Policy avenues: Interventions to reduce social inequalities in health
Public policies contribute to the creation of social inequalities in health, and can serve as critically important levers to reduce health inequities. This paper from the Institut national de santé publique du Québec (INSPQ) reviews comprehensive approaches to reducing health inequities, as well as policy interventions on specific determinants of health implemented in Quebec, Canada, Europe and elsewhere in the world. The report discusses intersectoral action, Health in All Policies and health impact assessments as relevant approaches for use by government organizations.
Differing intervention strategies: comprehensive and determinant specific
Comprehensive interventions such as intersectoral coordination led by government institutions and mechanisms that have built in accountability for the implementation of specific policies are identified in Norway, Finland, New Zealand and the United Kingdom. In circumstances like those in Australia, Sweden and the United Kingdom, there are organizations that are responsible for knowledge translation, monitoring and evaluation of interventions. Comprehensive interventions in these regions were usually led by departments of health. Some enablers of these approaches are political will, justice and equity values and intersectoral governance. The report also notes a few challenges, such as lack of evaluation of the interventions and the struggle to balance of universal and non-stigmatizing targeted interventions.
Interventions on specific determinants, such as early childhood and education, employment and land use planning, are typically sector-led, including health. In these interventions, citizen participation and mobilization around existing priorities (e.g., sustainable development) have been beneficial. As is the case with comprehensive policy interventions, the impact of determinant-specific policies is not always present and the most marginalized groups may not benefit.
The report notes the absence of specific public policies on reducing social inequalities in health in Quebec. However, there are numerous government and local public health initiatives which can impact that goal. Examples include the National Strategy to Combat Poverty and Social Exclusion at the government level and equity oriented public health monitoring and reporting by departments of public health.
Lambert, R., St-Pierre, J., Lemieux, L., Chapados, M., Lapointe, G., Bergeron, P., Choinière, R., Leblanc, M.-F., Trudel, G. (2014). Policy Avenues: Interventions to Reduce Social Inequalities in Health. Montreal, QC: Institut national de santé publique du Québec.
Use this resource to:
- Identify specific policy interventions to reduce health inequities
- Compare and contrast comprehensive and determinant-specific approaches to addressing health equity