Driving Health Equity Into Action: Planning and Strategy to Address Complex Social Determinants of Health<br />Bob Gardner...
Health Equity Context = Systemic Disparities in Ontario<br /><ul><li>there is a clear gradient in health in which people w...
+ major differences between women and men
the gap between the health of the best off and most disadvantaged can be huge – and damaging
in addition, there are systemic disparities in access to and quality of care within the healthcare system</li></ul>2<br />
<ul><li>addressing health disparities has become a major priority within the health system:
from the prov Ministry of Health and Long-Term Care, through LHINs and PHUs to many providers
some promising equity strategy, planning and operationalization
will draw out some parallels and lessons learned from health system reform
but overall health is shaped by factors well beyond health care – income inequality, the jobs we do, racism, housing and l...
and reducing health disparities involves far more than health reform
will focus on how equity needs to be considered in health care, climate change policy and many other spheres and some tool...
4<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...
we need comprehensive strategy to drive policy action and social change across these determinants</li></li></ul><li>SDoH M...
so climate change and its effects on air, water, disasters and other environmental trends is very much a health issue
but the inequitable distribution and impact of these underlying determinants also means:
some health disadvantaged populations are far more vulnerable to the effects of climate change and other environmentally d...
some populations have fewer resources and less capacity to cope with the impact of climate change and other emerging chall...
so climate change and clean air are very much a health equity issue</li></ul>5<br />
SDoH As a Complex Problem<br /><ul><li>Determinants interact and intersect with each other
In constantly changing and dynamic system
In fact, through multiple interacting and inter-dependent economic, social and health systems
Determinants have a reinforcing and cumulative effect on individual and population health
Figuring out effective policy and community responses to these complex and inter-dependent determinants is a crucial probl...
Three Cumulative and Inter-Dependent Levels Shape Health Inequities<br />because of inequitable access to wealth, income, ...
‘Wicked’ Policy Problems<br /><ul><li>social determinants of health and health disparities are classic ‘wicked’ policy pro...
shaped by many inter-related and inter-dependent factors
in constantly changing social, economic, community and policy environments
action has to be taken at multiple levels, by many governments, service providers, other stakeholders and communities
solutions are not always clear and policy agreement can be difficult to achieve
effect takes years to show up – far beyond any electoral cycle
need comprehensive strategy to tackle the underlying roots of health inequality in the wider social determinants of health
from high-level national social and policy change to reduce inequality through community-based innovation, cross-sectoral ...
that can identify the lines of connection between all these factors and identify the crucial leverage points for change</l...
Part of Addressing these ‘Wicked’ Problems Is Making the Connections<br /><ul><li>climate change is very much a complex so...
will weave in and out in this talk:
some lessons learned from working to develop equity strategy, planning and implementation within the health system
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Driving Health Equity into Action: Planning Strategy to Address Complex Social Determinants of Health

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This presentation provides insight on the importance of a planning strategy to address complex social determinants of health.

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

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  • inequality in how well people live:clear gradient of health in chronic conditions in Ontario¼ of low income people report that their activities are prevented by pain – 2X that for high incomePower Studyinequality in how long people livedifference btwn life expectancy of top and bottom income decile = 7.4 years for men and 4.5 for womenmore sophisticated analyses add the pronounced gradient in morbidity to mortality -&gt; taking account of quality of life and developing data on health adjusted life expectancyeven higher disparities btwn top and bottom = 11.4 years for men and 9.7 for women Statistics Canada Health Reports Dec 09
  • highlight RoadmapOut: health equity is all about reducing inequalities in health outcomesneed to start by understanding nature, impact and roots of current health disparities
  • so search for pathways from particular determinants to health effects is illusionaryintroduce term if needed to further illustrate complexity of landscape? inter-sectionality – reflecting the fact that personal identities and group dynamics do not reflect a single line of oppression/identity such as gender, race or class, but their reinforcing and interacting natureOut: what is the impact of all this?
  • Ont 2005 age standardized 25&gt;
  • Principle applies throughout system – at provider and often at program level as wellwhat are equivalents in climate change strategy intoaction?
