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

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The Culture, Diversity and Equity Project: Literature Review Box 3.2: Cross-Government Action on Health Inequities, the United Kingdom In 2002, as part of the formal government-wide spending negotiations, the Department of Health and the Treasury led discussions between 18 departments to inform a delivery plan for the targets and identified the contribution required from each part of government. The Treasury’s financial and political authority was instrumental and brought departments to the table to engage in a cross-cutting goal. It facilitated agreement between departments to combine expertise and resources behind government priorities. The 2003 Programme for Action identified 82 funded commitments, owned by 12 government departments, which in the following 3 years would lay a foundation for achieving the 2010 targets and provide a sustainable impact on the wider determinants of health. The Programme for Action provided a strategic framework to direct all actions towards a single goal. This prescribed coordination at both national and local levels of government and strong performance management systems to drive delivery. An open process of regular audit, reporting, and review provides understanding of the target trajectory and the ability to refine the approach. Status reports were published in 2005 and 2008. The target has put pressure on the government to coordinate activities. This has required good communication between departments and Treasury leadership. National frameworks now mandate health inequities as a top priority for health planners and local government, while central guidance and support has targeted underperforming areas and promoted best practice. The current Secretary of State for Health has made health inequities his priority, challenging the National Health Service, which has its 60th anniversary in 2008, to live up to its founding principles of universality and fairness. Source: Hayward, 2007, as featured in WHO’s (2008) Closing the Gap Report . Other unique and innovative features of the UK policy and strategy landscape include: • The introduction of Health Action Zones (HAZs). See Box 3.3 below for more information on these innovative pilot projects. Box 3.3: Health Action Zones The introduction of Health Action Zones (HAZs) in selected areas as 7-year pilot projects “'to explore mechanisms for breaking through current organizational boundaries to tackle inequalities and to deliver better services'. Local partnerships between health and local authorities were invited to bid for HAZ status. Forty-one bids were received; 11 areas were successful in achieving HAZ status in April 1998, and a further 15 in April 1999. Together these areas cover 13 million people in England and include some of the most disadvantaged areas of the country./ Tackling inequalities in health is central to HAZs' agenda, with Ministers frequently describing them as being in the 'vanguard' or 'frontline of the war on health inequalities'….The foundation of this new way of working is a partnership between health and local authorities, voluntary and community groups and, in some places, other agencies. The way in which these partnerships are formed and work together to assess their needs, develop their strategies and deliver their services is fundamental to the success of the HAZ initiative. Crucially, they must develop a strategy to achieve their goal of improving health and reducing health inequalities, and ways of monitoring and learning from what they achieve” Source: Judge et al., 1999; cited in Judge and Mackenzie, 2002, p.306. • Another particularly distinguishing feature of the UK governmental/policy landscape is the statutory ‘equality’ duties and legally enshrined obligations to not only eliminate discrimination but promote equality along multiple dimensions, including race, gender and ability, and, more recently, age, sexual orientation and religion or belief. Current duties require all public bodies (including the NHS) to develop and put into place ‘equality schemes’ which are essentially action plans outlining measures and initiatives being undertaken to promote equality in the abovementioned areas. The recently created Equality and Human Rights Commission (which brings together the work of the three previous equality commissions around race, sex and disability) is currently working with the UK government to move towards single equality 72
The Culture, Diversity and Equity Project: Literature Review legislation. Such legislation will legally require public bodies to conduct equality impact assessments (see Box X) and develop equality schemes (see Box X below) relating to not only gender and race but also other dimensions of inequality including age, sexual orientation and religion or belief. The Department of Health has already proactively developed two Single Equality Schemes - SES (2007-2010) and, more recently, in updated and revised form, SES (2008-2011) – in anticipation of this requirement. The DOH SES’s set out the Department’s public commitments and plans for action across six ‘equality strands’ of race/ethnicity, gender, disability, age, sexual orientation and religion or belief (see http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_0754 63 for downloadable copy of the latest 2008 Department of Health Single Equality Scheme). Policy commitments within the UK Department of Health are also guided by an overarching (2003) Equality Framework which commits the Management Board of the DOH to “improving the health and well-being of the population through a health and social care system which: • Is provided equally to those who need it, free at the point of need • Offers a personal service which is truly patient-centred • Has sufficiently increased capacity to enable choice and diversity to be offered to patients • Is fair and provides equity of access to care. The National Health Service (NHS) has also developed an Equality Framework -The Vital Connection: An Equalities Framework for the NHS - that has oriented work in the health sector since 2003.The (2003) Vital Connection Framework has three strategic equality aims that all parts of the NHS are required to work towards through a series of priorities, objectives and targets. These three strategic equality aims are: 1. A workforce for equality and diversity - To recruit, develop and retain a workforce that is able to deliver high quality services that are accessible, responsive and appropriate to meet the diverse needs of different groups and individuals. 2. A better place to work - To ensure that the NHS is a fair employer achieving equality of opportunity and outcomes in the workplace. 3. A service using its leverage to make a difference - To ensure that the NHS uses its influences and resources as an employer to make a difference to the life opportunities and the health of its local community, especially those who are shut out or disadvantaged. Such NHS and Department of Health Strategic Frameworks and objectives are primarily enforced at the local level by Strategic Health Authorities (see Appendix 2 and Box 4.1, 4.2, 4.4, and 4.7 for more on functions and governance of Strategic Health Authorities). • In their international review of public health policy, Raphael & Bryant draw attention to five ways in which such UK policy developments differ from what is happening in the Canadian and US contexts: • The first is the recognition that health inequalities are a cause for serious concern. • The second is the serious use of available research evidence by government authorities. • The third is the recognition that these areas are cause for concern not only by health ministries and departments but also the entire government. • Fourth, there is a commitment to action through the development and implementation of public policy. 73
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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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