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

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

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

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

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

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

Use this resource to

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

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

Tags: National Collaborating Centre for Determinants of Health, Document

Public Health Speaks: Advancing health equity through public health competencies

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

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

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

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

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

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

Speakers include

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

Use this resource to

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


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

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

Public health speaks: Intersectoral action for health equity

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


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

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

Speakers include

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

Use this resource to

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

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

 

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

Public health speaks: Community engagement for health equity

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

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

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

Speakers include

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

Use this resource to

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

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

Tags: Community engagement, Video

Public health leadership development in Canada

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

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

Factors that impact effective public health nursing leadership include

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

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

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

The report contains a summary of all the literature reviewed.

Use this resource to

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

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

Related resources

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

 

Tags: Competencies & organizational standards , Intersectoral action, Document

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

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

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

Health Evidence rated the quality of this research

Use this resource to

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

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

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

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

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

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

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

Use this resource to

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

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

Tags: Document

Vancouver Coastal Health Population Health: Advocacy guideline and resources

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

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

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

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

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

Use this resource to

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


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

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

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

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

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

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

Use this resource to

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

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

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

Communicating the social determinants of health common messaging guidelines

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

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

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

Use this resource to:

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


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

Tags: Communicate, Document

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

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

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

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

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

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

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

Use this resource to

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

Related Resources:

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

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

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

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

This resource is available in French only.

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

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

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

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

Use this resource to:

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

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

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

Comprehensive school health research: Evidence to action in PEI

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

Use this resource to

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

Tags: National Collaborating Centre for Determinants of Health, Video

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

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

Use this resource to

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

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

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

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

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

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

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

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

Use this document to

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

A summary is available here.

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

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

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

What does it mean to “mobilize” community health?

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

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

Use this resource to

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

Tags: National Collaborating Centre for Determinants of Health, Video

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

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

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

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

Use this resource to

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

Tags: National Collaborating Centre for Determinants of Health, Video

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

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

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

Use this resource to

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

Tags: National Collaborating Centre for Determinants of Health, Video

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

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

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

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

Use this resource to

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


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

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

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

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

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

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

Use this resource to

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

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

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

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

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

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

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

Use this resource to

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

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

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

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

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

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

Use this resource to

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

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

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

Understanding Racism

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

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

Use this resource to learn about the

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

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

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

Public Health Speaks: Tuberculosis and the social determinants of health

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

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

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

Use this resource to

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

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

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

Learning from practice: Targeting within universalism

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

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

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

The three examples describe targeting within universalism at

Use this resource to

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

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

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

Let's talk… Moving upstream

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

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

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

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

Use this resource to

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

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

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

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

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

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

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

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

Use this resource to

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

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

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

Rio Political Declaration on Social Determinants of Health

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

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

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

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

Use this resource to

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

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

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

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

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

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

Use this resource to

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


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

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

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

Let's talk… Populations and the power of language

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

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

Use this resource to

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

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

 

 

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

The Public Health Observatory handbook of health inequalities measurement

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

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

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

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

Use this resource to

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

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

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

Cross-country analysis of the institutionalization of health impact

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

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

Key factors that enable the institutionalization of HIA are identified as

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

Challenges to institutionalization include

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

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

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

Use this resource to

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

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

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

Promoting health equity - Choosing appropriate indicators: Literature scan

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

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

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

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

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

Use this resource to

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

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

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

Health equity tools

This inventory was created to help people working in public health make sense of the growing number of health equity tools available. The tools were identified by researchers at the University of Victoria who received a five-year Programmatic Grant in health equity from the Canadian Institutes of Health Research and the Public Health Agency of Canada.

The research team searched peer-reviewed and grey literature (published before 2011) for tools that clearly identify improving health equity as a goal. They used search terms such as health equity, inequities and disparities, combined with terms for various types of tools. The search results included reports and articles that self-identified as a tool, guide, resource, audit or framework for health equity. These documents were screened for relevance to public health and for their inclusion of steps or a process to follow.

Each tool is described on a page graphically designed to help the reader find specific categories of information:  the objectives, intended users, how the tool can be used, keywords related to content and type of tool, and past application and evaluation information.

The inventory can be searched using keywords or the index. In the next phase of the project, the researchers will conduct a thorough practical and theoretical assessment of each tool. For the present, the appendix includes supplementary resources currently available.

Use this resource to:

  • Assess the degree to which health equity is integrated into a public health program or policy
  • Measure the impact of a program or policy on the distribution of health outcomes
  • Promote the inclusion of health equity in public health policies and programs
     

Pauly, B., MacDonald, M., O'Brian, W., Hancock, T., Perkin, K., Martin, W., …Riishede, J. (2013). Health Equity Tools. Victoria, BC: Equity Lens in Public Health.

Tags: Assess and report, Knowledge translation , Methods & tools, Modify & orient, Link

Health care in Canada: What makes us sick?: Canadian Medical Association town hall report

In an effort to drive health system change, the Canadian Medical Association (CMA) launched, in 2011, the National Dialogue on Health Care Transformation. The dialogue took place online and in six town hall meetings across Canada.  What makes us sick? summarizes the public dialogues, and makes 12 recommendations for action.

Participants in the consultations told the CMA that the health care system is only one predictor of good health. They identified four factors—income, housing, nutrition, and early childhood development—that have an equal, if not more important, role in determining health. One clear message was that the medical profession has an ethical duty to work towards a society in which everyone has the opportunity to lead a healthy life. The CMA team heard that Canada should be a compassionate society in which everyone has decent living conditions and equal access to the health care system. However, while dialogue participants were clear that issues such as poverty and inadequate housing need to be rectified, they struggled with how this should be done.

The report recommends actions to address the four factors that participants identified as having the greatest influence on health.  One recommendation is for a national food security program to ensure equitable access to safe and nutritious food, regardless of people’s neighbourhood or income.  Another is to prioritize investments in early childhood development, including education programs and parental supports at all levels of government.

