SlideShare a Scribd company logo
Driving Local Action on Health
Equity
Bob Gardner
North Hamilton Community Health Centre
June 19, 2013
Problem to Solve:
Systemic Health Inequities in Ontario
•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 of
the best off and most
disadvantaged can be huge – and
damaging
•impact and severity of these
inequities can be concentrated in
particular populations and
neighbourhoods
2
And Locally
Code Red series on health
inequities by
neighbourhoods:
• 21 years difference in age
at death
• major differences in health
outcomes across many
measures
plus inequitable access to
health care in poorest areas
• 50% higher rates of
emergency department
visits in downtown core
• 2X for psychiatric
emergencies
• less access to primary care
3July 2, 2013 | www.wellesleyinstitute.com
Today
• these health disparities are deep-seated and complex
• but they can be tackled addressed through comprehensive health
equity strategy and concerted action
• means acting on health equity within the health system
• will set out elements of a roadmap to build equity into health
planning and delivery
• CHC have long played a crucial role in driving equity into action
• also have to act well beyond health care -- tackling the underlying
social determinants of health
• through community-based innovation, cross-sectoral
collaborations and fundamental social and policy change to
reduce inequality
• again, with examples and opportunities for CHCs
4
Planning For Complexity
even though roots of health
disparities lie in social and
economic inequality
need to also look at how
these other systems shape
the impact of SDoH:
•access to health
services can mediate
harshest impact of
SDoH to some degree
•so too can responsive
social services
•structure, resources
and resilience of
communities shape
impact and dynamics of
inequalities
5July 2, 2013 | www.wellesleyinstitute.com
Building Equity Into the Health System: How
1. building health equity into all health care planning and delivery
• doesn’t mean all programs are all about equity
• but all take equity into account in planning their services and
outreach
• Health Equity Imapct Assessment is one tool
2. aligning equity with system drivers and priorities
• quality improvement, chronic disease prevention and management,
wait times, Health Links
• none of these directions can succeed without taking equity barriers,
social determinants of health and differential risks and needs into
account
• action idea = all Hamilton hospitals and CHCs to include equity
indicators in their QIPs
• aligning with key priorities also enhances chance for success and
sustainability of equity focus
6July 2, 2013
Building Equity Into the Health System: II
3. identifying those levers that will have the greatest impact on reducing
health inequities and driving system change
• solid interntional evidence that enhanced primary care is one of key
means to improve inequitable health care and health for
disadvantaged populations
• improving primary care is a major Ministry priority
• Family Health Teams, Health Links and many other initiatives are part
of this
• Community Health Centre model of care is the only sector
• explicitly geared to supporting people from marginalized
communities
• with comprehensive multi-disciplinary services covering full
range of needs
7July 2, 2013 | www.wellesleyinstitute.com
Building Equity Into the Health System: III
4. embedding equity in provider organizations’ deliverables,
accountabilities and performance management – in the incentives and
pressures that really drive the system
• a big problem for primary care is the doctor-driven incentives of
other models
• CHCs are working to develop a comprehensive performance
measurement and management system
5. targeting some resources or programs to reducing health disparities or
improving the health of the most disadvantaged, fastest
6. investing up-stream in health promotion and addressing the underlying
determinants of health
7. enabling equity-focused innovation
• a huge range of promising and innovative programs have been
developed by Community Health Centres, hospitals, networks and
other providers to address the needs of disadvantaged communities.
• we need to share lessons learned, evaluate and identify what is
working, and build on the enormous amount of local imagination and
innovation going on
8
Where to Start?
• can’t just be ‘experts’, planners or professionals who define issues and
drive system transformation
• have to build diverse voices and community needs into planning
• not just as occasional community engagement
• but to identify fundamental needs and priorities
• and to evaluate how we are doing
→ need to start from communities and clients
+ through an equity lens:
• not all clients are the same – diverse cultures, backgrounds and
perspectives, and unequal social and economic conditions
• how to involve all types of clients?
• specifically, how to involve and empower those not normally included
• adapt different and innovative methods – e.g. principles of inclusion
research
+ thinking about the communities in which they live and the social
determinants that shape their opportunities for health
9July 2, 2013 | www.wellesleyinstitute.com
Ensure Planning Is Community
Driven
• many hospitals and other
providers have community
advisory committees
• LHINs do a great deal of
community engagement
• CHCs have community boards
• CHCs demonstrate how to really
build community interests/voices
into planning and delivery →
lessons for other sectors
make this community engagement
real
• for all providers:
• community committees’
recommendations must be
responded to by mgmt
• committees make decisions
over a proportion of
discretionary budget
• for LHINs:
• build local health and well-
being councils, with
information and other
resources so they can work
effectively
• give these local councils
control over a proportion of
discretionary budget
11July 2, 2013 | www.wellesleyinstitute.com
Collaborative Equity Planning
12July 2, 2013 | www.wellesleyinstitute.com
• to meet accountability
requirements from Toronto
Central LHIN
• developed common equity
principles
• identified common priorities to
work on together:
• interpretation
• building equity into CHC
performance management
system
• uninsured
• action idea: similar joint equity
plan for local CHCs (+ others?)
• action idea = Hamilton health
equity plan, building on
Roundtable in spring
Never Just Equitable Access, But Quality:
Build Equity-Driven Service Models
• drill down to further specify needs and barriers:
• health disadvantaged populations have more complex and greater
needs for services and support
→ customizing care mix to meet those needs
→ continuum of care especially important
• also face greater access barriers – e.g.. availability/cost of
transportation, childcare, language, discrimination
→ facilitated access and effective navigation/transitions is crucial
• all of this is CHC model of care = constant demonstration about how to
deliver comprehensive equity-driven care
• pre-condition = need to know social context/conditions of
community/clients
• language, income, immigration history
• project in Toronto Central to collect such data directly
• as electronic health records are being developed, ensure equity and
social determinants data is built in
13
Extend Equity-Driven Service → Address Roots of
Health Inequities in Communities
build on equity-orientated models
• CHCs, public health and many community providers have established ‘peer
health ambassadors’ to provide system navigation, outreach and health
promotion services to communities facing particular barriers
• hub-style multi-service centres →
• coordinated services -- a range of health and employment, child care,
language, literacy, training and social services are provided out of single
‘one stop' locations
• based solidly in local communities and responding to local needs and
priorities → can become important community ‘space’ and support
community capacity building
look beyond vulnerable individuals to the communities in which they live
→ meeting full range of needs means moving beyond health care
• focus on community development as part of mandate for CHCs
• providing and partnering to provide comprehensive services/support such as
settlement, language, child care, literacy, employment training, youth
programs, etc.
14July 2, 2013 | www.wellesleyinstitute.com
• vulnerable populations will vary in different places:
• poor neighbourhoods with high % of racialized population in many big
cities
• newcomers = major theme of earlier Roundtable
• highlights importance of community health profiles
• identifying ‘priority populations’ is key public health strategy
and mandate of CHCs is to serve most vulnerable
• action idea = create local primary care coordinating tables to
bring CHCs, Health Links, Family Health Teams, public health
and other providers together
• action idea = HNHB primary care initiatives to apply HEIA to
plans and adopt explicit equity objectives and targets
Invest in Health Disadvantaged
Populations or Communities
15
Target Systemic Barriers
•in Toronto and other cities: people without
health insurance
• immigrants in 3 month wait time,
refugees
• inequitable access → delayed care
and worse outcomes
• CHCs and community clinics provide
some access
• Women’s College Hospital Network
on Noninsured is forum for
coordination
•federal cuts to refugee healthcare
→ adverse impact on particularly
vulnerable people
→ increased healthcare costs/demands
at prov and provider levels
•action idea = create local network or
initiatives to improve access for uninsured
and/or refugees
16
Addressing Systemic Barriers: Interpretation as
a Key Quality and Equity Lever
precondition for equity
• ensuring that adequate
interpretation is available
wherever needed → improves
quality and equity
• LHINs using available levers →
formal requirement on all
providers
+ alignment
• access to interpretation also
underlies wait times, safety and
other system priorities
•action idea = Hamilton providers
consider centralized/coordinated
interpretation services
17July 2, 2013 | www.wellesleyinstitute.com
Canadians With Chronic Conditions
Who Also Report Food Insecurity
18
Health Promotion Through an Equity Lens
• programs have to take account of inequitable resources of vulnerable
individuals and communities
• advice to manage diabetes or heart problems by exercising depends
upon affording a gym or being close to safe park
• if not customized, generic health promotion programs can widen
disparities as better off take them up disproportionately
• adjust programs to inequitable risks and specific barriers
• South Asian immigrants had 3X and Caribbean and Latin American 2X
risk of diabetes than immigrants from Western Europe or North
America (Creatore et al CMAJ Aril 19, 2010)
• deliver in languages and cultures of particular population/community
• go where people are -- e.g. CHCs/promoters into malls
• action idea = Immigrant Women's’ Health Centre, Aboriginal
communities and other vans
• CHCs lead/demonstrate how equity-driven health pomrotion can be
done
19July 2, 2013 | www.wellesleyinstitute.com
Pulling it All Together: Local Cross-Sectoral Planning
• cross-sectoral coordination and planning can identify
community health needs, access barriers, fragmentation,
service gaps, and how to address them
• public health departments and LHINs are pulling together
or participating in cross-sectoral planning tables
• Local Immigration Partnerships, Social Planning Councils
• such broad collaboration will be particularly important to
Health Links and other system integration initiatives
• and coordinated services are particularly important in less
advantaged communities with less resources
• also key means to address deep-seated health inequities and
wider SDoH at community level
• CHCs have long played a key role in developing and
connecting these resources and partnerships
21
Equity and Community-Driven Local Planning
pre-condition for this kind of
coordinated action = creating an
effective cross-sectoral planning
forum
action idea = create local health
equity forum with concrete planning
mandate
can build on earlier roundtable
Looking for Ideas : SETO
•arose out of community concern re access
•brings together public health, CHCs, shelters,
researchers and service providers serving
marginalized communities in south-east
Toronto
•for an overview of SETo’s development see
http://knowledgex.camh.net/researchers/pr
ojects/semh/profiles/Pages/seto.aspx
•ongoing collaboration and idea sharing →
supports service coordination and problem
solving
•emphasized concrete demonstration
projects → many with lasting impact
•advocacy with institutions and governments
around results of projects and key issues such
as harm reduction, dental care and access for
non-insured people
22July 2, 2013 | www.wellesleyinstitute.com
Back to Community Again: Build Momentum
and Mobilization
• sophisticated strategy, solid equity-focused research, planning and
innovation, and well-targeted investments and services are key
• but in the long run, also need fundamental changes in over-arching
social policy and underlying structures of economic and social inequality
• these kinds of huge changes come about not just because of good
analysis, but through widespread community mobilization and public
pressure
• 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
• 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’
25
© The Wellesley Institute
www.wellesleyinstitute.com
Shifting the Frame
Sudbury & other public health
July 2, 2013 | www.wellesleyinstitute.com 26
Health Equity
• could be one of those ‘big’ unifying ideas..
• if we see opportunities for good health and well-being as a basic
right for all
• if we see the damaged health of disadvantaged and
marginalized populations as an indictment of an unequal society
– but that focused initiatives can make a difference
• if we recognize that coming together to address the social
determinants that underlie health inequalities will also address
the roots of so many other social problems
• thinking of what needs to be done to create health equity is a way
of imagining and forging a powerful vision of a progressive future
• and showing that we can get there from here
27
Key Messages
• health inequities are pervasive and deep-seated – but can’t let that
paralyze us
• do need a comprehensive and coherent health equity strategy – but
don’t wait for perfect strategy
• think big and think strategically – but get going where you are
• have set out a roadmap – of strategies, tools and ideas -- to drive equity
into action through policy change and community mobilization
where CHCs come in:
• demonstrating every day that something can be done about systemic
inequities -- by delivering the best possible health care to disadvantaged
communities
• working in partnerships and collaborations well beyond health care to
address the underlying determinants of health
• I see CHCs as a beacon and inspiration – showing change is possible and
how to move towards a more equitable health future
28

