This presentation offers ways to leverage a health equity strategy in order to inspire public action.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Health Equity: Why it Matters and How to Achieve itHealth Catalyst
According to the Robert Wood Johnson Foundation, health equity is achieved when everyone can attain their full health potential and no one is disadvantaged from achieving this potential because of social position of any other socially defined circumstance.
Without health equity, there are endless social, health, and economic consequences that negatively impact patients, communities, and organizations. The U.S. ranks last on measures of health equity compared to other industrialized countries. Healthcare contributes to this problem in many ways, including ignoring clinician biases toward certain populations and overlooking the importance of social determinants of health.
Fortunately, there are effective, tested steps organizations can take to tackle their health inequities and disparities (e.g., incorporating nonmedical vital signs into their health assessment processes and partnering with community organizations to connect underserved populations with the services they need to be healthy). Some health systems, such as Allina Health, have achieved impressive results by making health equity a systemwide strategic priority.
Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. "Health equity” or “equity in health” implies that ideally, everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.
This presentation offers critical insights on thinking and acting on health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Health Equity: Why it Matters and How to Achieve itHealth Catalyst
According to the Robert Wood Johnson Foundation, health equity is achieved when everyone can attain their full health potential and no one is disadvantaged from achieving this potential because of social position of any other socially defined circumstance.
Without health equity, there are endless social, health, and economic consequences that negatively impact patients, communities, and organizations. The U.S. ranks last on measures of health equity compared to other industrialized countries. Healthcare contributes to this problem in many ways, including ignoring clinician biases toward certain populations and overlooking the importance of social determinants of health.
Fortunately, there are effective, tested steps organizations can take to tackle their health inequities and disparities (e.g., incorporating nonmedical vital signs into their health assessment processes and partnering with community organizations to connect underserved populations with the services they need to be healthy). Some health systems, such as Allina Health, have achieved impressive results by making health equity a systemwide strategic priority.
Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. "Health equity” or “equity in health” implies that ideally, everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.
This presentation offers critical insights on thinking and acting on health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
A presentation by Karen Nelson, MBA, MSW, RSW, of the Ottawa Hospital, made to social workers at their 2013 Annual Meeting. A very thorough overview with significant research supporting the link between Social Determinants of Health and healthcare outcomes.
Globalization, Global Health and Public Health.
Changing Concepts of Public Health.
Causes, Aspects and Types of Globalization.
Social Changes due to Globalization.
How Globalization affects Public Health.
Globalization of Public Health.
Threats to Global Health.
Social Determinants of Health: Why Should We Bother?Renzo Guinto
Presentation delivered during the 2nd Social Oncology Forum with the theme "Social Determinants of Health in Agricultural Communities." November 10, 2013, Benguet State University, La Trinidad, Benguet.
Mode of Human Resource for Health Production in Nepal
Various Academic and Non Academic Institutes and Councils producing all sorts of Human Resource for Health in Nepal.
The presentation by Professor David Peters was given at the First Complex Adaptive Systems Training Workshop for CNHDRC, which was held in Beijing, China, from 18-19 July. It explains the basic elements of health systems and how they relate to a complex adaptive systems approach.
A presentation by Karen Nelson, MBA, MSW, RSW, of the Ottawa Hospital, made to social workers at their 2013 Annual Meeting. A very thorough overview with significant research supporting the link between Social Determinants of Health and healthcare outcomes.
Globalization, Global Health and Public Health.
Changing Concepts of Public Health.
Causes, Aspects and Types of Globalization.
Social Changes due to Globalization.
How Globalization affects Public Health.
Globalization of Public Health.
Threats to Global Health.
Social Determinants of Health: Why Should We Bother?Renzo Guinto
Presentation delivered during the 2nd Social Oncology Forum with the theme "Social Determinants of Health in Agricultural Communities." November 10, 2013, Benguet State University, La Trinidad, Benguet.
Mode of Human Resource for Health Production in Nepal
Various Academic and Non Academic Institutes and Councils producing all sorts of Human Resource for Health in Nepal.
The presentation by Professor David Peters was given at the First Complex Adaptive Systems Training Workshop for CNHDRC, which was held in Beijing, China, from 18-19 July. It explains the basic elements of health systems and how they relate to a complex adaptive systems approach.
