PHIRN: Population Health Improvement Research Network

Appendix 6. Key Findings and Recommendations from other Local, National and International Population Health Equity Reviews

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Key findings

Recommendations/
Actions for change

Toronto Central LHIN (2008). Environmental Scan of Research by Community based Organizations within the Toronto Central LHIN

  • Research activities taking place at the community level, yield local knowledge that can be used to inform the development of policies and to guide the planning and implementation of service delivery
  • Community-based research also acts as a tool for community engagement in research and encourages the adoption of proactive health strategies.
  • Community level research and research-related education initiatives that are well placed to advance health equity at the local level.

 

  • Recognize the important contributions of community-based research in promoting equity and addressing health disparities
  • Support collaborative research partnerships and develop Communities of Practice
  • Support the growth of research capacity at the local level
  • Increase knowledge transfer and exchange
  • Improve access to training and skills development for staff and community members engaging in CBR Research
  • Develop coordinated support mechanisms for involving diverse community members in research

National Collaborating Centre for Determinants of Health. (2010). Integrating Social Determinants of Health and Health Equity into Canadian Public Health Practice: Environmental Scan 2010. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

  • Action on health determinants and health inequities is not widespread.
  • Considerable misunderstanding of key concepts that need to be applied to address determinants and inequities.
  • Determinants tend to cluster for disadvantaged populations so that it is often difficult to address a particular determinant in isolation of others.
  • A balanced combination of universal and targeted interventions is needed to improve population health outcome.
  • Improve the conceptual clarity about public health action
  • Study and share existing practices
  • Support the practice of those committed to address health inequities
  • Provide links to evidence regarding specific interventions
  • Foster engagement and dialogue in the public health community

 

Source                 

Key findings

Recommendations/
Actions for change

The Standing Senate Committee on Social Affairs, Science and Technology Final Report of the Subcommittee on Population Health. 2009. A Healthy Productive Canada: A Determinant of Health Approach.

  • 75% of factors that influence health are not related to the health care system.
  • Investing more in health care has not resulted in improved population health.
  • Public policy is a sound approach to economic recovery and viability · Population health is an investment, not an expense.
  • A critical gap in our current knowledge is "which public policy interventions work to improve population health?"
  • Governance requires a whole of government approach
  • Population health data infrastructure is needed
  • Policy should focus on healthy communities
  • There should be a renewed focus on Aboriginal population health
  • The current global discourse on social determinants offers a 'window of opportunity' for Canada to take strong leadership in population health.

 

Canadian Public Health Association (2008). Canadian Public Health Association response to the World Health Organization (WHO) Report on the Commission on the Social Determinants of Health.

 

  • Advocate for an increased federal investment in public health, as well in sectors that have a significant effect on population health and health equity such as housing, employment, child development and care.
  • Help formulate, in consultation with all stakeholders responsible for health outcomes, a “made-in-Canada” approach to address the SDOH;
  • Convene a forum for stakeholders to share experiences, knowledge, and best practices in support of a SDOH approach to address health inequity in Canada and around the world;
  • Consult with the provincial and territorial public health associations and public health practitioners across Canada to identify and make accessible tools for addressing the SDOH in their respective jurisdictions
  • Devise effective ways to build broad public awareness and engagement by “telling the stories” of health inequities;
  •  Contribute to the development of a process to measure progress within Canada for reducing the social gradient in health.

Source                 

Key findings

Recommendations/
Actions for change

Marmot, M. Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in England Post-2010 (Marmot Review)

  • Reducing health inequalities is a matter of fairness and social justice.
  • There is a social gradient in health – the lower a person’s social position, the worse his or her health.
  • Health inequalities result from social inequalities.
  • Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently.
  • Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities.
  • Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.
  • Action on health inequalities requires action across all the social determinants of health.
  • Focus on reducing the gradient in health. Universal actions to reduce the steepness of social gradients with a scale and intensity that is proportionate to the level of disadvantage -- proportionate universalism.
  • Reducing health inequalities will require action on six policy objectives:
  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives
  •  Create fair employment and good work for all
  • Ensure healthy standard of living for all
  • Create and develop healthy and sustainable places and communities
  • Strengthen the role and impact of ill health prevention
  • Delivering these policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups. Effective local delivery requires effective participatory decision-making at local level by empowering individuals and local communities.