More Related Content

What's hot

Driving Health Equity in Tough Times
Driving Health Equity in Tough TimesDriving Health Equity in Tough Times
Driving Health Equity in Tough Times
Wellesley Institute
 
CIW AOHC - 2015 CACHC Conference Presentation
CIW AOHC - 2015 CACHC Conference PresentationCIW AOHC - 2015 CACHC Conference Presentation
CIW AOHC - 2015 CACHC Conference Presentation
cachc
 
Driving Health Equity into Action
Driving Health Equity into ActionDriving Health Equity into Action
Driving Health Equity into Action
Wellesley Institute
 
Healthy connections heia workshop feb 17 2010
Healthy connections heia workshop feb 17 2010Healthy connections heia workshop feb 17 2010
Healthy connections heia workshop feb 17 2010
guest9b4551b
 
Driving Health Equity into Action: Strategy, Ideas, and Tools for Midwifery M...
Driving Health Equity into Action: Strategy, Ideas, and Tools for Midwifery M...Driving Health Equity into Action: Strategy, Ideas, and Tools for Midwifery M...
Driving Health Equity into Action: Strategy, Ideas, and Tools for Midwifery M...
Wellesley Institute
 
'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...
'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...
'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...
Wellesley Institute
 
Building Health Equity: The Role of Public Health
Building Health Equity: The Role of Public Health Building Health Equity: The Role of Public Health
Building Health Equity: The Role of Public Health
Wellesley Institute
 
Implementing social determinant of health
Implementing social determinant of  healthImplementing social determinant of  health
Implementing social determinant of health
PPPKAM
 
Age friendly initiative: Introduction to Self Management Workshop
Age friendly initiative: Introduction to Self Management WorkshopAge friendly initiative: Introduction to Self Management Workshop
Age friendly initiative: Introduction to Self Management Workshop
Aloka Banerjee
 
Health Equity Workshop - Promising Practices
Health Equity Workshop - Promising PracticesHealth Equity Workshop - Promising Practices
Health Equity Workshop - Promising Practices
ASI_HSC
 
Socialpolicygradclassjan2012 120124145555-phpapp01
Socialpolicygradclassjan2012 120124145555-phpapp01Socialpolicygradclassjan2012 120124145555-phpapp01
Socialpolicygradclassjan2012 120124145555-phpapp01
ArleneJohnson13
 
Jia Chen, The Social Determinants of Health - Changing the way we see health ...
Jia Chen, The Social Determinants of Health - Changing the way we see health ...Jia Chen, The Social Determinants of Health - Changing the way we see health ...
Jia Chen, The Social Determinants of Health - Changing the way we see health ...
IBM Cúram Software Health and Social Programs
 