  • start from solid strategic commitmentmajor priority within OAHPP, OPHA, collaboration among urban PHUs across Canada, etc.a number of Public Health Units have been pioneering social determinants approachesSudbury has developed comprehensive strategyWaterloo has focused especially on food insecurityToronto has emphasized health impact of increasing income inequalitywide range of promising approaches, programs and interventions -&gt; potential to share and build on all this local innovationMinistry of Health Promotion and Sport is taking a healthy community planning approach – potentially more equity-orientated
  • broad public and policy recognition that creating healthy communities and populations is critical to society as a wholeand the cost of poor and inequitable health are a significant driver of public spending
  • backgrounder does thatsupplement through local place-based and community-based research
  • need to match tools to purpose equity-focused as a specific angle is not consistently developed in all these levels
  • theme: use levers to hand – LHINs can require use of such toolscould also require planning, environment and other relevant municipal departments to undertake health equity impact assessments
  • lesson from health reform and equity strategyrecognizing that what gets measured, matterswhat are equivalents for climate change strategy/action?
  • SSM was one of these big ideas and tremendous work of AOHC and allies
  • summary again
  • Driving Health Equity into Action: Planning Strategy to Address Complex Social Determinants of Health

    1. 1. Driving Health Equity Into Action: Planning and Strategy to Address Complex Social Determinants of Health<br />Bob Gardner<br />Climate Change Adaptation and Health Equity Workshop<br />May 24, 2011<br />
    2. 2. Health Equity Context = Systemic Disparities 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 of the best off and most disadvantaged can be huge – and damaging
    5. 5. in addition, there are systemic disparities in access to and quality of care within the healthcare system</li></ul>2<br />
    6. 6. <ul><li>addressing health disparities has become a major priority within the health system:
    7. 7. from the prov Ministry of Health and Long-Term Care, through LHINs and PHUs to many providers
    8. 8. some promising equity strategy, planning and operationalization
    9. 9. will draw out some parallels and lessons learned from health system reform
    10. 10. but overall health is shaped by factors well beyond health care – income inequality, the jobs we do, racism, housing and living conditions, social connectedness – the social determinants of health
    11. 11. and reducing health disparities involves far more than health reform
    12. 12. will focus on how equity needs to be considered in health care, climate change policy and many other spheres and some tools and principles on how to build equity into strategy across the determinants of health</li></ul>Building Solutions -> Comprehensive Health Equity Strategy<br />3<br />
    13. 13. 4<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
    14. 14. 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
    15. 15. we need comprehensive strategy to drive policy action and social change across these determinants</li></li></ul><li>SDoH Meets Climate Change Strategy<br /><ul><li>environmental factors – air, water, built environment, communities we live in – are crucial components of these determinants
    16. 16. so climate change and its effects on air, water, disasters and other environmental trends is very much a health issue
    17. 17. but the inequitable distribution and impact of these underlying determinants also means:
    18. 18. some health disadvantaged populations are far more vulnerable to the effects of climate change and other environmentally driven problems
    19. 19. some populations have fewer resources and less capacity to cope with the impact of climate change and other emerging challenges
    20. 20. so climate change and clean air are very much a health equity issue</li></ul>5<br />
    21. 21. SDoH As a Complex Problem<br /><ul><li>Determinants interact and intersect with each other
    22. 22. In constantly changing and dynamic system
    23. 23. In fact, through multiple interacting and inter-dependent economic, social and health systems
    24. 24. Determinants have a reinforcing and cumulative effect on individual and population health
    25. 25. Figuring out effective policy and community responses to these complex and inter-dependent determinants is a crucial problem across all the spheres in which we work</li></ul>6<br />
