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

The Culture, Diversity and Equity Project: Literature Review
Canada, although an intellectual leader in research on health equity (from a health promotion and population health
perspective), has failed to develop concrete health equity policies and political leadership on the issue of health
disparities. There are promising developments in this respect however, such as the formation of an intergovernmental
Health Disparities Task Group and growing attention to health equity in the Ontario Provincial
Ministry of Health and Long Term Care (MOHLTC) and Local Health Integration Networks (LHIN) contexts.
Policy Lessons From Around the World
A review of international health equity policy literature provides a number of key policy lessons:
• Academic, governmental, and community collaboration in the realm of health in/equity is critical to advancing
health equity policy.
• The most effective approaches to health equity combine and incorporate, in varying degrees:
• Health equity and health care equity policy objectives;
• Upstream, midstream and downstream (‘all stream’) policy interventions; and
• Universalist and selectivist approaches.
This is partly due to the political acceptability of such broad, compound approaches which can appeal to
multiple audiences and constituencies across the political spectrum (depending on their emphases). Health
equity policies should strategically align themselves, wherever possible, with national and local political/policy
contexts to gain traction;
• Policy objectives should be clearly articulated in achievable, measurable terms;
• Policies should base themselves on evidence of what causes health inequity and what remedies or prevents
health inequity (i.e., appropriate and successful interventions). In the absence of evidence, pilot demonstration
projects, and their evaluation, are crucial. However, evidence is not enough, and policy choices must also be
made upon ethical priorities and commitments; and
• The health care sector should play a leading role in advancing a broad intersectoral health equity policy agenda
that addresses social determinants of health. Intersectoral collaboration has been shown to be fundamental to the
success of a comprehensive health equity policy.
Part 2: Accountability, Compliance and Quality Assurance
Part II examines the means of ensuring accountability and compliance with respect to health equity policies and
objectives, and quality assurance strategies.
The ways in which health equity policies and strategies are formulated can greatly impact their realization and how
accountability is established. It is particularly important to:
• Articulate clear and realistic policy objectives in terms that can be measured and made operational;
• Establish concrete action plans that clarify what will be done, by when and by whom, and how success will be
measured;
• Include diverse stakeholders (including community stakeholders) in the policy development process; and
• Ensure compliance and accountability through leadership and governance arrangements.
Governance for health equity strategies should extend to the highest authority in the health care service system (‘the
tree top’) to ensure:
• Coherent integration of health equity concerns across all policy, program, service/function areas;
• Effective performance management across the system; and
• Local relevance of decisions, services, and public accountability by involving and supporting the ‘grassroots’
and building on their insights and experience.
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