Use this resource to

  • learn more about the work of the Canadian Medical Association, and the outcome of this important consultation process
  • consider how a process of consultation about the determinants of health and health equity could be implemented by your association or organization
  • support and inform your work as a practitioner, decision maker or policy maker interested in making access to the social determinants of health more equitable in Canada


Canadian Medical Association (2013).  Health care in Canada: What makes us sick?: Canadian Medical Association Town Hall Report. Ottawa (ON): Canadian Medical Association.

Tags: Access to health services, Community engagement, Early childhood development, Food security, Intersectoral action, Leadership & capacity building, Socioeconomic status , Link

Tackling health inequities through public health practice: Theory to action

This book, published by the National Association of County and City Health Officials (NACCHO), is the second edition of a 2006 publication (which is still available online) with a similar name: Tackling health inequities through public health practice: A handbook for action. This 2010 edition, which is written for people inside and outside public health, is almost a complete revision.

According to its preface, this book is designed as a starting point for health practitioners “ready to reorient public health practice to address the root causes of health inequities.” (p. vi) This reorientation is no small task, as “no predefined set of protocols or tools can eliminate health inequities.”(p. vi)  Rather, public health will have to reimagine its practice, take risks, and work for “active and strategic engagement of the public health community in the political process.”(p. vi)

Tackling health inequities is divided into four parts.  Part 1 introduces frameworks and evidence for integrating health equity into public health practice.  Part 2 explores how racism, class exploitation and sexism shape individuals and communities, and offers insights into how these roots of inequity can be addressed.  Part 3 includes case studies that describe public health-community collaborations for social and environmental justice. The cases present protocols and methods: how to monitor organizational accountability, forge relationships, and purposefully collect and report on data.

The chapters in Part 4 focus on the difficult work of shifting consciousness and paradigms.  One chapter focuses on how to overcome barriers to teaching about social inequalities in university settings. The appendices contain example guidelines, frameworks and charters to support  the public health workforce in taking a more “expended and expansive view of the scope of public health practice.”

More information about NACCHO is available on their website.

Use this resource to

  • Get practical, evidence-informed information about how to reorient public health practice to address the social determinants of health
  • Challenge assumptions and inspire change in public health organizations to address the root causes, rather than the consequences, of  the unequal distribution of health
  • Learn how others in public health have tackled the structures and beliefs that maintain health inequities

Hofrichter, R. & Bhatia, R., ed. (2010). Tackling health inequities through public health practice: Theory to action. 2nd ed. A project of the National Association of County and City Health Officials. Oxford University Press: New York, New York.

Tags: Assess and report, Community engagement, Critical works in health equity, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Document

Principes et méthodologie de Santé Publique : Concepts et savoirs de base

This resource is available in French only.

This program is part of an online French Master in Public Health and Environmental Risks (Santé Publique et Environnement) offered by l’Ecole de Santé Publique, Faculté de Médecine, Université de Lorraine and covers the following subjects:  what is public health?; determinants of health status in individuals and populations; observation, research, action, the stakeholders, and ethics in public health.

The program is semi-tutorial, interspersed with three self-correcting or tutored exercises, exams, and two case studies, also self-correcting or tutored. The training includes five one-hour “chats” to foster exchange and communication within the group. This program requires 50 to 70 hours over a nine-week period and costs 800 euros.

You can access this course from http://www.sante-pub.u-nancy.fr/esp/index.php?page=formation-continue

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses go to http://nccdh.ca/latest-news/entry/online-courses-SDOH

Université de Lorraine /Nancy-Université (2011).  Principes et méthodologie de Santé Publique: Concepts et savoirs de base. Retrived from:http://www.sante-pub.u-nancy.fr/esp/index.php?page=formation-continue

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

Réduire les inégalités sociales en santé

This resource is available in French only.

This comprehensive report, built on the contributions of 50 or so experts, was published in 2010 by the National Institute for Health Prevention and Education (INPS or L’Institut national de prévention et d’éducation pour la santé). The report does not offer standard responses or specific solutions. Instead, its aim is to serve as a basic support tool for people working to reduce the social inequalities in health.

Nearly a quarter of a century after the Ottawa Charter for Health Promotion was signed, this important study evaluates the road that still lies ahead in terms of the objectives set forth in 1986. The authors all agree there is a need to better articulate and structure the strategies and methods directed at reducing social inequalities in health. Even more importantly, they make the case for better occupational training, to reinforce the skills of those involved in the fight against social inequalities in health.

The first section, which takes a historic look at France and Europe, is followed by four sections dedicated to

  • public policies
  • health care and prevention systems
  • assessment, and
  • partnerships

Each of the work’s five sections provides examples and recommendations, including

  • effective public policies implemented in Belgium, Geneva, and Montreal
  • a Parisian program linking doctors with maternal and child care
  • a six-pronged argument to put equity on the political agenda
  • linking health care and prevention systems to mental health, with program examples from northern Canada

This 380-page book features an impressive number of examples—supported by statistics, tables, and figures—of interventions aimed at closing gaps in health care systems between the most disadvantaged and advantaged populations.  It describes concepts and causal models such as “social gradient” and “determinants of determinants.”

Use this resource to

  • Identify potential partners— social and community workers, front-line health care workers, regulators, and policy-makers—in the fight against health inequalities caused by social inequalities
  • Select assessment methods to determine the impact of social inequalities on health at a local level
  • Investigate ways to work with health practitioners to implement integrated strategies to reduce social inequalities in health

Potvin, L., Moquet, M.-J. & Jones, C. M. (sous la dir.). (2010). Réduire les inégalités sociales en santé. Saint-Denis: Institut national de prévention et d’éducation pour la santé, collections.

 

Tags: Competencies & organizational standards , Evaluation, Healthy public policy, Intersectoral action, Key concepts, Modify & orient, Document

Les inégalités sociales de santé au Québec

This resource is available in French only.

The resource introduction was written by Martine Shareck, Ph.D. Candidate, Public Health, Université de Montréal.