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...
Wellesley Institute
 
CSIP Highlight Review Progress And Outcomes 2007
CSIP Highlight Review Progress And Outcomes 2007CSIP Highlight Review Progress And Outcomes 2007
CSIP Highlight Review Progress And Outcomes 2007
Rowan Purdy
 
Building on the Evidence: Advancing Health Equity for Priority Populations
Building on the Evidence: Advancing Health Equity for Priority PopulationsBuilding on the Evidence: Advancing Health Equity for Priority Populations
Building on the Evidence: Advancing Health Equity for Priority Populations
Wellesley Institute
 
Driving Health Equity into Action: The Potential of Health Equity Impact Asse...
Driving Health Equity into Action: The Potential of Health Equity Impact Asse...Driving Health Equity into Action: The Potential of Health Equity Impact Asse...
Driving Health Equity into Action: The Potential of Health Equity Impact Asse...
Wellesley Institute
 
Widening Digital Participation
Widening Digital Participation Widening Digital Participation
Widening Digital Participation
HLGUK
 
Engaging communities for health improvement
Engaging communities for health improvementEngaging communities for health improvement
Engaging communities for health improvement
Dr Lendy Spires
 
Driving Health Equity into Action: Policy Change and Community Mobilization t...
Driving Health Equity into Action: Policy Change and Community Mobilization t...Driving Health Equity into Action: Policy Change and Community Mobilization t...
Driving Health Equity into Action: Policy Change and Community Mobilization t...
Wellesley Institute
 
LDawson KShafto - CACHC 2015 Conference Presentation
LDawson KShafto  - CACHC 2015 Conference PresentationLDawson KShafto  - CACHC 2015 Conference Presentation
LDawson KShafto - CACHC 2015 Conference Presentation
cachc
 

What's hot (20)

Driving Health Equity in Tough Times
Driving Health Equity in Tough TimesDriving Health Equity in Tough Times
Driving Health Equity in Tough Times
 
CIW AOHC - 2015 CACHC Conference Presentation
CIW AOHC - 2015 CACHC Conference PresentationCIW AOHC - 2015 CACHC Conference Presentation
CIW AOHC - 2015 CACHC Conference Presentation
 
Driving Health Equity into Action
Driving Health Equity into ActionDriving Health Equity into Action
Driving Health Equity into Action
 
Healthy connections heia workshop feb 17 2010
Healthy connections heia workshop feb 17 2010Healthy connections heia workshop feb 17 2010
Healthy connections heia workshop feb 17 2010
 
Driving Health Equity into Action: Strategy, Ideas, and Tools for Midwifery M...
Driving Health Equity into Action: Strategy, Ideas, and Tools for Midwifery M...Driving Health Equity into Action: Strategy, Ideas, and Tools for Midwifery M...
Driving Health Equity into Action: Strategy, Ideas, and Tools for Midwifery M...
 
'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...
'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...
'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...
 
Building Health Equity: The Role of Public Health
Building Health Equity: The Role of Public Health Building Health Equity: The Role of Public Health
Building Health Equity: The Role of Public Health
 
Implementing social determinant of health
Implementing social determinant of  healthImplementing social determinant of  health
Implementing social determinant of health
 
Age friendly initiative: Introduction to Self Management Workshop
Age friendly initiative: Introduction to Self Management WorkshopAge friendly initiative: Introduction to Self Management Workshop
Age friendly initiative: Introduction to Self Management Workshop
 
Health Equity Workshop - Promising Practices
Health Equity Workshop - Promising PracticesHealth Equity Workshop - Promising Practices
Health Equity Workshop - Promising Practices
 
Socialpolicygradclassjan2012 120124145555-phpapp01
Socialpolicygradclassjan2012 120124145555-phpapp01Socialpolicygradclassjan2012 120124145555-phpapp01
Socialpolicygradclassjan2012 120124145555-phpapp01
 
Jia Chen, The Social Determinants of Health - Changing the way we see health ...
Jia Chen, The Social Determinants of Health - Changing the way we see health ...Jia Chen, The Social Determinants of Health - Changing the way we see health ...
Jia Chen, The Social Determinants of Health - Changing the way we see health ...
 
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...
 
CSIP Highlight Review Progress And Outcomes 2007
CSIP Highlight Review Progress And Outcomes 2007CSIP Highlight Review Progress And Outcomes 2007
CSIP Highlight Review Progress And Outcomes 2007
 
Building on the Evidence: Advancing Health Equity for Priority Populations
Building on the Evidence: Advancing Health Equity for Priority PopulationsBuilding on the Evidence: Advancing Health Equity for Priority Populations
Building on the Evidence: Advancing Health Equity for Priority Populations
 
Driving Health Equity into Action: The Potential of Health Equity Impact Asse...
Driving Health Equity into Action: The Potential of Health Equity Impact Asse...Driving Health Equity into Action: The Potential of Health Equity Impact Asse...
Driving Health Equity into Action: The Potential of Health Equity Impact Asse...
 
Widening Digital Participation
Widening Digital Participation Widening Digital Participation
Widening Digital Participation
 
Engaging communities for health improvement
Engaging communities for health improvementEngaging communities for health improvement
Engaging communities for health improvement
 
Driving Health Equity into Action: Policy Change and Community Mobilization t...
Driving Health Equity into Action: Policy Change and Community Mobilization t...Driving Health Equity into Action: Policy Change and Community Mobilization t...
Driving Health Equity into Action: Policy Change and Community Mobilization t...
 
LDawson KShafto - CACHC 2015 Conference Presentation
LDawson KShafto  - CACHC 2015 Conference PresentationLDawson KShafto  - CACHC 2015 Conference Presentation
LDawson KShafto - CACHC 2015 Conference Presentation
 

Similar to Driving Local Action on Health Equity

Advancing Health Equity: Building on Community-Based Innovation
Advancing Health Equity: Building on Community-Based InnovationAdvancing Health Equity: Building on Community-Based Innovation
Advancing Health Equity: Building on Community-Based Innovation
Wellesley Institute
 
Health Equity for Immigrants and Refugees: Driving Policy Action
Health Equity for Immigrants and Refugees: Driving Policy ActionHealth Equity for Immigrants and Refugees: Driving Policy Action
Health Equity for Immigrants and Refugees: Driving Policy Action
Wellesley Institute
 
Health Equity Strategy into Public Health Action
Health Equity Strategy into Public Health ActionHealth Equity Strategy into Public Health Action
Health Equity Strategy into Public Health Action
Wellesley Institute
 
Driving Health Equity in Canada: From Strategy to Action and Impact
Driving Health Equity in Canada: From Strategy to Action and ImpactDriving Health Equity in Canada: From Strategy to Action and Impact
Driving Health Equity in Canada: From Strategy to Action and Impact
Wellesley Institute
 
Thinking About Health Equity, Acting on Health Equity
Thinking About Health Equity, Acting on Health EquityThinking About Health Equity, Acting on Health Equity
Thinking About Health Equity, Acting on Health Equity
Wellesley Institute
 
Realizing the Potential of Health Equity Impact Assessment
Realizing the Potential of Health Equity Impact AssessmentRealizing the Potential of Health Equity Impact Assessment
Realizing the Potential of Health Equity Impact Assessment
Wellesley Institute
 
