The document discusses the pervasive health disparities in Ontario, emphasizing the need for a comprehensive health equity strategy to address the systemic roots of these inequalities. It outlines the importance of equitable access to quality healthcare and the integration of social determinants of health in policy design and program interventions. The document highlights successful international examples and concludes with a call for targeted actions and collaborative efforts to close the health equity gap.

1. Bob Gardner
The ACHIEVE Research Partnership: Action for
Health Equity Interventions
Dec 2, 2009
© The Wellesley Institute
www.wellesleyinstitute.com

2. • understanding the scale, impact and roots of existing
health disparities in Ontario
• why we need a comprehensive health equity strategy to
address these pervasive disparities:
• macro level social and economic policy
• within the health system
• through specific service interventions
• analyzing where evaluation fits:
• driving more effective equity-focused planning
• underpinning more effective program and service interventions
• grounding more effective and innovative collaborations
• supporting strategic coherence across all these levels
2

3. • 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 + major differences
between women and men
• the gap between the health status of the best off and most
disadvantaged can be huge – and damaging
• difference btwn life expectancy of top and bottom income decile in
Canada = 7.4 years for men and 4.5 for women
• 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
• even higher disparities btwn top and bottom = 11.4 years for men and
9.7 for women (Statistics Canada Health Reports Dec 09)
• in addition, there are systemic disparities in access to and
quality of care within the healthcare system
3

4. 4

5. 5

6. 6

7. 7

8. • clear research consensus that roots
of health disparities lie in broader
social and economic inequality and
exclusion
• 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
• real problem is differential access to
these determinants – many analysts
are focusing more specifically on
social determinants of health
inequalities
© The Wellesley Institute
8
www.welleseyinstitute.com

9. 9

10. 10

11. Determinants interact and
intersect with each other -- in
a 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
11

12. • Health disparities or inequities are differences in health
outcomes that are avoidable, unfair and systematically
related to social inequality and disadvantage
• This concept:
• is clear, understandable and actionable
• identifies the problem that policies will try to solve
• is 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 and
differential outcomes
12

13. • a positive and forward-looking definition = equal opportunities
for good health
• health equity is a broad concept that also prioritizes diversity:
• reflecting the increasing diversity of Ontario society and the fact that
racism and ethno-cultural differences are important determinants of
health disparities
• recognizing that services that reflect and speak to the diversity of
cultures -- cultural competence – are essential to an equitable system
• and can encompass equity-focused health promotion
• recognizing that vulnerable populations face more complex and
serious barriers to good health
• recognizing that programs and plans need to always take this social
context and constraints into account
• achieving health equity would extend far beyond enhancing
individual and collective well-being
13

14. 14

15. • health disparities can seem so overwhelming and their
underlying social determinants so intractable → can be
paralyzing
• think big and think strategically, but get going
• make best judgment from evidence and experience
• experiment and innovate
• learn lessons and adjust – why evaluation is so crucial
• gradually build up coherent sets of policy and program
actions – and keep evaluating
• need to start somewhere – and we’re in health systems
15

16. • need action addressing health disparities at multiple
levels:
• macro social and economic policy
• broad strategic frameworks within health and other
systems
• policies and strategies for particular issues – chronic
conditions, primary care, e health
• specific service interventions geared to specific outcomes
or places
• interventions at every one of these levels are complex
• impact is inter-dependent and contingent → need
coherent overall strategy
16

17. • we want policy and program interventions to have:
• the most impact in reducing disparities
• that sustain that impact over the long-term
• reducing overall social and economic inequality may
be the most significant single way to reduce health
disparities
→need to reduce unequal distribution of social and
economic resources – of SDoH
→ requires a significant commitment and re-orientation
of social and economic policy and fundamental
institutional arrangements
17

18. • there is always much to be learned from policies, programs
and initiatives in other jurisdictions
• a number of countries have made lessening health
disparities a top national priority and have developed cross-
sectoral policy frameworks and/or action plans:
• England, Scotland, Australia, New Zealand
• many European countries
• also increasing international and high-level attention:
• WHO Commission on Social Determinants of Health
• European Union, with its Closing the Gap project to tackle health disparities
• look broadly for policy solutions, and adapt flexibly to
local/provincial circumstances
18