In Quebec, close to 15 years of life in good health separate the most disadvantaged populations from the most affluent. Despite this reality, social inequalities in health in Quebec were not studied until 2008, when Les inégalités sociales de santé au Québec appeared on the scene to fill this void. The work was published with support from the Réseau de recherche en santé des populations du Québec (www.santepop.qc.ca). The first section paints a portrait of social inequalities in health using, as an example, the evolution of premature mortality. The multidisciplinary take on premature mortality and social inequalities helps us understand “how” inequalities develop.

The second part of the book presents a brief overview of the several theoretical perspectives—going from anthropology to neurobiology, by way of geography and sociology—to help us understand how social inequalities in health develop. This multi-level analysis, using a life course perspective, equips the reader to better understand the complex mechanisms by which social inequalities generate health inequalities.

The last part of the book describes the imaginative interventions and public policies in place in Quebec that could help reduce social inequalities in health. These include interventions in disadvantaged environments, as well as in workplace health programs. Far from leaving the reader overwhelmed by the complex nature of social inequalities in health, the work concludes on a positive note by identifying promising courses of action, such as intersectoral action and equity assessment in public health interventions.

Use this resource to:

  • Facilitate reflection and discussion on the many approaches and disciplines that can help us understand social inequalities in health, in all of their complexity
  • Further your knowledge of the ways and means to reduce social inequalities in health

Frohlich, K.L., & De Koninck, M. (2008). Les inégalités sociales de santé au Québec. Montréal: Presses de l'Université de Montréal.

Tags: Critical works in health equity, Healthy public policy, Intersectoral action, Key concepts, Methods & tools, Socioeconomic status , Document

Santé: pourquoi ne sommes-nous pas égaux. Comment les inégalités sociales de santé se créent et se perpétuent.

This resource is available in French only.

The resource introduction was written by Martine Shareck, Ph.D. Candidate, Public Health, Université de Montréal.

Written primarily for political actors and community stakeholders, this report from l’Institut National de Santé Publique du Québec would be of interest to anyone who wants to know more about the role of individuals and the local environment in the production of social inequalities in health. This 106-page report brings together the results of several studies conducted in three areas in the region of Quebec City (Quebec, Canada). The goal of these studies, published elsewhere as monographs and scholarly articles, was to answer the following research question: “How do social processes interact to create and perpetuate health disparities within a population?”

The authors used a combination of methods (questionnaires, interviews with respondents and key informants, geographic databases, field surveys) to take a multidisciplinary look at how neighbourhood, family, and workplace environments interact to generate social inequalities in health. The comparative approach (three localities) led to interesting findings, in particular, the finding that the most resource-deprived areas are not necessarily those where residents have the “unhealthiest” behaviours. The authors arrive at several conclusions that shed as much light on the research process as on the community intervention.  For example, the impact of resource availability is affected by residents’ perceptions of the resources, and how they use them. Suggestions are offered to guide the interventions of community stakeholders, particularly related to involving several sectors and targeting initiatives for specific groups or geographic areas.

Use this this resource to:

  • Further your knowledge about the role of individuals, their local environments, and the interaction of the two in the production of social inequalities in health
  • Illustrate how methods that combine quantitative analyses and qualitative exploration contribute to research and interventions on social inequalities in health
  • Encourage reflection on the development and implementation of intersectoral actions to reduce social inequalities in health

Institut National de Santé Publique du Québec. (2008). Santé: pourquoi ne sommes-nous pas égaux.  Comment les inégalités sociales de santé se créent et se perpétuent.

Tags: Community engagement, Intersectoral action, Socioeconomic status , Document

The Gradient Evaluation Framework (GEF)

The Gradient Evaluation Framework is a toolkit to help you assess whether a policy will contribute to greater health equity among children and their families.  It came out of a three-year (2009-2012) collaborative research project involving 12 European organizations in academia and public health.  The project was coordinated by EuroHealthNet and received funding from the European community. 

The toolkit is a flexible collection of checklists, worksheets, activities, strategies, questions and case examples to help you design or evaluate policies aimed at reducing health inequities.  You can download a mobile device application (Mac and Android compatible) from the website.

The application section of the document has two dimensions, each of which informs the design of “gradient-friendly” policy action.

  • Dimension 1 has checklists for each of eight key areas
  • Dimension 2 describes more detailed self-assessment steps and activities

An impetus to design the Gradient Evaluation Framework was EuroHealthNet’s recognition that the evidence base is weak for both effective health equity policies and evaluation frameworks.  Since its creation, this Framework has undergone a formal consensus-building process with external experts from European member states.

A description and assessment of this tool is also available, in English and French, in the National Collaborating Centre for Methods and Tools’ (CCMT) online registry:  http://www.nccmt.ca/registry/view/eng/150.html. 

Use this resource to

  • understand the effects of policies on the health of the most disadvantaged, the gap between better-off and worse-off groups, and the social gradient
  • undertake either a rapid assessment or an in-depth review of your current policies to predict their impact on health equity among children and their families
  • design new policies to reduce health inequities

Davies, J.K. & Sherriff, N.S. (2012). The gradient evaluation framework (GEF): A European framework for designing and evaluating policies and actions to level-up the gradient in health inequalities among children, young people and their families. Brighton, UK: University of Brighton.  Retrieved from the Gradient Project website:  http://health-gradient.eu/gef-the-gradient-evaluation-framework/.

Tags: Early childhood development, Evaluation, Healthy public policy, Knowledge translation , Methods & tools, Link

Health equity audit: A self-assessment tool

Health equity audits examine whether resources are distributed fairly, relative to the health needs of different groups.  They systematically review health inequities and access to services for particular groups or areas to

  • ensure actions to address health inequities are incorporated in planning decisions;
  • prioritize actions to address health inequities; and
  • evaluate the impact of actions on reducing inequities.

The UK Department of Public Health developed this tool and collection of resources to support the health equity audit processes of the National Health Services (NHS), local authorities, and strategic partner organizations in the United Kingdom.

This tool supports the assessment of the six main stages of a health equity audit cycle:

  • Agree on partners and issues
  • Create an equity profile; identify the gap
  • Agree on high-impact local action to narrow the gap
  • Agree on priorities for action
  • Secure changes in investment and service delivery
  • Review the progress and assess the impact

The tool directs users to a number of resources that support a health equity audit.