Presentation by Paula Braveman, MD, MPH at the 2009 Virginia Health Equity Conference.
Dr. Braveman described the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America and explained the RWJF’s rationale for creating the Commission and for the Commission’s work to focus on the social determinants of health, and its relevance to health equity. She also discussed the Commission’s recommendations.
Presentation by Howard Frumkin, MD, MPH, DrPH at the 2009 Virginia Health Equity Conference.
Focusing on how inequities in the built environment – places where we work, live and play; transportation; food; and parks and green spaces - impact health, Dr. Frumkin described the dimensions of healthy communities and community design principles and the opportunities for effective interventions. He described the work of the Centers for Disease Control and Prevention in promoting health equity through healthy places. He also gave examples of communities that are advancing health equity through healthy places.
Dr. Bechara Choucair, Commissioner, Chicago Department of Public Health, giving the keynote for the conference on "Breaking Silos to Reduce Health Disparities: Successful Strategies in a Changing Healthcare System" sponsored by the Robert Wood Johnson Foundation's "Finding Answers: Disparities Research for Change Program."
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...Wellesley Institute
This presentation offers insight into the policy challenges that inhibit health equity.
Bob Gardner, Director of Policy
Steve Barnes, Policy Analyst
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Drawing Out Links: Health Equity, Social Determinants of Health and Social Po...Wellesley Institute
This presentation provides insight on health equity, social determinants of health and social policy.
Bob Gardner, Director of Policy
Steve Barnes, Policy Analyst
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Building on the Evidence: Advancing Health Equity for Priority PopulationsWellesley Institute
This presentations offers critical insights on how to advance health equity for priority populations.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
This presentation talks about the importance of health equity during difficult times.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Building Equity and Social Determinants of Health into 'Healthy Communities' ...Wellesley Institute
This presentation provides critical insights on how build equity and healthy communities.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Health Equity Strategy, Interpretation and Other Levers for Driving ChangeWellesley Institute
This presentation outlines effective ways to create change within your community.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Making Evaluations Matter for 'Wicked' Policy Problems; Supporting Strategy, ...Wellesley Institute
This presentation provides critical insights on supporting strategy, policy and interventions that drive health equity.
Bob Gardener, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Acting on Social Determinants and Health Equity: An Equity Toolkit for Public...Wellesley Institute
This presentation examines the relationship between the social determinants of health and health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Acting on Social Determinants and Health Equity: Opportunities and Promising ...Wellesley Institute
This presentation looks at the opportunities and practices that establish an effective public health system.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Health Equity Impact Assessment Workshop: Healthy Connection Wellesley Institute
This presentation provides insights on health equity.
Anthony Mohamed, Aboriginal Health CAP
St. Michael's Hospital
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Driving Health Equity in Canada: From Strategy to Action and ImpactWellesley Institute
This presentation provides insight on health equity and public action in Canada.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Advancing Health, Health Equity and Opportunities for Children and Youth in T...Wellesley Institute
This presentation examines the ways in which to advance health and health equity for children and youth during difficult times.
Bob Gardner, Director of Policy
Steve Barnes, Policy Analyst
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Advancing Health Equity: Building on Community-Based InnovationWellesley Institute
This presentation offers insights on how to advance health equity by building on community-based innovation.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Driving Health Equity for Kids: From the Earliest Years to Transforming the S...Wellesley Institute
This presentation provides the history of health equity for children and how we need to transform the system.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Health Equity into Action: Building on Partnerships and CollaborationsWellesley Institute
This presentation offers insight on how to put health equity into action by building on partnerships and collaborations.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Driving Health Equity into Action: The Potential of Health Equity Impact Asse...Wellesley Institute
This presentation provides a critical analysis of the potential of a health equity impact assessment.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
'Wicked' Policy Challenges: Tools, Strategies and Directions for Driving Ment...Wellesley Institute
This presentation provides critical insights on how to drive mental health and health equity strategy into action.
Bob Gardner, Director of Policy
Nimira Lalani
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
This presentation provides insight on how to translate health equity into action.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Similar to Health Equity Strategy into Public Health Action (20)
This presentation suggests that housing and homelessness are not just concerns for the city centre. It looks at how housing insecurity is deep and persisting; how poor housing effects people, communities, the economy and government; the diminishing federal investments in housing; and our lack of a comprehensive national plan.
