This presentation examines the relationship between the social determinants of health and health equity. Bob Gardner, Director of Policy www.wellesleyinstitute.com Follow us on twitter @wellesleyWI

1. Acting on Social Determinants
and Health Equity: An Equity
Toolkit for Public Health
Bob Gardner
Windsor-Essex County Public Health
November 29, 2013

2. Problem to Solve:
Systemic Health Inequities in Ontario
clear gradient in health in
which people with lower
income, education or other
indicators of social inequality
and exclusion tend to have
poorer health
however measured -- by
conditions, quality of life, life
expectancy
the gap between the health of
the best off and most
disadvantaged can be huge –
and damaging
2

3. Towards Health Equity Solutions
will set out a toolkit of 18 ideas, directions
and techniques
• to build equity into public health
planning and delivery
• and well beyond health system -tackling the underlying roots of health
inequality in the wider social
determinants of health
• solidly based in research evidence and
years of best practices
• action-orientated and manageable
• measureable – so can monitor and
assess progress
• adaptable to specific organizational and
local contexts
the particularly good news = don’t need to
start from scratch
3

4. Today
key message:
• health inequities are pervasive, damaging and deep-rooted
• but can be addressed through comprehensive health equity
strategy and concerted action
will set out a multi-facetted equity toolkit on how
• ideas and directions, tools and techniques, you could adapt
• will also highlight a few unintended consequences and challenges
to watch for
two exercises to test out these directions and tools at your tables
lots of chance for discussion
will start by looking at underlying social determinants of health
4

5. Gradient of Health Across Many
Conditions
5

6. Windsor-Essex County Blood Pressure, Arthritis and Diabetes Rates by
Income Quintile, 2007-2012
30
Percentage (%)
25
20
Quintile 1
Lowest income
Quintile 2
15
Quintile 3
Quintile 4
10
Quintile 5
Highest income
5
0
High Blood Pressure
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Arthritis Rates
Diabetes Rates
6

7. Impact of Health Inequities on How We Live
Our Lives
7

8. Impact of Health Inequities II
• not just inequitable differences in quality of life
• inequality in how long people live
• difference btwn life expectancy of top and bottom
income decile = 7.4 years for men and 4.5 for women
• more sophisticated analyses add the pronounced
gradient in morbidity to mortality → taking account of
quality of life and developing data on health adjusted
life expectancy
• even higher disparities btwn top and bottom = 11.4
years for men and 9.7 for women
Statistics Canada Health Reports Dec 09
8

9. Acting on Social Determinants of Health
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10. Canadians With Chronic Conditions
Who Also Report Food Insecurity
10

11. SDoH As a Complex Problem
Determinants interact and intersect
with each other → reinforcing and
cumulative effect on:
• individuals throughout their
lives; and
• on particular communities
and populations
In constantly changing and dynamic
social and policy environments
In fact, through multiple interacting
and inter-dependent
economic, social, environmental and
health systems
11

12. Acting Across Systems
and Sectors
even though roots of health
inequities lie in social and
economic inequality
need to also look at how these
other systems shape the
impact of SDoH:
•access to health services
can mediate harshest
impact of SDoH to some
degree
•so too can responsive
social services
•structure, resources and
resilience of communities
shape impact and
dynamics of inequalities
POWER Study: Gender and
Equity Health Indicator Framework
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13. WHO Model Again: Focusing on the Right Policy Levels
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14. Three Cumulative and Inter-Dependent Levels Shape Health
Inequities → Different Opportunities for Public Health Action
1. because of inequitable access to
→ gradient of health in which more
wealth, income, education and other
disadvantaged communities have
fundamental determinants of health
poorer overall health and are at
greater risk of many conditions
2. also because of broader social and
economic inequality and exclusion
→ some communities and populations
have less infrastructure, resources
and resilience to cope with the
impact of poor health
3. because of all this, disadvantaged
and vulnerable populations have
more complex needs, but face
systemic barriers within the
healthcare and other systems
→ these disadvantaged and vulnerable
communities tend to have
inequitable access to services and
support they need
14