A description and assessment of this tool is also available, in English and French, in the National Collaborating Centre for Methods and Tools’ (CCMT) online registry: http://www.nccmt.ca/registry/view/eng/128.html.

Use these resources to

  • systematically incorporate health equity into policy and program planning
  • ensure that resources are directed towards reducing health inequities
  • initiate projects with local stakeholders to improve health outcomes for disadvantaged communities


The Department of Health, United Kingdom. (2004). Health equity audit: A self-assessment tool. UK Government Web Archive.  Retrieved from http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4070715

Tags: Healthy public policy, Knowledge translation , Methods & tools, Link

Social determinants of health – online course

This free, one-hour, interactive eLearning module communicates how social and economic conditions influence the health of individuals, communities and nations. It is one of 15 multimedia modules created by Toronto’s SickKids  hospital to build cultural competence (the ability to interact effectively with people of different cultures and socio-economic backgrounds) among health care providers. The modules are supported by a film (Journey to cultural competence) and a community-of-practice (a web-based forum) designed to build knowledge and improve practice.

In this module, participants learn

  • the meaning of terms such as health equity and the social determinants of health,
  • how cultural competence can address some of the health inequities experienced by immigrant populations; and
  • apply the ABCDE cultural competence framework and SickKids’ DARE (discover, acknowledge and recognize, and enable) approach to this work.

You can access this module at http://www.sickkids.ca/culturalcompetence/elearning-modules/eLearning-modules.html

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses, click here.

SickKids Hospital (2012). Cultural competence e-learning modules series: Social determinants of health [Online course]. Retrieved from:http://www.sickkids.ca/culturalcompetence/elearning-modules/eLearning-modules.html

Tags: Key concepts, Racism/racialization, Link

Roots of health inequity – online course

This free, 15-to-30 hour course is intended for an American public health audience. While many of the SDOH concepts and issues discussed are relevant for Canadian practitioners, the course is rooted in US politics and culture.

The course explores root causes of inequity in the distribution of disease, illness, and death. It seeks to ground participants in the concepts and strategies that can help them take effective action.

In it, participants

  • explore social processes that produce inequities in the distribution of illness,
  • strategize effective ways to act on the root causes of health inequity; and
  • form relationships with other local health departments that are working to improve health equity.

The course is intended to be followed by a workplace group. Each group selects a leader/administrator who moderates the face-to-face discussions, as well as activities in the online-community area (where goals, deadlines, meetings and an overall schedule are posted). Individuals can follow the course by creating a one-person group, or by joining a general group.

This course is a health equity and social justice initiative of the National Association of County and City Health Officials  in the US. You can access the course by creating an account and logging in at http://members.rootsofhealthinequity.org/.

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses, click here.

National Association of County and City Health Officials (2011). Roots of health inequity: A web-based course for the public health workforce [Online course]. Retrieved from http://members.rootsofhealthinequity.org/

Tags: Healthy public policy, Key concepts, Leadership & capacity building, Link

Reducing gaps: Using area-based socio-economic measures to explore population health—online course

This free, one-hour course explores how putting health and socio-economic data together can help health professionals better understand how populations characteristics affect health outcomes.  It is a high-quality tutorial built with the Articulate Studio “rapid e-learning” development tool.

Participants work with data to understand the distribution of socio-economic status (SES) in Canada, and how SES affects how people use health services.  Participants learn how to apply this understanding in creating programs and policies, in any jurisdiction, to reduce disparities in health or access to health services.

The course is intended for decision makers and planners involved in population health, public health, health promotion, urban planning and health, social and community services. It was developed by the Canadian Institute for Health Information  (CIHI).  You can access the course by contacting education@cihi.ca to get a free account, which you use to access the course through the CIHI Learning Centre at https://learning.cihi.ca/users/index.aspx.  To review the course content, go to the Learning Centre and click on the Courses/Registration – Population Health link.

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience. To learn more about this project and other recommended courses, click here.

Canadian Institute for Health Information (2012).  Reducing gaps:  Using area-based socio-economic measures to explore population health [Online course]. Retrieved from http://www.cihi.ca/CIHI-ext-portal/internet/EN/Events/events+and+education/cihi021451

Tags: Assess and report, Methods & tools, Link

New directions in public health and community development online workshop series – online course

These ongoing, date-specific, online workshops are designed for staff and board members of non-profit health and community development organizations, as well as public health and healthcare professionals in the US and internationally. 

Recent workshops topics include

  • Health equity and health communication—strategies to reach the underserved,
  • Implementing the social determinants of health agenda—new trends, strategies and case studies; and
  • Assessing organizational capacity via health equity-related assessment—an introductory workshop.

The online workshops use a GoToMeeting platform, which includes an online facilitator and extended audio and chat-style Q&A periods. The workshops are two hours and cost $30 each. Certificates are given to people who participate in four workshops over a six-month period.  

The workshops are developed by the Health Equity Initiative  team in New York.  You can access the courses at http://www.healthequityinitiative.org/hei/hei-events

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses, click here.

Health Equity Initiative. (2013).  New directions in public health and community development online workshop series (série d’ateliers virtuels sur les nouvelles avenues en santé publique et en développement communautaire) [cybercours]. Récupéré à l’adresse www.healthequityinitiative.org/hei/what-we-do/counseling-partnership-and-capacity-building/professional-development-workshops-summer.

 

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

Introducing public health – online course

This eLearning course introduces the broad scope of public health work in the UK, illustrated by a video case study of public health approaches and activities in Coventry, England.  The course contents emphasize public health work that addresses the determinants of ill health.  Introducing public health is one course in a three-part series on public health. The course is free, takes about six-hours to complete and consists of four modules:  1) public health on the ground; 2) thinking about your own health; 3) scope of public health; and 4) everybody’s business?

Learners respond to questions related to video vignettes, web research and readings, and they can compare their answers with embedded instructor comments on each activity.

Introducing public health was developed by the Open Learning University  in the UK.  You can access the course at www.open.edu/openlearn/body-mind/health/public-health/introducing-public-health/content-section-0

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses, click here.