Michael Shapcott, Director of Housing and Innovation
http://www.wellesleyinstitute.com/
Follow us on twitter @wellesleyWI
This presentation examines social housing and housing needs in Toronto and Canada.
Michael Shapcott, Director of Housing and Innovation
www.wellesleyinstitute.com
Follow us on twiter @wellesleyWI
Ending Homelessness in Kingston and Across Canada: What's the Plan?Wellesley Institute
This presentation examines the steps necessary to end homelessness in Kingston and Canada.
Michael Shapcott, Director of Housing and Innovation
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
A Health Equity Toolkit: Towards Health Care Solutions For AllWellesley Institute
This presentation offers health solutions that will help create a more equitable system.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
This presentation focuses on the links between good housing and good health, and the critical role that federal investments play in assuring that all Canadians have access to good quality, healthy and affordable housing.
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www.wellesleyinstitute.com
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Getting to Yes: Overcoming Barriers to Affordable Family-friendly Housing in ...Wellesley Institute
This presentation examines the barriers that inhibit many people from accessing affordable and family-friendly housing in inner Melbourne, Australia.
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This presentation examines the link between quality cancer care and equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
This presentation examines the ways in which local action can achieve health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
State of homelessness infographic.
Stephen Gaetz, Jesse Donaldson, Tim Richter, & Tanya Gulliver (2013): The State of Homelessness in Canada 2013. Toronto: Canadian Homelessness Research Network Press.
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www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Housing Insecurity and Homelessness: What Should Be Done?Wellesley Institute
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This presentation introduces complexity and systems thinking, and how they relate to the social determinants of health.
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www.wellesleyinstitute.com
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Health Equity for Immigrants and Refugees: Driving Policy ActionWellesley Institute
This presentation discusses health equity for immigrants and refugees.
Bob Gardner, Director of Policy
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This presentation provides facts about legalized gaming in Canada and situates these facts within the larger discussion on the negative impacts of Casinos on our health.
Jim Cosgrave, Professor of Sociology
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Dr. David McKeown, Toronto's Medical Officer of Health
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This presentation looks at the ways in which cities can be inclusive and examines interesting projects happening around the globe.
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Person-Centred Care, Equity and Other Building Blocks For Excellent Care For AllWellesley Institute
This presentation examines the building blocks for excellent care.
Bob Gardner, Director of Policy
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This presentations offers critical insight into the potential of an health equity impact assessment.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Health Equity Strategy into Public Health Action
1. Health Equity Strategy Into
Public Health Action
alPHa-OPHA Health Equity Working Group
April 5, 2012
Bob Gardner
2. The Problem to Solve:
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
2
3. Foundations of Health Disparities Roots Lie in
Social Determinants of Health
• 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
3
5. SDoH As a Complex Problem
Determinants interact and intersect
with each other in a constantly
changing and dynamic system
In fact, through multiple interacting
and inter-dependent economic,
social, environmental and health
systems
Determinants have a reinforcing and
cumulative effect on:
• individuals throughout their lives
• and on communities and
population health
5
6. Three Cumulative and Inter-Dependent Levels
Shape Health Inequities
1. because of inequitable access to 1. gradient of health in which more
wealth, income, education and other disadvantaged communities have
fundamental determinants of health poorer overall health and are at
→ greater risk of many conditions
2. also because of broader social and 2. some communities and populations
economic inequality and exclusion→ have fewer capacities, resources and
resilience to cope with the impact of
poor health
3. because of all this, disadvantaged 3. these disadvantaged and vulnerable
and vulnerable populations have communities tend to have
more complex needs, but face inequitable access to services and
systemic barriers within the health support they need
and other systems →
6
7. Planning For
Complexity
Need to look at how these
other systems shape the
impact of SDoH:
•access to health
services can mediate
harshest impact of
SDoH to some degree
•community resources
and resilience are
important
POWER Study: Gender and
Equity Health Indicator
Framework
7
8. Health Inequities = Classic ‘Wicked’ Problem
• health inequities and their underlying social determinants of health are:
• shaped by many inter-related and inter-dependent factors
• in constantly changing social, economic, community and policy environments
• action has to be taken at multiple levels -- by many levels of government,
service providers, other stakeholders and communities
• solutions are not always clear and policy agreement can be difficult to achieve
• effects take years to show up – far beyond any electoral cycle
• have to be able to understand and navigate this complexity to develop
solutions
• we need to be able to:
• identify the connections and causal pathways between multiple factors
• articulate the mechanisms or leverage points that we assume drive change in
these factors and population health as a whole
• identify the crucial policy levers that will drive the needed changes
• specify the short, intermediate and long-term outcomes expected and the
preconditions for achieving them.
