Driving Health Equity Into Action at a Community Level<br />Bob Gardner<br />Central LHIN<br />Health Equity Advisory Netw...
The Challenge = Health Inequities in Ontario<br /><ul><li>there is a clear gradient in health in which people with lower i...
+ major differences between women and men
the gap between the health status of the best off and most disadvantaged can be huge – and damaging
in addition, there are systemic inequities in access to and quality of care within the health care system
these inequities can be concentrated in particular communities, neighbourhoods and areas</li></ul>2<br />
Context<br /><ul><li>focus today is on concentrated equity initiatives in three communities:
Chippewas of Georgina Island First Nation (Northern York)
Rural area of South Simcoe
Diverse urban communities in North York West
focusing on particular communities or populations is a critical component of an overall equity strategy
will talk about the constant need to align and balance local/specific initiatives with wider system changes and strategies
LHINs can effectively use the levers they control:
 allocating resources and influencing health care providers
can also enable partnerships, collaborations and other change initiatives
shown to be effective way to drive quality improvement and system reforms
especially important when levers of change are outside LHINs’ formal mandates and resources</li></ul>3<br />
Percentage of Adults Who Reported Their Health as Fair or Poor: Ontario and Central LHIN<br />4<br />
5<br />
August 4, 2011<br />Hospitalization Rates for Diabetes: Ontario and Central LHIN<br />
7<br />
Impact of Disparities<br />inequality in how long people live<br /><ul><li>difference btwn life expectancy of top and bott...
more sophisticated analyses add the pronounced gradient in morbidity to mortality -> taking account of quality of life and...
even higher disparities btwn top and bottom = 11.4 years for men and 9.7 for women </li></ul>Statistics Canada Health Repo...
9<br />www.welleseyinstitute.com<br />Foundations of Health Disparities Roots Lie in Social Determinants of Health <br /><...
impact of inadequate early childhood development, poverty, precarious employment, social exclusion, inadequate housing and...
real problem is differential access to these determinants – many analysts are focusing more specifically on social determi...
Health Equity = Reducing Unfair Differences<br /><ul><li>Health disparities or inequities are differences in health outcom...
This concept:
is clear, understandable and actionable
identifies the problem that policies will try to solve
is also tied to widely accepted notions of fairness and social justice
The goal of health equity strategy is to reduce or eliminate socially and institutionally structured health inequalities a...
A positive and forward-looking definition = equal opportunities for good health
Equity is a broad goal, including diversity in background, culture, race and identity</li></li></ul><li>12<br />Think Big,...
think big and think strategically, but get going</li></ul>make best judgment from evidence and experience<br />identify ac...
<ul><li>goal is to ensure equitable access to high quality healthcare regardless of social position
can do this through a three pronged strategy:</li></ul>building health equity into all health planning and delivery<br />d...
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Driving Health Equity into Action at a Community Level

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This presentation provides insight on how to drive health equity into action at a community level.

Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI

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  • that’s the problem we are trying to solve
  • esp. with different professionals and providers in a very complex system
  • self-reported health is seen as a reliable measure of overall health status2X as low as higher income across prov – a little better in Central
  • key point is gradient in alldiabetes is key prov and central priority – almost 3x incidence in lower income as high
  • inequitable incidence of diabetes has been identified as key issue across CentralLHIN is doing better than prov averages – but we know this won’t be the case in these two communitiesthis shows impact of that social gradient of health – lower income end up in hospital morethat, of course, also has system implications: reducing inequality of health outcomes -&gt; could reduce overall expendituresneed to update this data – could be local project for hospitals and LHIN
  • getting more specific on concrete impact of health disparities on quality of livesactivities of ¼ of low income people are limited by pain = 2X than high incomealmost certainly worse in two communities
  • In: that&apos;s impact on daily livesthat type of impact adds up over people&apos;s lives
  • another way of looking at this complexity and what to do about itcommunity resilience and capacities operates at key intersections herewill come back to how SDoH can be driven into action on the ground through:community-based development or capacity building e.g. community development workers in many CHCscross-sectoral collaborations – many local groups and networkscross-sectoral planning tables and processes= focus of this planning day
  • Principle applies throughout system – at provider and often at program level as well
  • openings = LHINs are mandated to undertake community engagement
  • Sick Kids analysis of patients by neighbourhood income levelneed to match tools to purpose
  • need to match tools to purpose can adapt to particular care and disciplinary settingscould the policy or initiative have a differential or inequitable impact on different groups?= simple equity lens that can be broadly appliedtemplate for today&apos;s planning is a good example
  • theme: use levers to hand – Ls can require use of such tools
  • recognizing that what gets measured, matters
  • appropriate -- meaning especially that every plan need not be huge and cannot add excessively to agency workload
  • not just being an immigrantbut where people came from and what conditions they find themselves in here:more precarious position in labour marketfacing racism and dynamics of social exclusion
  • smoking is about ¾ higher in adults with lower education – better in Centralpart of picture for gradient in chronic conditionslesson of considerable research – need to understand social context and pressures of more disadvantaged populations, to be able to develop programs that support there being able to stop smoking
  • same principle applies – working up-stream to prevent people getting sick and needing more acute treatmentwatch for opportunities for collaborative planning and action as MHP rolls out this approach
  • addressing wider SDoH is the glue for collaboration into action in many sectors
  • and identify issue for wider collaboration and advocacy
  • many jurisdictions: Italian example for immigrant pop’nscould consider for Central for any expansion
  • SSM was one of these big ideas and tremendous work of AOHC and allies
  • summary again
  • Driving Health Equity into Action at a Community Level

    1. 1. Driving Health Equity Into Action at a Community Level<br />Bob Gardner<br />Central LHIN<br />Health Equity Advisory Network Roundtable<br />May 19, 2011<br />
    2. 2. The Challenge = Health Inequities in Ontario<br /><ul><li>there is a clear gradient in health in which people with lower income, education or other indicators of social inequality and exclusion tend to have poorer health
    3. 3. + major differences between women and men
    4. 4. the gap between the health status of the best off and most disadvantaged can be huge – and damaging
    5. 5. in addition, there are systemic inequities in access to and quality of care within the health care system
    6. 6. these inequities can be concentrated in particular communities, neighbourhoods and areas</li></ul>2<br />
    7. 7. Context<br /><ul><li>focus today is on concentrated equity initiatives in three communities:
    8. 8. Chippewas of Georgina Island First Nation (Northern York)
    9. 9. Rural area of South Simcoe
    10. 10. Diverse urban communities in North York West
    11. 11. focusing on particular communities or populations is a critical component of an overall equity strategy
    12. 12. will talk about the constant need to align and balance local/specific initiatives with wider system changes and strategies
    13. 13. LHINs can effectively use the levers they control:
    14. 14. allocating resources and influencing health care providers
    15. 15. can also enable partnerships, collaborations and other change initiatives
    16. 16. shown to be effective way to drive quality improvement and system reforms
    17. 17. especially important when levers of change are outside LHINs’ formal mandates and resources</li></ul>3<br />
    18. 18. Percentage of Adults Who Reported Their Health as Fair or Poor: Ontario and Central LHIN<br />4<br />
    19. 19. 5<br />