The Open University (2012). Introducing public health [Online course]. Retrieved from http://www.open.edu/openlearn/body-mind/health/public-health/introducing-public-health/content-section-0

 

Tags: Healthy public policy, Intersectoral action, Key concepts, Knowledge translation , Leadership & capacity building, Link

Introduction to health impact assessment (HIA) of public policies – online course

This online course, offered in both French and English, teaches participants how to conduct a health impact assessment (HIA) of a public policy. It is offered through the University of Montréal, and can be taken as a stand-alone course or as part of the university’s postgraduate micro-program in public health (offered in French).  The course, which was co-developed and co-sponsored with the National Collaborating Centre for Healthy Public Policy  (NCCHPP), is intended for public health practitioners and decision makers. 

It covers three main themes:

  • the historical, methodological and scientific foundations of HIA
  • the five steps of the HIA process
  • decision making, and knowledge brokering and sharing related to HIA processes and results

A tutor guides students in their reflections, analyses and discussions, and gives feedback on an assignment based on a practical application.  The course costs $120 for Quebec residents and $245 for residents of Canada outside Quebec.  A Bachelor’s degree and some public health experience are required for registration.

Starting in October 2013, the NCCHPP will offer a 12-hour version of this course:  Online continuing education course – HIA step by step.  You can access both courses at www.ncchpp.ca/274/Online_Course.ccnpps.

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses, click here.

National Collaborating Centre for Healthy Public Policy and the Université de Montréal (2012).  Introduction to health impact assessment (HIA) of public policies [Online course]. Retrieved from http://www.ncchpp.ca/274/Online_Course.ccnpps

 

Tags: Healthy public policy, Methods & tools, Link

Indigenous cultural competency training program—online course

This three-part training program is intended for people working in health and non-health fields (justice, policing, child and family services, education, business and government). It is designed to strengthen the skills of professionals working directly or indirectly with Indigenous people by increasing Aboriginal-specific knowledge and enhancing self-awareness.  The training has three sections, each of which takes five-to-nine hours over a six-to-eight week period:  1) CORE—foundational issues of cultural competency; 2) CORE Health—health care issues experienced by Indigenous people; and 3) CORE Mental Health—¬mental health issues experienced by Indigenous people.

Through interactive activities and the support of a facilitator, participants examine culture, stereotyping and the legacy of colonization, and develop more effective communication and relationship building skills.

Over the past three years, about 10,000 people have taken the three courses.  The program is free for anyone employed by a BC regional health authority or the Ministry of Health, or health care workers who work for Aboriginal organizations; it costs $250 for others.  The program is approved for Continuing Education Credits by the Canadian Counselling and Psychotherapy Association. 

You can access the course at www.culturalcompetency.ca.

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses, click here.

BC Provincial Health Services Authority, Aboriginal Health (2009). Indigenous cultural competency training program [Online course]. Retrieved from http://www.culturalcompetency.ca

Tags: Aboriginal health , Access to health services, Community engagement, Competencies & organizational standards , Leadership & capacity building, Racism/racialization, Link

Health impact assessment in practice - online course

This free, six to 12 hour course is designed for public health practitioners who have some research skills, but limited experience in conducting a health impact assessment (HIA). The course was developed by the National Health Services in Scotland, and is one of almost two dozen eLearning courses offered to health practitioners and managers. The course includes three HIA case studies; participants work through them using a workbook, which forms a record of their learning. Among other topics, the course teaches why and how to consider health inequalities when doing HIA, the spectrum of steps to go through, how to conduct a rapid tabletop HIA, and why and how to involve stakeholders and informants.

You can access the course by signing in as a “guest” at http://elearning.healthscotland.com/login/index.php.

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses, click here.

National Health Service, Scotland (2008).  Health impact assessment in practice [Online course]. Retrieved from http://elearning.healthscotland.com/

Tags: Assess and report, Community engagement, Healthy public policy, Intersectoral action, Methods & tools, Modify & orient, Link

Health equity impact assessment (HEIA) - online course

This free, two-hour, skill-building course teaches participants how to identify and address the health impacts that a plan, policy or program might have on vulnerable or marginalized groups. The HEIA tool itself, which is used extensively in Ontario, was designed by the Ontario Ministry of Health and Long-Term Care. The course was developed in collaboration with the Centre for Addictions and Mental Health, Canada's largest mental health and addiction teaching hospital.

The course has three “teaching” modules that do not include learner feedback, and five case studies that learners use to practice completing an HEIA form. The modules cover definitions of terms, why and when an HEIA should be conducted, and a case-based demonstration of how to apply the tool. Each case study is recommended for a specific category of learner, although a learner can choose to practice by using all five cases. Expert-completed forms are available if learners want to assess their progress.

You can access the course at: http://knowledgex.camh.net/HEALTH_EQUITY/Pages/healthEquityImpactAssessment(HEIA)OnlineCourse.aspx

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience. To learn more about this project and other recommended courses, click here.

Health Equity Impact Assessment (2012). Centre for Addiction and Mental Health [Online course]. Retrieved from http://knowledgex.camh.net/HEALTH_EQUITY/Pages/healthEquityImpactAssessment(HEIA)OnlineCourse.aspx

Tags: Assess and report, Community engagement, Competencies & organizational standards , Healthy public policy, Intersectoral action, Methods & tools, Modify & orient, Link

Gender based analysis PLUS - online course

This online course was designed to increase the awareness and skills of Canadian civil servants in applying gender-based analysis to the development of policies and programs.  Status of Women Canada developed this course to promote the use of the Gender-Based Analysis PLUS (GBA+) analytical tool used by the federal government to advance gender equality in Canada. The "plus" in the name signifies that gender-based analysis goes beyond gender to include intersecting identification factors such as age, education, language, geography, culture and income.

Participants work through cases to learn how paying attention to sex, gender and diversity can enhance the effectiveness of policies and the outcomes of programs.  Module titles include 1) Is sex the same as gender? 2) What do assumptions have to do with it? and 3) How do I do GBA+?