April 9, 2012 8
9. Think Big, But Get Going
• the point of all this analysis is to be able to identify policy and program changes
needed to reduce health disparities
• but health disparities can seem so overwhelming and their underlying social
determinants so intractable → can be paralyzing
• will never have full understanding of all pathways and causal links
• don’t need to
• think big and think strategically, but get going
• make best judgment from evidence and experience
• identify actionable and manageable initiatives that can make a difference
• 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 focus here is on building equity into public health
system
9
11. Ideas From the Acute Side:
Building Equity Into the Health System
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
2. aligning equity with system drivers and priorities – such as chronic disease
prevention and management, quality – to enhance chance for success
3. identifying those levers that will have the greatest impact on reducing health
inequities and driving system change – enhanced primary care
4. embedding equity in provider organizations’ deliverables, incentives and
performance management
5. 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 looking to improve the health of
most vulnerable, fastest
6. while investing up-stream in health promotion and addressing the
underlying determinants of health
April 9, 2012 11
12. Start with Levers
• key challenge is to identify those levers that can have the most effective
equity impact
• both analytical and strategic question:
• evidence of effect on disadvantaged pop’n or structure of inequities
• window of opportunity, readiness to drive change
• considerable international evidence that enhancing access to primary
care is one of most effective ways to improve health of disadvantaged
populations
• public health can also be a key lever for equity-driven change:
• through enhancing screening, preventative care and health promotion
for populations facing the greatest health risks and burdens → laying
foundations for more equitable opportunities for good health
• PH expertise in analyzing population health, complex systems and
social determinants
• and leadership in cross-sectoral collaborations needed to concretely
act on SDoH
12
13. Equity-Focused Planning
• all of this needs good planning
• addressing health disparities in service delivery, planning and policy
development requires a solid understanding of:
• key barriers to equitable access to high quality health care and support
• the specific needs of health-disadvantaged populations
• gaps in available services for these populations
• and need to understand the roots of disparities:
• i.e. is the main problem language barriers, lack of coordination among
providers, sheer lack of services in particular neighbourhoods, racism,
concentrated poverty, precarious work, etc.
• which requires good local research and detailed information – speaks to great
potential of community-based research and involvement of local communities
• requires an array of effective and practical equity-focused planning tools:
• for health care to ensure equitable access – building equity into targets,
deliverables and performance management
• other sectors to ensure implications for health are taken into account -- HEIA
• all sectors to enhance policy and program coordination and coherent impact -
- Health in All Policies
13
14. Equity-Focused Planning Tools Into Public
Health
• a number of PHUs have developed and use equity lens:
• Toronto has a simple 3 question lens -- not just for public health, but
other departments
• Sudbury has used an equity planning tool for several years
• but uneven use and impact
• one lever = could enable/require PHUs to undertake HEIA or other
equity planning processes
• for all new programs and those focusing on particular populations
• to be eligible for particular programs or funding
• as part of overall prov standards/expectations
• advantage of using the same tool/processes = build up comparable
experience and data
• role for OPHA or PHO in developing PH specific resources, training,
enabling?
14
15. Aligning Equity in Public Health With Key
System Priorities
• showing how equity will be critical to achieving system goals and linking
equity into central priorities will enhance uptake and success
• one overarching system priority is sustainability:
• powerful case to be made for preventative programs and health
promotion as key to reducing avoidable acute care use/costs
• another priority is chronic disease prevention and management
• long been key focus of PH health promotion efforts
• Health Quality Ontario looked for cross-cutting goals/projects that can
drive quality improvement and transform the acute system = reducing
hospital readmission rates
• could reducing prevalence and impact of chronic disease be a common
goal to integrate health promotion and chronic care efforts?