Health Equity Impact Assessment Workshop: Healthy Connection
Health Equity Impact Assessment Workshop: Healthy Connection  Health Equity Impact Assessment Workshop: Healthy Connection
Health Equity Impact Assessment Workshop: Healthy Connection
Wellesley Institute
 
Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...
Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...
Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...
Wellesley Institute
 
Quality Cancer Care for All: An Equity Toolkit
Quality Cancer Care for All: An Equity Toolkit Quality Cancer Care for All: An Equity Toolkit
Quality Cancer Care for All: An Equity Toolkit
Wellesley Institute
 
Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...
Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...
Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...
Wellesley Institute
 
Unit 7 Primary Health Care.pptx
Unit 7 Primary Health Care.pptxUnit 7 Primary Health Care.pptx
Unit 7 Primary Health Care.pptx
GraceT12
 
Enhancing Health Equity: The Potential of Peer Health Ambassadors
Enhancing Health Equity: The Potential of Peer Health AmbassadorsEnhancing Health Equity: The Potential of Peer Health Ambassadors
Enhancing Health Equity: The Potential of Peer Health Ambassadors
Wellesley Institute
 
LHINs, Health Reform and HIV/AIDS Care
LHINs, Health Reform and HIV/AIDS CareLHINs, Health Reform and HIV/AIDS Care
LHINs, Health Reform and HIV/AIDS Care
Wellesley Institute
 
Health Promotion with Policy Impact
Health Promotion with Policy ImpactHealth Promotion with Policy Impact
Health Promotion with Policy Impact
Wellesley Institute
 
Health Equity into Policy Action: A Policy Conversation at MOHLTC
Health Equity into Policy Action: A Policy Conversation at MOHLTCHealth Equity into Policy Action: A Policy Conversation at MOHLTC
Health Equity into Policy Action: A Policy Conversation at MOHLTC
Wellesley Institute
 
Health Equity Impact Assessment: A Tool for Driving Equity Into Action May 18...
Health Equity Impact Assessment: A Tool for Driving Equity Into Action May 18...Health Equity Impact Assessment: A Tool for Driving Equity Into Action May 18...
Health Equity Impact Assessment: A Tool for Driving Equity Into Action May 18...
guest9b4551b
 
Reducing health inequalities: System, scale and sustainability
Reducing health inequalities: System, scale and sustainability Reducing health inequalities: System, scale and sustainability
Reducing health inequalities: System, scale and sustainability
Public Health England
 
Driving Health Equity for Kids: From the Earliest Years to Transforming the S...
Driving Health Equity for Kids: From the Earliest Years to Transforming the S...Driving Health Equity for Kids: From the Earliest Years to Transforming the S...
Driving Health Equity for Kids: From the Earliest Years to Transforming the S...
Wellesley Institute
 
The ear anatomy and physiology
The ear anatomy and physiology The ear anatomy and physiology
The ear anatomy and physiology
MuniraMkamba
 
LHINs: Drivers of a More Equitable and Responsive Health System?
LHINs: Drivers of a More Equitable and Responsive Health System?LHINs: Drivers of a More Equitable and Responsive Health System?
LHINs: Drivers of a More Equitable and Responsive Health System?
Wellesley Institute
 

Similar to Driving Local Action on Health Equity (20)

Advancing Health Equity: Building on Community-Based Innovation
Advancing Health Equity: Building on Community-Based InnovationAdvancing Health Equity: Building on Community-Based Innovation
Advancing Health Equity: Building on Community-Based Innovation
 
Health Equity for Immigrants and Refugees: Driving Policy Action
Health Equity for Immigrants and Refugees: Driving Policy ActionHealth Equity for Immigrants and Refugees: Driving Policy Action
Health Equity for Immigrants and Refugees: Driving Policy Action
 
Health Equity Strategy into Public Health Action
Health Equity Strategy into Public Health ActionHealth Equity Strategy into Public Health Action
Health Equity Strategy into Public Health Action
 
Driving Health Equity in Canada: From Strategy to Action and Impact
Driving Health Equity in Canada: From Strategy to Action and ImpactDriving Health Equity in Canada: From Strategy to Action and Impact
Driving Health Equity in Canada: From Strategy to Action and Impact
 
Thinking About Health Equity, Acting on Health Equity
Thinking About Health Equity, Acting on Health EquityThinking About Health Equity, Acting on Health Equity
Thinking About Health Equity, Acting on Health Equity
 
Realizing the Potential of Health Equity Impact Assessment
Realizing the Potential of Health Equity Impact AssessmentRealizing the Potential of Health Equity Impact Assessment
Realizing the Potential of Health Equity Impact Assessment
 
Health Equity Impact Assessment Workshop: Healthy Connection
Health Equity Impact Assessment Workshop: Healthy Connection  Health Equity Impact Assessment Workshop: Healthy Connection
Health Equity Impact Assessment Workshop: Healthy Connection
 
Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...
Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...
Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...
 
Quality Cancer Care for All: An Equity Toolkit
Quality Cancer Care for All: An Equity Toolkit Quality Cancer Care for All: An Equity Toolkit
Quality Cancer Care for All: An Equity Toolkit
 
Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...
Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...
Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...
 
Unit 7 Primary Health Care.pptx
Unit 7 Primary Health Care.pptxUnit 7 Primary Health Care.pptx
Unit 7 Primary Health Care.pptx
 
Enhancing Health Equity: The Potential of Peer Health Ambassadors
Enhancing Health Equity: The Potential of Peer Health AmbassadorsEnhancing Health Equity: The Potential of Peer Health Ambassadors
Enhancing Health Equity: The Potential of Peer Health Ambassadors
 
LHINs, Health Reform and HIV/AIDS Care
LHINs, Health Reform and HIV/AIDS CareLHINs, Health Reform and HIV/AIDS Care
LHINs, Health Reform and HIV/AIDS Care
 
Health Promotion with Policy Impact
Health Promotion with Policy ImpactHealth Promotion with Policy Impact
Health Promotion with Policy Impact
 
Health Equity into Policy Action: A Policy Conversation at MOHLTC
Health Equity into Policy Action: A Policy Conversation at MOHLTCHealth Equity into Policy Action: A Policy Conversation at MOHLTC
Health Equity into Policy Action: A Policy Conversation at MOHLTC
 
Health Equity Impact Assessment: A Tool for Driving Equity Into Action May 18...
Health Equity Impact Assessment: A Tool for Driving Equity Into Action May 18...Health Equity Impact Assessment: A Tool for Driving Equity Into Action May 18...
Health Equity Impact Assessment: A Tool for Driving Equity Into Action May 18...
 
Reducing health inequalities: System, scale and sustainability
Reducing health inequalities: System, scale and sustainability Reducing health inequalities: System, scale and sustainability
Reducing health inequalities: System, scale and sustainability
 
Driving Health Equity for Kids: From the Earliest Years to Transforming the S...
Driving Health Equity for Kids: From the Earliest Years to Transforming the S...Driving Health Equity for Kids: From the Earliest Years to Transforming the S...
Driving Health Equity for Kids: From the Earliest Years to Transforming the S...
 
The ear anatomy and physiology
The ear anatomy and physiology The ear anatomy and physiology
The ear anatomy and physiology
 
LHINs: Drivers of a More Equitable and Responsive Health System?
LHINs: Drivers of a More Equitable and Responsive Health System?LHINs: Drivers of a More Equitable and Responsive Health System?
LHINs: Drivers of a More Equitable and Responsive Health System?
 

