001 census and the Canadian Community Health Survey (2000/2001). It includes a review of the research literature initiatives for the working poor.

Use this resource to:

•  Gain knowledge about issues related to the working poor identified by workers and key informants
•  Learn about the recommendations made by the Steering Committee to address the issues associated with the working poor

National Collaborating Centre for Determinants of Health. (2008). Using a social inequity lens in public health: Working poor project, Sudbury and district health unit: A case study. Antigonish, NS: Author.

Tags: Income inequity, National Collaborating Centre for Determinants of Health

Discussion Paper: Public Health Early Child Home Visiting Forum

This discussion paper describes the work completed by the NCCDH which focused on early child home visiting and health outcomes/health equity. It includes a description of an environmental scan, themes derived from an inventory of programs and an annotated bibliography.

Use this resource to:

• Learn about how public health early child visiting programs contribute to health outcomes and health equity
• Reflect and discuss the issues and benefits of early child visiting programs

National Collaborating Centre for Determinants of Health. (2008). Discussion paper: Public health early child home visiting forum. Antigonish, NS: Author.

Tags: Early childhood development, National Collaborating Centre for Determinants of Health

Health for all?  A Critical Analysis of Public Health Policies in Eight European Countries

Published by the Swedish National Institute of Public Health, this critical analysis explores health equity concepts in relation to eight European countries.  The context, content, and effects of public health policies in Denmark, England, Finland, Italy, The Netherlands, Norway, Spain, and Sweden are considered throughout the resource.  A comparative analysis of health equity trends in European public health policy is also included. 

Use this resource to:

• Learn about how health equity is conceptualized, measured, and translated into public health policy and practice in Europe

Hogstedt, C., Moberg, H., Lundgren, B., & Backhans, M. (2008). Health for all? A critical analysis of public health policies in eight European countries. Östersund: Swedish National Institute of Public Health. Retrieved from http://www.fhi.se/en/Publications/All-publications-in-english/Health-for-all/
 

Tags: Healthy public policy

Early Child Development: A Powerful Equalizer

This knowledge synthesis report, submitted to the World Health Organization’s Commission on the Social Determinants of Health, emphasizes that in most situations, parents and caregivers cannot provide strong nurturant environments without help from local, regional, national, and international agencies. The authors propose ways in which government and civil society actors, from local to international, can work in concert with families to provide equitable access to strong nurturant environments for all children globally.

Use this resource to:

• Increase your knowledge about opportunities to intervene and improve the state of early childhood development
• Learn about the Total Environment Assessment Model of Early Child Development (TEAM-ECD)

Irwin, L. G., Siddiqi, A., & Hertzman, C. (2007).  Early child development: A powerful equalizer final report for the world health organization’s commission on the social determinants of health. Retrieved from World Health Organization website: http://www.who.int/social_determinants/themes/earlychilddevelopment/en/index.html

Tags: Early childhood development

An Integrated Model of Population Health and Health Promotion

This model integrates the determinants of health with the Ottawa Charter actions and levels of intervention.

Hamilton, N., & Bhatti, T. (1996). Population health promotion: an integrated model of population health and health promotion. Retrieved from Public Health Agency of Canada website: http://www.phac-aspc.gc.ca/ph-sp/php-psp/index-eng.php

Tags: Key Concepts, Public Health Agency of Canada

The Population Health Template

This resource is only available in draft form.

This planning framework incorporates measuring population health status, analyzing health determinants, evidence-based decision making, increasing upstream investments, multiple strategies, public involvement and intersectoral collaboration.

Use this resource to:

• Guide policy and program development so as to reflect a population health approach
• Assess preparedness and capacity to implement population health initiatives

Health Canada. (2001). Population health template: key elements and actions that define a population health approach: July 2001 draft. Ottawa, ON: Author. Retrieved from  http://www.phac-aspc.gc.ca/ph-sp/pdf/discussion-eng.pdf

Tags: Intersectoral action, Methods & tools, Key Historical Documents

Toward a Healthy Future: Second Report on the Health of Canadians

This follow-up report for the Federal, Provincial and Territorial Ministers of Health further describes the influence of health determinants on the health of Canadians including inequities.

