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Health Equity

ENH 821 – Health Administration

Ian Young, Assistant Professor

School of Occupational and Public Health

Ryerson University

Definitions

• (^) Health inequality:
  • (^) Any difference in the distribution of health status or health determinants between different population group
• (^) Health inequity:
  • (^) Differences in health that are not only unnecessary and avoidable but are also considered unfair and unjust
  • (^) Is an ethical concept reflecting principles of social justice
  • (^) In general, differences due to biological variations, fully informed decisions to participate in higher risk behaviours, and “chance” are not considered inequities
  • (^) Better understanding of the causes and context of health inequalities can help health units to better target interventions and advocate for necessary changes

Health Inequities

Can influence environmental health in

four ways:

1. They may be associated with undue exposure to unhealthy environments
2. They affect individuals’ behaviours in ways that affect their exposure and health status
3. They can increase vulnerability to environmental factors that negatively impact health and wellbeing
4. They may be associated with decreased access to services that could address the impacts of unhealthy environmental exposures

• (^) PHIs are front line public health

practitioners who deal with a cross-section

of the population through their regulatory

and educational activities

• (^) Inequities create barriers to compliance
• (^) May or may not be recognized by PHI
  • (^) PHI response may help mitigate inequities, but could also exacerbate them Equity in Environmental Health Practice http:// www.bccdc.ca/health-profession als/professional-resources/hea lth-equity-environmental-healt

Equity in Environmental Health Practice

Example: Food Premise Inspections

• (^) Cash flow and other economic issues
• (^) Small or isolated communities
  • (^) Limited, slow, costly access to equipment and services
  • (^) Reliance on locally produced or wild foods for diet
• (^) Ability to read, understand and follow food

safety guidelines and instructions

• (^) Education and language

Source: Rideout and Oickle, Equity in Environmental Health Practice PHI Strategies to Address Barriers:

• (^) Build trust and relationships
• (^) Adaptive communication

Risk

Communicatio

n

• (^) Progressive enforcement
• (^) Prioritization and contextualization of risks

Risk

Management

• (^) Borrow tools and resources
• (^) Mutual support, networking and referral

Collaboration

• (^) Acknowledge, educate and flag system gaps Documentati on

Scenarios – How Would you Respond?

1. A couple who were operating a small drinking water system (SDWS) took the required SDWS Training Course at the health unit three times and failed the exam each time, even though they appeared to understand the concepts during the classroom-based course. Before the next exam, they come to you (PHI) and say they are not very good at reading.
2. A resort in an isolated community has a dishwasher that can no longer provide an adequate sanitizer step, so you tell them the dishwasher needs to be replaced immediately. The next available delivery for a replacement dishwasher is 3 weeks away, but the resort is about to open for the season.
3. During a routine inspection of a small restaurant, you notice a food handler sneezing and coughing while preparing food. When asked if she is sick, the food handler insists it is an allergy and not a cold or flu. After some discussion, you learn that the handler is unable to afford to miss a paid shift, so comes to work despite the risk of spreading illness.

Public Health Unit

Requirements

• (^) The new “Ontario Public Health Standards” include health equity as one of four foundational standards - (^) Includes particular focus on Indigenous Communities
• (^) Includes requirements that the BOH must:
  • (^) Assess and report on local population health, describing the existence and impact of health inequities, and strategies to decrease them
  • (^) Modify public health interventions to decrease health inequities by engaging priority populations and improving their health
  • (^) Engage in multi-sectoral collaborations to decrease inequities, including meaningful relationship with Indigenous organizations

Health Equity Impact Assessment Tool Step 1: Scoping Step 2: Potential Impacts Step 3: Mitigation Step 4: Monitoring Step 5: Dissemination

• (^) Health equity assessment tools provide systematic steps for policy-makers, program planners and researchers to assess their initiatives through a health equity lens
• (^) MOHLTC developed a HEIA tool that allows users to identify how a program, policy or initiative will impact population groups in different ways: - (^) Goal is to maximize positive impacts and reduce negative

Step 1: Scoping

• (^) Identify populations that may potentially experience unintended health impacts resulting from the planned policy, program, or initiative must be identified
• (^) Should rely on multiple sources of information (e.g. literature review, environmental scan, surveillance data, consultations)
• (^) Vulnerable or marginalized populations may vary from one project or situation to another
• (^) Various lines of inequality and identity can intersect and often reinforce each other in individuals and communities

Steps 2-3: Impacts and

Mitigation

• (^) Step 2: Potential impacts
  • (^) Determine if your planned policy or program will have any unintended health impacts or consequences (positive or negative) in your identified population
• (^) Step 3: Mitigation
  • (^) Determine adjustments to your policy or program that may be required to: - (^) Minimize negative impacts of your policy or program that may be contributing to health inequities in identified populations - (^) Maximize positive impacts that contribute to health equity

Steps 4-5: Monitoring and Dissemination

• (^) Step 4: Monitoring
  • (^) Determine if your mitigation strategy has been effective
  • (^) Monitoring should be integrated into program evaluation (required for all public health programs in OPHS)
• (^) Step 5: Dissemination
  • (^) Sharing results and recommendations for addressing equity with relevant population groups and stakeholders
  • (^) Embed this information into the health unit’s planning and operational structures