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

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The Culture, Diversity and Equity Project: Literature Review Box 4.7: Examples of health policy targets relating to inequalities in health NHS London Strategic Plan 2008-2013 [UK] Target 1: Average life expectancy of Londoners increased by at least 2 years for males and females. Target 2: Number of primary care clinicians per population to increase as a function of deprivation so that the most deprived boroughs have more primary care clinicians. Target 3: The difference in life expectancy between the best and worst boroughs in London is reduced by 10 per cent. Source: NHS London, 2008. The WHO Commission on Social Determinants of Health Closing the Gap (2008) Target 1: Reduce by 10 years, between 2000 and 2040, the LEB [Life Expectancy at Birth] gap between the one third of countries with the highest and the one third of countries with the lowest LEB levels, by levelling up countries with lower LEB. Halve, between 2000 and 2040, the LEB gap between social groups within countries, by levelling up the LEB of lower socioeconomic groups. Target 2: Halve, between 2000 and 2040, adult mortality rates in all countries and in all social groups within countries. In effect, achieving this target means reducing the gap in adult mortality between and within countries by half. Target 3: Reduce by 90%, between 2000 and 2040, the under-5 mortality rate in all countries and all social groups within countries, and reduce by 95%, between 2000 and 2040, the maternal mortality rate in all countries and all social groups within countries. In effect, achieving this target means reducing the gap in under-5 mortality between and within countries by 90%, and reducing the gap in maternal mortality between and within countries by 95%. Source: WHO, 2008 Health 21 – Health for All in the 21 st Century [WHO] Target 2 – Equality in Health By the year 2020, the health gap between socioeconomic groups within countries should be reduced by at least one fourth in all Member States, by substantially improving the level of health of disadvantaged groups. In particular: *the gap in life expectancy between socioeconomic groups should be reduced by at least 25 per cent; *the values for major indicators of morbidity, disability and mortality in groups across the socioeconomic gradients should be more equally distributed; *socioeconomic conditions that produce adverse health effects, notably differences in income, educational achievement and access to the labour market, should be substantially improved; *the proportion of the population living in poverty should be greatly reduced; people having special needs as a result of their health, social or economic circumstances should be protected from exclusion and given easy access to appropriate care. Source: WHO, 1999 Ongoing Monitoring & Assessment Health equity policy performance indicators and targets need not only be developed, but also consistently monitored and reported on an ongoing basis, in order to ensure accountability and the intelligent (on the basis of evaluation evidence) steering and review of policy objectives and strategic interventions. As Exworthy et al. stress, policymakers “need to demonstrate the progress of their policies in order to sustain their momentum and to promote accountability” (2006, p.76). 92
The Culture, Diversity and Equity Project: Literature Review Box 4.8: Tracking Healthy People 2010 Launched in 2000, ‘Healthy People 2010’ is a Federal US public health policy and plan developed by the Department of Health and Human Services (DHHS) with two primary goals in mind: “to eliminate health disparities among specific segments of the population” and “to increase quality and years of health life”. These goals inform the policy’s 467 objectives which are organized into 28 focus areas. A selected set of 10 objectives – physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behaviour, mental health, injury and violence, environmental quality, immunization, and access to health care - known as the Leading Health Indicators, form part of a larger ‘tracking’ program that sets targets and assesses the progress toward its objectives. The National Center for Health Statistics (NCHS) is responsible for coordinating the effort to monitor the Nation's progress toward the targets, using data from NCHS data systems as well as from more than 190 different other data sources, from more than seven Federal Government Departments (including Health and Human Services, Commerce, Education, Justice, Labor, Transportation, and the Environmental Protection Agency), and from voluntary and private non-governmental organizations. To the extent appropriate, data for the objectives are provided for subgroups defined by relevant dimensions such as sociodemographic subgroups of the population, health status, or geographic classifications. Data are made available through DATA2010, an interactive database system accessible through the NCHS web site and the CDC WONDER system. Source: www.healthypeople.gov/About/ (Retrieved March 3, 2009) E. Health Equity Impact Assessment Ongoing evaluation and assessment of policy initiatives, programs and services for their health equity impact is particularly critical to ensuring effective, efficient and equitable programs and services and accountability for the latter. Health Equity Impact Assessment tools, as currently used by various health authorities in the UK, Australia and New Zealand, are of particular usefulness in this respect (see Department of Health, 2008a, 2008b [UK]; London Health Commission, 2008; Rangahau and Pomare, 2003 [New Zealand]; Simpson, 2005 [Australia]; Ritsatakis et al. 2002 [Europe]). Health Canada has adopted Frankish et al.’s (1996) definition of Health Impact Assessment as “any combination of procedures or methods by which a proposed policy or program may be judged as to the effect(s) it may have on the health of a population”. While health impact assessments (HIAs) have a longer history, with origins in environmental impact assessment and healthy public policy (see for instance Health Canada 1994), health equity focused impact assessments (also known as equity audits) have more recent origins in the UK, owing in part to that countries legislated ‘duties’ around equality, which include requirements to assess policies for their impact on various diversity groups. The UK Department of Health describes health equity impact assessments as “appraisals of the impact of policies or interventions on health disparities” (2002). Health equity impact assessments were a major recommendation of the Acheson Inquiry (1998) and have since been operationalized in numerous jurisdictions around the world, most notably, at present, Australia, New Zealand and the UK (see Box 3.4, 3.5, 3.6 and Box 4.9 and Box 4.10 for more on Australian, UK and New Zealand uses of such Impact Assessment Tools). Canada has developed a similar genderspecific methodological tool - Gender-Based Analysis (GBA) - for assessing the gender impact of policies, programs and services (see Health Canada, 2000). According to an international (‘Gothenburg’) consensus paper deriving from an international seminar in Manchester in June 2000, HIA includes “consideration of evidence about the anticipated relationships between a proposed policy or project and the health of a population and of the opinions, experience and expectations of those who may be affected. It aims to provide more informed understanding by decision-makers and the public regarding the effects of the proposed policy, and to propose adjustments and options to maximize positive and minimize negative health impacts” (Gothenburg, 2001; as paraphrased by Ritsatakis et al., 2002). 93
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Appendix 1: Health Equity Literatur
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HEALTH EQUITY LITERATURE REVIEW INT
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