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

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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). 64
The Culture, Diversity and Equity Project: Literature Review • There is a dearth of “comprehensive, integrated efforts to address known health disparities, and the factors and conditions that lead to them. Although health ministries in all jurisdictions, often in collaboration with other sectors, have launched a variety of initiatives to improve health and reduce health disparities, these efforts could benefit from a more coherent, system-wide approach” (Health Disparities Task Group, 2004). • Existing health equity strategies, more specifically the Integrated Pan-Canadian Healthy Living Strategy, limits areas of emphasis to individual health-related behaviours such as physical inactivity, unhealthy eating, and tobacco use (even if acknowledging that broader determinants of health shape individual health-related behaviour). No mention is made of the conditions of daily life as determinants of health, nor is it deemed important to specifically address such health determinants through public policy initiatives (Raphael & Bryant, 2006). • “Canada has yet to develop policies to require systematic cultural sensitivity in the health care regimes of all provinces. While some hospitals have begun to develop ad hoc programs and adapt practices to enhance delivery of culturally competent health care services, they have been developed in isolation” (Oxman-Martinez & Hanley, 2004, quoting Bowen, 2002). • Current frameworks developed by the Canadian Institute for Health Information and Statistics Canada have insufficient indicators of health disparities (Health Disparities Task Group, 2004). • The structural design of the LHINs, in particular the exclusion of public health authorities from the LHINS (in contrast to the situation in all of Canada’s other provinces’ Regional Health Authorities), could complicate and/or compromise its ability to collaboratively address broader determinants of health and health equity (Moloughney, 2007). Dominant Framework • In Canada, Health Equity/Population Health frameworks are dominant in the academic and grey literature. In practice, however, approaches adopted tend to take a narrower focus on issues of healthcare equity. While cultural competence research initiatives are growing (particularly toolkits and best practice guidelines etc.), the operationalization of such frameworks in practice, organizationally and systemically, remains limited and sparse. Rating on Whitehead’s Action Spectrum • Between ‘Concern’ and ‘Isolated initiatives’ USA Policy/Strategy Developments Exworthy and Washington (2006) distinguish four main features of US policies tackling health-care disparities in their review of US organizational strategies to reduce healthcare disparities. Table 3.3: Features of US policy on healthcare disparities Source: Exworthy and Washington, 2006, p. 46. 65
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Appendix 1: Health Equity Literatur
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The Culture, Diversity and Equity P
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HEALTH EQUITY LITERATURE REVIEW INT
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REFERENCES ACAS [Advisory Conciliat
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