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Building a culture of equity in Canadian public health: An environmental scan

This is the third environmental scan undertaken by the National Collaborating Centre for Determinants of Health (NCCDH) since 2010. It responds to recent concerns about the significant decline in commitment to public health programs and services in the Canadian health sector. The scan explores implications for the public health sector in undertaking effective action to address the social determinants of health and improve health equity in this context.

The four public health roles to address health equity are revisited and the essential resources for undertaking these roles are explored further, along with the implications for how these resources can be used for organizational and system development. The resulting framework uses “resources for action” to bridge public health action (the four roles) and organizational and community change processes focused on supporting health equity.

The resources for action provide the information and tools public health practitioners need to fulfill the four roles and build a culture of equity:

  1. Leadership – formal leadership and systems leadership (transformational)
  2. Evidence - research and evaluation to guide decision-making
  3. Communication – to frame, educate, and inform internally and externally
  4. Training – skill development and partnership development

Five action areas for building organizational and leadership capacity to improve health equity in the context of the current health system are distilled from the findings. These recommendations include the following:

  1. Incorporate health equity as a foundational value for the health system
  2. Support a values-reflection process for leaders
  3. Prepare public health leaders to advocate for health equity work across the health system
  4. Support use of an equity lens in evidence-based decision-making
  5. Support grounded community engagement as a foundation for health equity work

The potential strategies described under each action area have been selected to align with the knowledge translation role of the NCCDH. However, each action area (and resources for action) is equally applicable across public health and the wider health system at all levels (local, provincial/territorial, national).

Use this document to

  • learn about the challenges and opportunities from across the country for public health to take action to improve health equity;
  • explore ways your organization can strengthen resources for action to support change processes; and
  • identify possible strategies and next steps to guide your health equity work and build a culture of equity.


Related resources

Nurturing a culture of equity: goals and approaches for a common agenda for public health action – summary (2017)

Public health leadership for action on health equity: A literature review (2018)

Let’s Talk: Public health roles to address health equity (2013)

Integrating social determinants of health and health equity into Canadian public health practice: Environmental scan 2010 (2010)

Boosting momentum: Applying knowledge to advance health equity (2014)


National Collaborating Centre for Determinants of Health. (2018). Building a culture of equity: 2017 environmental scan. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

Tags: Assess and report, Environmental Scan