    26. 26. Three Cumulative and Inter-Dependent Levels Shape Health Inequities<br />because of inequitable access to wealth, income, education and other fundamental determinants of health -><br />also because of broader social and economic inequality and exclusion-><br />because of all this, disadvantaged and vulnerable populations have more complex needs, but face systemic barriers within the health and other systems -><br />gradient of health in which more disadvantaged communities have poorer overall health and are at greater risk of many conditions<br />some communities and populations have fewer capacities, resources and resilience to cope with the impact of poor health<br />these disadvantaged and vulnerable communities tend to have inequitable access to services and support they need<br />7<br />
    27. 27. ‘Wicked’ Policy Problems<br /><ul><li>social determinants of health and health disparities are classic ‘wicked’ policy problems:
    28. 28. shaped by many inter-related and inter-dependent factors
    29. 29. in constantly changing social, economic, community and policy environments
    30. 30. action has to be taken at multiple levels, by many governments, service providers, other stakeholders and communities
    31. 31. solutions are not always clear and policy agreement can be difficult to achieve
    32. 32. effect takes years to show up – far beyond any electoral cycle
    33. 33. need comprehensive strategy to tackle the underlying roots of health inequality in the wider social determinants of health
    34. 34. from high-level national social and policy change to reduce inequality through community-based innovation, cross-sectoral collaborations and mobilization
    35. 35. that can identify the lines of connection between all these factors and identify the crucial leverage points for change</li></ul>8<br />
    36. 36. Part of Addressing these ‘Wicked’ Problems Is Making the Connections<br /><ul><li>climate change is very much a complex social problem and ‘wicked’ policy challenge
    37. 37. will weave in and out in this talk:
    38. 38. some lessons learned from working to develop equity strategy, planning and implementation within the health system
    39. 39. links between environmental and climate issues as determinants of health – fleshed out in your Backgrounder
    40. 40. benefits of thinking of these issues in inter-connected ways, so:
    41. 41. climate change is defined as a critical health equity issue – and this is built into strategy and planning
    42. 42. health reform is always connected to bigger picture of addressing underlying determinants of health, including environmental factors
    43. 43. those addressing complex issues can learn from each other and build momentum to address the root issues</li></ul>9<br />
    44. 44. SDoH -> Gradient of Health-> Inequitable Risks and Vulnerabilities<br />10<br />
    45. 45. Asthma = Sensitive to Air Quality<br />neighbourhood patterns parallel distribution of poverty, income inequality and other social determinants <br />11<br />
    46. 46. Drill Down: Health Equity Implications of Climate Change<br /><ul><li>consistent gradient by income of these and other chronic conditions
    47. 47. because of the health burden of these conditions – and their inequitable distribution -- some are more vulnerable than others to adverse impact of climate change
    48. 48. also because of overall inequality these more vulnerable populations tend to have less capacity and resources to cope with adverse effects
    49. 49. this has to be built into public policy around climate change adaptation</li></ul>12<br />
    50. 50. <ul><li>goal is to ensure equitable access to high quality healthcare regardless of social position
    51. 51. can do this through a multi-pronged strategy:</li></ul>building health equity into all health care 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 priorities<br />embedding equity in provider organizations’ deliverables, incentives 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 />while thinking up-stream to health promotion and addressing the underlying determinants of health<br />Lessons Learned from One Sector: Health Equity Strategy Into Action<br />13<br />
    52. 52. Powerful Starting Point Equity Is a Fundamental Priority Within Public Health and SDoH are Understood<br />14<br />
    53. 53. Start From a Clear Strategy<br /><ul><li>need to develop clear overall strategy:
    54. 54. clear vision of success – of what health equity or equitable climate change adaptation strategy looks like
    55. 55. identify key levers or drivers for change + coherent and coordinated set of programs and activities
    56. 56. grounded in a clear ‘theory of change’ -- the principles, assumptions, ambitions and activities that will lead to the changes we want
    57. 57. within health, important changes can and have been made:
    58. 58. provincially, population health and equity are important principles of Excellent Care for All Act and public health standards
    59. 59. locally, equity is a major priority of Toronto Central LHIN and Toronto Public Health; they have both built this priority into their overall planning and operations; and both have led or enabled many promising equity service or collaboration initiatives
    60. 60. parallel for climate change?
