About this Article: This paper presents the findings of a review of academic and grey literature published between 2005 and 2009. The review sought to describe the scope and nature of Ontario research on population health equity and interventions to identify research expertise in this field, to ascertain the geographic locations of conducted research and to determine gaps.
About This Series: The É/Exchange working paper series is designed to facilitate sharing of results and to encourage discussion of concepts, practices, and policies in applied health. This series provides a way to disseminate well-written, but not yet published, reports of research. It is also a way to make research conducted by affiliated community members accessible to a wider readership. The series is co-sponsored by The Population Health Improvement Research Network (PHIRN), Réseau de recherche appliquée sur la santé des francophones de l'Ontario (RRASFO); and the Ontario Health Human Resources Research Network (OHHRRN).
Who is undertaking population health equity and intervention research in Ontario and where? PHIRN recently conducted a review of the literature to explore activity in this field of research between 2005 and 2009. It also set out to identify research gaps and contribute to the dissemination and utilization of existing health knowledge. These efforts are intended to minimize the duplication of research efforts and optimize building on existing research.
Defining Health Equity
Health equity is defined as the absence of unjust, unfair and avoidable systematic social inequalities in health or major social determinants of health, based on such things as class, gender or occupation. Interdisciplinary research can generate the knowledge needed to help avoid and prevent health inequalities through reasonable action or intervention. Population health equity and intervention research:
- Explores systematic differences that precipitate health inequalities;
- Applies multiple methods of inquiry by experts from various disciplinary backgrounds;
- Intervenes on upstream determinants that reside within and outside of health domains; and
- Develops policies and programs to reduce inequalities and improve equalities in health.
In their analysis of 173 academic articles and 114 grey literature documents published in both English and French, the authors found that:
- the bulk of the research was undertaken by researchers located in large urban Ontario settings and associated with universities; most particularly with the University of Toronto. In contrast, research projects of investigators affiliated with rural or northern Ontario settings received relatively less funding.
- Both academic and grey literature focused on a broad range of overlapping social determinants of health. However, the greatest focus was on populations with low income or socio-economic status, followed by immigrants, ethnic minorities, women and Aboriginal peoples. The most frequently studied population health outcome studied in both types of literature was mental health.
- In addition, the academic literature focused on the health determinants of income and immigrant status; the behaviours of healthy eating, substance abuse and physical activity; and the population health outcomes of cancer, maternal, reproductive, and sexual health, and HIV/AIDS.
- In addition to the common areas mentioned above, the grey literature focused on access to health care and health services, service utilization and income; health behaviour intervention and health promotion practices; and the population health outcomes of cardiovascular diseases, diabetes, violence and cancer.
The review's findings suggest "there is a need in this type of research to move beyond a focus on health behaviour to address various determinants of health at the individual as well as collective levels, particularly among disadvantaged populations."
As a result of their findings, the authors recommend the following:
- Efforts should be made to encourage research in un- and under-researched Ontario locations to explore how their unique characteristics contribute to health equity. Such efforts should be encouraged despite potential barriers that the population or small areas may be too small for representative quantitative studies, and the possibly higher costs of conducting research in such locations.
- Ontario's changing population mix will necessitate ongoing examination and identification of the full range of factors that bear on the health status of subpopulations.
- Determinants of health inequities often lie outside the health system and require a balance of solutions from both within and outside of health care.
- Research will need to focus on understanding the different social bases of inequalities that shape health risks and outcomes and to what extent these intersections are affected by different social policies.
- Interdisciplinary research using qualitative or mixed method research is needed to effectively examine the complex interactions among determinants of population health inequity. To this end, a sustainable path for interdisciplinary research capacity-building in Ontario will play an important role.
- Policy-makers will need to find ways to make effective program adjustments based on the evidence, as policy changes have the potential to have a profound impact on health and wellbeing.
Finally, the authors note that adequate funding for population health intervention research in Ontario is vitally important to reduce the gap in population health inequities within and between sub-populations, and to improve the health outcomes of all Ontarians.
Reference: PHIRN Scoping Review Committee. Scoping Review of the Population Health Equity and Intervention Literature in Ontario: 2005-2009. Exchange Working Paper Series, Volume 2, Number 6. University of Ottawa, Ottawa, Canada. Available at rrasp-phirn.ca.