The course is free, and takes about three hours to complete; learners have three chances to score 80% or higher on the final quiz to pass the course.  You can access it at http://www.swc-cfc.gc.ca/pol/gba-acs/index-eng.html. Click on the “training” option.

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience. To learn more about this project and other recommended courses, click here.

Status of Women Canada (2012). Gender Based Analysis PLUS [Online course]. Retrieved from http://www.swc-cfc.gc.ca/gba-acs/gbacourse-coursacs-eng.html

Tags: Access to health services, Competencies & organizational standards , Healthy public policy, Key concepts, Leadership & capacity building, Racism/racialization, Sex & gender, Link

The community tool box — online courses for community health improvement

This free, eight-part series of online courses (30 to 45 minutes each) helps learners build the skills they need to support community health assessment and health improvement work.  Course titles include 1) assuring engagement in community health improvement efforts; 2) identifying community health needs and assets; 3) developing a logic model for community health improvement; 4) developing an intervention; and 5) assuring collaboration during implementation.  The series was produced by a community-university collaboration that has also created The Community Tool Box, a global resource for free information on essential skills for building healthy communities.

The online courses include interactive exercises and activities, online references (“ask an advisor”), stories of innovation from around the world, individual or group assignments, and a certificate of completion.

You can access the course at http://ctb.ku.edu/en/online-courses.aspx. If you want to take a course, you have to sign up for a free account at the Centre for Disease Control’s training site. Then search for “community tool box.”  Click on one of the eight modules, go to the registration tab, and click “launch.”

This course was recommended as a professional development resource by an NCCDH project team reviewing online courses related to health equity and the social determinants of health for a public health audience.  To learn more about this project and other recommended courses, click here.


The Community Tool Box, Work Group for Community Health and Development (2011). Online courses for community health improvement [Online course]. Retrieved from http://ctb.ku.edu/en/online-courses.aspx

Tags: Assess and report, Community engagement, Intersectoral action, Knowledge translation , Leadership & capacity building, Methods & tools, Modify & orient, Link

A conceptual framework for action on the social determinants of health

This paper, the second in a series produced by the World Health Organization’s (WHO) Commission on the Social Determinants of Health (CSDH), outlines a conceptual framework for action on the social determinants of health.

The framework, which guided the CSDH’s work from 2005 to 2008, was built on theoretical models to explain the underlying processes of “causation” that underpin health inequities. As an “action oriented” framework, it is designed to help policy-makers pinpoint where to intervene in these underlying processes to most effectively fight health inequities. The model includes three core components: 1) socioeconomic and political context; 2) structural determinants of health inequities; and 3) intermediary determinants of health.

The authors make a critical distinction between the structural determinants of health inequities and the intermediary determinants of health. The structural determinants include “all social and political mechanisms that generate … stratification and social class divisions in society and that define individual socioeconomic position within hierarchies of power, prestige and access to resources” (p. 5). The structural determinants cause and operate through intermediary determinants of health—housing, physical work environment, social support, stress, nutrition and physical activity—to shape health outcomes.

The authors draw heavily from work by Diderichsen et al. (2001),  as well as from theories of power, to make the case that effective actions on the social determinants of health are inherently political, in that they seek to change large-scale structural power relations between more and less privileged groups.

Use this resource to

  • Distinguish between the mechanisms underlying social stratification and the intermediary determinants of health that are caused by stratification and that lead to inequities in health
  • Identify where policy interventions can address both downstream and upstream causes of health inequities
  • Ground policy action on the social determinants of health in an evidence-informed, theoretical framework


Solar O, Irwin A. (2010). A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva; World Health Organization.

Tags: Critical works in health equity, Healthy public policy, Key concepts, Leadership & capacity building, Document

Learning from others: Comprehensive health equity strategies in Europe

In this short paper, Haber and Wong present the national health equity strategies of 14 European countries, hoping to encourage the development of a comprehensive health equity strategy for Canada. The authors claim that while Canada has contributed to awareness of the concept of social determinants of health (SDOH), its policies have largely failed to address the unequal distribution of health and its social determinants. They also claim that a national strategy is needed, both symbolically and strategically, to encourage all levels of government to make health disparities a priority.

The national strategies differ in significant ways: some focus solely on health inequalities, while others blend health equity with other goals; some are driven by central government, while others are driven by the department of health.

In Sweden, the Public Health Objectives Bill (2003) requires all departments to take responsibility for 11 objectives aimed at creating equitable social conditions for the entire population. Norway’s Ministry of Health coordinates health equity policy development with politicians and bureaucrats from six other ministries. England has health and well-being boards that coordinate, through local authorities, the integrated work of health, social services, and tackling health inequalities. Scotland has recently given local authorities more autonomy to frame and implement strategies to align with community values and needs.

The paper also describes two European-wide initiatives: the European Charter for Health Equity (2011), and the European Portal for Action on Health Inequalities (2011). The portal provides a sharing space for information, policies and best practices on SDOH and health in all policies.

According to Haber and Wong, an effective national health equity strategy should include

  • a focus on the social determinants of health
  • thoughtful selection of targets and evaluation steps
  • mechanisms to steer and coordinate policy within and beyond government
  • strong linkages between policy and programs at the national and local levels
  • coordination among government policy actors outside of health

Use this resource to:

  • Advocate for a national health equity strategy in Canada
  • Learn how national, provincial and local health initiatives can be coordinated through a national policy
  • Investigate the success factors and options for policy designed to reduce the social inequities that cause health disparities


Haber, R. & Wong, E. (2013). Learning from others: Comprehensive health equity strategies in Europe. Toronto, ON: Wellesley Institute.

Tags: Healthy public policy, Intersectoral action, Leadership & capacity building, Document

Liberating structures

Liberating Structures (LS) is a web-based resource that offers three dozen processes to get people thinking and working together effectively. The processes are tools, as well as a way of thinking about working with people. They are designed to neutralize power dynamics and build trust. LS do not require lengthy training to adopt, and they can be mixed and matched for particular organizational needs. They use simple rules to encourage managers to step back and encourage employees to take leadership roles at all levels.