    20. 20. August 4, 2011<br />Hospitalization Rates for Diabetes: Ontario and Central LHIN<br />
    21. 21. 7<br />
    22. 22. Impact of Disparities<br />inequality in how long people live<br /><ul><li>difference btwn life expectancy of top and bottom income decile = 7.4 years for men and 4.5 for women
    23. 23. more sophisticated analyses add the pronounced gradient in morbidity to mortality -> taking account of quality of life and developing data on health adjusted life expectancy
    24. 24. even higher disparities btwn top and bottom = 11.4 years for men and 9.7 for women </li></ul>Statistics Canada Health Reports Dec 09<br />8<br />
    25. 25. 9<br />www.welleseyinstitute.com<br />Foundations of Health Disparities Roots Lie in Social Determinants of Health <br /><ul><li>clear research consensus that roots of health disparities lie in broader social and economic inequality and exclusion
    26. 26. impact of inadequate early childhood development, poverty, precarious employment, social exclusion, inadequate housing and decaying social safety nets on health outcomes is well established here and internationally
    27. 27. real problem is differential access to these determinants – many analysts are focusing more specifically on social determinants of health inequalities</li></li></ul><li>Planning For Complexity of SDoH<br />POWER Study<br />Gender and<br />Equity<br />Health Indicator<br />Framework<br />10<br />
    28. 28. Health Equity = Reducing Unfair Differences<br /><ul><li>Health disparities or inequities are differences in health outcomes that are avoidable, unfair and systematically related to social inequality and disadvantage
    29. 29. This concept:
    30. 30. is clear, understandable and actionable
    31. 31. identifies the problem that policies will try to solve
    32. 32. is also tied to widely accepted notions of fairness and social justice
    33. 33. The goal of health equity strategy is to reduce or eliminate socially and institutionally structured health inequalities and differential outcomes
    34. 34. A positive and forward-looking definition = equal opportunities for good health
    35. 35. Equity is a broad goal, including diversity in background, culture, race and identity</li></li></ul><li>12<br />Think Big, But Get Going<br /><ul><li>health disparities can seem so overwhelming and their underlying social determinants so intractable -> can be paralyzing
    36. 36. think big and think strategically, but get going</li></ul>make best judgment from evidence and experience<br />identify actionable and manageable initiatives that can make a difference<br />experiment and innovate --- learn lessons and adjust<br />gradually build up coherent sets of policy and program actions – and keep evaluating, learning and adapting<br /><ul><li>need to start somewhere – and focus today is on </li></ul>building equity into health system<br />by focusing on concentrated action in three communities<br />
    37. 37. <ul><li>goal is to ensure equitable access to high quality healthcare regardless of social position
    38. 38. can do this through a three pronged strategy:</li></ul>building health equity into all health planning and delivery<br />doesn’t mean all programs are all about equity<br />but all take equity into account in planning their services and outreach<br />aligning equity with system drivers and embedding it in provider organizations and performance management <br />targeting some resources or programs specifically to addressing disadvantaged populations or key access barriers<br />looking for investments and interventions that will have the highest impact on reducing health disparities or enhancing the opportunities for good health of the most vulnerable<br />Equity Into Health System<br />13<br />
    39. 39. Start From The Community<br /><ul><li>goal is to reduce health disparities and speak to needs of most vulnerable communities – who will define?
    40. 40. can’t just be ‘experts’, planners or professionals
    41. 41. have to build community into core planning and priority setting
    42. 42. not as occasional community engagement, but to identify equity needs and priorities, and to evaluate how we are doing
    43. 43. many providers have community advisory panels or community members on their boards
    44. 44. can also build on innovative methods of engagement – e.g. citizens’ assemblies or juries in many jurisdictions
    45. 45. idea = develop innovative community engagement and partnerships to ground and drive action in these two communities
    46. 46. need good local data on needs, gaps and opportunities
    47. 47. community-based research, needs assessment and evaluation
    48. 48. build on data from Toronto Health Profiles, public health, etc.
    49. 49. idea = identify information needs and build actionable profile of community health needs</li></ul>14<br />
    50. 50. Into Practice Through Equity-Focused Planning<br /><ul><li>addressing health disparities in service delivery and planning requires a solid understanding of:
    51. 51. key barriers to equitable access to high quality care
    52. 52. the specific needs of health-disadvantaged populations
    53. 53. gaps in available services for these populations
    54. 54. need to understand roots of disparities:
    55. 55. i.e. is the main problem language barriers, lack of coordination among providers, sheer lack of services in particular neighbourhoods, etc.