15
16. Beyond Planning: Embed Equity in System
Performance Management
• clear consensus from research and policy literature, and
consistent feature in comprehensive policies on health equity
from other countries:
• setting targets for reducing access barriers, improving health
outcomes of particular populations, etc
• developing realistic and actionable indicators for service delivery
and health outcomes
• tying funding and resource allocation to performance
• closely monitoring progress against the targets and indicators
• disseminating the results widely for public scrutiny
• need comprehensive performance measurement and
management strategy
• then choose appropriate equity targets and indicators for
particular populations/communities
16
17. Success Condition: Effective Equity Targets
• considerable international experience and innovative work underway to
develop Canadian equity indicators
→ look for synergies between PH national and prov indicator
development and initiatives in hospitals, CHCs and other areas of
acute care
• not just about reviewing the literature and evidence:
• strategy: clearly defining success – the structural and outcomes
changes sought
• identify how best to measure progress towards this
• practical context – won’t have perfect data, what indicators will work
within existing systems?
• don’t need to wait -- an immediate direction is to build equity into
indicators already being collected
→ equity angle is to reduce differences between particular
populations/communities and others or PHU as a whole on these
indicators
17
18. Adapting Equity Targets
• reducing diabetes incidence is prov priority
• equity target = reduce differences in incidence, complications and
rates of hospitalization by income, ethno-cultural backgrounds, etc.
and among neighbourhoods or regions
• also good reform driver = can only be achieved through coordinated
action
• similarly, common goal is reducing childhood obesity → if goal is to
increase the % of kids who exercise regularly
• equity target = reduce the differentials in % of kids who exercise by
neighbourhood, gender, ethno-cultural background, etc.
• and achieving that won’t be just a question of education and
awareness, but proactive empowerment of kids and ensuring
equitable access to facilities, space and programs
18
19. Challenges: Equity Indicators and Targets
• can’t just measure activity like number or % of priority pop’n that
participated in program
• if theory of change for particular health program begins with enabling
more exercise or healthier eating – then we measure change in that
initial step
• need to assess reach
• who isn’t signing up? who needs program/support most?
• who stuck with program and what impact it had on their health – and
how this varies within the pop’n
• and assess impact through equity lens
• need to differentiate those with greatest need = who programs most
need to support and keep to have an impact
• then adapt incentives and drivers
• develop weighting that recognizes more complex needs and challenges
of most disadvantaged, and builds this into incentive system
• need to measure health outcomes – even when impact only shows up in
long-term
19
20. Success Condition = Better Data
•looking abroad for promising
practices = Public Health
Observatories in UK
• consistent and coherent collection and
analysis of pop’n health data
• specialization among the
Observatories – London focuses on
equity issues
•interest/development in Western
Canada
•national project to develop health
disparity indicators and data
•Toronto PH is addressing
complexities of collecting and using
race-based data
•pilot project in 3 Toronto academic
hospitals to collect equity data
•key direction = explore potential of
equity/SDoH data for Ontario
20
21. Levers for Action: Equity Plans
• lesson from health care sector = building equity into provider
requirements/ plans
• ECFAA requires hospitals and then other providers to develop
quality improvement plans → need to build equity in as key
dimension
• equity priorities will/can be built into accountability
agreements with LHINs
• a promising direction several LHINs have taken up is to require
providers to develop equity plans designed to:
• identify access barriers, disadvantaged populations, service
gaps and opportunities in their catchment areas and spheres
• develop programs and services to address those gaps and
better meet healthcare needs of disadvantaged communities
21
23. Equity-Focused Planning In Public Health
• provincial standards offer a possible lever
• building on current requirements, each PHU could be expected to
develop an explicit health equity plan showing how it was putting
population health standards into practice
• does not need to be onerous – templates simplified the process within
TC LHIN
• could be requiring and reviewing more explicit equity priorities,
deliverables, targets and indicators in strategic plans
• and then:
• call a province-wide roundtable to share, debate and learn from all the
individual plans
• which can be build into a coherent overall strategy
• and simultaneously develop specific expectations and targets and
build these into routine PHU performance management and
accountabilities going forward
23
24. Alignment Again: to Quality and Person-
Centred Services
• taking social context and living conditions into account are part of good
service delivery
• when people face adverse social determinants of health
→ can increase risk of mental and physical health illness