More from Wellesley Institute

Wellesley Institute 2014 A Year In Review
Wellesley Institute 2014 A Year In ReviewWellesley Institute 2014 A Year In Review
Wellesley Institute 2014 A Year In Review
Wellesley Institute
 
Housing and Homelessness: Lenten Reflections
Housing and Homelessness: Lenten ReflectionsHousing and Homelessness: Lenten Reflections
Housing and Homelessness: Lenten Reflections
Wellesley Institute
 
Homes for All: Social Housing in Toronto and Canada
Homes for All: Social Housing in Toronto and CanadaHomes for All: Social Housing in Toronto and Canada
Homes for All: Social Housing in Toronto and Canada
Wellesley Institute
 
Ending Homelessness in Kingston and Across Canada: What's the Plan?
Ending Homelessness in Kingston and Across Canada: What's the Plan?Ending Homelessness in Kingston and Across Canada: What's the Plan?
Ending Homelessness in Kingston and Across Canada: What's the Plan?
Wellesley Institute
 
Health and Your Home
Health and Your HomeHealth and Your Home
Health and Your Home
Wellesley Institute
 
Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...
Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...
Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...
Wellesley Institute
 
Homelessness in Canada: By the Numbers
Homelessness in Canada: By the NumbersHomelessness in Canada: By the Numbers
Homelessness in Canada: By the Numbers
Wellesley Institute
 
Housing and Homelessness: Organizing for Social Change
Housing and Homelessness: Organizing for Social ChangeHousing and Homelessness: Organizing for Social Change
Housing and Homelessness: Organizing for Social Change
Wellesley Institute
 
Housing Insecurity and Homelessness: What Should Be Done?
Housing Insecurity and Homelessness: What Should Be Done?Housing Insecurity and Homelessness: What Should Be Done?
Housing Insecurity and Homelessness: What Should Be Done?
Wellesley Institute
 
Introducing Complexity and Systems Thinking
Introducing Complexity and Systems ThinkingIntroducing Complexity and Systems Thinking
Introducing Complexity and Systems Thinking
Wellesley Institute
 
Housing and Cities as Human Rights: Dialogues between Latin America and Canada
Housing and Cities as Human Rights: Dialogues between Latin America and CanadaHousing and Cities as Human Rights: Dialogues between Latin America and Canada
Housing and Cities as Human Rights: Dialogues between Latin America and Canada
Wellesley Institute
 
Casinos and Your Health
Casinos and Your HealthCasinos and Your Health
Casinos and Your Health
Wellesley Institute
 
The Health Impacts of Gambling Expansion in Toronto
The Health Impacts of Gambling Expansion in TorontoThe Health Impacts of Gambling Expansion in Toronto
The Health Impacts of Gambling Expansion in Toronto
Wellesley Institute
 
Building Inclusive Cities: Planning Tools that promote the Right to the City
Building Inclusive Cities: Planning Tools that promote the Right to the CityBuilding Inclusive Cities: Planning Tools that promote the Right to the City
Building Inclusive Cities: Planning Tools that promote the Right to the City
Wellesley Institute
 
The Wellesley Hospital Legacy: 100 Years Later
The Wellesley Hospital Legacy: 100 Years Later The Wellesley Hospital Legacy: 100 Years Later
The Wellesley Hospital Legacy: 100 Years Later
Wellesley Institute
 
Concept Mapping of Photo Voices: Neighbourhood and Health
Concept Mapping of Photo Voices: Neighbourhood and HealthConcept Mapping of Photo Voices: Neighbourhood and Health
Concept Mapping of Photo Voices: Neighbourhood and Health
Wellesley Institute
 
Social Determinants of Health for Immigrant Youth: Experiences from St. James...
Social Determinants of Health for Immigrant Youth: Experiences from St. James...Social Determinants of Health for Immigrant Youth: Experiences from St. James...
Social Determinants of Health for Immigrant Youth: Experiences from St. James...
Wellesley Institute
 
Photovoice as an Arts-Based Participatory Research Approach
Photovoice as an Arts-Based Participatory Research ApproachPhotovoice as an Arts-Based Participatory Research Approach
Photovoice as an Arts-Based Participatory Research Approach
Wellesley Institute
 
Community Based Participatory Research Approaches: Experiences from St. James...
Community Based Participatory Research Approaches: Experiences from St. James...Community Based Participatory Research Approaches: Experiences from St. James...
Community Based Participatory Research Approaches: Experiences from St. James...
Wellesley Institute
 
St. James Town Initiative: Neighbourhood and Health
St. James Town Initiative: Neighbourhood and HealthSt. James Town Initiative: Neighbourhood and Health
St. James Town Initiative: Neighbourhood and Health
Wellesley Institute
 

More from Wellesley Institute (20)

Wellesley Institute 2014 A Year In Review
Wellesley Institute 2014 A Year In ReviewWellesley Institute 2014 A Year In Review
Wellesley Institute 2014 A Year In Review
 
Housing and Homelessness: Lenten Reflections
Housing and Homelessness: Lenten ReflectionsHousing and Homelessness: Lenten Reflections
Housing and Homelessness: Lenten Reflections
 
Homes for All: Social Housing in Toronto and Canada
Homes for All: Social Housing in Toronto and CanadaHomes for All: Social Housing in Toronto and Canada
Homes for All: Social Housing in Toronto and Canada
 
Ending Homelessness in Kingston and Across Canada: What's the Plan?
Ending Homelessness in Kingston and Across Canada: What's the Plan?Ending Homelessness in Kingston and Across Canada: What's the Plan?
Ending Homelessness in Kingston and Across Canada: What's the Plan?
 
Health and Your Home
Health and Your HomeHealth and Your Home
Health and Your Home
 
Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...
Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...
Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...
 
Homelessness in Canada: By the Numbers
Homelessness in Canada: By the NumbersHomelessness in Canada: By the Numbers
Homelessness in Canada: By the Numbers
 
Housing and Homelessness: Organizing for Social Change
Housing and Homelessness: Organizing for Social ChangeHousing and Homelessness: Organizing for Social Change
Housing and Homelessness: Organizing for Social Change
 
Housing Insecurity and Homelessness: What Should Be Done?
Housing Insecurity and Homelessness: What Should Be Done?Housing Insecurity and Homelessness: What Should Be Done?
Housing Insecurity and Homelessness: What Should Be Done?
 
