This presentation provides a critical analysis of the potential of a health equity impact assessment.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
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6. in addition, there are systemic disparities in access to and quality of care within the healthcare system
7. not just unfair and unjust, but health disparities make it more difficult to achieve provincial priorities such as ALCs, ER, diabetes, etc, and contribute to avoidable costs
8. enhancing health equity has become a clear priority – from the Province to LHINs to many providers
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16. impact of inadequate early childhood development, poverty, precarious employment, social exclusion, inadequate housing and decaying social safety nets on health outcomes is well established here and internationally
56. i.e. is the main problem language barriers, lack of coordination among providers, sheer lack of services in particular neighbourhoods, etc.
57. which requires good local research and detailed information – speaks to great potential of community-based research
58. involvement of local communities and stakeholders in planning and priority setting is critical to understanding the real local problems
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63. final version of template and workbook released by Ministry in 2011 see their page at http://www.health.gov.on.ca/en/pro/programs/heia/background.aspx
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72. We are developing a drop-in counselling and support program for people with mental health needs in a poor neighbourhood. The whole point is to provide better services to a disadvantaged community. But are there other factors we need to take into account?
these damaging disparities = the problem we are trying to solvethese disparities + and their impact on people's ability to cope with health challenges = vital part of the context for all health, home and related service delivery
mental health is crucial component of overall well-being – also major provincial prioritysame social gradient of mental health
OHIP core services
Getting specific on concrete impact of health disparities on quality of livesactivities of ¼ of low income people are limited by pain = 2X than high income
In: that's impact on daily livesthat type of impact adds up over people's livesesp.. impt in this context – home and community services deal with the impact of chronic conditions and inequitable morbidity
reinforcing nature of social determinants on health disparities = complex problemsignificance for key priorities = crucial part of managing diabetes and other chronic conditions is good nutrition need to assess this and other facets of people’s living conditions and resources for case management and planning – what % of mw clients face food insecurityneed to customize services to meet complex and often more challenging needs of disadvantaged populations
this complexity is felt on the ground at program levelhighlights need to drill down to identify underlying basis of problems introduce term if needed to further illustrate complexity of landscape? inter-sectionality – reflecting the fact that personal identities, group dynamics and relations of power and opportunity do not reflect a single line of oppression/identity such as gender, race or class, but their reinforcing and interacting nature
another way of looking at this complexity and what to do about itcommunity resilience and capacities operates at key intersections herethis highlights that SDoH can be driven into action on the ground through:community-based development or capacity building e.g. community development workers in many CHCscross-sectoral collaborations – many local mh groups and networkscross-sectoral planning tables and processesto drive local coordinated action e..g comprehensive community initiatives such as Vibrant Communities or common pattern in European health equity strategies of concentrated/coordinated local investment/focusa central issue is how to build mental health into all that
Principle applies throughout system – at provider and often at program level as well
practical local example – esp. impt to UHN
In: start from solid strategic commitment – which you haveopenings: providers and LHINs are mandated to undertake community engagement
Sick Kids analysis of patients by neighbourhood income levelneed to match tools to purpose
need to match tools to purpose can adapt to particular care and disciplinary settings
tool --- better to think of as a process
where workbook comes in:provides definitions, examples, prompts and possible questionsis set up to help users work through the HEIA process in a step-by-step wayusers simply fill out the appropriate tables in workbook itself to complete their HEIAthe workbook was designed so it can be adapted to become a Web-based interactive resource
highlights looking for unintended consequences
which is equity-orientated by def’nthis is about need to drill down to complexities and specifics
which is equity-orientated by def’nthis is about need to drill down to complexities and specificsfor place-based = need to take account of built and social environment
variations would not just be unfair, but contribute to avoidable complications – quality issue – and costspart of bigger picture:here also would drill down at scoping stage to specify the problem:variations in treatment?are there variations in outcomes – immediate success of treatment, longer-term recovery, morbidity, re-admissions?
Step 2 – identifying possible impactsevidence tells us what does that meanStep 3 -- identifying possible mediating or remedial actionson the face of it, not much hospitals and other providers can do about social conditions?but drilling down, can actthese remedial actions seem beyond hospital mandatebut what if relatively modest costs and programs reduced re-admission and attendant costs?Sick Kids partnership with Law Society to provide landlord, legal and other support for poor families – assuming this will support children’s healthrole for LHINs in just this kind of experiment and innovation?
Step 2 – identifying possible impactsevidence indicates a fairly obvious implicationwhat else?any access barriers?Step 3 -- identifying possible mediating or remedial actionsbut drilling down, can act
many experts see recs for action as critical stage – no point in identifying inequitable impacts if nothing is going to be doneStep 4 -- monitoring impacts -- need to think about that as part of HEIA process and set up evaluation mechanisms from the start
recognizing that what gets measured, matters
if time is tight – end hereif not, skip
a few illustrative questions for eachwould need to drill down even deeper in working group