Use this resource to:

• Gain a better understanding of the history of public health in Canada
• Learn about population health trends in Canada leading up to 1999

Federal Provincial and Territorial Advisory Committee on Population Health. (1999). Toward a healthy future: second report on the health of Canadians. Ottawa, ON: Minister of Public Works and Government Services Canada. Retrieved from http://www.phac-aspc.gc.ca/ph-sp/report-rapport/toward/pdf/toward_a_healthy_english.PDF

Tags: Key Concepts, Key Historical Documents

Report on the Health of Canadians

Prepared for the Federal, Provincial and Territorial Ministers of Health, this report illustrates how population health is not equally shared across Canada and how health inequalities can be reduced by addressing living and working conditions; the physical environment; personal health practices and coping skills; and, health services.

Use this resource to:

• Gain a better understanding of the history of public health in Canada
• Learn about population health trends in Canada in the decades leading up to 1996

Federal Provincial and Territorial Advisory Committee on Population Health. (1996). Report on the health of Canadians. Ottawa, ON: Health Canada. Retrieved from  http://publications.gc.ca/collections/Collection/H39-385-1996-1E.pdf

Tags: Key Concepts, Key Historical Documents

Achieving Health for All: A Framework for Health Promotion

Published while Jake Epp was Minister of National Health and Welfare, this paper focused on reducing the inequities in the health of low income groups. The paper offers implementation strategies encouraging public participation, strengthening community services, and coordinating healthy public policy.

Use this resource to:

• Gain a better understanding of Canada’s historic contributions to health promotion and global public health
• Reflect on the Canadian public health context

 Epp, J. (1986). Achieving health for all: a framework for health promotion. Ottawa, ON: Health and Welfare Canada. Retrieved from Health Canada website: http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/1986-frame-plan-promotion/index-eng.php

Tags: Income inequity, Key Historical Documents

Ottawa Charter for Health Promotion

The Ottawa Charter is a global health milestone, and remains a vital reference for health promotion. The Charter identifies five components of health promotion action and prerequisites for health, including peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity.

Use this resource to:

• Gain a better understanding of Canada’s historic contributions to health promotion and global public health
• Reflect on the Canadian public health context
• Support the development of policy, programs, and practice to promote health equity

World Health Organization (1986). Ottawa charter for health promotion. Retrieved from World Health Organization website: http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf

Tags: Critical works in health equity, Key Concepts, Key Historical Documents

A New Perspective on the Health of Canadians

The Lalonde Report was published while Marc Lalonde was Canada’s Minister of National Health and Welfare, and had a transformative effect on the way world thinks about health. It remains one of the founding documents of health promotion. The report outlines a conceptual framework for a holistic understanding of health as an outcome of human biology, environment, lifestyle, and health care organization. The Public Health Agency of Canada describes it as “a cornerstone of Canada's international reputation and a proud historical achievement in the health field.”

Use this resource to:

• Gain a better understanding of Canada’s historic contributions to health promotion and global public health
• Reflect on Canadian public health context
   

Lalonde, M. (1974). A new perspective on the health of Canadians. Ottawa, ON: Minister of Supply and Services Canada. Retrieved from Public Health Agency of Canada website: http://www.phac-aspc.gc.ca/ph-sp/pdf/perspect-eng.pdf

Tags: Critical works in health equity, Key Historical Documents

Reducing Health Disparities – Roles of the Health Sector

Reducing Health Disparities – Roles of the Health Sector focuses on the role of health services in addressing health disparities in Canada by providing insight on their causes and costs. The paper discusses the significance of health disparities, and provides a recent history of Canadian efforts, options, and best practices, and key opportunities for reducing disparities. 

Use this resource to:

• Increase knowledge about health disparities in Canada
• Learn about with the role of the Health Disparities Task Group of the Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security

Federal Provincial and Territorial Advisory Committee on Population Health and Health Security. (2005). Reducing health disparities - Roles of the health sector: Discussion paper. Ottawa, ON: Public Health Agency of Canada. Retrieved from  http://www.phac-aspc.gc.ca/ph-sp/disparities/pdf06/disparities_discussion_paper_e.pdf

Tags: Key Concepts

Population Health Policy: Issues and Options

Population Health Policy: Issues and Options offers an introductory discussion of population health, the determinants of health, the impact and scale of health disparities of Canada.  It also provides a rationale for government implementation of population health policy, and presents relevant policy options.

Use this resource to:

• Learn about the recommendations of the Senate Committee on Social Affairs, Science and Technology for improving population health policy
• Identify opportunities to improve population health, reorient government policy, implement an Aboriginal population health strategy, and foster political will 

Subcommittee on Population Health of the Standing Senate Committee on Social Affairs, Science and Technology. (2008). Population health policy: issues and options. Ottawa, ON: Senate of Canada. Retrieved from http://www.parl.gc.ca/Content/SEN/Committee/392/soci/rep/rep10apr08-e.pdf

Tags: Healthy public policy

Healthy People, Healthy Performance, Healthy Profits

This report compiled for The Conference Board of Canada provides both health and economic arguments to support action on health determinants. Recommendations are outlined for both business and government action to support action on health determinants.

