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

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

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

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

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

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

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

Use this resource to:

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


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

Related resources:

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

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