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

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The Culture, Diversity and Equity Project: Literature Review Figure 3.1 Whitehead’s Action Spectrum on inequalities in health Source: Mackenbach et al. (2002b). Adapted from Whitehead (1998) Whitehead counsels her readers not to view this action spectrum as a linear evolutionary process as not all countries will necessarily go through the same sequence of stages and there is always the possibility of abrupt regress and/or progress along this health equity action spectrum or continuum. While different jurisdictions within countries may differ in their positioning along this action spectrum, it provides a useful means of generalizing, situating and comparing international and intra-national policy developments in the area of health equity, as explored below. The policy trends examined in this section are necessarily selective in nature, in part due to the uneven reporting of these in the literature, difficulties of accessing policies ‘internal’ to various state/provincial and national health authorities and in part due to the sheer scope of equity-related policies in those jurisdictions actively pursuing health equity (e.g. the UK context, with its many policies and strategies). The policies addressed below, as such, are largely those that have either been written about in the academic literature and/or are accessible in university/public libraries and/or posted on the worldwide web. Not infrequently, only aspects of various health policies are addressed in the academic literature, which further made it difficult to compare policies on the basis of a consistent comparative schema. B. Cross-national survey of health equity policies Canada In part due to the piecemeal and selective reporting of health equity policies made available to the public, the following section does not claim to comprehensively represent all or the most recent health equity policy developments internationally. It does however seek to offer, at minimum, a general picture of major policy trends, primarily within Europe and North America. 62
The Culture, Diversity and Equity Project: Literature Review Policy/Strategy Developments The Health Disparities Task Group (HDTG) of the Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security for the Public Health Agency of Canada describes Canada as having “few comprehensive, integrated efforts to address known health disparities and the factors and conditions that lead to them” (2004). Their formative (2004) Discussion Paper, Reducing Health Disparities: The Role of the Health Sector, tempers this observation with a measure of optimism, noting the recent launching of “some promising…initiatives to reduce disparities” (Health Disparities Task Group, 2004). The HDTG (2004) breaks down Canadian interventions around health equity into four main categories: 1. Leadership and policy development, e.g. the development of the Healthy Living initiative, establishing population health units in Health Ministries, wellness and health promotion programs, strategic plans that include disparities reduction priorities, primary health care innovations, etc. In Quebec the Health Ministry is required by law to examine the health impact of policies across the government. 2. Intersectoral collaboration and partnerships, e.g. child health initiatives, nutrition programs, prevention and harm reduction strategies, intra-governmental awareness-raising task groups, targeted programs for highrisk groups, etc. 3. Building community capacity, e.g. community development activities at regional health authority level, primary health care outreach, staff training in a population health approach, core area rehabilitation initiatives in cities, comprehensive school health programs, etc. 4. Knowledge development and exchange, e.g. widely publicized health status reports, detailed community profiles, health atlases, workshops for staff, health status indicators, specific research support programs, etc. (HDTG 2004:16) Among the more promising contemporary policy/strategy developments in Canada are: • The 2002 and 2003 First Ministers’ Health Accords which make national commitments to reducing disparities, more specifically through the adoption and promotion of a national Healthy Living Strategy. The Healthy Living Strategy’s two overarching goals are (1) to improve the health of Canadians and (2) to reduce health disparities (see Healthy Living Task Group 2003). 19 The Federal-Provincial-Territorial Advisory Committee on Population Health’s establishment of a Health Disparities Task Group in 2002 with the mandate of providing advice on the role of the health sector in addressing health disparities. The Task Group, which includes policy-makers and researchers from the health and social service sectors (within and beyond government), has identified four roles for the health sector in the reduction of health disparities. These include to: 1. Make the reduction of health disparities a health sector priority (establish a national leadership capacity; set goals and targets; use Health Impact Assessment; collaborate with jurisdictions, develop priority areas); 2. Integrate disparities reduction into health programs and services; 3. Engage with other sectors in health disparities reduction; 19 The February 2003 Health Accord of the First Ministers states in this respect: “First Ministers direct Health Ministers to continue their work on healthy living strategies and other initiatives to reduce disparities in health status.” 63
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Appendix 1: Health Equity Literatur
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The Culture, Diversity and Equity P
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Page 11 and 12: HEALTH EQUITY LITERATURE REVIEW INT
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REFERENCES ACAS [Advisory Conciliat
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