Use this resource to:

• Learn about the work of the Conference Board of Canada’s Roundtable on Socio-Economic Determinants of Health
• Inform a business case for action on the socio-economic determinants of health

Munro, D. (2008). Healthy people, healthy performance, healthy profits: the case for business action on the socioeconomic determinants of health. Ottawa, ON: Conference Board of Canada. Retrieved from  www.conferenceboard.ca/Libraries/NETWORK_PUBLIC/dec2008_report_healthypeople.sflb

Tags: Socioeconomic status

Closing the Gap in a Generation

Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health is the final report of the WHO Commission on Social Determinants of Health. The evidence reviewed demonstrates that health is determined in large part by the political, social, and economic forces that shape the conditions in which they grow, live, work, and age. The report argues that avoidable health inequalities are unjust, and provides three overarching recommendations to improve health equity: 1) improve daily living conditions; 2) tackle the inequitable distribution of power, money, and resources; and 3) measure and understand the problem and assess the impact of action. 

Use this resource to:

• Reflect on the overarching recommendations and principles of action offered by the WHO Commission on Social Determinants of Health
• Inform the development of policies, programs, and practices to improve health equity

Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Retrieved from World Health Organization website: http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf

Tags: Key Concepts

Closing the Gap: Policy into Practice on Social Determinants of Health

This discussion paper informed the proceedings at the 2011 World Conference on Social Determinants of Health, in Rio de Janeiro, Brazil. The paper outlines key priorities for all countries to integrate as they advance health equity through action on the social determinants of health.

Use this resource to:

• Reflect on the overarching recommendations and principles of action offered by the WHO Commission on  Social Determinants of Health
• Inform the development of policies, programs, and practices to improve health equity

World Health Organization. (2011). Closing the gap: Policy into practice on social determinants of health: Discussion paper. Retrieved from World Health Organization website: http://www.who.int/sdhconference/Discussion-Paper-EN.pdf

Tags: Key Concepts

Social Determinants of Health: The Canadian Facts

Social Determinants of Health: The Canadian Facts provides an introduction to the social determinants of health in Canada, outlining why they are important and what can be done to improve their quality. The authors provide illustrative data, discuss implications for healthy public policy, and offer recommendations for action to improve population health.  

Use this resource to:

• Learn more about the social determinants of health in Canada
• Facilitate discussion on the importance of public action to motivate social change

Mikkonen, J., & Raphael, D. (2010). Social determinants of health: The Canadian facts. Toronto, ON: York University School of Health Policy and Management. Retrieved from  http://www.thecanadianfacts.org/

Tags: Key Concepts

Public Health Observatories: Learning From Our World Neighbours

Public Health Observatories: Learning From Our World Neighbours explores the system of public health surveillance established in the United Kingdom, and discusses the development of similar systems within Canada.  The report is based on a visit by a Canadian delegation to the “Health Observatories: Learning from Our World Neighbours, 2008” meetings hosted by the London Health Observatory. 

Use this resource to:

• Learn about the United Kingdom’s system of public health observatories
• Learn about recent efforts to adapt and apply similar models of public health surveillance in Canada

National Collaborating Centre for Determinants of Health. (2011). Public health observatories: Learning from our world neighbours. Antigonish, NS: Author.
 

Tags: Reporting & measurement, National Collaborating Centre for Determinants of Health

Integrating Social Determinants of Health and Health Equity Into Canadian Public Health Practice

Integrating Social Determinants of Health and Health Equity Into Canadian Public Health Practice is an environmental scan that analyzes literature and expert opinion and proposes key roles for public health practitioners and organizations to advance health equity. This environmental scan included a focused scan of the literature; key informant interviews with practice and research experts; focus group teleconferences to validate early emerging themes; and, an online survey with over 600 respondents.

Use this resource to:

• Gain insight into the integration of social determinants of health in policy and programs in Canada
• Increase awareness about knowledge and service gaps that influence the ability to advance health equity in Canada
• Learn more about the priorities, activities, and overall strategic direction of the National Collaborating Centre for Determinants of Health

National Collaborating Centre for Determinants of Health. (2011). Integrating social determinants of health and health equity into Canadian public health practice: Environmental scan 2010. Antigonish, NS: Author.

