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

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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. 6
The Culture, Diversity and Equity Project: Literature Review To ensure system-wide compliance and accountability, health equity policies and strategies should be integrated into existing performance management systems. In this regard, health equity impact assessments are a promising tool for: • ‘Mainstreaming’ accountability across an entire organization (versus siloing responsibility only with specialists); and • Ensuring that all policy/program areas consider the impact of their interventions on various diverse groups (not just the one that the policy/program is focused on). Policies should also be monitored by a corporate level oversight body to assure and monitor progress and coordinate efforts for eliminating disparities. The Role of the LHINs The major ‘levers’ currently available to the LHINs for managing performance are their: • Funding and allocation powers; • Local health system planning and contracting role (e.g., Integrated Health Service Plans; LHIN-Provider service accountability agreements etc.); and • Potential oversight role regarding compliance with health equity policy objectives as reflected in service plan agreements. Establishing accountability and quality assurance depends on continuing measurement, evaluation, and reporting of progress in relation to health equity policy objectives. As part of its service plan agreements, the LHIN can, for instance, require: • Annual targets per health equity policy goals and objectives; • Ongoing performance monitoring and control action; and • Regular reporting on progress to both the LHIN and the public (e.g., annual report cards). The LHINs could play a critical role in delivering the capacity that makes compliance possible: • Provide and/or support training initiatives; • Develop health equity/cultural competence ‘guidelines’ and standards for care; and • Assist and coordinate existing health equity researchers and research units in intelligence gathering and exchanges. The health care system’s licensing and accreditation agencies, although beyond the direct control of the LHINs, can also play a quality assurance role. For example, they could require health care providers to meet health equity/cultural competence ‘standards’ as a condition of licensing and/or accreditation (Exworthy et al., 2006; Betancourt et al., 2002; Office of Minority Health, 2001). Part 3: Cultural Competence Education and Training While there is significant variation in the specific content of cultural competence training initiatives, they tend to focus on three main areas: • Attitudes; • Knowledge; and • Skills (Sue et al., 1992, 1996; Curtis, Dreachslin, & Sinioris, 2007; California Endowment, 2003; Haarmans, 2004). 7
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REFERENCES ACAS [Advisory Conciliat
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