15. Think Big, But Get Going
•
contradictions of SDoH analysis:
•
•
•
•
•
keep the fundamentals of SDoH in mind, but get going:
•
•
•
•
health inequities can seem so overwhelming and their underlying
determinants so intractable → can be paralyzing
a classic ‘wicked’ policy problem – meaning long-term action is
needed across many govts, depts and sectors
can't do everything at once
don’t wait for perfect strategy or evidence that connects and
understands everything
make best judgement from available evidence and experience
identify actionable and manageable initiatives that will make a
difference
innovate and evaluate → learn lessons and adapt
start from where you are – and focus here is on building equity
into public health practice
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16. Health Equity = Reducing Unfair
Differences
• Health disparities or inequities are differences in health outcomes that
are avoidable, unfair and systematically related to social inequality and
disadvantage
• This concept:
• is clear, understandable and actionable
• identifies the problem that policies will try to solve
• is also tied to widely accepted notions of fairness and social justice
• The goal of health equity strategy is to reduce or eliminate socially and
institutionally structured health inequalities and differential outcomes
• A positive and forward-looking definition = equal opportunities for good
health
• Equity is a broad goal, including diversity in background, culture, race
and identity

17. Powerful Starting Point = Equity Is a Priority
Within Public Health
17

18. + Promising Strategic Environment
can bring tradition, expertise and local
strengths to key system challenges:
•
Excellent Care for All Act enshrines
equity and population health as
fundamental principles
•
Action Plan emphasizes keeping people
healthier -- preventing chronic and
other conditions, childhood
obesity, screening, smoke-free
→ opportunity to demonstrate that these
challenges can be met – and how
PH has more experience than acute sector:
•
building necessary cross-sectoral
collaborations
•
up-stream interventions to sustain
healthier communities
→ opportunity for public health leadership
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19. Starting Point: Solid Commitment + Strategic
Opening + Community Engagement
• can’t just be ‘experts’, planners or professionals who define
issues and drive system transformation
• have to build diverse voices and perspectives into planning
• not just as occasional community engagement, but to identify
fundamental service needs and priorities, and opportunities for
creating healthier community structures and resources
• and to evaluate how we are doing
→ need to start from communities and residents
• involving all types of people – diverse cultures, backgrounds and
perspectives, and unequal social and economic conditions?
• specifically, how to involve and empower those not normally
included
• adapt different and innovative methods – e.g. principles of
inclusion research, go where people are, build trust
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20. 1. Operationalizing Commitment: Build Health
Equity into All Planning and Delivery
•
•
doesn’t mean all programs are all about equity
but equity is built into working culture and routine
planning → all programs take equity into account in
planning their services and outreach
• obvious example – given inequitable gradient of prevalence and
impact of chronic diseases + impact of living conditions → CDPM
programs have to take social determinants and community conditions
into account
• not so obvious example – from acute side
• concern about reducing hospital re-admission rates → need to
understand living and social conditions into which people are
being discharged → need to ensure more intensive discharge
planning and web of community-based support
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21. 2. Into Practice Through Equity-Focused
Planning
• addressing impact of health disparities at system level requires a
solid understanding of:
• the needs of health-disadvantaged populations
• gaps in available services for these populations
• key barriers to equitable access to high quality care
• at delivery level:
• considering equity in all program planning means drilling down
on above questions to identify specific needs and barriers for
that particular service
• requires an array of effective and practical equity-focused
planning tools
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22. Always Plan through a Health Equity Lens
Could this program or policy have a
differential and inequitable impact on
some populations or communities?
Providers should apply this type of basic
equity lens routinely – from strategic to
service planning
How do we need to take the specific
needs of disadvantaged individuals and
communities into account in planning
and delivering this service?
if we don’t know → find out
• highlights importance of collecting
better equity-relevant data across the
system and by every provider
• can use proxy data from postal code =
neighbourhood characteristics from
census data
• can use case studies and draw on
provider experience and community
perceptions
•if evidence indicates there could be
inequitable impact → then drill down using
fuller HEIA
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23. First Exercise: Using a Health Equity Lens
Could this program or policy have a
differential and inequitable impact on
some populations or communities?
How do we need to take the specific
needs of disadvantaged individuals and
communities into account in planning
and delivering this service?
At your tables, quickly apply this
basic equity lens to a program
you are working on
We’ll then share the possible
barriers, gaps and inequitable
impacts you identified.
And the innovations underway
to address them.
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24. • analyzes potential impact of program or policy change on health
disparities and/or health disadvantaged populations
• using HEIA can help
•
uncover unintended consequences or nuances easily missed in program
planning
• embed equity into routine planning processes and working culture
• ensure that projects not specifically about equity or particular
populations, will take language, diversity, local community conditions, etc. into
account
• especially important for health service providers who are not
experienced with equity and for non-health organizations to take the
population health impact of their policies into account
• growing, if uneven, use:
• across LHINs -- Toronto Central has required HEIA within recent funding
application processes, and refreshing hospital equity plans → some hospitals
have built HEIA into their routine planning processes
• adaptation geared to public health settings and standards been developed
and promoted by Public Health Ontario
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25. 3. Collect SDoH/Equity Data
need solid equity-orientated data
• to identify gaps and needs of
disadvantaged patients
• to measure and monitor progress
pilot project in 3 Toronto hospitals (and
Toronto Public Health) to collect patient
SDoH type data
scaled up to all hospitals in Toronto Central
LHIN
valuable website of resources on how to
collect and use this data
Action idea = adapt and use framework in
Windsor
• at best, across public health settings and
whole health system
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26. Make That Data Actionable
promising practice = Public Health
Observatories
• consistent and coherent
collection and analysis of pop’n
health data
• UK has system of observatories
specializing in different spheres –
London on inequities
• Saskatoon Observatory is
innovative example
opportunity: public health to use its
analytical capacity/expertise to support
wider health system
• partnering in community health
profiles
action idea = adapt observatory model
regionally or provincially
• role for PHO?
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27. 4. Build Knowledge We Can Act On
need broad research base and
expansive view of knowledge:
• epidemiological – scale of
disparities, disadvantaged
communities/groups
• population level linked datasets
• community-based research =
unique understanding of needs
and interests of marginalized
populations
• evaluation – need to know what
works and why, for which
populations, in varying contexts
systematic data collection + capacity
to measure/monitor /evaluate + rich
research evidence = knowledge to
guide/ground action