19. • coordinated national policy to reduce health disparities
by reducing the number of people at risk of social and
economic vulnerability
• national public health strategy has 12 key objectives –
five of which, defined as fundamental to all the others,
are about improving social and economic determinants
• also focus on inclusive labour market, anti-discrimination, childcare,
affordable housing and other policies
• equitable access to improved health care was seen to be just one part
of this broader package
• emphasized partnerships with community service
providers and organizations – in both policy
development and service delivery
19

20. • reducing health disparities – and underlying social
and economic inequality – are complex challenges
• developing and mobilizing health policy is a classic
‘wicked problem’:
• the issue crosses policy fields and jurisdictional boundaries
• involves many govt and external stakeholders
• is shaped by forces beyond govt control
• is necessarily long-term
• won’t align neatly with party/govt interests and electoral
cycles
20

21. • but goal is reducing health disparities – is that ultimate evaluation
criteria?
• disparities do not appear to be lessening in countries with good
strategies
…. but these effects are necessarily long-term?
• no evidence that comprehensive policies work is the wrong conclusion
…. but have not been evaluating properly to conclude interventions don't
work
• Britain has reviewed its comprehensive policies:
• no decline in disparities – perhaps worsening
• mixed results on specific objectives – some on target, some not
• can't conclude that interventions don’t work – too soon to tell
• but did conclude that evaluation was not properly built into policy and
program design
21

22. • might need more modest immediate to mid-term evaluation approaches
and objectives – more process than outcomes?
• is there coherence in strategies and objectives across policy fields and
departments?
• more specifically, comprehensive strategies are generally accompanied
by efforts for greater ‘joined-up’ government coordination and
collaboration
• can evaluate processes
• are priorities and directions aligned towards common goals and vision?
• were the right stakeholders involved – in the right ways – in developing
policy?
• is strategy based on best available theory, evidence and experience?
• is strategy comprehensive – are critical components missing or under-
developed?
22

23. • even though roots of health disparities lie in far wider social
and economic inequality
• how the health system is organized and how services and
care are delivered is still crucial to tackling health disparities
• many countries have developed comprehensive multi-
sectoral strategies to reduce health disparities
• in all of them, transforming the health system is an
indispensable element, 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 these services in coordinated way at community/local level
23

24. 1. it’s in the health system that the most disadvantaged
in SDoH terms end up sicker and needing care
• equitable healthcare and proactive health promotion can help to
mediate the harshest impact of the wider social determinants of
health on health disadvantaged populations and communities
2. in addition, there are systemic disparities in access
and quality of healthcare that need to be addressed
• people lower down the social hierarchy tend to have poorer access
to health services, even though they may have more complex needs
and require more care
• unless we address inequitable access and quality, healthcare and
health promotion could make overall disparities even worse
• at the least, the goal is to ensure equitable access to care/support
for all who need it, regardless of their social position
24

25. while health disparities are
pervasive and deep-rooted, they
can be changed through policy and
program action
comprehensive strategy developed
in 2008 for Toronto Central LHIN
many recommendations have been
acted on
other LHINs are also prioritizing and
moving to address health disparities
25

26. • given impact of wider SDoH, cannot expect even the most
progressive and equitable health system to lead to major
reductions in disparities of outcomes
• goal is to ensure equitable access to high quality healthcare
regardless of social position
• can do this through a two pronged strategy :
1. building health equity into all health planning and delivery
• doesn’t mean all programs are all about equity
• but all take equity into account in planning their services and
outreach
2. targeting some resources or programs specifically to addressing
disadvantaged populations or key access barriers
• 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
26

27. • one critical component of this strategic
approach is good planning
• to develop effective planning, we need:
• clear strategy
• coherent approach
• repertoire of effective tools and techniques
• with support for planning authorities and
practitioners to effectively use them
• good actionable information
• and then drilling down: what is our ‘theory’ of
how equity-focused planning works?
27

28. not just
taking account individual
of social programs but
constraints & coordination,
conditions partnerships &
collaboration
28

