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

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.
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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%).
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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
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