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

2. 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

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

4. 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:

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

6. 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

7. What can be done to promote health equity?
Review of strategies in:
Europe
US & Canada
Australia & New Zealand

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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”

15. 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.

16. 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

17. 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

18. 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

19. 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.

20. 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

21. Thank you seonggee@wellesleyinstitute.com