Introducing Complexity and Systems Thinking
Introducing Complexity and Systems ThinkingIntroducing Complexity and Systems Thinking
Introducing Complexity and Systems Thinking
 
Housing and Cities as Human Rights: Dialogues between Latin America and Canada
Housing and Cities as Human Rights: Dialogues between Latin America and CanadaHousing and Cities as Human Rights: Dialogues between Latin America and Canada
Housing and Cities as Human Rights: Dialogues between Latin America and Canada
 
Casinos and Your Health
Casinos and Your HealthCasinos and Your Health
Casinos and Your Health
 
The Health Impacts of Gambling Expansion in Toronto
The Health Impacts of Gambling Expansion in TorontoThe Health Impacts of Gambling Expansion in Toronto
The Health Impacts of Gambling Expansion in Toronto
 
Building Inclusive Cities: Planning Tools that promote the Right to the City
Building Inclusive Cities: Planning Tools that promote the Right to the CityBuilding Inclusive Cities: Planning Tools that promote the Right to the City
Building Inclusive Cities: Planning Tools that promote the Right to the City
 
The Wellesley Hospital Legacy: 100 Years Later
The Wellesley Hospital Legacy: 100 Years Later The Wellesley Hospital Legacy: 100 Years Later
The Wellesley Hospital Legacy: 100 Years Later
 
Concept Mapping of Photo Voices: Neighbourhood and Health
Concept Mapping of Photo Voices: Neighbourhood and HealthConcept Mapping of Photo Voices: Neighbourhood and Health
Concept Mapping of Photo Voices: Neighbourhood and Health
 
Social Determinants of Health for Immigrant Youth: Experiences from St. James...
Social Determinants of Health for Immigrant Youth: Experiences from St. James...Social Determinants of Health for Immigrant Youth: Experiences from St. James...
Social Determinants of Health for Immigrant Youth: Experiences from St. James...
 
Photovoice as an Arts-Based Participatory Research Approach
Photovoice as an Arts-Based Participatory Research ApproachPhotovoice as an Arts-Based Participatory Research Approach
Photovoice as an Arts-Based Participatory Research Approach
 
Community Based Participatory Research Approaches: Experiences from St. James...
Community Based Participatory Research Approaches: Experiences from St. James...Community Based Participatory Research Approaches: Experiences from St. James...
Community Based Participatory Research Approaches: Experiences from St. James...
 
St. James Town Initiative: Neighbourhood and Health
St. James Town Initiative: Neighbourhood and HealthSt. James Town Initiative: Neighbourhood and Health
St. James Town Initiative: Neighbourhood and Health
 

Recently uploaded

05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
Santhosh Raj
 
Columbia毕业证书退学办理
Columbia毕业证书退学办理Columbia毕业证书退学办理
Columbia毕业证书退学办理
ozcot
 
Sexual Disorders.gender identity disorderspptx
Sexual Disorders.gender identity  disorderspptxSexual Disorders.gender identity  disorderspptx
Sexual Disorders.gender identity disorderspptx
Pupayumnam1
 
Fit to Fly PCR Covid Testing at our Clinic Near You
Fit to Fly PCR Covid Testing at our Clinic Near YouFit to Fly PCR Covid Testing at our Clinic Near You
Fit to Fly PCR Covid Testing at our Clinic Near You
NX Healthcare
 
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
The Lifesciences Magazine
 
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa AjmanFriendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
DrDevTaneja1
 
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa AjmanSatisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
Media Logic
 
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 FaridkotFaridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
varun0kumar00
 
Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -
Gokul Rangarajan
 
nurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdfnurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdf
Carolyn Harker
 
Monopoly PCD Pharma Franchise in Tripura
Monopoly PCD Pharma Franchise in TripuraMonopoly PCD Pharma Franchise in Tripura
Monopoly PCD Pharma Franchise in Tripura
SKG Internationals
 
Mohali Call Girls 7742996321 Call Girls Mohali
Mohali Call Girls  7742996321 Call Girls  MohaliMohali Call Girls  7742996321 Call Girls  Mohali
Mohali Call Girls 7742996321 Call Girls Mohali
Digital Marketing
 
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
5sj7jxf7
 
English Drug and Alcohol Commissioners June 2024.pptx
English Drug and Alcohol Commissioners June 2024.pptxEnglish Drug and Alcohol Commissioners June 2024.pptx
English Drug and Alcohol Commissioners June 2024.pptx
MatSouthwell1
 
Emotional and Behavioural Problems in Children - Counselling and Family Thera...
Emotional and Behavioural Problems in Children - Counselling and Family Thera...Emotional and Behavioural Problems in Children - Counselling and Family Thera...
Emotional and Behavioural Problems in Children - Counselling and Family Thera...
PsychoTech Services
 
Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...
rightmanforbloodline
 
The Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-TechThe Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-Tech
Gokul Rangarajan
 
3. User Guide Activity Budget Tracking App Steps to apply.pptx
3. User Guide Activity Budget Tracking App Steps to apply.pptx3. User Guide Activity Budget Tracking App Steps to apply.pptx
3. User Guide Activity Budget Tracking App Steps to apply.pptx
habtegirma
 

Recently uploaded (20)

05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
 
Columbia毕业证书退学办理
Columbia毕业证书退学办理Columbia毕业证书退学办理
Columbia毕业证书退学办理
 
Sexual Disorders.gender identity disorderspptx
Sexual Disorders.gender identity  disorderspptxSexual Disorders.gender identity  disorderspptx
Sexual Disorders.gender identity disorderspptx
 
Fit to Fly PCR Covid Testing at our Clinic Near You
Fit to Fly PCR Covid Testing at our Clinic Near YouFit to Fly PCR Covid Testing at our Clinic Near You
Fit to Fly PCR Covid Testing at our Clinic Near You
 
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
 
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa AjmanFriendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
 
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
 
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa AjmanSatisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
 
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...
 
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 FaridkotFaridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
 
Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -Health Tech Market Intelligence Prelim Questions -
Health Tech Market Intelligence Prelim Questions -
 
nurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdfnurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdf
 
Monopoly PCD Pharma Franchise in Tripura
Monopoly PCD Pharma Franchise in TripuraMonopoly PCD Pharma Franchise in Tripura
Monopoly PCD Pharma Franchise in Tripura
 
Mohali Call Girls 7742996321 Call Girls Mohali
Mohali Call Girls  7742996321 Call Girls  MohaliMohali Call Girls  7742996321 Call Girls  Mohali
Mohali Call Girls 7742996321 Call Girls Mohali
 
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
 
English Drug and Alcohol Commissioners June 2024.pptx
English Drug and Alcohol Commissioners June 2024.pptxEnglish Drug and Alcohol Commissioners June 2024.pptx
English Drug and Alcohol Commissioners June 2024.pptx
 
Emotional and Behavioural Problems in Children - Counselling and Family Thera...
Emotional and Behavioural Problems in Children - Counselling and Family Thera...Emotional and Behavioural Problems in Children - Counselling and Family Thera...
Emotional and Behavioural Problems in Children - Counselling and Family Thera...
 
Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...
 
The Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-TechThe Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-Tech
 
3. User Guide Activity Budget Tracking App Steps to apply.pptx
3. User Guide Activity Budget Tracking App Steps to apply.pptx3. User Guide Activity Budget Tracking App Steps to apply.pptx
3. User Guide Activity Budget Tracking App Steps to apply.pptx
 