At the NCCDH, we use Liberating Structures (LS) for both our internal management work and our health equity engagement work with audiences across the country. These “simple, subtle [and] powerful” processes have been exceedingly well received. In fact, in our leadership for health equity research, the ability to facilitate groups with these processes was identified as a core skill.

The conventional methods people use to share or seek information—presentations, brainstorming, and discussions—are not so effective at engaging people. In the early 2000s, Henri Lipmanowicz, and Keith McCandless  noted this weakness. They were convinced that the complexity science principle—which states that a small change can make a big difference—could be applied to the way people work together. In the course of their research, they found that small adjustments in the way people interact have large impacts on organizational culture and resilience, which led to their creation of the LS website and consulting work.

Three of the simplest liberating structures are

  • 1-2-4-All . Silent self-reflection on a question, followed by sharing reflections in pairs and groups of four, and a full group discussion of what stood out in the conversations
  • TRIZ . A process using humour to 1) identify what we do to reliably get the worst result imaginable; 2) honestly compare this list with what we do now; and 3) generate ideas about how to stop doing those things
  • Impromptu networking  . People have three conversations, in short rounds, in response to an important question about their work together

Use this resource to

  • Add new energy and engagement to conversations that are “stuck”
  • Design workshops, conferences and meetings that draw on everyone’s insights in solving problems or designing new approaches
  • Build a team of employees or volunteers who feel valued and involved in the direction of the organization

Lipmanowicz, H. & McCandless, K. (n.d.) Liberating Structures.

Tags: Community engagement, Knowledge translation , Leadership & capacity building, Methods & tools, Working conditions, Link

Tackling health inequities through public health practice: A handbook for action

This handbook comes from the Washington, DC-based organization, NACCHO, which represents 2700 local health departments (LHDs) from across the United States. It provides public health practitioners with a conceptual background to the root causes of health inequities, as well as practical examples, tools and exercises to help bring these concepts to life. At just over 250 pages, you can read it from beginning to end, or use it as a “toolbox” of exercises and cases to reference for specific needs.

The authors work from a social justice perspective, pushing practitioners to seek solutions beyond basic programming and services. Instead, they emphasize the need to question and transform departmental structures, and challenge organizational culture in order to address health inequities.

The handbook is organized into two sections and 12 chapters. The first section (chapters 1-4) includes a historical overview of health equity work in public health; an account of health equity research to date; a conceptual framework with which to frame public health work on the social determinants of health and health inequities; and evaluated methods to engage practitioners and the public in dialogue around these issues.

Section two (chapters 5-12) contains case studies detailing practices that have successfully reduced health inequities, from living wage campaigns (chapter 9) to capacity building within communities (chapter 7). The appendices offer exercises, resources and articles on evaluation and measurement, social marketing, and injustice.

Use this resource to:

  • Inspire action on the underlying inequities in the social determinants of health through your practice
  • Learn where to target your efforts to best gain traction to improve the root causes of health inequities
  • Be emboldened by the experiences of others who have overcome barriers and discovered meaningful ways to reduce health inequities through public health practice

Richard Hofrichter (ed). (2006). Tackling health inequities through public health practice: A handbook for action. Washington, DC; National Association of County and City Health Officials.

Tags: Assess and report, Community engagement, Income inequity, Intersectoral action, Leadership & capacity building, Methods & tools, Modify & orient, Sex & gender, Working conditions, Document

The Last Straw! A board game on the social determinants of health

The Last Straw! is a board game and participatory education tool focused on the social determinants of health.

The game has three objectives:

  1. to promote discussion about the social determinants of health
  2. to help players build empathy with marginalized people and gain an awareness of their own location on the socio-economic spectrum
  3. to encourage learning in a fun and supportive environment

The game can be played with almost any number of players, from a small group of four or five to a group of 25. Key to the game is the role of the facilitator or “Game Master,” as this person must ensure that the examples and discussions are appropriate for the playing audience. Training manual and videos are available to help the Game Master prepare to host.

In this character-based game, each player develops a profile that includes his or her gender, socio-economic status and race, and receives “vitality chips” based on his or her profile. Chips are gained and lost based on scenarios and “community events,” and the character with the most vitality chips at the end of the game is the winner.

The game was developed 10 years ago, as a graduate student project, by Kate Rossiter and Kate Reeve; it has been refined and updated frequently based on feedback and evaluation data, and has won awards from the University of Toronto, Health Nexus, and Community-Campus Partnerships for Health. Kate Rossiter continues to work in the areas of public health, bioethics, and theatre at Wilfrid Laurier University.

Use this resource to

  • Facilitate discussion and engage critical thinking about the social determinants of health with your public health colleagues, students and other stakeholders
  • Engage community decision makers around the importance of policy and program decisions that address the social determinants of health
  • Help increase understanding within marginalized groups of the importance of the structural determinants when exploring opportunities for social change and empowerment

The game is available for a fee ($100)

Training Videos:

Rossiter, K. & Reeve, K. (2008).  The Last Straw!: A Tool for Participatory Education About the Social Determinants of Health.  Progress in Community Health Partnerships: Research, Education, and Action, Volume 2, Issue 2, Summer 2008, pp. 137-144.  Retrieved from: http://muse.jhu.edu/journals/cpr/summary/v002/2.2.rossiter.html.

Tags: Leadership & capacity building, Link

Cracking the nut of health equity: top down and bottom up pressure for action on the social determinants of health

This classic paper was written by the pre-eminent Australian health equity scholar, Fran Baum (Professor of Public Health, and Director of both the Southgate Institute of Health, Society and Equity; and the South Australian Community Health Research Unit, Flinders University). At the time of writing, she was a member of the World Health Organization’s (WHO) Commission on the Social Determinants of Health.