28. 5. Beyond Planning: Embed Equity in Targets, Deliverables, and
Performance Management
• clear consensus from research and policy literature, and
consistent feature in comprehensive policies on health
equity from other jurisdictions:
• setting targets for reducing access barriers, improving
health outcomes of particular populations, etc
• developing realistic and actionable indicators for more
equitable service delivery and health outcomes
• tying funding and resource allocation to performance
• closely monitoring progress against the targets and
indicators
• disseminating the results widely for public scrutiny
= embedding equity into comprehensive performance
measurement and management strategy
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29. Effective Public Health Equity Targets
•
•
•
•
various national projects underway to develop equity indicators
can also build equity into indicators already being collected → equity angle
is to reduce inequitable differences faced by particular populations or
communities on these indicators
reducing impact of diabetes is prov priority
• equity target = reduce differences in prevalence, complications and
hospitalization rates by income, ethno-cultural backgrounds, etc. and
among neighbourhoods or regions
• achieving that will require targeted programming and proactive
engagement with under-served communities
• also good reform driver = can only be achieved through coordinated
action
similarly, common goal is increasing rates of childhood immunization
• equity target = reduce the differentials in % of kids immunized by
neighbourhood, gender, ethno-cultural background, etc.
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30. Challenges: Equity Indicators and Targets
•
•
•
•
can’t just measure activity, like number or % of priority pop’n that participated in
program
• if theory of change for particular health program begins with enabling more
exercise or healthier eating – then we measure change in that initial step
need to measure contribution to health outcomes – even when impact only
shows up in long-term
need to assess reach
• differentiate those with greatest need who need program/support most
• are these populations signing up?
• who stuck with program and what impact did it have on their health – and
how this varies by sub-pop’n
then adapt incentives and drivers
• develop weighting that recognizes more complex needs and challenges of
most disadvantaged, and builds this into funding and incentive system
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31. 6. Use Effective Levers to Institutionalize Equity
•
•
•
public health standards have been effective way to prioritize and
embed equity:
• as foundational element of high-performing public health
• assessing needs, identifying priority populations, underlying
SDoH
interesting work underway to help implement:
• PHO on how to assess and identify priority populations
• alPHa/OPHA Health Equity Working Group is also an effective
forum
some lessons to be learned from acute side:
• following equity standards arose out of WHO Health Promoting
Hospitals project
• adapted to Canadian context, starting with hospitals
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32. Promising Practice: Actionable Equity Standards
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33. 7. Align Equity in Public Health With Key
System Priorities
•
•
•
showing how equity will be critical to achieving system goals and linking
equity into central priorities will enhance uptake and success
one overarching system priority is sustainability:
• powerful case to be made for preventative programs and health
promotion as key to reducing avoidable acute care use/costs
another priority is chronic disease prevention and management
• long been key focus of PH health promotion efforts
• a challenge for health reform is finding cross-cutting goals/projects that
can address a key issue and help to transform the wider health care
system
• reducing prevalence and impact of chronic disease could be such a
common goal to integrate upstream health promotion, primary care and
chronic care
• and it necessarily involves cross-sectoral collaboration
35