→ fewer resources to cope (from supportive social networks, to good food
and being able to afford medication)
• providers and programs need to know this to customize and adapt care to
SDoH and population needs and contexts
• e.g. well-baby care has to be more intensive for poor or homeless women
• to get beyond barriers, screening and health promotion has to be
delivered in languages and cultures of particular population/community
• focus in acute sectors and ECFAA on patient-centred care → means taking
the full range of people’s specific needs into account → more intensive
case management, referral planning and post-discharge follow-up
• so focus on priority populations means different types of service mixes to
take account of their specific context and needs
24
25. Not Just at Individual Level: 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 → continuum of care especially important
• poorer people also face greater barriers – e.g. availability/cost of
transportation, childcare, language, discrimination → facilitated access is
especially important
• e.g. Community Health Centre model of care
• explicitly geared to supporting people from marginalized communities
• comprehensive multi-disciplinary services covering full range of needs
• e.g. hub models of one-stop coordinated services
• public health and many community providers have established ‘peer health
ambassadors’ to provide system navigation, outreach and health promotion
services to particular communities
• PH is involved with many innovative local initiatives
25
26. Target Investment for Equity Impact
• consistent tradition within PH has been to identify priority
populations and target services to:
• those facing the harshest disparities – to raise the worst off fastest
• or most in need of specific services
• or the worst barriers to equitable access to high-quality services
• this requires sophisticated analyses of the bases of disparities:
• which requires good local research and detailed information
• community-based research to provide rich local needs assessments
and evaluation data
• community health profiles
• involvement of local communities and stakeholders in planning and
priority setting is critical to understanding the real local problems
• and requires incentives and resources
• lever = certain % of PHU budgets to be targeted to priority populations
26
27. Drilling Down: How to Focus on Particular
Populations
• defining priority populations
• not just a general or statistical category – bottom 20 %, all immigrants
• but social groups who face particularly poor health or inequitable
determinants of health
• these populations could occupy particular positions – precarious
workers, recent immigrants – or may share common backgrounds,
identities or other community interests – Aboriginal people, LGBTQ,
homeless
• could be people who live in particularly disadvantaged
neighbourhoods
• however defined, no population or community is ever homogeneous
• need to drill down – e.g. youth vs. seniors within Francophone African
immigrants -- to identify needs and plan interventions
April 9, 2012 | www.wellesleyinstitute.com 27
28. Build Equity Upstream: Chronic Disease Prevention
and Management
•very clear gradient in
incidence and impact of
chronic conditions
•some populations and
communities need greater
support to prevent and
manage chronic conditions
•chronic disease prevention
and management programs
cannot be successful unless
they take health disparities
and wider social conditions
into account
28
29. Watch for Unintended Consequences:
Health Promotion
• health promotion that emphasizes individual health behaviour or risks
without setting it in wider social context
• can lead to ‘blame the victim’ portrayals of disadvantaged who practice ‘risky’
behaviour
• focus on individual lifestyle in isolation without understanding wider social
forces that shape choices and opportunities won’t succeed
• universal programs that don’t target and/or customize to particular
disadvantaged communities
• inequality gap can widen as more affluent/educated take advantage of
programs
• programs that focus on most disadvantaged populations without
considering gradients of health and specific need
• the quintile or group just up the hierarchy may be almost as much in need
• e.g. access to medication, dental care, child care and other services for which
poorest on social assistance are eligible do not benefit working poor
• supporting the very worst off, while not affecting the ‘almost as worse off’ is
unlikely to be effective overall
29
30. Build SDoH In:
Cross-Sectoral Planning Through an Equity Lens
• another part of overall strategy for public health = key role
as connector
• back to levers = cross-sectoral coordination and planning are
key means to address wider SDoH in action
• public health departments and LHINs are pulling together
or participating in cross-sectoral planning tables → Prov
should make this an explicit expectation
• + Local Immigration Partnerships, Social Planning Councils
• the former Ministry of Health Promotion and Sport
developed a healthy communities strategic approach
• cross-sectoral planning to ground health promotion
• at best, this implies wider community development and
capacity building approaches
30
31. Enabling Cross-Sectoral and Equity-
Focused Innovation
• key lever = build equity-focused collaboration and innovation into
incentives:
• expectation that X% of budget will be devoted to equity-orientated
innovation, sustaining cross-sectoral initiatives or planning, etc.