Tags: Knowledge translation , Program planning, National Collaborating Centre for Determinants of Health, Document

Population Health Intervention Research Casebook

The Population Health Intervention Research Casebook presents eight Canadian case studies. Summarized from the perspective of the research teams, the cases describe strategies to address structural conditions affecting health and health inequities. This resource explores how research question(s) arose, how partners were involved, how local context shaped the interventions, and how challenges in scaling up and sustaining interventions were addressed. Expert commentary is provided by Penny Hawe, Founding Director of the Population Health Intervention Research Centre, and Ted Bruce, Executive Director of Population Health at Vancouver Coastal Health.

Use this resource to:

• Learn about population health intervention research
• Stimulate discussion about intersectoral and community-based interventions to advance health equity
• Apply lessons from Canadian experiences to your own public health practice

Canadian Institutes of Health Research - Institute of Population and Public Health, Canadian Institute for Health Information - Canadian Population Health Initiative. (2011). Population health intervention research casebook. Retrieved from  http://secure.cihi.ca/cihiweb/products/ipph_casebook_2011_en.pdf

Tags: Intersectoral action, Methods & tools, Research

Health Disparity in Saskatoon: Analysis to Intervention

This report describes the distribution and the determinants of health disparities in Saskatoon, and demonstrates that health disparity is mostly preventable.  The resource presents evidence from other jurisdictions and recommends public policy options for reducing health disparities and improving population health. 

Use this resource to:

• Increase knowledge of determinants of health in Saskatoon
• Design population health status reports with a health equity focus
• Identify evidence-informed public policy options for reducing health inequities

Lemstra, M., & Neudorf, C. (2008). Health disparity in Saskatoon: analysis to intervention. Retrieved from Saskatoon Health Region website: http://www.saskatoonhealthregion.ca/your_health/documents/PHO/HealthDisparityRept-complete.pdf

Tags: Reporting & measurement

A Developmental Evaluation Primer

The Developmental Evaluation Primer introduces the concept of developmental evaluation and provides tools to support its use. The primer is based on collaboration between the JW McConnell Family Foundation, DuPont Canada, and the PLAN Institute for Caring Citizenship, as they used developmental evaluation as to track methods and procedures involved in social innovation. Their evaluation experience included a series of developmental workshops, and was enhanced  by the involvement of Michael Quinn Patton, an internationally recognized evaluator and the author of Getting to Maybe. This resource provides tools and language that support ongoing learning. This is particularly relevant when evaluating complex problems that require innovative solutions, such as those related to the social determinants of health.

Use this resource to:

• Increase knowledge about the ideal conditions for using developmental evaluation
• Develop an understanding of what skills and capacities are necessary for developmental evaluation
• Learn about appropriate tools for developmental evaluation, including network mapping, revised and emergent   modeling, appreciative inquiry, simulations and rapid reconnaissance

Gamble, J. A. A. (2008).  A developmental evaluation primer.  Retrieved from The J.W. McConnell Family Foundation website:       http://www.mcconnellfoundation.ca/en/resources/publication/a-developmental-evaluation-primer

Tags: Evaluation, Methods & tools

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.

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

Sudbury & District Health Unit. (2011). Let’s start a conversation about health… and not talk about health care at all: User guide. Retrieved from http://www.sdhu.com/uploads/content/listings/EN_LetsStartaConversationUserGuide_Sept_20_2011.pdf

Tags: Community engagement, Income inequity, Socioeconomic status

Promoting Action on Equity Issues: A Knowledge-to-Action Handbook

Promoting action on equity issues: A knowledge-to-action handbook is a toolkit for health professionals that describes common knowledge translation barriers and provides practical guidance and support. The resource builds upon the experiences of the Winnipeg Regional Health Authority working to advance a specific equity issue: access to health care for underserved and culturally diverse populations. The National Collaborating Centre for Methods and Tools (NCCMT) has also included this toolkit in their Registry of Methods and Tools.

Use this resource to:

• Develop an equity-focused knowledge translation strategy
• Incorporate evidence in planning and decision making  (see page 44)
• Develop a business case for interventions (see page 34)

Bowen, S., Botting, I., & Roy, J. (2011). Promoting action on equity issues: a knowledge-to-action handbook. Edmonton, AB: School of Public Health, University of Alberta. Retrieved from http://www.publichealth.ualberta.ca/research/research_publications.aspx

Tags: Knowledge translation , Methods & tools