With that in mind, we did this assessment of the 2001, release 1.0 of the Core Competencies for Public Health in Canada We reviewed competencies from other countries and found that there where sometimes more explicit.
The conversations featured in this resource were adapted from one-to-one interviews with four leaders in public health practice and research. These experts were selected from across Canada to share their experiences and reflections on the conceptualization, development, and implementation of organizational standards in varied contexts. The purpose of the resource: Share knowledge about organizational standards as a promising practice for health equity Build capacity among public health leaders, practitioners, and researchers for the development and implementation of organizational standards.Inform change at all levels of the public health system to support organizational standards as an opportunity to advance health equity.
A research project conducted by Sudbury & District Health Unit - interviewed 34 PHIs across northeastern OntarioThe bad news: PHIs frequently encounter poor housing conditions in their day-to-day work—conditions that most of us cannot even imagine. The good news: PHIs are deeply committed to their work. Many reported going “above and beyond” to resolve issues, improve housing conditions, and protect the health of the residents.Partnership was the necessary intervention - The outcomes largelydetermined by the working relationships between the partners & the clarity of respective rolesThe comments from the PHIs helped the research team and advisory committee develop nine recommendations… The recommendations range from specific public health unit practice to broader research and policy advocacy initiatives.
Health equity is ultimately about fairness and justice. Often the communities most affected by inequities are those with access to the least power. Meaningful engagement of communities in decisions and actions which affect their lives ensures that their voices are centred in the conversation on improving health equity. Oftentimes this means letting ourselves experience a modicum of professional discomfort as we step aside from what we think we know best or in the words of … getting comfortable with being uncomfortableA range of frameworks and strategies are being employed across the country which provide excellent models of practice.
From New Brunswick's Community Inclusion Networks tasked with implementing the poverty reduction strategy in that province to involving community in health assessments. In this process we must ensure that we are not only talking to the usual suspects.
So I went back to our earlier work – about the purpose and benefit of population health status reporting. Thought it would serve as a useful reminder for us. Which methods and tools that are also effective for capturing knowledge and feedback in inform the process and future recommendations?
Really also a story of community engagement
Sharing your passion for health equity:Building our collective understandingApril 9, 2013Charlottetown, PEI
The 10 Promising Practices for AdvancingHealth EquityHannah MoffattKnowledge Translation Specialist
Public health roles for health equity1. Assess & report on: a) the existence & impact ofhealth inequities, & b) effective strategies to reduce theseinequities.2. Modify & orient interventions & services to helpreduce inequities, with an understanding of the uniqueneeds of populations that experience marginalization.3. Partner with other government & communityorganizations to identify ways to improve healthoutcomes for populations that experiencemarginalization.4. Lead, support & participate with other organizations inpolicy analysis & development, & in advocacy forimprovements in the determinants of health.Forthcoming, NCCDH 2013
10 Promising Practices to Reduce SocialInequities in Health• Intersectoral action• Targeting withuniversalism• Purposeful reporting• Social marketing• Health equity targetsetting• Equity-focused healthimpact assessment• Competencies/organizational standards• Contribution to evidencebase• Early childhooddevelopment• Community engagementhttp://nccdh.ca/resources/entry/10-promising-practices-guideSudbury & District Health Unit 2009
Competencies & Organizational Standards• Guide public health practice• Competencies - essential knowledge, skills and attitudes• Organizational standards - internal guidelines used byorganizations to outline expected levels of service and toprovide benchmarks for performance and accountability
Core Competencies & the Determinants of Health• An assessment and comparison ofdeterminant of health content in theCore Competencies for Public Healthin Canada• The explicit inclusion of determinantsof health in public health competencystatements ensures that action on thedeterminants is a visible andconcrete part of public health practicehttp://nccdh.ca/resources/entry/core-competencies-assessment
An Assessment and Comparison ofDeterminants of Health Content• The determinants of health are throughout PHAC’sRelease 1.0• The references are often general, implicit andcontained in sections other than the CoreCompetency Statements (e.g., values; examples)• International sets of competencies were sometimesmore explicit in their inclusion of health equity work