Driving Local Action on Health Equity

  • 1. Driving Local Action on Health Equity Bob Gardner North Hamilton Community Health Centre June 19, 2013
  • 2. Problem to Solve: Systemic Health Inequities in Ontario •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 of the best off and most disadvantaged can be huge – and damaging •impact and severity of these inequities can be concentrated in particular populations and neighbourhoods 2
  • 3. And Locally Code Red series on health inequities by neighbourhoods: • 21 years difference in age at death • major differences in health outcomes across many measures plus inequitable access to health care in poorest areas • 50% higher rates of emergency department visits in downtown core • 2X for psychiatric emergencies • less access to primary care 3July 2, 2013 | www.wellesleyinstitute.com
  • 4. Today • these health disparities are deep-seated and complex • but they can be tackled addressed through comprehensive health equity strategy and concerted action • means acting on health equity within the health system • will set out elements of a roadmap to build equity into health planning and delivery • CHC have long played a crucial role in driving equity into action • also have to act well beyond health care -- tackling the underlying social determinants of health • through community-based innovation, cross-sectoral collaborations and fundamental social and policy change to reduce inequality • again, with examples and opportunities for CHCs 4
  • 5. Planning For Complexity even though roots of health disparities lie in social and economic inequality need to also look at how these other systems shape the impact of SDoH: •access to health services can mediate harshest impact of SDoH to some degree •so too can responsive social services •structure, resources and resilience of communities shape impact and dynamics of inequalities 5July 2, 2013 | www.wellesleyinstitute.com
  • 6. Building Equity Into the Health System: How 1. building health equity into all health care planning and delivery • doesn’t mean all programs are all about equity • but all take equity into account in planning their services and outreach • Health Equity Imapct Assessment is one tool 2. aligning equity with system drivers and priorities • quality improvement, chronic disease prevention and management, wait times, Health Links • none of these directions can succeed without taking equity barriers, social determinants of health and differential risks and needs into account • action idea = all Hamilton hospitals and CHCs to include equity indicators in their QIPs • aligning with key priorities also enhances chance for success and sustainability of equity focus 6July 2, 2013
  • 7. Building Equity Into the Health System: II 3. identifying those levers that will have the greatest impact on reducing health inequities and driving system change • solid interntional evidence that enhanced primary care is one of key means to improve inequitable health care and health for disadvantaged populations • improving primary care is a major Ministry priority • Family Health Teams, Health Links and many other initiatives are part of this • Community Health Centre model of care is the only sector • explicitly geared to supporting people from marginalized communities • with comprehensive multi-disciplinary services covering full range of needs 7July 2, 2013 | www.wellesleyinstitute.com
  • 8. Building Equity Into the Health System: III 4. embedding equity in provider organizations’ deliverables, accountabilities and performance management – in the incentives and pressures that really drive the system • a big problem for primary care is the doctor-driven incentives of other models • CHCs are working to develop a comprehensive performance measurement and management system 5. targeting some resources or programs to reducing health disparities or improving the health of the most disadvantaged, fastest 6. investing up-stream in health promotion and addressing the underlying determinants of health 7. enabling equity-focused innovation • a huge range of promising and innovative programs have been developed by Community Health Centres, hospitals, networks and other providers to address the needs of disadvantaged communities. • we need to share lessons learned, evaluate and identify what is working, and build on the enormous amount of local imagination and innovation going on 8
  • 9. Where to Start? • can’t just be ‘experts’, planners or professionals who define issues and drive system transformation • have to build diverse voices and community needs into planning • not just as occasional community engagement • but to identify fundamental needs and priorities • and to evaluate how we are doing → need to start from communities and clients + through an equity lens: • not all clients are the same – diverse cultures, backgrounds and perspectives, and unequal social and economic conditions • how to involve all types of clients? • specifically, how to involve and empower those not normally included • adapt different and innovative methods – e.g. principles of inclusion research + thinking about the communities in which they live and the social determinants that shape their opportunities for health 9July 2, 2013 | www.wellesleyinstitute.com
  • 10. Ensure Planning Is Community Driven • many hospitals and other providers have community advisory committees • LHINs do a great deal of community engagement • CHCs have community boards • CHCs demonstrate how to really build community interests/voices into planning and delivery → lessons for other sectors make this community engagement real • for all providers: • community committees’ recommendations must be responded to by mgmt • committees make decisions over a proportion of discretionary budget • for LHINs: • build local health and well- being councils, with information and other resources so they can work effectively • give these local councils control over a proportion of discretionary budget 11July 2, 2013 | www.wellesleyinstitute.com
  • 11. Collaborative Equity Planning 12July 2, 2013 | www.wellesleyinstitute.com • to meet accountability requirements from Toronto Central LHIN • developed common equity principles • identified common priorities to work on together: • interpretation • building equity into CHC performance management system • uninsured • action idea: similar joint equity plan for local CHCs (+ others?) • action idea = Hamilton health equity plan, building on Roundtable in spring
  • 12. Never Just Equitable Access, But Quality: Build Equity-Driven Service Models • drill down to further specify needs and barriers: • health disadvantaged populations have more complex and greater needs for services and support → customizing care mix to meet those needs → continuum of care especially important • also face greater access barriers – e.g.. availability/cost of transportation, childcare, language, discrimination → facilitated access and effective navigation/transitions is crucial • all of this is CHC model of care = constant demonstration about how to deliver comprehensive equity-driven care • pre-condition = need to know social context/conditions of community/clients • language, income, immigration history • project in Toronto Central to collect such data directly • as electronic health records are being developed, ensure equity and social determinants data is built in 13
  • 13. Extend Equity-Driven Service → Address Roots of Health Inequities in Communities build on equity-orientated models • CHCs, public health and many community providers have established ‘peer health ambassadors’ to provide system navigation, outreach and health promotion services to communities facing particular barriers • hub-style multi-service centres → • coordinated services -- a range of health and employment, child care, language, literacy, training and social services are provided out of single ‘one stop' locations • based solidly in local communities and responding to local needs and priorities → can become important community ‘space’ and support community capacity building look beyond vulnerable individuals to the communities in which they live → meeting full range of needs means moving beyond health care • focus on community development as part of mandate for CHCs • providing and partnering to provide comprehensive services/support such as settlement, language, child care, literacy, employment training, youth programs, etc. 14July 2, 2013 | www.wellesleyinstitute.com
  • 14. • vulnerable populations will vary in different places: • poor neighbourhoods with high % of racialized population in many big cities • newcomers = major theme of earlier Roundtable • highlights importance of community health profiles • identifying ‘priority populations’ is key public health strategy and mandate of CHCs is to serve most vulnerable • action idea = create local primary care coordinating tables to bring CHCs, Health Links, Family Health Teams, public health and other providers together • action idea = HNHB primary care initiatives to apply HEIA to plans and adopt explicit equity objectives and targets Invest in Health Disadvantaged Populations or Communities 15
  • 15. Target Systemic Barriers •in Toronto and other cities: people without health insurance • immigrants in 3 month wait time, refugees • inequitable access → delayed care and worse outcomes • CHCs and community clinics provide some access • Women’s College Hospital Network on Noninsured is forum for coordination •federal cuts to refugee healthcare → adverse impact on particularly vulnerable people → increased healthcare costs/demands at prov and provider levels •action idea = create local network or initiatives to improve access for uninsured and/or refugees 16
  • 16. Addressing Systemic Barriers: Interpretation as a Key Quality and Equity Lever precondition for equity • ensuring that adequate interpretation is available wherever needed → improves quality and equity • LHINs using available levers → formal requirement on all providers + alignment • access to interpretation also underlies wait times, safety and other system priorities •action idea = Hamilton providers consider centralized/coordinated interpretation services 17July 2, 2013 | www.wellesleyinstitute.com
  • 17. Canadians With Chronic Conditions Who Also Report Food Insecurity 18
  • 18. Health Promotion Through an Equity Lens • programs have to take account of inequitable resources of vulnerable individuals and communities • advice to manage diabetes or heart problems by exercising depends upon affording a gym or being close to safe park • if not customized, generic health promotion programs can widen disparities as better off take them up disproportionately • adjust programs to inequitable risks and specific barriers • South Asian immigrants had 3X and Caribbean and Latin American 2X risk of diabetes than immigrants from Western Europe or North America (Creatore et al CMAJ Aril 19, 2010) • deliver in languages and cultures of particular population/community • go where people are -- e.g. CHCs/promoters into malls • action idea = Immigrant Women's’ Health Centre, Aboriginal communities and other vans • CHCs lead/demonstrate how equity-driven health pomrotion can be done 19July 2, 2013 | www.wellesleyinstitute.com
  • 19. Pulling it All Together: Local Cross-Sectoral Planning • cross-sectoral coordination and planning can identify community health needs, access barriers, fragmentation, service gaps, and how to address them • public health departments and LHINs are pulling together or participating in cross-sectoral planning tables • Local Immigration Partnerships, Social Planning Councils • such broad collaboration will be particularly important to Health Links and other system integration initiatives • and coordinated services are particularly important in less advantaged communities with less resources • also key means to address deep-seated health inequities and wider SDoH at community level • CHCs have long played a key role in developing and connecting these resources and partnerships 21
  • 20. Equity and Community-Driven Local Planning pre-condition for this kind of coordinated action = creating an effective cross-sectoral planning forum action idea = create local health equity forum with concrete planning mandate can build on earlier roundtable Looking for Ideas : SETO •arose out of community concern re access •brings together public health, CHCs, shelters, researchers and service providers serving marginalized communities in south-east Toronto •for an overview of SETo’s development see http://knowledgex.camh.net/researchers/pr ojects/semh/profiles/Pages/seto.aspx •ongoing collaboration and idea sharing → supports service coordination and problem solving •emphasized concrete demonstration projects → many with lasting impact •advocacy with institutions and governments around results of projects and key issues such as harm reduction, dental care and access for non-insured people 22July 2, 2013 | www.wellesleyinstitute.com
  • 21. Back to Community Again: Build Momentum and Mobilization • sophisticated strategy, solid equity-focused research, planning and innovation, and well-targeted investments and services are key • but in the long run, also need fundamental changes in over-arching social policy and underlying structures of economic and social inequality • these kinds of huge changes come about not just because of good analysis, but through widespread community mobilization and public pressure • 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 • 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’ 25
  • 22. © The Wellesley Institute www.wellesleyinstitute.com Shifting the Frame Sudbury & other public health July 2, 2013 | www.wellesleyinstitute.com 26
  • 23. Health Equity • could be one of those ‘big’ unifying ideas.. • if we see opportunities for good health and well-being as a basic right for all • if we see the damaged health of disadvantaged and marginalized populations as an indictment of an unequal society – but that focused initiatives can make a difference • if we recognize that coming together to address the social determinants that underlie health inequalities will also address the roots of so many other social problems • thinking of what needs to be done to create health equity is a way of imagining and forging a powerful vision of a progressive future • and showing that we can get there from here 27
  • 24. Key Messages • health inequities are pervasive and deep-seated – but can’t let that paralyze us • do need a comprehensive and coherent health equity strategy – but don’t wait for perfect strategy • think big and think strategically – but get going where you are • have set out a roadmap – of strategies, tools and ideas -- to drive equity into action through policy change and community mobilization where CHCs come in: • demonstrating every day that something can be done about systemic inequities -- by delivering the best possible health care to disadvantaged communities • working in partnerships and collaborations well beyond health care to address the underlying determinants of health • I see CHCs as a beacon and inspiration – showing change is possible and how to move towards a more equitable health future 28

