The 10 Promising Practices for Advancing Health Equity

1. Sharing your passion for health equity:
Building our collective understanding
April 9, 2013
Charlottetown, PEI

2. The 10 Promising Practices for Advancing
Health Equity
Hannah Moffatt
Knowledge Translation Specialist

3. Public health roles for health equity
1. Assess & report on: a) the existence & impact of
health inequities, & b) effective strategies to reduce these
inequities.
2. Modify & orient interventions & services to help
reduce inequities, with an understanding of the unique
needs of populations that experience marginalization.
3. Partner with other government & community
organizations to identify ways to improve health
outcomes for populations that experience
marginalization.
4. Lead, support & participate with other organizations in
policy analysis & development, & in advocacy for
improvements in the determinants of health.
Forthcoming, NCCDH 2013

4. 10 Promising Practices to Reduce Social
Inequities in Health
• Intersectoral action
• Targeting with
universalism
• Purposeful reporting
• Social marketing
• Health equity target
setting
• Equity-focused health
impact assessment
• Competencies/organizatio
nal standards
• Contribution to evidence
base
• Early childhood
development
• Community engagement
http://nccdh.ca/resources/entry/10-promising-practices-guide
Sudbury & District Health Unit 2009

5. Competencies & Organizational Standards
• Guide public health practice
• Competencies - essential knowledge, skills and attitudes
• Organizational standards - internal guidelines used by
organizations to outline expected levels of service and to
provide benchmarks for performance and accountability

6. Core Competencies & the Determinants of Health
• An assessment and comparison of
determinant of health content in the
Core Competencies for Public Health
in Canada
• The explicit inclusion of determinants
of health in public health competency
statements ensures that action on the
determinants is a visible and
concrete part of public health practice
http://nccdh.ca/resources/entry/core-competencies-
assessment

7. An Assessment and Comparison of
Determinants of Health Content
• The determinants of health are throughout PHAC’s
Release 1.0
• The references are often general, implicit and
contained in sections other than the Core
Competency Statements (e.g., values; examples)
• International sets of competencies were sometimes
more explicit in their inclusion of health equity work

8. Organizational Standards as a Promising
Practice for Health Equity: Conversations
with Public Health Experts
• Four public health experts interviewed about their
experiences and reflections on the
conceptualization, development, and implementation
of organizational standards
We have also been able to use the Standards as a bit of a
rallying cry to encourage other partners to work with us. We‟ve
been able to leverage the requirements and the societal goals
as a conversation starter to say, „we need to work together on
this‟ – Dr. Rosana Pellizzari
Forthcoming, NCCDH 2013

9. Nova Scotia Public Health Standards
• The work of public health is
grounded in:
– health equity and social
justice
– the principles of the
Ottawa Charter for
Health Promotion
• Requirements for Health
Equity and Social Justice
We interviewed the usual and
unusual suspects and it just
became clearer and clearer to us
across the health system that there
was no one area that really took
health equity on. And it became
clearer and clearer through our
process that this could be a very
strong role for public health. We
couldn‟t walk away from that role.
– Janet Braunstein Moody
http://www.gov.ns.ca/hpp/yourmove/Pu
blic_Health_Standards_EN.pdf

10. Intersectoral Action
• The solutions to health inequities lie outside the health sector
• To intervene on the social determinants of health partnerships are
required
• Strong relationships, common understanding, shared objectives

11. What’s the evidence? Intersectoral Action
• What is the impact/effectiveness of
intersectoral action as a public health
practice for health equity?
• Rapid systematic literature review
– Total of17 articles included:
1 systematic review, 14 quantitative
studies & 2 qualitative studies
– Difficult to determine how observed
outcomes relate to intersectoral
action
http://nccdh.ca/resources/entry/assessing-
the-impact-and-effectiveness-of-
intersectoral-action-on-the-SDOH

12. General Implications of the Review
• positive effect for children, especially for early literacy among children of
low-income mothers
Intervene in early childhood
• improve housing and employment conditions, evidence of impact for
other social determinants of health is limited
Upstream interventions
• employment/working conditions, child literacy, dental health, housing,
and organizational change
Midstream interventions
• increase access to oral health services, immunization rates, appropriate
use of primary health care services, and referrals from school readiness
checks.
Downstream interventions

13. Intersectoral Action:
Sudbury & District Health’s Experience
• Poor housing conditions in
rural and northern regions
• Vulnerable individuals,
limited resources
• Going “above and beyond”
• Referral to or consultation
with community partners
– Relationships
– Clarity of roles
Sudbury & District Health Unit, 2010
http://www.sdhu.com/uploads/content/listings/Exec
Summary_TheRoleofPublicHealthInspectors1.pdf

14. Community Engagement
• Involving the community in the development, implementation of
policies, programs and services
• Empowering communities, building relationships
• Interventions are more likely to be appropriate and response

15. What’s the evidence? Community engagement
• Review of reviews on community engagement, the social
determinants of health and health equity
Questions:
• What is the impact (direct and indirect) of community engagement
on the community and community members who are involved?
• What is the experience of community engagement for the
communities and/or community members involved?
– How are power and control in interventions addressed?
– What role do communities play?
– What is the quality of the engagement?
Coming soon from NCCDH

16. • What level of engagement occurs? Are different
levels of engagement associated with different
outcomes?
• What are the processes and approaches for
community engagement? How can public health
implement an inclusive practice at all levels of the
planning cycle? What is the optimal intensity of
community engagement?
(Expanded and adapted from Kelly et al, 2007:63-64 and
Popay et al. 2007)
What’s the evidence? Community engagement

17. Community Engagement:
New Brunswick’s Experience
• Empowering
communities to
address poverty
• 2500 residents
contributed to the
development of the
plan
• Local organizations
& unusual suspects
http://nccdh.ca/resources/entry/casestudy-NB

18. Purposeful Reporting
•Intentionally reporting the relationship between health and social
determinants of health
•Measuring the breadth and depth of health differences –
stratifying by socioeconomic status, using indicators
•Guide future interventions, assess the impacts of interventions

19. Population Health Status Reporting
• A “Learning Circle” to help modify population health status
reporting to advance equity
What is a health status report and why is it important?
“A report that doesn‟t get used won‟t help us to advance health
equity.”
Selecting health status indicators
http://nccdh.ca/resources/entry/population-health-status-reporting
“… every indicator has advantages
and disadvantages and needs to be
considered in context. There is no
such thing as a “perfect” health
inequality indicator.”
Learning Together Series

20. Population Health Status Reporting
• A knowledge translation tool that seeks to:
o Effectively disseminate information
o Facilitate intersectoral collaboration by
demonstrating links between sectors
o Result in action
• An iterative process
• Requires a culture of using
evidence to inform decisions

21. Purposefully Reporting:
Saskatoon’s Experience
• Population health status
reporting
• Conducted over 200
community consultations
• Gather opinions to rank
recommendations
http://nccdh.ca/resources/entry/casestudy-SK

22. Contact Us
National Collaborating Centre for Determinants of Health
St. Francis Xavier University
PO Box 5000 , Antigonish, NS B2G 2W5
Email: NCCDH@stfx.ca
Phone: (902) 867-5406 Fax: (902) 867-6130
www.nccdh.ca and www.ccnds.ca
@NCCDH_CCNDS