    56. 56. which requires good local research and detailed information – speaks to great potential of community-based research
    57. 57. involvement of local communities and stakeholders in planning and priority setting is critical to understanding the real local problems
    58. 58. requires an array of effective and practical equity-focused planning tools</li></ul>15<br />
    59. 59. Equity-Focused Planning Tools<br />quick check to ensure equity is considered in all service delivery/planning<br />take account of disadvantaged populations, access barriers and related equity issues in program planning and service delivery<br />assess current state of provider organization<br />determine needs of communities facing health disparities <br />assess impact of programs/interventions on health disparities and disadvantaged populations<br />simple equity lens<br />Health Equity Impact Assessment<br />equity audits and/or HEIA<br />equity-focused needs assessment<br />equity-focused evaluation<br />16<br />
    60. 60. Health Equity Impact Assessment<br /><ul><li>increasing attention to potential – from WHO, through most European strategies, PHAC, to MOHLTC and LHINs
    61. 61. planning tool that analyzes potential impact of program or policy change on health disparities and/or health disadvantaged populations</li></ul>can help to plan new services, policy development or other initiatives<br />can also be used to assess/realign existing programs<br />intended to be relatively easy-to-use tool <br />essentially prospective, helping plan forward<br /><ul><li>piloted in Toronto in 2009 by MOHTLC, Toronto Central LHIN and WI, final versions released by Ministry in 2011</li></ul>Toronto Central has required HEIA within recent funding application processes for Aging at Home, and refreshing hospital equity plans<br /><ul><li>idea = LHIN and providers to undertake HEIA for any service or program changes that could affect these communities</li></ul>17<br />
    62. 62. Beyond Planning: Embed Equity in Targets and Incentives<br /><ul><li>clear consensus from research and policy literature and consistent feature in comprehensive policies on health equity from other countries =
    63. 63. setting targets for reducing access barriers, improving health outcomes of particular populations, etc
    64. 64. developing realistic and actionable indicators for service delivery
    65. 65. closely monitoring progress against the targets and indicators
    66. 66. disseminating the results widely for public scrutiny
    67. 67. tying funding and resource allocation to performance
    68. 68. innovative work underway to develop equity indicators – but don’t need to wait
    69. 69. idea = what are appropriate equity targets for these communities?
    70. 70. simplest could be to build on indicators already being collected </li></ul>-> equity angle is to reduce differences between these communities and others or LHIN as a whole on these indicators<br />18<br />
    71. 71. Building Effective Equity Targets For Central Priorities<br /><ul><li>reducing diabetes incidence is prov and LHIN priority, and pressing issue in these communities</li></ul> -> equity target = reduce differences in incidence, complications and rates of hospitalization between populations or areas<br /><ul><li>a good service target has been proposed for diabetes = high/increasing % of people who get best standard care </li></ul>-> equity target = reduce differences by gender, income, ethno-cultural background, neighbourhood<br /><ul><li>need to drill down in specific areas that have high equity impact:</li></ul>-> ensuring access and use of primary health care does not vary inequitably by income level, immigration status, neigbourhood, gender, race, etc. <br /><ul><li>many providers and programs assess their services through client satisfaction surveys and look for high and improving satisfaction </li></ul>-> reduce any differences in satisfaction by gender, income, ethno-cultural background, neighbourhood, etc.<br />19<br />
    72. 72. <ul><li>where targets and indicators get tied to deliverables and incentives
    73. 73. key lever = all hospitals, CHCs and other providers sign Service Accountability Agreements with LHINs that govern flow of funds</li></ul>-> can build specific expectations and deliverables into those agreements<br /><ul><li>will vary by community and provider -- but could include:
    74. 74. undertaking appropriate equity-focused planning to identify areas where access to services is inequitable and developing plans to address barriers and gaps
    75. 75. stratifying quality indicators by equity – e.g. reducing hospital readmission rates is common objective</li></ul>->equity angle is to reduce any inequitable differences in readmission rates by language ability or neighbourhood<br /><ul><li>idea = identify the most relevant issues for the two communities – readmissions, primary care, clinic or specialist visits re diabetes – and include appropriate expectations in provider accountability agreements</li></ul>Embed Equity In Performance Management<br />20<br />
    76. 76. <ul><li>all this planning, monitoring indicators, and assessing progress against objectives and targets needs reliable data on:
    77. 77. ethno-cultural background, language, income, sexual orientation</li></ul>service use and health outcomes, differentiated by these equity and determinants of health variables<br /><ul><li>when hospitals in Toronto Central began working on their equity plans it became very clear that they simply did not have the necessary data to do equity-driven planning
    78. 78. three hospitals = Toronto Public Health are collaborating on how to collect and incorporate equity data at service level
    79. 79. Central hospitals could link into this
    80. 80. but don’t wait for perfect data
    81. 81. hospitals have been using postal code data as proxy for socio-economic conditions
    82. 82. idea = any project that arises out of this equity planning to collect relevant SDoH data</li></ul>Precondition: Equity-Relevant Data<br />21<br />
    83. 83. <ul><li>a promising direction several LHINs have taken up is to require providers to develop equity plans</li></ul>hospitals in Toronto Central have refreshed 2nd generation<br />hospitals and other providers in Central have completed progress reports for 10/11<br />CHCs are developing sector-wide plan in Toronto Central<br /><ul><li>these plans are designed to:
    84. 84. identify access barriers, disadvantaged populations, service gaps and opportunities in their catchement areas and spheres
    85. 85. develop programs and services to address those gaps and better meet healthcare needs of disadvantaged communities
    86. 86. these provider plans have the potential to:
    87. 87. raise awareness of equity within the organizations
    88. 88. build equity into planning, resource allocation and routine delivery
    89. 89. pull their many existing initiatives together into a coherent overall equity strategy
    90. 90. build connections among providers for addressing common equity issues
    91. 91. idea = ask providers to address specific issue arising out of this equity planning for the two communities in refreshed plans or as appendices to their plans</li></ul>Use Effective Tools: Equity Plans<br />22<br />
    92. 92. 23<br />Target Investment for Equity Impact<br /><ul><li>target services to:</li></ul>those communities or populations facing the harshest disparities – to raise the worst off fastest<br />or most in need of specific services<br />or the worst barriers to equitable access to high-quality services<br /><ul><li>this requires resources</li></ul>lever = certain % of LHIN budgets to be equity targeted<br /><ul><li>this requires sophisticated analyses of the bases of disparities:</li></ul>i.e. is the main problem language barriers, lack of coordination among providers, sheer lack of services in particular neighbourhoods, social exclusion, etc.<br />which requires good local research and detailed information –profile idea<br />involvement of local communities and stakeholders in planning and priority setting is critical to understanding the real local problems<br />
    93. 93. <ul><li>equity planning/policy challenge =
    94. 94. what are the key drivers or levers for change within the health system?
    95. 95. how to build equity into those drivers and effectively use those levers to advance health equity?
    96. 96. solid evidence that enhancing primary care is one of key ways to improve care of disadvantaged
    97. 97. lack of access to primary care has been identified as a key issue for Prov and LHINs – and for these communities</li></ul>-> concentrate new FHTs or other initiatives in particular regions or neighbourhoods, or in particular populations such as refugees or uninsured<br />challenge for LHIN = most of levers for transforming primary care are outside their mandate -> need cross-sectoral coordinated planning<br /><ul><li>idea = local projects to coordinate and enhance access to high quality primary care in the two communities
    98. 98. also a chance to be innovative around new ways of community-driven coordination and multi-disciplinary service integration</li></ul>Use Effective Levers to Drive Change: Primary Care<br />24<br />
    99. 99. 25<br />Up-Stream Through an Equity Lens: Chronic Conditions<br /><ul><li>improving chronic care prevention and management are key Provincial and LHIN priorities-> align community equity initiatives
    100. 100. chronic disease prevention and management programs cannot be successful unless they take health disparities and wider social conditions into account</li></ul>very clear gradient in incidence – and impact – of chronic conditions<br />poor, Aboriginal and other vulnerable communities face greater incidence<br />at the same, time these communities tend to have less access to good food, safe open space and recreational facilities to encourage exercise, and other resources to manage their conditions.<br />the Toronto diabetes atlas produced by ICES found that only 25% of people in low-income neighbourhoods participated in weekly sports – versus 75% from high-income<br />built environment is also key -- the atlas found that people in low-income areas walked more for transportation purposes but less for exercise<br />up-stream initiatives need to be planned and implemented through an equity lens<br />some populations and communities need greater support to prevent and manage chronic conditions<br />idea = adapt innovative diabetes prevention and management models to these communities<br />