Baum says that to bring about greater health equity we need the “nutcracker” effect: both top-down political commitment and bottom-up action from civil society groups. She notes that evidence on health inequities has existed for some time, but few governments have institutionalized remedial action. This is because governments have been more committed to individualism, and minimal government intervention, than to health equity, and because pressure from the better off in society has not been sufficient to “influence government’s desire to be socially just.” (p. 92)

Change requires political leaders who are committed to social justice values (a favouring of collective well-being over individual well-being), and who can lead people through complexity. Baum argues that many leaders still believe that treating high risk or diseased individuals improves population health, despite evidence to the contrary. Almost two decades ago, Geoffrey Rose (1985) showed that changing a health risk factor by a small amount has a greater impact than individual intervention on the incidence of a disease in a community.

Baum explains that public and institutional engagement on behalf of greater equity is called “linking social capital.” Societies high in “linking social capital” have high levels of trust in formal institutions and transparent government processes, characteristics that are declining in many Western countries. If we are to change this, civil society’s strategies for change must go beyond blaming individuals to creating health and equity-promoting environments.

Use this resource to

  • Foster discussion among colleagues about the factors required for governments to take concrete action for greater health equity
  • Learn more about the history of health equity and health promotion thinking
  • Reconnect with the centrality of social justice values in health equity work

Baum, F. (2007) Cracking the nut of health equity: Top down and bottom up pressure for action on the social determinants of health.  Promotion & Education, 14(2), 90-95.

Tags: Aboriginal health , Community engagement, Critical works in health equity, Healthy public policy, Leadership & capacity building, Document

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

Using organizational standards to make social inequities a public health priority is one of the ten promising practices that guide the NCCDH’s work. In interviews with Connie Clement, NCCDH’s Scientific Director, four public health experts reflect on their experiences of developing and implementing “standards” as part of a process of organizational renewal. 

Comparing the Ontario and British Columbia renewal of public health systems
Dr. Bernie Pauly, School of Nursing, University of Victoria, describes her research comparing public health renewal in British Coloumbia and Ontario .  She reflects on how the work of interpreting concepts and choosing language influenced how equity was incorporated into each province’s public health standards.

Developing Nova Scotia’s public health standards
Janet Braunstein Moody, Nova Scotia Department of Health and Wellness, discusses how the process of developing standards clarified public health’s overall vision, and increased employees’ understanding of their roles in the public health system

Implementing Ontario’s public health standards at Peterborough County-City Health Unit
Dr. Rosana Pellizzari, Peterborough County-City Health Unit, discusses the lessons she learned while implementing provincial organizational standards at the local level. The standards have clarified the organization’s focus and reinforced its partnerships with stakeholders.

Developing a conceptual framework for organizational capacity for public health equity action
Dr. Benita Cohen, School of Nursing, University of Manitoba, describes how health equity champions influenced the design of a conceptual framework for health equity work. The framework helps public health decision makers and practitioners consider the complexity of working for greater health equity. 

Use this resource to

  • Learn about how organizational  standards foster the capacity of public health organizations to do health equity work
  • Learn from people who have developed and implemented organizational standards that bring health equity work to the forefront
  • Advocate for organizational renewal that places “health for all” at the centre of its mission

National Collaborating Centre for Determinants of Health. (2013). Public health speaks: Organizational standards as a promising practice for health equity. Antigonish, NS: Author.

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

What contributes to successful public health leadership for health equity? An appreciative inquiry

This project set out to identify factors or conditions that influence effective public health leadership to address social determinants of health and health equity. Semi-structured interviews were conducted with 14 public health leaders from across Canada using an appreciative inquiry method.

Analysis of the interviews revealed that successful leadership requires three supporting factors, including:

  • organizational supports, including allocation of funds, human resources, high quality population health data, and adherence to external policies and standards;
  • bridging organizational activities with community action, for instance by partnering and engaging with community organizations; and
  • professional competencies, which include the essential knowledge, skills, and attitudes required to advocate for health equity.

This report contributes to the evidence base, and paves a way forward for public health action on the social determinants of health.

Use this resource to:

  • Identify and foster those factors in your organization that support effective leadership for health equity
  • Read examples of successful leadership activities to address social determinants of health and health equity
  • Learn about the role of public health leadership in building community partnerships

Click here for the key messages

Click here for the summary

National Collaborating Centre for Determinants of Health. (2013). What Contributes to Successful Public Health Leadership for Health Equity? An Appreciative Inquiry: 14 Interviews. Antigonish, NS: Author.

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

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 & organizational standards , Intersectoral action, Leadership & capacity building, Document

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 & organizational standards , Leadership & capacity building, Document

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, Assess and report, Community engagement, Evaluation, Intersectoral action, Knowledge translation , Methods & tools, Modify & orient, Document

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

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: Food security, Key concepts, Modify & orient, 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: Assess and report, Community engagement, Evaluation, Knowledge translation , Methods & tools, Modify & orient, 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: Evaluation, Knowledge translation , Methods & tools, Modify & orient, 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

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: Key concepts, Modify & orient, 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, Modify & orient, 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 , Document

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

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: Communicate, 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, Document

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 four-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: Evaluation, Leadership & capacity building, Modify & orient, Policy analysis, Public health unit / health authority, Document

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: Assess and report, Document

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, Document

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 , Document

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, Document

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: Leadership & capacity building, Document

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

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, Document

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, Healthy public policy, National Collaborating Centre for Determinants of Health, Document

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: Critical works in health equity, Healthy public policy, Intersectoral action, Document

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 an approach 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, Document

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: Assess and report, Link

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 & organizational standards , Document

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:

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 & organizational standards , National Collaborating Centre for Determinants of Health, Document

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, Document

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 , Document

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: Critical works in health equity, Income inequity, Key concepts, Document

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: Assess and report, Healthy public policy, Sex & gender, Document

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, Link

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, Document

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, Racism/racialization, Sex & gender, Socioeconomic status , Document

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.
  9. Learning Together:  How and What we Learned about Equity-Integrated Population Health Status Reporting summarizes the results of the developmental evaluation report and reflections from the final meeting of the Learning Circle of the National Collaborating Centre for Determinants of Health (NCCDH) Population Health Status Reporting Initiative in March 2013.

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

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: Racism/racialization, Document

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, Document

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, Document

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, Document

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: Video

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: Assess and report, Competencies & organizational standards , Early childhood development, Intersectoral action, Key concepts, Document

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, Document