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Health Equity Workshop - Case Study
- 1. Sharing your passionfor health equity: Building our collective understanding April 9, 2013 Charlottetown, PEI
- 2. Case Study • Problem-baselearning • Presentation: Description of the context, issues addressed, activities undertaken • Group work: Think critically about the information presented – analyze, synthesize, and consider solutions One of four developed for a workshop hosted by NCCDH and the Canadian Institutes of Health Research (CIHR) Institute of Population and Public Health in Toronto, ON Feb 14-15, 2012
- 3. MAKING THE CASEFOR HEALTH EQUITY INTERNALLY: WINNIPEG’S EXPERIENCE Developed by: Dr. Sande Harlos and Horst Backé Winnipeg Regional Health Authority
- 4. Setting the Stage:Health Disparity in Winnipeg Reducing Gaps in Health Report 2008- Large gaps seen in Winnipeg lowest vs highest SES: • Asthma in children – 3.0 time (PC 1.6) • Injuries in children – 2.5 times (PC 1.2) • Injuries all ages - 2.2 times (PC 1.4) • Unintentional falls – 1.8 times (PC 1.3) • Land transport accidents – 1.9 times (PC 1.3) • Diabetes – 3.7 times (PC 2.4) • Substance-related disorders – 5.0 times (PC 3.4) PC = Pan-Canadian comparison
- 5. Health Disparity inWinnipeg They had… •Local, timely data as a focal point •Anticipation of media attention •Collaboration between Research & Evaluation Unit and Population and Public Health Team •Appealed to key members of regional leadership’s existing paradigms and alliances
- 6. The Issue/Challenge The Challenge: Howcould the Winnipeg Regional Health Authority Population and Public Health Program increase awareness and stimulate the change required to promote health equity?
- 7. The Environment • WithinWRHA: An internal oversight committee formed to explore multifaceted action to promote health equity • Beyond WRHA: Increased participation of the Winnipeg Poverty Reduction Council (WPRC) and other partners to support efforts of others to address root causes • Within the City of Winnipeg, an increasing critical mass to address poverty seemed to be forming
- 8. The Key Players WRHAPromoting Health Equity Oversight Committee Working Groups: 1. Partnership (ongoing) 2. Planning (ongoing) 3. Directional (time limited working group) – Describing the problem task team – Best practices task team – Communications task team
- 9. WRHA Health EquityGroups PLANNING Working Group PARTNERSHIP Working Group DIRECTIONAL Working Group PROMOTING HEALTH EQUITY OVERSIGHT COMMITTEE DESCRIBING THE PROBLEM Task team COMMUNICATIONS Task team BEST PRACTICES Task team
- 10. Sources of PlanningInformation • Environmental scan and gap analysis of existing or potential partners • Data and indicators to describe health inequity • Grey literature review: key recommendations to promote health equity • Program budgeting and service trends
- 11. Group Work (10 minutes) Imagineyou work in this health authority and you wanted to support this initiative… • Who would you convince in your workplace that this is an important issue? How would you persuade them to take action? • Who else do you think should be involved? And how would you engage them?
- 12. Challenges Developing common ownership “Howdo we go from health equity being a concept that people support, to an issue that they ‘own’? We need to develop a shared identity within the health region that says, ‘Equity is what we are all about.’”
- 13. Challenges Finding the evidence,expertise and resources “At this stage, we work on an ad hoc basis – collaborating on various committees and on specific research projects. It would facilitate a more strategic sharing of plans if there were more developed linkages between research institutions and the health region.” (Academic)
- 14. Challenges Maintaining leadership andmotivation “Ideally, there will be many champions for this initiative among senior leadership. I am guessing that public health will still be the driving force, but would like to see other leaders emerge to take a significant lead in their areas of practice and influence.”
- 15. Challenges Competing budgets andresource allocation “It will take real creativity and courage to shift resources towards preventative work. How do you lobby for health equity promotion funding that will reduce needs for health care services later… when there are sick people right now?” “Funding health disparity work will contribute hugely to a sustainable health care system, but it’s very hard to do in the short term.”