• ear-marked funds for equity innovation and collaboration efforts
• build on public health tradition = many have pioneered cross-sectoral
action addressing wider determinants
• could PHO fund/support cross-sectoral collaborations and initiatives –
getting beyond programs that can’t fund outside their narrow silos?
• partner with other jurisdictions and agencies – PHAC, other provinces
• PHO or OPHA to be centre of expertise on equity and SDoH-orientated
collaboration?
31
32. Address Roots of Health Inequities in
Communities
• look beyond vulnerable individuals to the communities in which they live
• have to take SDoH into account in program design
→ meeting full range of needs means moving beyond health care
• focus on community development as part of mandate for many PHUs and
CHCs
• providing and partnering to provide related services/support such as
settlement, language, child care, literacy, employment training, youth
support, etc.
• promising direction = comprehensive community initiatives:
• broad partnerships of local residents, community organizations,
governments, business, labour and other stakeholders coming together to
address deep-rooted local problems – poverty, neighbourhood
deterioration, health disparities
• e.g. of Vibrant Communities – 14 communities across the country to build
individual and community capacities to reduce poverty
• Wellesley review of evidence = these initiatives have the potential to build
individual opportunities, awareness of structural nature of poverty and
local mobilization → into policy advocacy
April 9, 2012 | www.wellesleyinstitute.com 32
33. Building on the Potential of Community-Based
Innovation and Initiatives
• potential:
• huge number of community and
front-line initiatives already
addressing equity across province
• + equity focused planning through
HEIA or other tools will yield useful
information on existing system
barriers and the needs of
disadvantaged populations
• and we’ll be seeing more and more
population-specific program
interventions
• but
• these initiatives and interventions are
not being rigorously assessed
• experience and lessons learned are
not being shared systematically
• so potential of promising
interventions is not being realized
• role for PHO or OPHA?
33
34. Build From The Community
• goal is to reduce health disparities and speak to needs of most vulnerable
communities – who will define those needs?
• can’t just be ‘experts’, planners or professionals
• have to build community into core planning and priority setting
• not as occasional community engagement, but to identify equity needs and
priorities, and to evaluate how we are doing
• many providers have community advisory panels or community members on
their boards
• can also build on innovative methods of engagement – e.g. citizens’
assemblies or juries in many jurisdictions
• need to develop community engagement that will work for disadvantaged and
marginalized communities:
• in the language and culture of particular community
• has to be collaborative
• sustained over the long-term
• has to show results – to build trust
• need to go where people are
• need to partner with trusted community groups
34
35. Back Up to High-Level Strategy: Addressing
Systemic Inequality
• reducing overall social and economic inequality → requires a significant
commitment and re-orientation of social and economic policy
• need to build health and health equity into macro social and economic
policy:
• not just as one factor among many to be balanced, but as core priority
• some jurisdictions have built equity consideration into their policy
processes – e.g. a change in tax policy or new environmental policy
would be assessed for its health equity impacts
• which means more ‘joined-up’ policy processes:
• using HEIA and HiAP approaches
• built into cross-Ministry collaboration and incentives
• led from central authorities
• Saskatchewan, Quebec have been implementing such processes
35
36. Add Voice: Policy Platforms and Opportunities
• long tradition of advocating for healthy public policies
• Healthy Cities movement
• linking pop’n health into wide ranging issues -- climate change,
city design
• public health has unique position:
• part of local govt
• protected by provincial mandates and responsibilities
• long been solidly based in local communities and collaborations
• can use credible professional/evidence-based voice to intervene
in public debates
• many PHUs have played a lead role in local poverty reduction,
food security, environmental and other issues
36
37. Look for Policy Windows to Intervene to Advance
Health Equity
Commission on the Reform of
Social Assistance in Ontario
A broad collaborative of
leading Toronto health sector
institutions and experts came
together to:
• ensure that health and health
equity were taken into
account
• define a vision of a health-
enabling social assistance
system; and
• identify practical actions to
implement such a system
37
38. 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 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’
38
39. 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 public health is part of showing that we can get there from
here
39
Editor's Notes