    61. 61. aligning climate change with population health and health equity priorities may be useful direction</li></ul>15<br />
    62. 62. And Strategic Planning for Emerging/Complex Issues<br /><ul><li>various Ministries and governments often do forms of long-range scenario planning
    63. 63. has to take dynamic and complex nature of social determinants of health into account
    64. 64. for health planners:
    65. 65. can’t just be demographic, technological and medical forecasting
    66. 66. has to also include broader environmental trends and threats
    67. 67. similarly, long-term planning within environmental policy has to:
    68. 68. take account of health impact of climate change and other trends/threats
    69. 69. undertake equity analyses to assess inequitable risks and vulnerabilities of different populations
    70. 70. build this equity analysis into development of strategy on how to adapt to climate change</li></ul>16<br />
    71. 71. Start from Solid Evidence<br /><ul><li>analyze best available medical, health and community-based research:
    72. 72. links between air quality and asthma, lung disease and other chronic conditions
    73. 73. links between inequitable prevalence and impact of these chronic conditions and wider social determinants of health – at the multiple levels:</li></ul>exposure to poor air quality and attendant health risks varies inequitably by populations and neighbourhoods<br />capacity of communities and residents to cope with poor air and adverse health impacts also in turn shaped by wider social determinants of health<br />compounded by inequitable access to remedial health, social and environmental services and resources<br /><ul><li>to build the case that poor air quality and other environmental factors are population health issues
    74. 74. idea: environmental and planning agencies to collect equity-relevant data</li></ul>17<br />
    75. 75. Into Practice Through Equity-Focused Planning<br /><ul><li>lessons learned from health equity strategy = addressing health disparities requires a solid understanding of:
    76. 76. the specific needs of health-disadvantaged populations
    77. 77. key barriers to equitable access to high quality care
    78. 78. gaps in available services for these populations
    79. 79. 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, etc.<br />what is the immediate environment in different communities and how does this affect health and health disparities?<br />which requires good local research and detailed information – speaks to great potential of community-based research<br />involvement of local communities and stakeholders in planning and priority setting is critical to understanding the real local problems<br /><ul><li>and requires an array of effective and practical equity-focused planning tools</li></ul>18<br />
    80. 80. Equity-Focused Planning Tools: For Climate Change Adaptation Policy<br />ensure health impact and health equity are considered in development of client change adaptation policy and relevant environmental service delivery/planning<br />assess implications for health disadvantaged populations of climate change adaptation policies and programs<br />assess current state of climate change policy stakeholders re awareness of health and health equity impact<br />determine needs of communities facing inequitable health impact of climate <br />assess impact of programs/interventions on health disadvantaged populations<br />simple equity lens<br />OAHPP Equity Assessment Framework or MOHLTC Health Equity Impact Assessment<br />policy and program audits and/or HEIA<br />equity-focused needs assessment, place-based analysis, community health profiles, local CBR<br />equity-focused evaluation<br />19<br />
    81. 81. Health Equity Impact Assessment<br /><ul><li>Health Impact Assessments grew out of environmental impact assessments and have been used for several decades
    82. 82. but concern that HIAs did not sufficiently focus on equity -> increasing attention to equity-focused impact assessment – from WHO, through most European strategies, PHAC, to MOHLTC and LHINs
    83. 83. 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 />20<br />
    84. 84. Into Practice<br /><ul><li>piloted in Toronto in 2009 by MOHTLC, Toronto Central LHIN and WI, and in several LHINs
    85. 85. final version of template and workbook released by Ministry in 2011 see their page at http://www.health.gov.on.ca/en/pro/programs/heia/background.aspx
    86. 86. growing use within health:</li></ul>HEIA is being used in Toronto Central and other LHINs <br />by many hospitals and other providers across Toronto<br />Toronto Central has required HEIA within recent funding application processes for Aging at Home, and refreshing hospital equity plans<br />primers on HEIA and a variant Mental Health Wellbeing Impact Assessment, many Wellesley workshops and other resources can be found on page at http://www.wellesleyinstitute.com/policy-fields/healthcare-reform/roadmap-for-health-equity/heath-equity-impact-assessment<br /><ul><li>Equity Assessment Framework being developed and piloted by the Ontario Agency for Health Protection and Promotion
    87. 87. following workshop</li></ul>21<br />
    88. 88. And For Climate Change Adaptation?<br /><ul><li>build health equity impact assessment into policy development process
    89. 89. could use HEIA to analyze potential impacts of climate change on poorest and poorest serviced neighbourhoods – where will indoor temperature get unsafe? what options do people in those neighbourhoods have?
    90. 90. then analyze how to target program responses to those neighbourhoods and communities most in need/at risk – who benefits from home retrofitting?
    91. 91. could drill down to analyze specific issues such as heat islands, availability of safe open spaces and air conditioning, etc.