34. Always Drill Down: For Diabetes and Other Conditions, What
Are Key Dimensions of Inequities? What Determinants and
Barriers Underlie These Inequities?
Windsor-Essex County Diabetes Rates by Immigration Status, 20072012
16
14
Percentage (%)
12
10
8
6
4
2
0
Born in Canada
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Immigrant
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35. 8. Embed Equity into Quality
•
•
•
quality improvement is another key transformational driver across the
health system
taking social context and living conditions into account are part of good
service delivery
• when people face adverse social determinants of health → fewer
resources to cope (from supportive social networks, to good food and
being able to afford medication)
• e.g. primary care guidelines on best care for people living in poverty
providers and programs need to know this, to customize and adapt care to
SDoH and specific needs and contexts
• e.g. well-baby care has to be more intensive for poor or homeless women
• to get beyond barriers, preventative screening and health promotion has
to be delivered in languages and cultures of particular
population/community
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36. Not Just at Individual Level: Build Equity-Driven
Service Models
peer programs
• CHCs, public health and many community providers have established ‘peer health
ambassadors’ to provide system navigation, outreach and health promotion
services to communities facing particular barriers
• Waterloo has had peer program for over 20 years – nutrition, parenting, social
support – partnering with community groups
neighbourhood focus of many health promotion initiatives:
• not just disease by disease, or lifestyle elements in isolation, but coordinated
programming to meet local needs
being part of hub-style multi-service centres
• a range of health and employment, child care, language, literacy, training and social
services are provided out of single ‘one stop' locations
• based solidly in local communities and responding to local needs and priorities →
can become important community ‘space’ and support community capacity
building
• from provider and funder points of view = more efficient use of scarce resources
and better overall coordination
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37. 9. Priority Populations
Target Programs and Resources for Equity Impact
• consistent tradition within PH has been to identify priority populations
and target services to:
• those facing the harshest disparities – to raise the worst off fastest
• or most in need of specific services – e.g. poor young moms
• or the worst barriers to equitable access to high-quality services –
newcomers, Aboriginal populations
• this requires sophisticated analyses of the bases of inequities:
• which requires good local research and detailed information
• community health profiles to identify local disparities, unmet needs and
gaps
• community-based research to provide rich and deep local knowledge –
especially for designing effective program solutions
• involvement of local communities and stakeholders in planning and priority
setting is critical to understanding the real local problems
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38. Effective Targeting = Clear Focus
•
•
•
defining priority populations
• not just a general or statistical category – bottom 20 %, all immigrants
• but social groups who face particularly poor health or inequitable
determinants of health – and why
• these populations could occupy particular positions – precarious
workers, recent immigrants – or may share common
backgrounds, identities or other community interests – Aboriginal
people, LGBTQ, homeless
• could be people who live in particularly disadvantaged neighbourhoods
get priority populations involved in what matters to them and what
programs will meet their needs
however defined, no population or community is ever homogeneous
• need to drill down further – e.g. youth within Francophone African
immigrants have specific needs
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39. 10. Not Just Priority Populations: Target
Systemic Barriers
in Toronto and other cities: people without
health insurance
• immigrants in 3 month wait
time, refugees, undocumented
• inequitable access → delayed care and
worse outcomes
• TPH staff have played a key role in
Scarborough Volunteer Clinic and
networks
federal cuts to refugee healthcare
→ adverse impact on particularly
vulnerable people
→ increased healthcare costs/demands at
prov and provider levels
equity is ‘wicked’ policy problem, but not always
= predictable and avoidable results of bad policy
action idea = create local network to improve
access for uninsured and/or refugees
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40. Problem = Newcomers Face Service Barriers
One Solution = Interpretation as a Key Quality and Equity Lever
•access to interpretation underlies
wait times, safety and other acute
system priorities
•requirement that adequate
interpretation be available
wherever needed → improves
quality and equity
•equally crucial for health
promotion
•action idea = Windsor area
LHIN, PH, acute, community health
and other providers consider
centralized/coordinated
interpretation services
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41. Inequitable Access to Preventative Care: Pap
Smears
Toronto Public Health: health status indicator
series Sept 2011
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42. Problem = Under-Screened Populations
Solution = Focused Community Partnerships
lower screening rates in particular
ethno-cultural or disadvantaged
groups e.g. South Asian women in
Peel
→ community-based research to
assess why
→ broad partnerships of Public
Health, providers and trusted
community organizations to get
beyond barriers
→ outreach to diverse
community settings where
women live, work