29. enhanced up-stream heath
access to conditions &
health opportunities
promotion for improve fastest
most for those in
disadvantaged greatest need
29

30. • processes and constraints are complex, and outcomes
uncertain and unpredictable, at each of these junctures
• and all of this varies by context:
• particular communities or neighbourhoods – with their different
health challenges and needs
• particular population health and service landscape in specific areas
• further specified by health condition or concern (e.g. mental health)
• existing municipal and local polices and traditions
• community resilience, connectedness, organizing and traditions
• we don’t really know what works best at each of these
junctures (let alone cumulatively) or in varying contexts
→ need to build evaluation in from the start to learn
30

31. 1. quick check to ensure equity is 1. simple equity lens
considered in all service
delivery/planning
2. Health Equity Impact
2. take account of disadvantaged
Assessment – has been piloted in
populations, access barriers and
Toronto and MOHLTC is
related equity issues in program
considering wider roll-out
planning and service delivery
3. assess current state of provider
organization 3. equity audits and/or HEIA
4. determine needs of communities
facing health disparities 4. equity-focused needs
5. assess impact of assessment
programs/interventions on
health disparities and 5. equity-focused evaluation
disadvantaged populations
31

32. 1. screening – projects where while HEIA is sometimes promoted
HEIA would be useful as easy-to-use ‘first-pass’ planning
2. scoping – which pop’n and tool
health effects to consider
3. assessing potential equity risks does not mean it is only about 1 -- 3
and benefits – specifying
particular pop’n
4. developing recommendations – experts argue core of HEIA is in fact
to promote positive or mitigate 4 – assessing & developing
negative effects recommendations to address equity
5. report results to decision implications
makers
6. monitoring and evaluation – of
effectiveness of
recommendations
32

33. • a premise of the draft Ontario HEIA – and many others – is
that:
• assessing the potential impact of initiatives on particular populations
requires solid understanding of that population's health status, needs
and context
• this can benefit from ongoing community engagement with the
population and/or specific needs assessment
• analyzing possible mitigation strategies will also benefit
from engaging the affected population in designing the
necessary service changes
• similarly, the stage of monitoring and assessing the impact
of the initiative – and how HEIA contributed -- also needs:
• research and input from the affected population on impact
• outcome data stratified by population and determinants
33

34. • comprehensive policies on health equity from other
countries all include:
• setting clear strategic objectives and targets
• defining indicators – that build on available reliable data
and make the most sense in the particular context
• closely monitoring progress against the indicators or
targets
• disseminating the results widely for public scrutiny
• key driver of system change = building equity
targets and objectives into routine performance
management and provider planning
34

35. • we know there will be broad targets for priorities such as diabetes
and mental health → build equity into these targets:
• several LHINs have identified areas where diabetes incidence is
highest → equity target = reduce differences in incidence,
complications and rates of hospitalization among areas across Central
• similarly, systemic inequities in depression → equity target = reduce
those differences by gender, income, region
• looking up-stream → equity target = ensuring take-up of health
promotion programs does not vary inequitably by income level,
neigbourhood, gender, race, etc.
• many programs assess their services through client satisfaction
surveys and similar methods
• providers look for high and improving satisfaction → equity target =
reduce any differences in satisfaction by gender, income, ethno-cultural
background, etc.
35

36. • MOHLTC flow funds to LHINS, who in turn allocate funds to
health service providers
• these funding programs, and the accountability agreements
that go with them with providers, provide an opportunity to
build in specific equity expectations
• expectations will vary by community and provider, but could
include:
• undertaking appropriate equity-focused planning
• providing sufficient services in languages of community and
appropriate interpretation
• identifying areas where access to services is inequitable and
developing plans to address barriers and gaps
• ensuring service utilization matches appropriately with demography
and needs of their catchment profile
• developing specific services or outreach to particular disadvantaged
populations – homeless, isolated seniors, etc.
36