    92. 92. need resources to enable this use of HEIA:
    93. 93. leading jurisdictions have offices that work with various sectors to undertake HEIA
    94. 94. tools, resources and support are needed from Province
    95. 95. + teeth:
    96. 96. idea = any new environmental/climate change policy going to Cabinet or Council must have HEIA done before approval</li></ul>22<br />
    97. 97. Beyond Planning: Embed Equity in Targets, Incentives and Ongoing Performance Management<br /><ul><li>clear consensus from research and policy literature + consistent feature in comprehensive policies on health equity from other countries =
    98. 98. setting targets for reducing access barriers, improving health outcomes of particular populations, etc
    99. 99. into performance management through cascading expectations through the system -- Prov -> LHINs, agencies, etc.-> providers
    100. 100. developing realistic and actionable indicators for service delivery and outcomes
    101. 101. closely monitoring progress against the targets
    102. 102. disseminating the results widely for public scrutiny
    103. 103. tying funding and resource allocation to performance
    104. 104. how to adapt for climate change strategy?
    105. 105. target = reduce differences in prevalence of asthma by neighbourhood
    106. 106. monitor = ensure programs collect data by neighbourhood and other equity-related indices to ensure uptake and reach is equitable </li></ul>23<br />
    107. 107. Use Strategic Levers to Drive Equity Into Action<br /><ul><li>from health system:
    108. 108. LHINs have required providers to prepare equity plans
    109. 109. been effective at embedding equity within organizational planning and priorities and encouraging front-line equity initiatives
    110. 110. all providers will be doing Quality Improvement Plans under new Act
    111. 111. embed equity as one of dimensions of quality in these plans
    112. 112. PHUs have to meet key standards around population health and equity
    113. 113. align equity with system priorities such as chronic disease prevention and management
    114. 114. can’t address diabetes without addressing the social circumstances and conditions in which people have to manage their conditions
    115. 115. and for climate change adaptation?</li></ul>24<br />
    116. 116. Strategic LeversFor Climate Change Adaptation?<br /><ul><li>require municipal plans to both:</li></ul>anticipate and analyse potential impact of climate change across the range of city concerns and services<br />explicitly analyse the equity implications of anticipated impact – differential vulnerability, ability to adapt, need to target response<br /><ul><li>what levers could be used?
    117. 117. build equity into any scenario planning or environmental impact assessments
    118. 118. into building codes and other regulatory powers
    119. 119. targeted programs such as Tower Renewal have particular implications for low-income tenants who live in these areas
    120. 120. what system and organizational drivers?
    121. 121. within health, can tie equity to crucial system priorities of quality, efficiency and sustainability
    122. 122. what equivalents for climate change adaptation – reducing long-term costs, ensuring overall sustainability?</li></ul>25<br />
    123. 123. SDoH into Action: Cross-Sectoral Planning<br /><ul><li>cross-sectoral coordination and planning are much emphasized in public health and health policy circles
    124. 124. public health departments and LHINs are pulling together or participating in cross-sectoral planning tables on health issues
    125. 125. Local Immigration Partnerships, Social Planning Councils, poverty reduction initiatives, etc on many other connected issues
    126. 126. the Ministry of Health Promotion and Sport is developing a healthy communities strategic approach
    127. 127. cross-sectoral planning to ground health promotion </li></ul>anti-smoking, exercise and other health promotion programmes 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 especially for most disadvantaged<br />if this isn’t done -> can unintentionally widen disparities as better off take up programs more<br />26<br />
    128. 128. And For Climate Change Adaptation?<br /><ul><li>from healthy community planning angle:
    129. 129. ensuring healthy environments with clear air can be part of planning and program changes to build healthier communities = get to those tables
    130. 130. highlighting community activism to address environmental issues as one powerful way to highlight SDoH
    131. 131. from climate change and environmental issue angles
    132. 132. need to bring health and equity organizations/issues to those tables
    133. 133. through showing the inequitable health impact of climate change and other environmental trends
    134. 134. identifying areas where most disadvantaged neighbourhoods and communities need enhanced services:
    135. 135. indoor air quality is crucial to health -> concentrate remedial and restorative programs to improve quality of living conditions where need is greatest
    136. 136. if parks and trees are seen to be one way of enhancing local environmental quality -> concentrate new investments in worst-off areas </li></ul>27<br />
    137. 137. SDoH into Action: Policy Coordination<br /><ul><li>addressing these ‘wicked’ policy challenges -> requires a significant commitment and re-orientation of social and economic policy + more ‘joined-up’ policy:
    138. 138. more coordinated, cross-departmental and cross-government policy development and coordination
    139. 139. growing interest in a ‘health in all policies’ approach:
    140. 140. Quebec requires any laws or regulations that could have health implications to be reviewed by the Ministry
    141. 141. Ontario has done policy research on HIAP and developed several tools
    142. 142. policy forums have been created:
    143. 143. Saskatchewan has provincial and regional forums of all ministries involved in human and social services
    144. 144. innovative planning processes have been developed
    145. 145. in Peel, planners and public health staff work together to ensure health impact is considered in planning decisions</li></ul>28<br />
    146. 146. Back to Community: Building on Potential of Community-Based Service Initiatives and Innovation<br /><ul><li>huge number of community and front-line health initiatives addressing equity across province
    147. 147. Community Health Centres, community mental health, community organizations based out of specific ethno-cultural communities
    148. 148. e.g. many community providers have established ‘peer health ambassadors’ to provide system navigation, outreach and health promotion services to particular communities
    149. 149. not being systemically shared or built upon -> need to create forums and infrastructure to identify, assess and adapt this potential
    150. 150. this progressive service delivery = beacon of inspiration for other sectors + constant living demonstration that action is possible
    151. 151. what are clean air equivalent initiatives that could capture imagination and build initiative?
