Strategies to Improve Health Equity Seong-gee Um, PhD Researcher, Wellesley Institute May 19, 2017

Improving Health in the GTA Wellesley Institute works to improve health and health equity in the Greater Toronto Area through research and policy development based on the social determinants of health Research aimed at informing the development of health and social policy

Coming up… What is health equity? Review of strategies to address health equity Two case examples

Health Equity Source: www.cdc.gov Health equity allows people to reach their full health potential and receive high quality care that is fair and appropriate to them and their needs, no matter where they are, what they have, or who they are (HQO definition of health equity) Source: www.cdc.gov

Determinants of Health Employment &Income Education Housing and Physical Environment Social/cultural identity and Discrimination Health Services Social Support and Community Food Insecurity

Health inequities in Ontario People in low-income areas live 4.5 fewer years than those in high-income areas Diabetes risk twice as high for those identifying as “Black”, “Arab”, South and West Asian as those identifying as “White” Recent immigrant mothers 29% more likely have low birth weight babies

What can be done to promote health equity? Review of strategies in: Europe US & Canada Australia & New Zealand http://www.wellesleyinstitute.com/wp-content/uploads/2016/07/International-Review-of-Health-Equity-Strategies.pdf

Health Systems Approaches Common Target Areas Leadership Collaboration, engagement, multi-sectoral action Equitable access and utilization Equitable quality of care Capacity building Cultural and linguistic competency Data, research and evaluation Strategies from within the health system that aim to improve health equity

Health in All Policies (HiAP) A collaborative approach to improving the health of all people by incorporating health considerations into decision making across sectors and policy areas This approach is a recognition that the greatest health challenges – including health inequities – are highly complex and interrelated Public health and health care institutions do not have authority over many of the policy and program areas that impact health. So a Health in All Policies Approach works across sectors to address determinants of health, such as transportation, housing, economic, education policy.

Health in All Policies (HiAP) Common target areas: Embedding equity into multiple sectors Embedding equity into practices between departments within health sector Addressing wide-ranging social determinants of health Empowering communities Research, evidence and evaluation This all sounds very theoretical. So to give you an idea of what’s actually been done, I’m going to tell you about two cases in

Health Services Approach: Alberta Proposed Framework, 2013 Goal: Reduce inequities in population level health outcomes Purpose: cultivate shared responsibility for promoting HE in and beyond AHS

AHS Promoting Health Equity Foundational Concepts Health is a resource for everyday living Social justice Community engagement: “Nothing about us without us” Accountability Social gradient in health Universal and targeted approaches

AHS Promoting Health Equity Strengthening capacity + policy action Apply health equity perspective to all organizational decision-making Generate and maintain community participation Ensure AHS equipped to engage productively with different sectors that play a role in changing social gradient of health

HiAP Case Example: Norway Norwegian Ministry of Health and Care Services, 2007 Primary focus on levelling up “A fair distribution is good public health policy”

Norway’s national strategy Objective: To reduce social inequalities in health Over the past 15 years, Norway has gone from being what analysts termed a `laggard` on health inequalities, compared to countries like the UK and Sweden, to a leader.

Norway’s National Strategy: Priority Areas Reduce social inequalities that contribute to inequalities in health Reduce social inequalities in health behaviour and use of health services Targeted initiatives to promote social inclusion Develop knowledge and cross-sectoral tools

1. Reduce social inequalities that contribute to health inequalities Income Taxation system improved to ensure fairer income distribution Monitor developments in income inequalities Education as a tool to reduce social inequalities Improve accessibility, price, quality of kindergartens School day lengthened Monitor children’s language development at 2y and 4 y medical check ups

2. Reduce social inequalities in health behaviour & health service use Design campaigns effective in reaching target groups from a social perspective. Gender perspective in health information Modifications to physical environment to facilitate physical activity Regulate access to goods and services Tobacco and sugar taxes; fruit and veg subsidies

While there are no data available yet on health outcomes, there have been significant investments on infrastructure and programs which target the social determinants of health. Here you can see, for example, the increase in kilometres of cycle track/pedestrian zones. In the early 2000s, health inequalities were seen basically as an individual problem rooted in differences in lifestyle, but they are now seen as a matter of social justice, embedded in social structure.

What’s next? To eliminate health inequities, must address the social determinants of health across sectors Look outside Canada to Health in All Policies models for Ontario

Thank you seonggee@wellesleyinstitute.com