43. 11. Health Promotion Through an Equity Lens
• need to customize and concentrate health promotion
programs to be effective for most disadvantaged
• programs have to take account of inequitable resources of
vulnerable individuals and communities
• advice to manage chronic conditions by exercising depends upon
affording a gym or being close to safe park
• diet and nutrition are key – yet high degree of food insecurity
• adjust programs to specific barriers and community needs
• deliver in languages and cultures of particular population/community
• go where people are -- e.g. CHCs/health promoters into malls
• Immigrant Women's’ Health Centre, Sherburne, Aboriginal
communities and other vans in Toronto
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44. Windsor-Essex County Vegetable and Fruit Consumption Five or More Times a
Day, by Income Category, 2009-2010
45
40
Percentage (%)
35
30
25
20
15
10
5
0
Lowest Income
Lower-Middle
Upper-Middle
Highest Income
Annual Household Income
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45. Build Equity Upstream: Chronic Disease Prevention
and Management
start by identifying populations and
communities at greater risk
• South Asian immigrants had 3X and
Caribbean and Latin American 2X risk of
diabetes than immigrants from Western
Europe or North America
→ design programs to meet specific needs
build in equity target = common goal is reducing
childhood obesity → if goal is to increase the %
of kids who exercise regularly
• equity target = reduce the differentials
in % of kids who exercise by
neighbourhood, gender, ethno-cultural
background, etc.
• and achieving that won’t be just a
question of education and
awareness, but proactive
empowerment of kids and ensuring
equitable access to facilities, space and
programs
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46. Watch for Unintended Consequences
• health promotion that emphasizes individual health behaviour or risks
without setting it in wider social context
• can lead to ‘blame the victim’ portrayals of disadvantaged who practice ‘risky’
behaviour
• focus on individual lifestyle in isolation without understanding wider social
forces that shape choices and opportunities won’t succeed
• universal programs that don’t target and/or customize to particular
disadvantaged communities
• inequality gap can widen as more affluent/educated take advantage of
programs
• programs that focus on most disadvantaged populations without
considering gradients of health and specific need
• the quintile or group just up the hierarchy may be almost as much in need
• e.g. access to medication, dental care, child care and other services for which
poorest on social assistance are eligible do not benefit working poor
• supporting the very worst off, while not affecting the ‘almost as worse off’ is
unlikely to be effective overall
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47. 12. Key Lever for Acting on SDoH: Inter-Sectoral
Collaboration and Coordination
• equity-driven quality care is not just customizing immediate service
delivery, but ensuring networks of community-based care and support
•
particularly important in less advantaged communities with less resources
• needs good cross-sectoral coordination and planning
•
can identify community health needs, access barriers, fragmentation, service
gaps, and how to address them
• public health units and LHINs are pulling together or participating in crosssectoral planning tables
• also Local Immigration Partnerships, Social Planning Councils
• and looking beyond vulnerable individuals to the communities in which
they live
• providing and partnering to provide related services/support such as
settlement, language, child care, literacy, employment training, youth
programs, etc.
• a number of PHUs have been pioneering social determinants approaches
through broad community collaborations on food security, poverty reduction
and other facets of building healthier communities
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48. Structural Determinants of Health Inequities:
and Simultaneously Always Local
poor housing, high levels of poverty and
precarious employment can be
concentrated in particular
neighbourhoods and
areas, compounded by racism and other
forms of social exclusion
impact and severity of health inequities
can also be concentrated in particular
populations and neighbourhoods
+ inequitable access to healthcare and
other services
+ services can be poorly coordinated and
planned
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49. 13. Plan Strategically/Act Locally
• clear benefits of comprehensive national/prov health equity strategy:
• but even best national strategy needs to be adapted/implemented
locally
• and even without national strategy, can still act locally
• recent Wellesley comparative survey of local health equity strategies