POWER data age-standardized % of adults 2005overall patterns – 3 X as many low income as high report health to be only fair or poor difference btwn life expectancy of top and bottom income decile = 7.4 years for men and 4.5 for womentaking 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)Health disparities or inequities are differences in health outcomes that are avoidable, unfair and systematically related to social inequality and disadvantageThis concept:is clear, understandable and actionableidentifies the problem that policies will try to solveis also tied to widely accepted notions of fairness and social justiceThe goal of health equity strategy is to reduce or eliminate socially and institutionally structured health inequalities and differential outcomesA positive and forward-looking definition = equal opportunities for good health
preaching to the choirbut want to briefly stress complexity of all this – impt to developing effective strategy and action
In: SDoH lead to gradient of health in chronic conditionsplus affect how people can deal with the conditions= big constraint on strategy to dealing with chronicOut: complex and reinforcing nature of social determinants on health disparities
idea of inter-sectionality – reflecting the fact that personal identities and group dynamics do not reflect a single line of oppression/identity such as gender, race or class, but their reinforcing and interacting nature
need to specify different levels in which SDoH and structured inequality affect health -> different policy solutions
In: captures the complex and dynamic environments in which SDoH play outOut: shows that for broad social sectors, paying attention to building community resilience and capacities is crucial also highlights the need for action across various policy spheres and sectorspublic health works in both of these mediating spheres
pleasure to partner/speak tostart from solid strategic commitmentmajor priority within OAHPP, OPHA, collaboration among urban PHUs across Canada, etc.a number of Public Health Units have been pioneering social determinants approachesSudbury has developed comprehensive strategyWaterloo has focused especially on food insecurityToronto has emphasized health impact of increasing income inequalitywide range of promising approaches, programs and interventions -> potential to share and build on all this local innovationMinistry of Health Promotion and Sport is taking a healthy community planning approach – potentially more equity-orientatedchallenge = system is fragmented – LHINs, primary care, provincial programs, acute and up-stream, public health – let alone beyond healthneed to make equity one of driving priorities for health system and reformequity and a population health focus are among key principles enshrined in Excellent Care for All Act = opening and contextneed clear provincial strategy for equity: implicit from MOHLTC, but promised ten year strategy has not been releasedequity and population health are in public health standardsneed strategic coherence across health system in approach to equityPHUs, LHINs, CCACs, and other coordinating agencies need to prioritize equity – and many havecascading down to all providers prioritizing equity in their overall strategic plans and then into service delivery and resource allocation
In: even though roots of health disparities lie in far wider social and economic inequality, it is crucial to ensure equitable access to health care regardless of social positionwill try to draw out some lessons learned from health reform and possible parallels for PH
+ to tie these together: PH and CHCs in particular often partner together at local level
Brian to speak also PHAC, RMHIA
a central driver on acute side is quality improvement -> key role for Health Quality Ontario as catalyst in accelerating use of evidence, brokering improvement focusing the system on common quality agendaparallels for Public Health Ontario?role of OPHA in on-the-ground QI partnerships/initiatives?PH will want to be part of any broad Provincial quality strategycollaborations with HQO?
recognizing that what gets measured, matters
many programs assess their services through client satisfaction surveys and look for high and improving satisfaction -> reduce any differences in satisfaction by gender, income, ethno-cultural background, etc.
IN: need to drive equity into routine system and performance mgmt systems and build on levers to handLHINs requiring providers to develop health equity plans = experience to date indicatesthese 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 issuesnext stage for these plans is to build priorities that come out of them into accountability expectations
many PHUs already have such plans
all of this equity planning loops back to quality
not 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
probably not much consistency across the systems in how priority pop’n are definedrationale for whyequity rationale:certain groups within society are most adversely affected by systemic health inequitiesgoal of many strategies is to raise the worst off, fastestnot just a social justice argument, but improving adverse health of worst off can contribute to more effective use of scarce healthcare resources, positively affect social productivity and cohesion, enhance overall population health, etc.health and underlying social disadvantage can be inter-generationalwill persist – if not worsen – if not addressedaccess to quality servicesmost disadvantaged populations have greater and more complex needsuniversal programs can leave vulnerable groups out – and behindspecific at-risk groups need specific interventionsuniversal programs will not be effective unless adapted to specific needs, constraints and dynamics of vulnerable populations
key role for OPHA?
OWHN model of inclusive research as one wayagain -- parallels