Organizational Standards as a PromisingPractice for Health Equity: Conversationswith Public Health Experts• Four public health experts interviewed about theirexperiences and reflections on theconceptualization, development, and implementationof organizational standardsWe have also been able to use the Standards as a bit of arallying cry to encourage other partners to work with us. We‟vebeen able to leverage the requirements and the societal goalsas a conversation starter to say, „we need to work together onthis‟ – Dr. Rosana PellizzariForthcoming, NCCDH 2013
Nova Scotia Public Health Standards• The work of public health isgrounded in:– health equity and socialjustice– the principles of theOttawa Charter forHealth Promotion• Requirements for HealthEquity and Social JusticeWe interviewed the usual andunusual suspects and it justbecame clearer and clearer to usacross the health system that therewas no one area that really tookhealth equity on. And it becameclearer and clearer through ourprocess that this could be a verystrong role for public health. Wecouldn‟t walk away from that role.– Janet Braunstein Moodyhttp://www.gov.ns.ca/hpp/yourmove/Public_Health_Standards_EN.pdf
Intersectoral Action• The solutions to health inequities lie outside the health sector• To intervene on the social determinants of health partnerships arerequired• Strong relationships, common understanding, shared objectives
What’s the evidence? Intersectoral Action• What is the impact/effectiveness ofintersectoral action as a public healthpractice for health equity?• Rapid systematic literature review– Total of17 articles included:1 systematic review, 14 quantitativestudies & 2 qualitative studies– Difficult to determine how observedoutcomes relate to intersectoralactionhttp://nccdh.ca/resources/entry/assessing-the-impact-and-effectiveness-of-intersectoral-action-on-the-SDOH
General Implications of the Review• positive effect for children, especially for early literacy among children oflow-income mothersIntervene in early childhood• improve housing and employment conditions, evidence of impact forother social determinants of health is limitedUpstream interventions• employment/working conditions, child literacy, dental health, housing,and organizational changeMidstream interventions• increase access to oral health services, immunization rates, appropriateuse of primary health care services, and referrals from school readinesschecks.Downstream interventions
Intersectoral Action:Sudbury & District Health’s Experience• Poor housing conditions inrural and northern regions• Vulnerable individuals,limited resources• Going “above and beyond”• Referral to or consultationwith community partners– Relationships– Clarity of rolesSudbury & District Health Unit, 2010http://www.sdhu.com/uploads/content/listings/ExecSummary_TheRoleofPublicHealthInspectors1.pdf
Community Engagement• Involving the community in the development, implementation ofpolicies, programs and services• Empowering communities, building relationships• Interventions are more likely to be appropriate and response
What’s the evidence? Community engagement• Review of reviews on community engagement, the socialdeterminants of health and health equityQuestions:• What is the impact (direct and indirect) of community engagementon the community and community members who are involved?• What is the experience of community engagement for thecommunities and/or community members involved?– How are power and control in interventions addressed?– What role do communities play?– What is the quality of the engagement?Coming soon from NCCDH
• What level of engagement occurs? Are differentlevels of engagement associated with differentoutcomes?• What are the processes and approaches forcommunity engagement? How can public healthimplement an inclusive practice at all levels of theplanning cycle? What is the optimal intensity ofcommunity engagement?(Expanded and adapted from Kelly et al, 2007:63-64 andPopay et al. 2007)What’s the evidence? Community engagement
Community Engagement:New Brunswick’s Experience• Empoweringcommunities toaddress poverty• 2500 residentscontributed to thedevelopment of theplan• Local organizations& unusual suspectshttp://nccdh.ca/resources/entry/casestudy-NB
Purposeful Reporting•Intentionally reporting the relationship between health and socialdeterminants of health•Measuring the breadth and depth of health differences –stratifying by socioeconomic status, using indicators•Guide future interventions, assess the impacts of interventions
Population Health Status Reporting• A “Learning Circle” to help modify population health statusreporting to advance equityWhat is a health status report and why is it important?“A report that doesn‟t get used won‟t help us to advance healthequity.”Selecting health status indicatorshttp://nccdh.ca/resources/entry/population-health-status-reporting“… every indicator has advantagesand disadvantages and needs to beconsidered in context. There is nosuch thing as a “perfect” healthinequality indicator.”Learning Together Series
Population Health Status Reporting• A knowledge translation tool that seeks to:o Effectively disseminate informationo Facilitate intersectoral collaboration bydemonstrating links between sectorso Result in action• An iterative process• Requires a culture of usingevidence to inform decisions
Purposefully Reporting:Saskatoon’s Experience• Population health statusreporting• Conducted over 200community consultations• Gather opinions to rankrecommendationshttp://nccdh.ca/resources/entry/casestudy-SK
Contact UsNational Collaborating Centre for Determinants of HealthSt. Francis Xavier UniversityPO Box 5000 , Antigonish, NS B2G 2W5Email: NCCDH@stfx.caPhone: (902) 867-5406 Fax: (902) 867-6130www.nccdh.ca and www.ccnds.ca@NCCDH_CCNDS