    152. 152. look for insight and inspiration from ‘out of angle’ sources:
    153. 153. e.g. community gardens and kitchens can contribute to food security to some degree, but they can also help build social connectedness and cohesion</li></ul>29<br />
    154. 154. 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
    155. 155. but in the long run, also need fundamental changes in over-arching state social policy and underlying structures of economic and social inequality
    156. 156. these kinds of huge changes come about not because of good analysis, but through widespread community mobilization and public pressure
    157. 157. 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
    158. 158. we need to find ways that governments, providers, community groups, unions, and others can support each others’ campaigns and coalesce around a few ‘big ideas’</li></ul>30<br />May 23, 2011<br />
    159. 159. Health Equity +<br />health equity broadly defined could be one of those ‘big’ unifying ideas..<br />if we see opportunities for good health and wellbeing as a basic right of all<br />if we see these pervasive health disparities as not only incredibly damaging to so many, but also as an indictment of an unequal society<br />if we recognize that coming together to address the social determinants that underlie health inequalities will pull together and benefit many other spheres – such as building safe and healthy living environments and communities<br />if we see that addressing the roots of so many of our social problems requires broad collaboration and mobilization<br /><ul><li>we can start to connect these ideas – so being able to live in a safe and healthy environment can be seen as an essential building block of health and healthy communities
    160. 160. thinking of what needs to be done to create healthy and equitable communities is a way of imagining and forging a powerful vision of a progressive future
    161. 161. and showing that we can get there from here</li></ul>31<br />
    162. 162. Inter-Connected Messages<br /><ul><li>health disparities are pervasive and deep-seated – but can’t let that paralyze us
    163. 163. do need a comprehensive and coherent health equity strategy – but don’t wait for perfect strategy
    164. 164. think big and think strategically – but get going
    165. 165. there is a solid base of evidence, provider experience, commitment and community connections to build on
    166. 166. poor quality air has an adverse impact on health
    167. 167. because of overall health disparities, this impact is inequitable and places a greater burden on the most vulnerable</li></ul>+ these disadvantaged populations have less capacity to cope with adverse climate impacts to come<br /><ul><li>any policies addressing climate change, air and other environmental issues need to take health impact and equity into account</li></ul>32<br />
    168. 168. Key Messages II<br /><ul><li>have set out a roadmap of strategies, principles and tools to drive health equity into action through policy change and community mobilization
    169. 169. many within the health, environmental and other sectors have long experience and strong commitment to equity -> build on this to drive coordinated and coherent system-wide equity agenda into action
    170. 170. work in broad partnerships and collaborations to address the underlying determinants of health inequalities
    171. 171. clean air and environmental quality are critical parts of these overall determinants of health – can be one key site of mobilization
    172. 172. making connections between all the issues/determinants is needed to build healthy and equitable communities</li></ul>33<br />
    173. 173. <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
    174. 174. my email is bob@wellesleyinstitute.com
    175. 175. 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 />
    176. 176. 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 />
    177. 177. 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;
    178. 178. eliminating unfair and inefficient barriers to access to the care people need;
    179. 179. 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;
    180. 180. integrated health, child development, language, settlement, employment, and other community-based social services;</li></ul>36<br />
    181. 181. 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 />
    182. 182. © The Wellesley Institute<br />www.wellesleyinstitute.com<br />38<br />

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