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

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EXECUTIVE SUMMARY The literature review of the Culture, Diversity and Equity Project draws on academic and grey 1 literature from local, national and international contexts in the following areas: • Policies and frameworks regarding health equity and cultural competence; • Documents on accountability, compliance, quality assurance agreements and other auditing tools to help ensure effective implementation of policies; and • Frameworks and standards for cultural competence education and training. The review gave priority to literature from North America, Europe, Australia and New Zealand because of similarities and transferability of findings to the Canadian context. This review is organized into three main parts: • PART I: Health Equity Frameworks and Policies; • PART II: Accountability, Compliance and Quality Assurance; and • PART III: Cultural Competence Education and Training. Part 1: Health Equity Frameworks and Policies Towards a Definition of Health In/equity There are different yet overlapping definitions of health equity and health inequity. In the Canadian context, the terms health disparity and health in/equity are frequently used, whereas in the UK/European context, health inequality is the recurring term, tending to relate health inequity to socio-economic status (SES). In the US, health or health care disparity is frequently used, in a way that evokes social divisions along racial and ethnic lines. Health inequity is defined as “those inequalities in health that are deemed to be unfair or stemming from some form of injustice” (The Health Disparities Task Group, 2004). It is also often defined as “those health differences that are avoidable, unnecessary and unfair” (Whitehead, 1998). Unlike health inequality or health disparity, health in/equity implies an ethical judgment, one that calls for action in the form of public policy intervention. At the core of discussions of health in/equity is the clear acknowledgement that certain health disparities are justifiable or unavoidable: for example, those that are self-inflicted or which result from biological inheritance. This review of international health equity policies makes clear the importance of articulating the ethical criteria by which to distinguish between just and unjust health inequalities. It also emphasizes the importance of forming a common language and ethics of health equity in Ontario, one that will make it possible to agree upon policy goals, commitments, and agreed-upon standards for judging progress. 1 The term grey literature is used to describe non-academic literature that is not easily found through regular channels.
The Culture, Diversity and Equity Project: Literature Review Frameworks Three main types of health equity frameworks emerged in the literature. Each of these frameworks approaches the problems to be tackled in slightly different ways. Though they are not explicitly named this way in the literature, we can refer to these overarching frameworks as: • Health equity frameworks; • Health care equity frameworks; and • Health equity in health care frameworks. Health Equity Frameworks Health equity frameworks are concerned with reducing disparities in health status broadly conceived and measured in terms of mortality and morbidity statistics, etc. Such frameworks focus on all potential determinants of health status, including those that extend beyond the health care system. These frameworks are exemplified by the WHO’s 2008 Closing the Gap Framework, New Zealand’s 2002 Framework for Reducing Inequalities in Health and the Canadian Institute of Health Research’s (CIHR) 2002 Population Health Framework. Health equity frameworks generally point towards ‘whole-of-government’ approaches to addressing health status inequities, since many of the strongest determinants of health status are located ‘upstream’ from the health care sector in broad social, political, and economic policies (e.g., poverty reduction). Health equity frameworks can be further subdivided between those that are primarily theoretical, exploring the causes and determinants of health status, and those that are focused more directly on evidenced-based intervention strategies (‘strategic intervention frameworks’). What makes the health equity frameworks discussed in this review so effective is that they: • Adopt a holistic understanding/definition of ‘health’ which enables them to recommend a wider range of preventative and health-promoting interventions beyond traditional medical-model approaches (that concentrate solely on treating individual illness); and • Ground proposed policy interventions in scientific and theoretical evidence, permitting more productive dialogues between stakeholders. Among the major limitations of such frameworks is the fact they bring into policy consideration various determinants of health that are beyond the immediate control of the health care sector such as poverty. Many such frameworks - at least from the more limited and immediate health care service/system vantage point - are better at identifying problems than offering solutions. In fact, the broad diagnoses and prognoses gained from these frameworks often require extensive intersectoral collaboration with stewardship at a national level, which itself poses many challenges, due to the structural organization of government along departmental lines (see WHO, 2008; Public Health Agency of Canada, 2007; PHAC & WHO, 2008). Health care Equity Frameworks Health care equity frameworks are concerned more narrowly with inequities in the accessibility and quality of health care services. They focus on disparities between advantaged and disadvantaged populations that can be traced back to the health care system: this includes, for example, access to primary care physicians and health practitioner stereotyping/racism, leading to inequitable diagnoses and treatment. 3
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REFERENCES ACAS [Advisory Conciliat
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