CDE Appendix 1 Literature Review - Central East Local Health ...

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The Culture, Diversity and Equity Project: Literature Review Abuse and Mental Health Services Administration (US); Agency for Health Care research and Quality (US); World Health Organization; • Other Public Health/Policy Think Tank Sources: The Wellesley Institute; Canadian Policy Research Network; Centre for Equity in Health and Society (CEHS); Canadian Institute of Health Research; Canadian Policy Research Network (CPRN); Canadian Healthcare Association; Canadian Institute for Health Information; Canadian Health Network; Health Care Information Resources (McMaster University); Centre for Health Promotion (University of Toronto); Conference Board of Canada; Canadian Health Network; National Anti-Racism Council of Canada (Health Section); CERIS/Metropolis website (Canada); Cultural Diversity Institute (CDI) [Canada]; National Centre for Cultural Competence (US); Commonwealth Fund (US); Institute for Public Policy Research (UK); National Research Register (Department of Health, UK); Open University/Resources/reports & grey literature (UK); Health Issues Centre (AUS) – An Independent Australian Health Policy and Research Action Center; Health Policy Monitor – International Network Health Policy and Reform. Library catalogues, databases and internet search engines were searched using the following search terms: • (health) or (mental health) or (healthcare) AND (equity) or (equality) or (inequality) or (disparity) or (inequity) AND/OR (cultural competence) or (cultural competency) or (linguistic competence) or (linguistic competency) or (cultural) or (multicultural) or (competence) or (diversity) or (inclusion) or (anti-oppression) AND/OR (system) or (organization) or (agency) AND/OR (policy) or (framework) AND/OR (standard) or (accountability) or (compliance) or (quality assurance) AND/OR (training) or (education) or (accreditation) In the case of academic journal databases, search areas were restricted to the title and/or keywords and/or abstract. Snowball methods were used to expand and focus the search throughout. Attention was, moreover, accorded to the number of citations of a journal article in a journal database as an index of the importance or prominence of a particular author or article in a subject area. Search results and marked references were recorded and saved in RefWorks and Reference Manager. Articles and book chapters were converted into pdf files and Microsoft Word files and imported into NVIVO 7 (qualitative coding software program) for further thematic coding and analysis. NVIVO 7 coding results informed the organization and writing up of the final literature review. Outline of Contents The literature review is organized into three main sections: • PART 1: HEALTH EQUITY FRAMWORKS & POLICIES • PART 2: ACCOUNTABILITY, COMPLIANCE & QUALITY ASSURANCE • PART 3: CULTURAL COMPETENCE TRAINING & EDUCATION 12
The Culture, Diversity and Equity Project: Literature Review PART 1 HEALTH EQUITY FRAMEWORKS & POLICIES 1.0 TOWARDS A DEFINITION OF HEALTH IN/EQUITY 1.1 Defining the Problem: Health Inequity, Inequality, Disparity The academic and grey literature on health disparities contains numerous, competing, overlapping, yet distinct, terms for its subject of study, variously termed health disparity, health inequality, health inequity and/or, positively conceived, health parity, health equality, and/or health equity. A necessary starting point for this review is the untangling of the different meanings and uses of these terms, not only for the sake of conceptual clarity but because of the significant policy implications and consequences deriving from such varying definitions, as discussed in subsequent sections. While health inequity, health disparity and health inequality are sometimes used interchangeably in the literature, each term tends to carry its own distinct set of implied meanings. Terminologies, and their distinct conceptual orientations and connotations, tend to vary along national lines, reflecting differing national political/policy contexts. Health disparity, for instance, is the term commonly used in the US literature, whereas in the UK and European contexts health inequality is the more commonly used term. All three terms appear in the Canadian literature, though there is a relatively more frequent and intentional use of the term health in/equity and/or health disparity. While each of these terms have a national valence partially reflecting differing national approaches, they are also used differently in different (e.g. academic vs. government) contexts, which makes any such exercise in conceptual definition and clarification at best tentative and partial. In a formative Discussion Paper entitled Reducing Health Disparities: Roles of the Health Sector, prepared by the Health Disparities Task Group of the Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security for the Public Health Agency of Canada, health disparities is defined as “differences in health status that occur among population groups defined by specific characteristics” (2004). The paper goes on to define “the most useful characteristics [for] policy purposes”, in keeping with its population health approach, as being “those consistently associated with the largest variations in health status”, which in Canada, it is argued, relate to “socio-economic status (SES), Aboriginal identity, gender, and geographic location” (Health Disparities Task Group 2004). In the US context, there is a much greater focus on race/ethnicity and health care-specific issues, owing in part to the greater significance and pronounced history of racial cleavages there, and the large numbers of persons without health insurance (45 million in 2003). The Institute of Medicine’s landmark (2003) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, for instance focuses on healthcare disparities (in accord with this US tendency), defining the latter as “differences in the quality of health care that are not due to accessrelated factors or clinical needs” (Smedley et al., 2003). By screening out access-related factors attributable to socioeconomic status, this definition and report foregrounds the significant contributing role of racial and ethnic disparities attributable to cultural incompetence, bias, prejudice, and stereotyping in the US healthcare system as a major explanation for healthcare disparities. Exworthy et al. (2006) use the term health disparities in their (2006) article to refer, comprehensively, to “both disparities in health care and inequalities of health status (unless there is a specific instance referring to inequalities of health and health care).” 13
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REFERENCES ACAS [Advisory Conciliat
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