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

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The Culture, Diversity and Equity Project: Literature Review • Integrated models which attempt to synthesize the aforementioned approaches through the construction of a ‘layered’ or ‘chain-like’ causation theory of health inequity (e.g. see Figure 2.3). Each of the layers or links represents different potential entry points for policy interventions. Such integrated models vary in the extent to which they (1) take into account a life-course perspective (some models only focusing in on adult stage), (2) represent individual biological pathways (some models only representing determinants that are external to the individual), and (3) address macrosocial factors and policies (some models limiting themselves to what happens at the individual level). Most of the frameworks discussed below draw on integrated models and understandings of the sources of health inequity. Figure 2.3 Canadian Institute of Health Research Population Health Framework Source: Rachlis (2007). Adaptation of CIHR-IPPH (2002). Mapping and Tapping the Wellsprings of Health: Strategic Plan 2002-2007. http://www.cihr-irsc.gc.ca/e/institutes/ipph/13789.shtml. Health Canada has defined the “overall goal of the population health approach” as “to maintain and improve the health of the entire population and to reduce inequities in health between population groups” (Health Canada, 1998). The Federal, Provincial and Territorial Ministers of Health officially adopted a population health approach in 1994 in the report, Strategies for Population Health: Investing in the Health of Canadians (see Health Canada, 1994). Population health frameworks, such as the one modeled above by the Canadian Institute of Health Research, are of much relevance and use to policymakers concerned with tackling health inequalities, particularly due to their concern with health status at the population group level, and attention to the multiple, interacting determinants of health, which provide multiple sites for policy intervention. Raphael & Bryant (2006) present another Health Canada population health framework that is geared more towards guiding specific population health interventions (see Figure 2.4). 20
The Culture, Diversity and Equity Project: Literature Review Figure 2.4 Health Canada’s population health template Source: Raphael & Bryant, 2006, p.42. The approach modelled in Figure 2.4 emphasizes the critical importance of gathering data and measuring population health status and bringing evidence-based analyses of the determinants of health to bear upon policy decisionmaking processes. Also emphasized in this model is the importance of upstream interventions which, by their very nature, demand considerable intersectoral collaboration. The model/framework furthermore stresses the importance of public involvement and accountability through recursive measurement and evaluation strategies. New Zealand Framework for Reducing Inequalities in Health The New Zealand Health Strategy on ‘health inequalities’ is elaborated in a (2002) New Zealand Ministry of Health strategic paper entitled Reducing Inequalities in Health. The paper “provides a framework for the health sector to improve the overall health of New Zealanders and to reduce inequalities amongst New Zealanders, with a focus on Maori, Pacific peoples and low-income New Zealanders” (p.1). This framework is informed by a population health approachwhich “takes into account all the factors that influence health and how they can be tackled to improve health” (ibid.). The various components of this framework are elaborated in significant detail below, due to the exemplariness of this framework, in combining theory and a concern with practical intervention strategies. Underlying the Reducing Inequalities in Health framework is the following ‘integrative’ determinant of health model featured below (Figure 2.5). 21
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