    101. 101. Gradient in Adult Smoking: Ontario and Central LHIN<br />26<br />
    102. 102. Up Stream Through an Equity Lens: Health Promotion<br /><ul><li>more emphasis on health promotion is vital to long-term sustainability of system and individual health</li></ul>consistent data on variations of risk factors along the social gradient<br />anti-smoking, exercise, harm reduction and other health promotion programs need to explicitly foreground the particular social, cultural and economic factors that shape risky behaviour in poorer communities– not just the usual focus on individual behaviour and lifestyle<br />need to customize and concentrate health promotion programs for particular community contexts and needs<br />if this isn’t done -> can unintentionally widen disparities as better off take up programs more<br /><ul><li>here again, challenge = programs and levers are outside LHIN scope -> partner across sectors</li></ul>27<br />
    103. 103. Cross-Sectoral Planning Through an Equity Lens<br /><ul><li>across Canada, leading Regional Health Authorities have developed operational and planning links with local social services or emphasized community capacity building:</li></ul>Saskatoon is developing cross-sectoral action on health equity:<br />began from local research documenting shocking disparities among neighbourhoods<br />focusing interventions in the poorest neighbourhoods – locating services in schools, relying on First Nations elders to guide programming, etc.<br />wide collaboration among public health, municipality, business, community, Aboriginal and other leaders<br /><ul><li>in Ont a number of public health units have been pioneering broad community collaborations -- Sudbury, Waterloo, Toronto, Peterborough
    104. 104. Local Immigration Partnerships , Social Planning Councils
    105. 105. the Ministry of Health Promotion and Sport is developing a healthy communities strategic approach and community partnerships
    106. 106. idea = sponsor or partner cross-sectoral planning with public health, health promotion, social services, settlement, education, etc. in the two communities</li></ul>28<br />
    107. 107. Back to Service Delivery and Excellent Care: Take SDoH Into Account<br /><ul><li>all of this equity planning loops back to quality
    108. 108. patient-centred care means taking the full range of people’s specific needs into account</li></ul>social context and living conditions are part of this<br />when people face adverse social determinants of health <br />-> can increase risk of mental and physical health challenges and illness <br />-> fewer resources to cope (from supportive social networks, to good food and being able to afford medication)<br />providers and programs need to know this to customize and adapt care to needs and contexts<br />more intensive case management, referral planning and post-discharge follow-up<br /><ul><li>idea = multi-disciplinary planning tables and projects to adapt quality of care to the specific social and cultural context of these two communities</li></ul>29<br />
    109. 109. Not Just at Individual Level: Build Equity-Driven Service Models<br /><ul><li>hub-style multi-service centres in which a range of health and employment, child care, language, settlement, literacy, training and social services are provided out of single ‘one stop' locations</li></ul>many countries have clinics that provide both health and wider social services in one place<br />some new satellite CHCs are being developed in designated high-need areas in Toronto will involve the CHCs delivering primary and preventive care and other agencies providing complementary social services out of the same location<br /><ul><li>not just health -- idea of schools as service hubs is being developed </li></ul>think back to earlier eras with public health nurses in schools <br />start by putting hubs in schools in most disadvantaged areas<br />concentrated and integrated services for most disadvantaged kids have proven to be effective investment<br /><ul><li>idea = explore potential of hub principles or model in these areas
    110. 110. important to realize that lessons learned from innovation in these two communities will benefit others as well</li></ul>30<br />
    111. 111. Extend That -> Build Community-Level Action<br /><ul><li>all leading jurisdictions with comprehensive equity strategies combine national policy with local adaptation and concentrated investment
    112. 112. many cities have developed neighbourhood revitalization strategies
    113. 113. Toronto’s priority neighbourhoods
    114. 114. Regent’s Park
    115. 115. promising direction = comprehensive community initiatives:
    116. 116. broad partnerships of local residents, community organizations, governments, business, labour and other stakeholders
    117. 117. coming together to address deep-rooted local problems – poverty, neighbourhood deterioration , health disparities