• many innovative local strategies at LHIN level, RHAs from other
prov, PHUs
• again, potential of PH:
• many PHUs work closely with local partners in community
collaborations, networks and planning forums
• tradition of researching/understanding local health needs and
challenges
• Manitoba has provincial community health mapping initiative,
• many Ontario PHUs have done local health mapping -- Toronto
profiles, Waterloo partnered with LHIN
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50. Realizing the Potential of Collaboration: Equity and
Community-Driven Local Planning Forums
pre-condition for coordination =
creating effective local crosssectoral planning forums
crucial to sustaining broad action
needed to address deep-seated
structural problems
action idea = create Windsor health
equity forums with concrete
planning mandate
• to develop a Windsor health
equity plan?
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Looking for Ideas : SETO
•arose out of community concern re access
•brings together public
health, CHCs, shelters, researchers and
service providers serving marginalized
communities in south-east Toronto
•for an overview of SETo’s development see
http://knowledgex.camh.net/researchers/pr
ojects/semh/profiles/Pages/seto.aspx
•ongoing collaboration and idea sharing →
supports service coordination and problem
solving
•emphasized concrete demonstration
projects → many with lasting impact
•advocacy with institutions and governments
around key issues such as harm
reduction, dental care and access for noninsured people
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51. 15. Realizing the Potential of Equity-Driven
Innovation
potential:
• huge number of initiatives already
addressing equity across province
• + equity focused planning will yield useful
information on existing system barriers and
the needs of disadvantaged populations
• and we’ll be seeing more and more
population-specific program interventions
but
• these initiatives and interventions are not
being rigorously assessed
• experience and lessons learned are not
being shared systematically
• so potential of promising interventions is
not being realized
need forums to share and build innovation
• NCCDH bringing together SDoH PHNs
• another advantage of local equity forum
• role for PHO or OPHA?
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52. 16. Add Public Health Voice: Policy Advocacy
• long tradition of advocating for healthy public policies
• Healthy Cities movement
• linking pop’n health into wide ranging issues -- climate
change, city design, transportation
• policy advocacy = one of key roles identified in NCCDH model
• public health has unique position:
• part of local govt
• protected by provincial mandates and responsibilities
• long been solidly based in local communities and collaborations
• can use credible professional/evidence-based voice to intervene
in public debates
• need to identify most effective platforms and policy opportunities
• and what the key issues are in your communities
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53. Policy Windows: II
also partnership with community
agencies, CHCs and other
providers and public health –
Peterborough
extended to developing an online tool to track impact of these
cuts
current focus – again in broad
collaborations – is on municipal
housing plans to ensure they
include this kind of flexible
support
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54. 17. Shifting the Frame:
Health = Healthy and Equitable Communities
Sudbury & other public health
videos, flyers, etc.
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55. Back to Community Again: Build Momentum
and Mobilization
• sophisticated strategy, solid equity-focused
research, planning and innovation, and well-targeted
investments and services are key
• but in the long run, also need fundamental changes in overarching social policy and underlying structures of economic
and social inequality
• these kinds of huge changes come about not just because of
good analysis, but through widespread community
mobilization and public pressure
• key to equity-driven reform will also be empowering
communities to imagine their own alternative health futures
and to organize to achieve them
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56. Second Exercise
From this equity toolkit, what are two or three
ideas or directions that you could develop
here?
How would you adapt them to your context?
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57. 18. Pull All This
Together into a Strategic
Roadmap
•
•
•
•
from a large
toolkit, develop a
roadmap of what you will
do – how and when
can’t be a rigid
blueprint, needs to be
adapted and implemented
flexibly to contexts and
circumstances
but need clear sense of
direction and overall goals
needs to pull various
initiatives into a coherent
and connected action plan