- 16. Challenges Determining roles “I havebeen involved in equity issues for my entire career. When I was first invited to participate in this internal committee with a lot of high-level people, I was concerned that there would be a lot of talk and little action.” (Community organizer)
- 17. Challenges Determining Roles “Within publichealth, we need to pay attention to actions that might be in conflict with other levels of government. Can we advocate for what we think is needed? Can we even create a public place for this discussion? Staff are still unsure about their role in advocacy…. More clarity and capacity building is needed. “ (Staff member)
- 18. Challenges Establishing priorities “We havea list of over 1000 recommendations from other equity reports. Even once we distil them to unique themes, that’s still far too many for a health authority to address. We need to create a broad enough plan to appeal to lots of stakeholder, but an actionable plan for the health authority. My biggest fear is that we take on too much.”
- 19. Group Work (10 minutes) Howwould you overcome these challenges? Where would you start? •Develop common ownership •Find the evidence, expertise and resources required •Maintain leadership and motivation •Set doable priorities
- 20. Strengths • A region-widecommittee leading efforts • Multiple sectors involved at the working level (working groups, task teams) • Endorsement and involvement of senior WHRA management • Well-established relationships in the community and with researchers
- 21. Outcomes to Date •Regional Health Plan proposals are being evaluated with health equity as a criterion • Population and Public Health strategic plans are being developed around the concept of ‘targeted universality’ • Further refinement of public health resource allocation (on basis of community need, not population) are being considered • A conceptual framework has been proposed • Mapping discussions are underway • WHRA Health Equity report is currently being drafted
- 22.
Editor's Notes
- #3 10 minutes opening presentation 10 minutes in small groups5 minutes for plenary – we will ask for each group to report back their best idea/suggestion10 minutes presentation about challenges10 minutes small group work5 minutes for plenary10 minutes – wrap up and summary of what happened
- #4 When Winnipeg agreed to do their case study they were admittedly a bit hesitate. So when they presented this case study in Toronto last year they very much talked about it being a “work in progress” – something we can all understand as we move through our daily work and activities
- #11 Sources of research All Working Groups and Task Teams are actively gathering research to inform their actions, including:An environmental scan and gap analysis of organizations most actively involved in poverty-related health equity work in the community and at the regional, provincial, national and international levels. To date, over 100 existing partners have been identified. (Partnership WG) Indicators to describe health inequity in the health region, with candidates being researched through a review of 14 local reports to determine the immediate availability of data (and associated gaps) specific to these indicators. Reports reviewed include community health assessments, reports of the Manitoba Centre for Health Policy (University of Manitoba), as well as population and disease-specific reports. (Describing the Problem Task Team)Key recommendations to promote health equity, found by reviewing over 80 resource documents or websites. Over 1000 recommendations have been gleaned through this review. (Best Practices Task Team)Program budgeting and marginal analysis process where equity was one of twelve criteria used to assess new initiatives (Planning Working Group) – was a new planning frame used by the regional health authority. (the planning process has benefits)
- #15 Maintaining leadership and ongoing motivation within the entire health region – While public health is leading the process, ongoing leadership is required for the initiative. There is already formal and informal leadership structures throughout the health region, and if an issue like equity doesn’t take hold within those in positions of influence to change the tone, direction and priorities of a system, then any one area (like public health) will have very little impact on organisational practices and culture. Keeping people motivated needs to consider why people may be interested and what people get out of being involved. Feeling like you are part of something important, meaningful and successful is key.“Ideally, there will be many champions for this initiative among senior leadership. I am guessing that public health will still be the driving force, but would like to see other leaders emerge to take a significant lead in their areas of practice and influence.”
- #19 Establishing priorities – “We have a list of over 1000 recommendations. If only one-quarter are unique, that’s still far too many to address. We need to create an actionable plan for the health authority, and I’m really not sure how we will prioritize the recommendations. My biggest fear is that we take on too much.” If overwhelmed you might do nothing well.
- #21 Strengths:A region-wide committee leading effortsAll sectors involved at the working level (working groups, task teams)Endorsement and involvement of senior WHRA managementWell-established relationships in the community and with researchers
- #23 If there is time…We welcome any thoughts or feedback.