37. • greater chance of success for equity strategy if aligned with
provincial priorities
• MOHLTC and MHP priorities such as mental health and
diabetes are particularly sensitive to social conditions
• chronic disease prevention and management programs cannot be successful
unless they take account of social conditions and constraints
• various supports designed to enable people with mental health challenges to
live in the community also need to take into account their social conditions
• Wellesley and Canadian Mental Health Association–Ontario
partnered on input to current discussions about mental
health strategy:
• stressed that programs had to take account of SDoH in ways discussed here
• highlighted healthy communities approach
• highlighted the potential of specific planning tools such as Mental Health
Impact Assessment
37

38. • identify key priorities and imperatives for wider health
system transformation
• equity also supports other system drivers
• better access to primary care is key to reducing pressure
on ER wait times and ALC
• reducing language barriers to good care through better
interpretation can reduce mis-diagnoses and over-
prescriptions → enhanced quality and cost effectiveness
• reducing higher expenditures on vulnerable populations
due to health disparities → can contribute to overall and
sustainability
38

39. • a promising direction several LHINs have taken up is to have
providers undertake specific equity planning exercises designed
to:
• identify access barriers, disadvantaged populations, service gaps and
opportunities in their catchement areas and spheres
• develop programs and services to address those gaps and better meet
healthcare needs of disadvantaged communities
• these provider plans have the potential to:
• raise awareness of equity within the organizations
• build equity into planning, resource allocation and routine delivery
• pull their many existing initiatives together into a coherent overall
equity strategy
• build connections among providers for addressing common equity
issues
39

40. http://www.torontoevaluation.ca/tclhin/index.html
40

41. • target services to specific areas or populations:
• those facing the harshest disparities – to improve the health of the worst
off fastest
• or those most in need of specific services
• or to the worst barriers to equitable access to high-quality services
• this requires sophisticated analyses of the bases of disparities:
• i.e. is the main problem language barriers, lack of coordination among
providers, sheer lack of services in particular neighbourhoods, etc.
• which requires good local research and detailed information – speaks to
great potential of community-based research to provide rich local needs
assessments and evaluation data
• involvement of local communities and stakeholders in planning and
priority setting is critical to understanding the real local problems
41

42. • language was a major theme in Toronto hospital equity plans
• we identified acting on this barrier as potential ‘quick win’ in
analysis of plans
• TC LHIN is funding project to explore innovative ways to
streamlining and enhancing access to interpretation
• build in evaluation:
• can track improvements in volume of interpretation provided
• but need to match that against need
• need to also assess quality
• need to assess impact on improving access to (which?) services
for (which?) populations
42

43. Diabetes Incidence, TC LHIN 2004/05
16
14 13.3
12
New Cases/1,000
10
8
5.8
6
4
2
0
Low Income High Income
Two fold difference in diabetes incidence between lowest and highest
neighbourhoods.
Age Standardized Rates. Data Source: Ontario Diabetes Database, 2004/05
www.ices.on.ca/intool 43

44. • investing in better chronic care prevention and management
are vital elements of health reform and major provincial
priority
• up-stream initiatives need to be planned and implemented
through an equity lens
• very clear gradient in incidence – and impact – of chronic conditions
• some populations and communities need greater support to prevent
and manage chronic conditions
– poor, Aboriginal and other vulnerable communities face greater incidence
and greater challenges in managing diabetes
– at the same, time these communities tend to have less access to safe
open space and recreational facilities to encourage exercise
– the Toronto diabetes atlas produced by ICES found that only 25% of in
low-income neighbourhoods participated in weekly sports – versus 75%
form high-income
– built environment is also key -- Atlas found that people -n low-income
areas walked more for transportation purposes but less for exercise
44

45. • a very interesting example is the integrated diabetes
program developed out of the London InterCommunity
Health Centre:
– far greater incidence and impact in local Hispanic community
– CHC, community groups and others worked closely together to
concrete services in these areas of greatest need
– language specific and culturally sensitive services
– preventative and promotion services offered where people went –
e.g. shopping malls
– also saw that social conditions had to be addressed → referrals to
social service support, advocacy around employment and other
problems
45