58. Promising Practice: Potential of Equity Plans
Demonstrated
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59. Build a Cycle of Equity-Driven
Planning and Innovation
•
•
•
•
•
not just a one-off plan
but building equity into
ongoing cycle of
analysis, planning and
implementation
see Saskatoon health
equity audit process
embed equity into routine
planning and performance
management processes
build evaluation and
learning into continuous
innovation
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www.wellesleyinstitute.com
Innovation
Analysis
Plan and
engage
Evaluate
Implement
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60. Health Equity and Community Mobilization
• we need to find ways that governments, providers, community
groups, unions, and others can support each others’ campaigns
and coalesce around a few ‘big ideas’
• health equity could be one of those ‘big’ unifying ideas..
• if we can shift the public and policy frame to see opportunities
for good health and well-being as a basic right for all
• if we frame the damaged health of marginalized populations as
an indictment of an unequal society – but also show that
focused initiatives can make a difference
• if we recognize that coming together to address the social
determinants that underlie health inequalities will also address
the roots of so many other social problems
• thinking of what needs to be done to create health equity is a way
of imagining and forging a powerful vision of a better future for all
• and showing that we can get there from here
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61. Key Messages
• health inequities are pervasive and deep-seated – but
can’t let that paralyze us
• do need a comprehensive and coherent health equity
strategy – but don’t wait for perfect strategy
• think big and think strategically – but get going
• have set out a roadmap – of strategies, principles and
tools -- to drive equity into action
• there is a solid base of public health
evidence, experience, commitment and community
connections to build on
• real opportunity within the current health and policy
environment for public health to lead the way on equity
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