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

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The Culture, Diversity and Equity Project: Literature Review New Zealand Box 3.6: Monitoring Health Inequities in New Zealand New Zealand has initiated a whole-of-government approach to reducing inequities in health, especially with regard to the ways in which ethnicity and socioeconomic inequities interact. Key policy documents released in 2000 and 2002 have embedded a health inequity focus into all levels of the work of the health sector and have provided a template (the Reducing Inequalities in health Framework) for how action to reduce health inequities could be achieved. New Zealand has performed particularly well in steadfastly monitoring inequities and reporting those inequities in ways that best facilitate action. This has been achieved through a number of mechanisms, including a strong emphasis on ethnicity recording in the health sector, the routine matching of census with mortality records, and widespread use of a census-based small area deprivation measure, the New Zealand Deprivation Index. These approaches have boosted cross-sectoral interest in inequities, facilitated discussion in academic and policy circles about the root causes of inequities, and provided social agencies with evidence on which they can plan programmes and policies to address health inequities in their respective areas. Original Source: WHO & PHAC, 2007; Taken from WHO, 2008. Sweden • “Sweden has a decentralized form of federalism and a political culture compatible with a broad, determinants-based strategy. The motivation to address health disparities in Sweden led to a sustained national dialogue on the determinants of health and their consequences. The government pursued a consensus-building process that involved all political parties, an evidence-based approach and extensive public consultation. The result was a strongly supported strategy that focuses almost exclusively on the non-medical determinants of health” (Health Disparities Task Group, 2004). 3.3 SOME KEY LESSONS & RECOMMENDATIONS This section concludes with some key lessons and recommendations discerned from this review of the grey and academic literature on international health equity policies. • Knowledge development (especially the development of appropriate health equity measures and indicators) and dissemination through partnerships and (community-government-academic) collaboration is critical to putting health equity on the public policy agenda and advancing health equity strategies. • Comprehensive approaches that combine and incorporate, in varying degrees, (1) health equity and healthcare equity policy objectives, (2) upstream, midstream and downstream (‘all stream’) interventions, and (3) universalist and selectivist approaches have proven most effective, in part due to their design and analysis of causal pathways of health inequity, and in part due to the politics of such multi-pronged approaches which can appeal to multiple audiences and constituencies (depending on their emphases) across the political spectrum. • The healthcare sector can and should play a lead role in advancing a broad inter-sectoral health equity policy agenda that addresses social determinants of health. Intersectoral collaboration is critical to the success of a truly comprehensive health equity policy agenda seeking to effectively reduce health inequities. • Political will and a conducive policy/political environment is critical to the advancement of the health equity policy agenda. Policies should thus strategically align themselves, wherever possible (i.e. while maintaining their integrity) with local policy contexts and drivers to gain traction and fruition. • Policies should be guided by evidence regarding the nature of the problem (health inequity) and the appropriate intervention solutions to the greatest extent possible. In the absence of evidence (particularly in the latter respect), pilot demonstration projects, and their evaluation, are critical. Evidence alone, however, cannot inform and steer policy choices, as ethical views and priorities, too, play a key role. It is thus critical that ethical commitments and foundations for policies are clearly spelled out in ways that can help inform difficult policy choices. • Policy objectives should be clearly articulated in realistic, operationalizable terms. 76
The Culture, Diversity and Equity Project: Literature Review PART 2 ACCOUNTABILITY, COMPLIANCE AND QUALITY ASSURANCE Having considered various health disparity frameworks, policy options, debates and trends, Part II of this review examines ways and means of ensuring accountability and compliance with such policies and providing quality assurance, as discussed in the health equity literature. Case studies profiling good practice are interspersed throughout this section. Most of the good practices profiled are drawn from the UK governmental context, as the UK government has made the most progress in tackling health inequalities among governments surveyed in Part I, Section 3. Part II is organized into three sections: • Policy and Strategy; • Leadership and Governance; and • Performance Management 4.1 POLICY AND STRATEGY: Essential Components and Dimensions of policy and strategy development to ensure compliance and accountability To ensure compliance across the system, equity policies and strategic goals need to be adopted at the highest levels of the organisation/system as an essential and integral component of the organization/system’s strategic goals, vision and mandate. It is moreover essential that such organizational strategic goals be performance managed by senior management (see Governance section below). The Local Health System Integration Act requires the Local Health Integration Networks (LHINs) to each develop an Integrated Health Service Plan (IHSP) - with input from the community, and in accordance with the provincial (MOHLTC) Health System Strategic Plan. The MOHLTC’s strategic plan is expected to contain a commitment to equity as a strategic priority and goal. It is essential that the vision statement, integration strategy and specific priorities laid out for the local health system in such IHSPs include and reflect a strong commitment to health equity. As discussed in Part I, clearly articulating one’s equity vision, policy goals and objectives, in terms that can be operationalised and measured, is critical to ensuring accountability. The more vague the vision and corresponding policy objectives, the less able are policymakers and other stakeholders (including the public) to measure and gauge progress, which is critical to ensuring accountability and responsibility for the performance of such policies. Strategic goals around equity need not only be clear and measurable but also achievable (versus merely aspirational) in order to ensure continued momentum on the basis of early and sustained achievements (see Box 4.1, 4.5 and 4.6 for good examples of clearly articulated, realistic, and operational health equity goals and objectives). It is also critical that policymakers elaborate the ethical foundations of their policy commitments (if not in the policy itself, then in policy guideline materials), so as to help guide tough decisions regarding which goals and strategies to pursue (see Section 3.1 for more on the importance of elaborating ethical premises, under the subsection, Policy Justification). 77
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Appendix 1: Health Equity Literatur
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HEALTH EQUITY LITERATURE REVIEW INT
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REFERENCES ACAS [Advisory Conciliat
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