46. • more emphasis on health promotion is vital to long-term
sustainability of system and individual health
• consistent data on variations of risk factors along the social
gradient
• anti-smoking, exercise and other health promotion programs
need to explicitly consider the particular social, cultural and
economic factors that shape risky behaviour in poorer
communities– not just the usual focus on individual behaviour
and lifestyle
• need to customize and concentrate health promotion programs
for most disadvantaged
• if this isn’t done → universal programs can unintentionally
widen disparities as better off take up programs more
• need to also build local community needs and a priority for
disadvantaged into decisions on where to locate new programs
46

47. • hub-style multi-service centres in which a range of health and
employment, child care, language, literacy, training and social
services are provided out of single ‘one stop' locations
• Winnipeg Regional Health Authority and Manitoba Family
Services and Housing have partnered on a new model to
integrate health and social service delivery – one-stop access
models in various communities to deliver a broad range of
health and social services directly and to refer on to other
agencies when services aren’t available
• Ontario provincial associations representing CHCs, mental
health and community service agencies have been promoting
idea -- including to LHIN CEO provincial planning table
47

48. • British example of comprehensive policy: Health Action
Zones and other models were designed to combine
community economic development with targeted healthcare
and social service improvements
• in Canada, some Regional Health Authorities have
developed operational and planning links with local social
services or emphasized community capacity building:
• Saskatoon is developing cross-sectoral action on health equity:
• began from local research documenting shocking disparities among
neighbourhoods
• focusing interventions in the poorest neighbourhoods – locating services
in schools, relying on First Nations elders to guide programming, etc.
• wide collaboration among public health, municipality, business,
community, Aboriginal and other leaders
48

49. • increasing international, Cdn and Ont interest in more
strategic and realist evaluation
• figuring our what interventions and approaches work, for
which populations, in what contexts and why
• also drawing on more community-based and participatory
approaches
• this is absolutely crucial for equity strategy:
• to identify ‘successful’ policies and programs that most effectively
reduce access barriers or support the most health disadvantaged
populations
• to guide investment in directions that will have the most equity impact
49

50. • at immediate levels:
• service and client objectives were built into program plan – were they met?
• does service provide good quality care?
• does it work for those with most complex needs or from most disadvantaged
circumstances?
• more equity-orientated:
• if service is targeted to equity objectives -- does it support the particular
population or address the particular access barrier as anticipated
• standard analysis of impact against objectives
• more generally:
• can’t just measure activity – number or % of pop’n that participated in a
program
• does this delivery help to lessen disparities in access for disadvantaged
populations or reduce access/quality barriers
• need to measure health outcomes – even when impact only shows up in long-
term
50

51. • does the overall strategy deliver the right mix of:
• quick wins to build momentum and address pressing immediate
problems
• longer-term and/or wider scale interventions
• are the many initiatives coordinated effectively?
• is it the particular service – better primary care – or the
context/combination – delivered out of comprehensive community
centres – that makes the difference?
• are interventions aligned coherently to build towards common strategic
directions?
• how can we evaluate the cumulative impact of many equity-focused
interventions – let alone of their degree of coherence and coordination?
51

52. • can’t go for simplistic indicators
• e.g. lowering the overall incidence of diabetes
• a number of researchers and LHINs have identified areas where diabetes
incidence is highest
→ equity target = reduce differences in incidence between populations or
areas
• need to evaluate if and how programs have met these equity objectives
• in fact, we should expect a successful strategy to lead to incidence getting
worse in the short tem as more disadvantaged people at greater risk of
diabetes are being identified and brought into the system to get care
• want to identify specific interventions or directions that have high equity
impact:
• ensuring access and use of primary health care does not vary inequitably by
income level, immigration status, neigbourhood, gender, race, etc.
• in fact, concentrating services in most disadvantaged communities with
greatest needs
52

53. • a good service target has been proposed for diabetes =
high/increasing % of people who get best standard care
• there is clear clinical consensus on what this best standard care
constitutes and how to measure it
→ equity target = reduce inequitable differences in quality care
• so we need to evaluate % who get the highest standard care by
gender, income, ethno-cultural background
• and assess any inequitable variations in outcomes in terms of
complications and rates of hospitalization
• many programs assess their services through client satisfaction
surveys and similar methods
• providers look for high and improving satisfaction → equity
target = reduce any differences in satisfaction by gender,
income, ethno-cultural background, etc.
53