Editor's Notes

  1. POWER data age-standardized % of adults 2005overall patterns – 3 X as many low income as high report health to be only fair or poor self-reported = good proxy for clinical outcomes but exactly the point here, capturing people’s experience of their health
  2. don’t know local scene – you will know best how to adaptbut do want to set out fairly full repertoire of strategies and programs
  3. more specifically = need to make sense of SDoH to be able to act use this to explore idea of SDoH operating at different levels =making healthcare more equitable can be crucialhighlights the crucial importance of social context and that community development is a key part of the equation for actiondifferent policy solutions for each
  4. also community-orientated public health
  5. again, CHCs demonstrate how to ensure significant community input
  6. a promising direction several LHINs have taken up is to require providers to develop equity planshospitals in Toronto Central and Central LHINs – just refreshed 2nd generation in TCand other providers in CentralCHCs have developed a sector-wide plan in GTAthese plans are designed to:identify access barriers, disadvantaged populations, service gaps and opportunities in their catchment areas and spheresdevelop programs and services to address those gaps and better meet healthcare needs of disadvantaged communitiesthese provider plans have the potential to:raise awareness of equity within the organizationsbuild equity into planning, resource allocation and routine deliverypull their many existing initiatives together into a coherent overall equity strategybuild connections among providers for addressing common equity issuescould do this in Hamilton, or:build equity into QIPs, as suggested earlierconsider cross-sectoral equity planning -- later
  7. adverse social context and living conditions-> can increase risk of mental and physical illness + fewer resources to cope (from supportive social networks, to good food and being able to afford medications)for high quality person-centred care -> providers and programs need to customize and adapt care to population needs and contexts-> good communications and provider-patient relationship means taking the full range of people’s needs/situations into account e.g.. more intensive case management, referral planning and post-discharge follow-up for health disadvantaged in an increasingly diverse society, high quality care = culturally competent care:requires organizational resources, commitment and operationalizationnot just in negative sense of identifying barriers and gaps, but what could be enablers and directions for innovationpeers have been from particular ethno-cultural communities or neighbourhoods or are newcomers, PHAs, drug users or others with particular lived experience
  8. hubs ---from provider and funder points of view = more efficient use of scarce resources
  9. 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
  10. partner/support local innovations – refugee clinincs and other work-arounds+ policy advocacy = eliminate the three month wait for OHIP for new immigrants
  11. consistent evidence that:poor communication due to language or cultural can contribute to misdiagnoses and inappropriate prescriptionsinability to read or understand instructions can lead to medication errors -> safety, cost and re-admission implicationspromising indications that good interpretation helps keep people out of hospital and get them out soonerTC LHIN centralized system came out of broad collaboration and good policy advocacy Access Aliance was leader in this – and in demonstrating that a systemtic appraoch to interpretation can workfor providers to meet these requirements, they will need to:know the language needs of the communities they servethis is far more than just the languages of those who come to them for servicesalso need to know who is not coming in because of language and other barriers = unmet needand it doesn't mean just basic demographic data on languages spokenit means what language people are most comfortable receiving care in -> providers assessing community needs far better, and integrating that richer knowledge into their planning
  12. In: SDoH lead to gradient of health in chronic conditionsplus affect how people can deal with the conditionsOut: complex and reinforcing nature of social determinants on health disparities
  13. but – as always -- through an equity lensneed to enable – info and other resources, mentoring, supportgiven systemic inequalities in health opportunities and resources – some are going to need more support than othersneed to also recognize barriers many will face – language, literacy, living conditionspromising idea of peer health ambassadors again
  14. have to expect a prolonged era of austerity, restraint and limited public investment – with implications for all our fieldsAOHC was part of thisissue to watch for and advocate for locally - ensuring municipality takes health and equity into account in housing plan and in use of downloaded housing funds from prov
  15. also crucial to community mobilization is to shift way health is understoodto build public awareness of the structural drivers of health – the SDoH
  16. basic ideas of health, fairness and social justice can be a powerful vision to drive action