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

The Culture, Diversity and Equity Project: Literature Review
4. Strengthen knowledge development and exchange activities (develop indicators to measure the impact of
health disparities; continue to support research; improve health information systems; share evidence on
health disparities).
The adoption and promotion of a ‘10 year plan to strengthen health care’ at the (2004) First Minister’s Meeting
on the Future of Health Care. First Ministers at this meeting agreed on an action plan based on the following
principles:
• Universality, accessibility, portability, comprehensiveness, and public administration;
• Access to medically necessary health services based on need, not ability to pay;
• Reforms focused on the needs of patients to ensure that all canadians have access to the health care services
they need, when they need them;
• Collaboration between all governments, working together in common purpose to meet the evolving health
care needs of canadians;
• Advancement through the sharing of best practices;
• Continued accountability and provision of information to make progress transparent to citizens; and
• Jurisdictional flexibility.
Many of the principles affirmed in this 10 year plan synchronize with, and are fundamentally informed by,
principles of equity in health status and health care. The 2004 First Minister’s Meeting also featured a special
meeting with Aboriginal leaders which resulted in the development of specific measures to address disparities in the
health status of Aboriginal peoples:
• The Quebec Public Health Act which requires all ministries and agencies to consult with the Ministry of
Health and Social Services when they are formulating policies that could have an impact on health (see PHAC
& WHO 2008 Report)
• The provincial Ontario Ministry of Health and Long-Term Care’s (MOHLTC) recent development of a tenyear
strategic vision and plan for Ontario’s health care system which is expected to feature equity as a
prominent direction (Lettner, 2008a; Gardner, 2008a). The fact that the Ministry has already established a
health equity unit to coordinate policy activities on health equity is particularly encouraging in this respect. In
light of such developments, Lettner suggests that “the new Local Health Integration Networks (LHINs) will
need to operationalize health equity as part of their mandate in response to the new provincial strategy” (2008a).
• The policy developments and strategic commitments made by various Local Health Integrated Networks at the
regional level, in particular the Toronto Central LHIN’s successful August 28, 2007 motion to insert health
equity and diversity performance indicators into the CEO's Annual Performance Plan and requirement, for
all 18 hospitals in the Toronto Central LHIN, to provide action plans.
• The formation of the GTA Diversity and LHINs Working group, specifically addressing diversity and equity
issues in the LHINs context.
Limitations and Challenges
Some of the challenges and limitations of Canadian health equity policy developments are discussed below.
• There is a substantial discrepancy between official Canadian governmental avowed commitments to health
equity, health promotion and population health and government policy and action on such matters. The
Canadian Population Health Initiative in this respect observes:
Canada has led the world in understanding health promotion and population health …However in recent years,
as the costs and delivery of health care has dominated the public dialogue, there has been inadequate policy
development reflecting these understandings. In fact, Canada has fallen behind countries such as the United
Kingdom and Sweden and even some jurisdictions in the United States in applying the population health
knowledge base that has been largely developed in Canada (2002, p.1).
This observation is reiterated by Raphael & Bryant (2006), Williamson et al. (2003), Williamson (2001), and
Sutcliffe et al. (1997).
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