54. • if goal is to increase the % of kids who exercise regularly
• equity target is to reduce the differentials in % of kids who
exercise by neighbourhood, gender, ethno-cultural background,
etc.
• and that won’t be just a question of education and awareness
but facilities and proactive empowerment of kids and
communities in which they live
• if goal is increasing overall exercise rates and decreasing smoking
→ equity target = reduce those differences by gender, income,
region
• drilling down: to achieve these equity targets, we need to:
• ensure take-up of health promotion programs does not vary
inequitably by income level, neigbourhood, gender, race, etc.
• in fact, take-up – and sticking with the programs – needs to be
highest in most disadvantaged communities with greatest needs
54

55. • don’t just want to evaluate results for those who make it through
the doors of service providers
• but also disadvantaged populations who are not being reached
• need to assess who isn’t signing up?
• and once signed up for particular program, are there inequitable
variations in who sticks with the program?
• need to differentiate those with greatest need = who programs
most need to reach and keep to have an impact
→ develop funding and evaluation weighting that recognizes more
complex needs and challenges of most disadvantaged, and builds
this into incentive system
→ again, to guide investment in policy directions and program
interventions that will have the strongest equity impact
55

56. • huge number of community and front-line initiatives already addressing
equity and health promotion across province
• + equity focused planning will yield useful information on existing
system barriers and the needs of disadvantaged populations, and on
promising and successful program interventions
• we need to be able to:
• collate and analyze all the useful intelligence gained from equity-focused
planning
• capture and share information on local initiatives, and build on local front-line
insights
• share the resulting knowledge across regions – and beyond
• assess the most promising initiatives or directions
• scale up promising initiatives across the province where appropriate
• central role of evaluation in all this
56

57. 1. Where would you start and what would be your
most important challenges in developing a
comprehensive cross-sectoral strategy to reduce
health disparities in ten years? How would you
build in an effective evaluation framework?
2. Outline a strategy to reduce the incidence and
impact of diabetes in Toronto and set up an
evaluation framework for it.
3. Develop a plan and set up an evaluation framework
for community-based programs in Parkdale to
reduce the incidence and impact of diabetes.
57

58. • back to bigger picture
• following is a roadmap for comprehensive
integrated policy action on determinants of
health and health inequality
58

59. 1. look widely for ideas and inspiration from jurisdictions with comprehensive
health equity policies, and adapt flexibly to Canadian, provincial and local needs
and opportunities;
2. 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;
3. develop a coherent overall strategy, but split it into actionable and manageable
components that can be moved on;
4. act across silos – inter-sectoral and cross-government collaboration and
coordination are vital;
5. set and monitor targets and incentives – cascading through all levels of
government and program action;
59

60. 6 rigorously evaluate the outcomes and potential of program initiatives and
investments – to build on successes and scale up what is working;
7 act on equity within the health system:
• making equity a core objective and driver of health system reform – every bit
as important as quality and sustainability;
• eliminating unfair and inefficient barriers to access to the care people need;
• targeting interventions and enhanced services to the most health
disadvantaged populations;
8 invest in those levers and spheres that have the most impact on health
disparities such as:
• enhanced primary care for the most under-served or disadvantaged
populations;
• integrated health, child development, language, settlement, employment, and
other community-based social services;
60

61. 9 act locally – through well-focussed regional, local or neighbourhood cross-
sectoral collaborations and integrated initiatives;
10 invest up-stream through an equity lens – in health promotion, chronic care
prevention and management, and tackling the roots of health disparities;
11 build on the enormous amount of local imagination and innovation going on
among service providers and communities across the country;
12 pull all this innovation, experience and learning together into a continually
evolving repertoire of effective program and policy instruments, and into a
coherent and coordinated overall strategy for health equity.
61

62. • 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
• my email is bob@wellesleyinstitute.com
• 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
62

63. The Wellesley Institute advances urban health through rigorous research,
pragmatic policy solutions, social innovation, and community action.
63