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

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The Culture, Diversity and Equity Project: Literature Review Box 4.10: A Health Equity Assessment Tool (Equity Lens) for Tackling Inequalities in Health – New Zealand Department of Health The New Zealand Department of Health (2004) has developed a health equity impact self-assessment tool for the healthcare sector that consists of a series of questions to assist health authorities to ‘consider how particular inequalities in health have come about, and where the effective intervention points are to tackle them.’ These questions include: 1. What health issue is the policy/programme trying to address? 2. What inequalities exist in this health area? 3. Who is most advantaged and how? 4. How did the inequality occur? (What are the mechanisms by which this inequality was created, is maintained or increased?) 5. What are the determinants of this inequality? 6. How will you address the Treaty of Waitangi in the context of the New Zealand Public Health and Disability Act 2000? 7. Where/how will you intervene to tackle this issue? Use the Ministry of Health Intervention Framework to guide your thinking. 8. How could this intervention affect health inequalities? 9. Who will benefit most? 10. What might the unintended consequences be? 11. What will you do to make sure it does reduce/eliminate inequalities? 12. How will you know if inequalities have been reduced/eliminated? Source: Te Roopu Rangahau a Erü Pomare., Ministry of Health and Public Health Consultancy. 2003. A Health Equity Assessment Tool. Wellington: Public Health Consultancy, Wellington School of Medicne and Health Sciences. Adapted by Ministry of Health in May 2004 from Bro Taf Authority. 2000. Planning for Positive Impact: Health inequalities impact assessment tool. Cardiff: Bro Taf Authority There are also numerous diversity and cultural competence organizational self-assessment tools and diversity performance management frameworks (see for instance the LHINS Diversity Self-Assessment Tool developed by the GTA Diversity Group; Wilson-Stronks et al., 2008; Olavarria et al., 2005; Vancouver Ethnocultural Advisory Committee of the Ministry of Children and Families, 1998). There are nevertheless limitations to relying solely on self-assessment, particularly insofar as these rely upon organizations and staff being honest, objective, self-critical and comprehensive. Partly to counter criticisms of an over-reliance on self-assessment of previous performance evaluation systems in the UK, the Healthcare Commission (an independent healthcare inspection agency in England and Wales) has come to play an expanded role in reviewing healthcare provider progress toward national standards (including health inequality targets) (Exworthy et al., 2006). National and local health authorities in the UK are also subject to external assessments as part of the process of applying for the ‘Equality Mark’ – a government sanctioned validation award of ones excellence in meeting the Equality Standard for Local Government (ESLG), which includes a 5-level evaluation framework for progress on equality (see Improvement and Development Agency website at http://www.idea.gov.uk/idk/core/page.do?pageId=5145192). NHS London and other strategic health authorities also regularly commission independent research into the degree of compliance of London NHS organisations with various equality legislative acts and duties. Trusts within NHS London are also required to seek out feedback from their users, employees and partner organisations on their performance around equity and diversity issues to ensure that a gap does not exist and open up between their perception of the organization’s achievements and the reality. Client satisfaction surveys are particularly critical to enhancing public accountability and ensuring that strategic policy initiatives and interventions are achieving their intended results, from the perspective of service users. 96
The Culture, Diversity and Equity Project: Literature Review F. Reporting and Transparency Finally it is critical, to the establishment and maintenance of accountability, that the results of monitoring and assessment are regularly reported, ideally, to the public, and in a manner that allows for comparability of reported information across the health system. The production and publication of diversity/health equity report cards on an annual basis, available to the public, is a particularly good incentive for motivating action, compliance and good performance on health equity issues (GTA Diversity and LHINs Working Group, 2008a). The use of reports cards or scorecards as a means of measuring the progress of health disparities policies is a growing phenomenon in numerous jurisdictions (see Box 4.11 below for example of San Francisco Health Report Card; also see Trivedi et al., 2005; Davies, Washington, and Bindman, 2002; Nerenz et al., 2002/2005; Exworthy et al., 2006). Report cards have been found to be a useful means of sustaining direction and momentum and increasing accountability. In the broader UK governmental system of checks, report cards take the simple form of a traffic light (red for failure to meet targets, yellow for intermediate outcome, and green for passing or surpassing targets). It is important, moreover, that consequences are attached to performance outcomes, whether positive or negative. Box 4.11: San Francisco Department of Public Health Report Card on Health Disparities The San Francisco Department of Public Health produced the first US public health report card in 2002, focusing on maternal and infant health indicators of different ethno-racial groupings in particular. The report card adopted six indicators relating to the city’s progress in meeting the national Healthy People 2010 objectives (see Table below). Each indicator was graded as to the extent (percentage more specifically) to which it had achieved the Healthy People 2000 objective. A positive or negative symbol denoted whether they were “within” or “off” the target for HP-2010, as the example of low birth weight below illustrates (see Table below). Each indicator reported also included local comparisons of the rates of “all races” and “African Americans”, as per below. _____________________________________________________________________________________ San Francisco Report Card: Low Birth Weight Indcator: Category All Races African Americans Healthy People 2000 Objective 5.0 % 9.0% Healthy People 2010 Objective 5.0% 5.0% San Francisco Rate, 2000 6.4% 12.4% San Francisco Grade* C- D- Note: *Grades are linked to the percentage of the 2000 target achieved (A = 90-100%; B = 80-89%; C = 70-79%; D = 60-69%; F = less than 60%). _________________________________________________________________________________ The results highlighted the enormous challenge facing San Francisco’s policymakers and practitioners in reducing disparities between African Americans and ‘all races’ as well as between the local rate and national policy objectives. Source: Exworthy et al., 2006 97
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HEALTH EQUITY LITERATURE REVIEW INT
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