    118. 118. collaborative cross-sectoral efforts – employment opportunities, skills building, access to health and social services, community development
    119. 119. Vibrant Communities – communities across the country to build individual and community capacities to reduce poverty</li></ul>31<br />
    120. 120. Back to Community Again: Build Momentum and Mobilization<br /><ul><li>sophisticated strategy, solid equity-focused research, planning and innovation, and well-targeted investments and services are key
    121. 121. but in the long run, also need fundamental changes in over-arching social policy and underlying structures of economic and social inequality
    122. 122. these kinds of huge changes come about not because of good analysis but through widespread community mobilization and public pressure
    123. 123. key to equity-driven reform will also be empowering communities to imagine their own alternative vision of different health futures and to organize to achieve them
    124. 124. collaborative action to find local health equity solutions is part of that community mobilization + is critical to driving immediate action on pressing problems</li></ul>32<br />August 4, 2011<br />
    125. 125. Key Messages<br /><ul><li>health disparities are pervasive and deep-seated – but can’t let that paralyze us
    126. 126. do need a comprehensive and coherent health equity strategy – but don’t wait for perfect strategy
    127. 127. think big and think strategically – but get going
    128. 128. there is a solid base of evidence, provider experience, commitment and community connections to build on
    129. 129. have set out a roadmap – of strategies, principles ,tools and options-- to drive equity into action through health system change and community mobilization
    130. 130. many within the health system and beyond have long experience and strong commitment to equity </li></ul>-> build on this to drive coordinated and coherent system-wide equity agenda into action<br />->and locally, work in partnerships and collaborations to address the health inequalities in these specific communities<br />33<br />
    131. 131. <ul><li>these speaking notes and further resources on policy directions to enhance health equity, health reform and the social determinants of health are available on our site at http://wellesleyinstitute.com
    132. 132. my email is bob@wellesleyinstitute.com
    133. 133. I would be interested in any comments on the ideas in this presentation and any information or analysis on initiatives or experience that address health equity</li></ul>Following Up<br />34<br />
    134. 134. Wellesley Roadmap for Action on the Social Determinants of Health<br />look widely for ideas and inspiration from jurisdictions with comprehensive health equity policies, and adapt flexibly to Canadian, provincial and local needs and opportunities;<br />address the fundamental social determinants of health inequality – macro policy is crucial, reducing overall social and economic inequality and enhancing social mobility are the pre-conditions for reducing health disparities over the long-term;<br />develop a coherent overall strategy, but split it into actionable and manageable components that can be moved on;<br />act across silos – inter-sectoral and cross-government collaboration and coordination are vital;<br />set and monitor targets and incentives – cascading through all levels of government and programme action;<br />35<br />
    135. 135. Wellesley Roadmap II<br />6 rigorously evaluate the outcomes and potential of programme initiatives and investments – to build on successes and scale up what is working; <br />7 act on equity within the health system:<br /><ul><li>making equity a core objective and driver of health system reform – every bit as important as quality and sustainability;
    136. 136. eliminating unfair and inefficient barriers to access to the care people need;
    137. 137. targeting interventions and enhanced services to the most health disadvantaged populations;</li></ul>8 invest in those levers and spheres that have the most impact on health disparities such as:<br /><ul><li>enhanced primary care for the most under-served or disadvantaged populations;
    138. 138. integrated health, child development, language, settlement, employment, and other community-based social services;</li></ul>36<br />
    139. 139. Wellesley Roadmap III<br />9 act locally – through well-focussed regional, local or neighbourhood cross-sectoral collaborations and integrated initiatives;<br />10 invest up-stream through an equity lens – in health promotion, chronic care prevention and management, and tackling the roots of health disparities;<br />11 build on the enormous amount of local imagination and innovation going on among service providers and communities across the country;<br />12 pull all this innovation, experience and learning together into a continually evolving repertoire of effective programme and policy instruments, and into a coherent and coordinated overall strategy for health equity.<br />37<br />
    140. 140. © The Wellesley Institute<br />www.wellesleyinstitute.com<br />38<br />
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