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

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The Culture, Diversity and Equity Project: Literature Review Figure 2.10: WHO model of causal pathways for health action Source: WHO 2008, p.175. This conceptual model more readily lends itself to policy intervention insofar as it more explicitly identifies possible entry points for intervention. The model suggests beginning with the evidence of differential individual health outcomes as a starting point for analysis, and then proceeding from there to explore consequences of this, followed by an explanatory account of the determinants of these differential individual health outcomes and consequences, which can then be used to guide strategic policy interventions (see Figure 2.10). B. Evidence-Based Health Equity Intervention Frameworks Global/Ottawa Equity Gauge Framework The Ottawa Equity Gauge is the outcome of a project that has brought together researchers, community leaders, NGOS and various public stakeholders with the objective of bridging the gap from evidence to action in reducing health inequalities (see Tugwell 2006). The 8 year-old Ottawa Equity Gauge is informed by the Global Equity Gauge (GEGA) initiative which describes itself as a “strategy that links measurement and analysis with the identification and evaluation of inequity reducing policies and actions” (GEGA, 2009). The Ottawa Equity Gauge has recently become an official GEGA associate. 30
The Culture, Diversity and Equity Project: Literature Review GEGA’s work places health squarely within a larger framework of social justice, focusing on health inequalities that are “avoidable and associated with unjust social constructs” (GEGA, 2009). More positively, GEGA describes its goal and perspective as “striving towards a world in which disadvantaged population groups (whether defined by age, gender, race-ethnicity, socio-economic class or residence) can better achieve their full health potential, as indicated by the health standards of those groups in society who are most advantaged” (ibid.). In this effort GEGA calls for “affirmative and preferential action to improve the health of those with the poorest health when they face unjust obstacles to achieving that potential” (ibid.). GEGA describes an equity gauge as “a health development project that uses an active approach to monitoring and addressing inequity in health and health care” in a manner that “moves beyond a mere description or passive monitoring of equity indicators to a set of concrete actions designed to effect real and sustained change in reducing unfair disparities in health and health care” (ibid.). The Equity Gauge framework is explicitly based on 3 broad spheres (called ‘pillars’) of action which are each accorded equal importance in ensuring a successful outcome. These three pillars are: 1. Assessment and Monitoring: Research and monitoring to measure and describe inequities 2. Advocacy and public participation to promote the use of information to effect change involving a broad range of stakeholders from civil society working together in a movement for equity 3. Community empowerment and involvement: to involve the poor and marginalized as active participants rather than passive recipients. The Ottawa Equity Gauge adds and emphasizes a fourth 'Intervention" pillar to the Global Equity Gauge based upon ‘Cochrane and Campbell systematic reviews’ 3 of the evidence-base around the impact of specific interventions (Tugwell et al., 2006). Figure 2.11 below represents the Ottawa Equity Gauge, as applied to the study of food security in Ottawa (see next page): 3 The Campbell Collaboration (named after Donald Campbell, an American psychologist and thinker) is a sibling organisation to The Cochrane Collaboration which has been formed “to prepare, maintain and promote the accessibility of systematic reviews in areas such as education, criminal justice, social policy and social care”, and, most recently, health equity (Retrieved March 9, 2009 form http://www.cochrane.org/docs/campbell.htm). 31
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