Source                 

Key findings

Recommendations/
Actions for change


The Public Health Association of Australia. (2009). Health Inequities Policy

  • Good health is not shared equally among Australians. These “health inequities” are associated with differences in education, occupation, income, employment status, rurality, ethnicity, Aboriginality and gender.
  • Indigenous people in Australia suffer the most significant health inequity when compared with the broader community.
  • There is a socioeconomic gradient in health. Increasing inequality in wealth within society leads to an increase in health inequities.
  • Impoverished people experience multiple forms of deprivation including material deprivation, marginalisation, exclusion, powerlessness and the denial of opportunities and choice.
  • The determinants of health inequities are largely outside the health system and relate to the inequitable distribution of social, economic and cultural resources and opportunities.
  • While conditions experienced during the early years of life have a major impact on health and life chances of individuals.
  • Health inequities are evident both within and between countries.
  • International trade agreements have been associated with adverse impacts on health and the provision of health services.

 

  • The Commonwealth government, in collaboration with the states, outline a comprehensive national cross-portfolio and cross-government framework on reducing health inequities; and should commit to the reduction of social and health inequities as a policy objective.
  • Reduce poverty and social inequity
  • Provide public health and health care services, especially to those most in need and disadvantaged communities.
  • Reduce the negative impacts of chronic illness and disability on social status. inequities and social, economic and cultural opportunities.

Source                 

Key findings

Recommendations/
Actions for change

Östlin. P. Schrecker, T. Sadana, R.  et al. (2009) Priorities for research on equity and health: Implications for global and national priority setting and the role of WHO to take the health equity research agenda forward

  • Go beyond the behavioral and other individual determinants of illness;
  • Examine the intersections among different social hierarchies and their cumulative impacts on health status and health inequities;
  • Examine the connections between proximal and structural (distal) determinants of ill health, which are often poorly conceptualised and integrated into research;
  • Consider the dynamic (rather than static) nature of equity in different country contexts
  • Describe the institutions and processes that influence the allocation of resources related to health and its social determinants ;
  • Focus on how the global context affects choices about resource allocation towards and within national and sub-national levels;
  • Pay special attention to the fact that certain kinds of evidence, such as results from randomised controlled trials, cannot be generated with respect to many interventions that address social determinants of health;
  • Involve affected populations, which is often essential to appropriate research designs and their execution.
  • Building a critical mass of professional staff with backgrounds in social science and non-medical disciplines, and with experience in a plurality of methods, to complement the existing competencies of biomedical and biostatistical staff.
  • Building networks for research support and advocacy and pursuing new research partnerships focused on social determinants of health and health equity.
  • Establishing and expanding a budget dedicated to supporting research and research policies related to social determinants of health and health equity.
  • Ensuring that norms and standards for the monitoring and assessment of health inequalities and health inequities are updated and used within WHO core statistics.

Source                 

Key findings

Recommendations/
Actions for change

Macintyre, S. Inequalities in health in Scotland: what are they and what can we do about them? MRC Social & Public Health Sciences Unit: Glasgow, 2007.

  • Maintain and extend equity in health and welfare systems
  • Address ‘upstream’ and ‘downstream’ causes
  • Level up not down
  • Reduce inequalities in life circumstances (especially education, employment, and income)
  • Prioritise early years interventions, and families with children
  • Address both health care and non health care solutions
  • Remove barriers in access to health and non-health care goods and services
  • Target, and positively discriminate in favour of, both deprived places and deprived people
  • Recognise need for more intensive support among more socially disadvantaged groups
  • Monitor the outcome of policies and interventions, both in terms of overall cost effectiveness and differential cost-effectiveness
  • Ensure programmes are suitable for the local context
  • Encourage partnership working across agencies, and involvement of local communities and target groups
  • Prioritise structural and regulatory policies
  • Structural changes in the environment: (e.g. area wide traffic calming schemes, separation of pedestrians and vehicles)
  •  Legislative and regulatory controls (e.g. drink driving legislation, lower speed limits, seat belt legislation,)
  • Fiscal policies (e.g. increase price of tobacco and alcohol products)
  • Income support (e.g. tax and benefit systems, professional welfare rights advice in health care settings)
  •  Reducing price barriers (e.g. free prescriptions, school meals, eye tests)
  • Improving accessibility of services (e.g. location and accessibility of primary health care and other core services, improving transport links, affordable healthy food)
  • Prioritizing disadvantaged groups (e.g. multiply deprived families and communities, the unemployed, and the homeless)
  • Offering intensive support (e.g. systematic, tailored and intensive approaches involving face to face or group work, home visiting, good quality pre-school day care)
  • Starting young (e.g. pre and post natal support and interventions, home visiting in infancy, pre-school day care)
Last Updated ( Wednesday, 21 September 2011 16:54 )