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Enhancing Health Equity: The Potential of Peer Health Ambassadors


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Enhancing Health Equity: The Potential of Peer Health Ambassadors

  1. 1. Bob Gardner and Estelle Sun Canadian Public Health Association Annual Conference, June 22, 2011 ENHANCING HEALTH EQUITY: THE POTENTIAL OF PEER HEALTH 1
  2. 2. Problem: Health InequitiesPervasive inequities in health outcomes are rooted in social determinants of health and systemic inequalitiesThe most disadvantaged in SDoH terms can become more marginalized in the health system • Language • Sexuality • Culture and Religion • Geography/Distance • Socioeconomic Status • Age • Race 2
  3. 3. POWER Study Gender and Equity Health Indicator Framework Highlights1. How the structure, resources and resilience of communities mediate the impact of SDoH2. Why we need to take SDoH into account in health service planning and delivery 3
  4. 4. Building Solutions → Comprehensive Health Equity StrategyNeed comprehensive strategy to address the foundations and impact ofhealth inequities → + Macro social and economic policy to reduce overall inequality • from childcare through improving precarious employment to education + Comprehensive community initiatives to build resources and resilience + Community mobilization to push for necessary policy changesEven though roots of health disparities lie in far wider social and economicinequality, how the health system is organized and how services and careare delivered is still crucial to tackling health disparities, including: • Reducing barriers to equitable access to high quality care • Targeted interventions to improve the health of the poorest, fastest • Up-stream investments in primary and preventative care directed to most vulnerable • Delivering a full continuum of services in coordinated way at community/local level 4
  5. 5. Part of the Solutions: Community-Driven InnovationNeed innovative community-based service delivery andpartnershipsPeer Health Ambassadors• Members of the community, from the community• Working with established healthcare providers to improve access and quality of care for targeted populations 5
  6. 6. Our ResearchPurpose• Survey the range and impact of Peer Health Ambassadors• Assess their potential to meet needs of marginalized populations• Identify key success conditions and enablers to realize this potentialMethods• Review of literature• Key informant interviews with 10 Toronto community organizations currently working with peer-based models 6
  7. 7. Findings: Great PotentialGeneral congruence between literature review andkey informant interviews:• Peer Health Ambassadors are a promising model for improving health equity through eliminating barriers to health care and improving engagement• Marginalized groups prefer healthcare providers who have personal experience with their problems, who understand their viewpoints, and who share key traits (race, gender, religion, sexuality, cancer, drug use, etc.)• When community impact is reported, the results are generally very positive 7
  8. 8. Findings: Characteristics of Peer Health Ambassadors• Wide range and no clear definitions of ``peer`` • Varies in level of expertise and “peerness”• Three broad areas: • navigating the system • health promotion • integrated into comprehensive service provision• Volunteers vs. paid staff• Tend to be women 8
  9. 9. Findings: Facilitators to Effectiveness and Impact• Financial compensation• Initial and ongoing training/support/mentoring for peers• Clear roles and division of labour + flexibility to accommodate dynamic needs of both peers and communities being served• Participation of peers in program or service planning and development• Rigorous quality assurance at every stage• Program evaluation to improve practices 9
  10. 10. Findings: Barriers• Peer life-stage, ability to adapt their own health and lifestyle to work environment• Breach of peers’ personal boundaries by clients and co-workers, because of the highly personal nature of this work• Organizational capacity to support peer needs, service demands and client expectations• Client preferences for credentialed professionals or specific delivery settings 10
  11. 11. Findings: Barriers (cont’d)• Resistance from professionals or institutions to community-based delivery• Mainstream marketing doesn’t work for marginalized populations• Unstable funding• Scaling up to larger projects 11
  12. 12. Realizing the Potential of Peer Health Ambassador Initiatives• Enlist users in planning and development• Provide ongoing training and support, driven by peer and community needs• Provide financial compensation, even during training• Allow for adaptability and flexibility of training and program to suit the needs of peer workers and clients• Monitor and evaluate for quality• Market the services using mediums that can reach the target population• Actively pursue alternative funding sources 12
  13. 13. Key Messages• Need comprehensive strategy to address health inequities• Part of this is ensuring equitable access to high-quality care for all – even the most vulnerable and isolated• Peer ambassador type initiatives have shown great potential in being able to reach, support and involve marginalized populations• In line with key themes of this conference: • Address complexity of social determinants of health through flexible and creative policy, programs and collaboration • Build on potential of community initiatives and innovation • Build on community empowerment and engagement 13
  14. 14. THANK YOU Please visit us