1. Blending targeted and universal approaches to advance health equity CPHA Conference 2014 Hannah Moffatt, Miranda Elliott & Dianne Kinnon National Collaborating Centre for Determinants of Health

2. Objectives Increase understanding and clarify the concepts of targeted, universal and targeting within universal approaches to health equity in public health practice Discuss key factors that support - and challenge - using a targeting with universal approaches in public health practice, and their impact on improving the health of all

3. The National Collaborating Centre for Determinants of Health One of six National Collaborating Centres for Public Health in Canada

4. Our audience: Practitioners, decision makers, and researchers working in public health Organizations in Canada’s public health sector Our work: Translate and share evidence to influence interrelated determinants and advance health equity Our focus: Social determinants of health & health equity National Collaborating Centre for Determinants of Health 4

5. Let’s Talk… Universal and targeted approaches to health equity A discussion guide about when and why to use a universal, targeted, targeting within universal, or proportionate universal approach NCCDH. Let’s Talk seies. Available at: http://nccdh.ca/blog/entry/Two-new-releases-in-the-Lets- Talk-series 5

6. Universal Approach Targeted Approach Applies to an entire population Each member of society has access Universal in principle may not be universal in practice Applies to a priority sub- group Interventions are designed to support populations experiencing disadvantage Can address the consequences of inequities, rather than the causes Let’s Talk: Targeted & universal approaches to health equity. http://nccdh.ca/resources/entry/lets-talk-universal-and- targeted-approaches http://nccdh.ca/resources/entry/lets-talk-universal-and- targeted-approaches 6

7. 7 Targeting within universalism – approaches define goals for all and tailor strategies to reduce barriers faced by specific groups

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9. “Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage” – Marmot Marmot M. Fair society, healthy lives. Strategic review of health inequalities in England post-2010. The Marmot Review. 2010. Available from: http://www. instituteofhealthequity.org/projects/fair- society-healthy-lives- the-marmot-review 9

10. Learning from Practice: Targeting within Universalism How does the theory apply to practice? Three case examples describe their process and lessons learned Available online http://nccdh.ca/resources/entry/lets-talk- universal-and-targeted-approaches 10

11. Sudbury and District Health Unit’s School Health Promotion Universal program with extra resources for CORE schools Comprehensive school health approach, multi-year strategy Partnership and relationship building Learning from practice: Targeting wtihin universaliismhttp://nccdh.ca/resources/entry/lets-talk- universal-and-targeted-approacheshttp://nccdh.ca/resources/entry/lets-talk- universal-and-targeted-approaches 11

12. Capital Health’s Healthy Beginnings Program Universal program pre-natal education and post-natal support with identification of families that require more intensive, long-term support Partnership with school boards, primary care practitioners, family resource centres Gathering feedback from clients and service providers Learning from practice: Targeting wtihin universaliismhttp://nccdh.ca/resources/entry/lets-talk- universal-and-targeted-approacheshttp://nccdh.ca/resources/entry/lets-talk- universal-and-targeted-approaches 12

13. Vancouver Coastal Health’s tobacco reduction program Universal programs to limit tobacco use and second-hand smoke exposure Targeted tobacco reduction for priority groups Shift to increase emphasize populations with the highest rates of tobacco dependency and known barriers to universal program participation Coming soon! 13

14. Overall Lessons Various reasons and approaches to applying the concept Strong partnerships, evaluation, and flexibility emphasized in the public health programs Efforts continue to seek balance to achieve best health outcomes for all

15. Visit our website - Contact us National Collaborating Centre for Determinants of Health St. Francis Xavier University PO Box 5000, Antigonish, NS B2G 2W5 Email: NCCDH@stfx.ca and CCNDS@stfx.caNCCDH@stfx.caCCNDS@stfx.ca Phone: (902) 867-5406 Fax: (902) 867-6130 www.nccdh.cawww.nccdh.ca and www.ccnds.cawww.ccnds.ca @NCCDH_CCNDS 62