A Health Equity Toolkit: Towards Health Care Solutions For All

A Health Equity Toolkit: Towards Health Care Solutions For All

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  A Health EquityToolkit: Towards Health Care Solutions For All Bob Gardner Solutions: East Toronto’s Health Collaborative January, 2014
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  Problem to Solve: SystemicHealth Inequities in Ontario clear gradient in health in which people with lower income, education or other indicators of social inequality and exclusion tend to have poorer health the gap between the best off and most disadvantaged can be huge – and damaging however measured -- by particular conditions, quality of life, life expectancy 2
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  Gradient of HealthAcross Many Conditions 3
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  Inequitable Quality • froma resident participating in Wellesley communitybased research in St James Town “Language is a big barrier to us whenever we use any services. When our doctor is on leave then we are unable to visit a different one due to language problem. So we may have to go to a walk-in clinic or emergency. There were no interpreter services. I do not know if they arrange them in hospitals. I couldn’t follow what the doctor said.” 4
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  Health Equity • • • goal ofhealth equity strategy is to reduce or eliminate socially and institutionally structured health inequalities and differential outcomes positive and forward-looking definition = equal opportunities for good health operationalizing equity in health care = providing care to meet different needs of different patients and populations, in ways that reduce inequitable differences in outcomes: • understanding and addressing barriers to good care such as language and misunderstanding/discrimination • recent immigrants need care that respects their cultures and preferences and adjusts to their often more precarious economic situation • understanding and addressing living conditions and social context of patients • poorer people face greater burdens and constraints on opportunities for good health = need to take into account in care planning February 11, 2014 | www.wellesleyinstitute.com 5
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  Towards Health EquitySolutions will set out a toolkit of ideas, directions and techniques to build equity into healthcare planning and delivery • solidly based in research evidence and years of best practice • action-orientated and manageable • measureable – so can monitor and assess progress • adaptable to specific organizational and local contexts • and can use to act well beyond health system -- tackling the underlying roots of health inequality in the wider social determinants of health the particularly good news = don’t need to start from scratch 6
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  Today equity toolkit • mostideas/initiatives will be familiar • but the great potential of networks like this is to identify communitylevel challenges and opportunities, and to pull initiatives and elements together into a coherent overall equity strategy was thinking of toolkit in three ways for Solutions: 1. some parts of the toolkit can be adapted in your organization and sector – where you’re a champion at organizational level 2. some can help plan collaborative actions – potential of connected local initiatives 3. some are about identifying broader systemic and policy issues -- adding your collective voice to efforts to shift policy or framing of equity at system level will speculate on a few ideas and directions Solutions could consider 7
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  1. Start fromSolid Foundations • high-performing healthcare systems build equity into all planning and service delivery • • • need clear strategic commitment to build equity into system as a whole • • • • doesn’t mean all programs are all about equity does mean all programs and planning need to take equity into account LHIN, Ministry cascading throughout all providers and programs so that equity becomes part of working culture across the system commitment has to be backed up by resources for equity planning and operationalization role for Solutions? – mbrs promoting this goal of embedding across all their organizations and work | www.wellesleyinstitute.com 8
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  2. Into PracticeThrough Equity-Focused Planning • addressing disparities in access to or quality of health care requires a solid understanding of: • the contours and scale of inequitable outcomes • the specific needs of health-disadvantaged populations • gaps in available services for these populations • key barriers to equitable access to high quality care along patient journey • at delivery level = considering equity in all program planning • e.g. given importance of communications and understanding to quality care → need to ensure cultural competence, access to interpretation wherever needed, etc. • need effective and practical equity-focused planning tools 9
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  Tools: Always Planthrough a Health Equity Lens Could this program or policy have a differential and inequitable impact on some populations or communities? How do we need to take the specific needs of disadvantaged individuals and communities into account in planning and delivering this service? Role for Solutions? Advocate that all their member organizations use this type of basic equity lens routinely – from strategic to service planning if this basic equity lens indicates there could be inequitable impact → then could drill down using fuller HEIA Role for Solutions? Promote/enable use of HEIA within its organizations February 11, 2014 | www.wellesleyinstitute.com 10
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  • analyzes potentialimpact of program or policy change on health disparities and/or health disadvantaged populations • using HEIA can help • uncover unintended consequences or nuances easily missed in program planning • embed equity into routine planning processes and working culture • ensure that projects not specifically about equity or particular populations, will take language, diversity, local community conditions, etc. into account • especially important for health service providers who are not experienced with equity and for non-health organizations to take the population health impact of their policies into account • growing, if uneven, use: • across LHINs -- Toronto Central has required HEIA within recent funding application processes, and refreshing hospital equity plans → some hospitals have built HEIA into their routine planning processes • adaptation geared to public health settings and standards been developed and promoted by Public Health Ontario 11
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  3. Success Condition= Collect Equity Data need solid equity-orientated data • to identify gaps and needs of disadvantaged patients • to measure and monitor progress pilot project in 3 Toronto hospitals (and Toronto Public Health) to collect patient SDoH type data scaled up to all hospitals in Toronto Central LHIN valuable website of resources on how to collect and use this data role for Solutions: all members to adapt data collection model to their situations, as standardized as possible → building pool of SDoH data 12
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  4. Build KnowledgeWe Can Act On base includes: • epidemiological research – scale of disparities, disadvantaged communities/groups, community health profiles • community-based research = especially unique understanding of needs and interests of marginalized or excluded populations • evaluation –what works, for which populations, in varying contexts • need forums to share lessons learned, emerging practices systematic data collection + ability to measure/monitor /evaluate + broad research evidence = knowledge to guide/ground action role for Solutions? advocate for this broad understanding and bring solid community knowledge into planning
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  5. Beyond Planning:Embed Equity Into Targets, Deliverables and Performance Management • clear consensus from research and policy literature, and consistent feature in comprehensive health equity policies and practice from other jurisdictions: • developing realistic and actionable indicators for more equitable service delivery and outcomes • setting targets for reducing access differentials, improving health outcomes of particular populations, etc • monitoring progress against the targets and indicators • disseminating the results widely for public scrutiny • aligning performance with funding incentives and resource allocation • principle here = build equity into system drivers and trends • performance measurement and management are here to stay • emerging challenge = building equity/population health into performance-based funding models 14
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  Success Condition =Effective Equity Targets • innovative work underway to develop comprehensive equity indicators – but don’t need to wait • pick what is most relevant to your context: • do rates of post-treatment recovery and hospital re-admission vary inequitably – by geography, ethno-cultural background, socio-economic status? → equity target = reduce inequitable differences • build equity into existing targets: • e.g. reducing hospital admission rates for ambulatory sensitive conditions and diabetes are system goals → equity target = reduce inequitable differences in rates between different populations or areas • role for Solutions? advocate within own organizations to build equity into scorecards and other performance measurement 15
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  6. Embed EquityInto Organizational and System Drivers • quality improvement is major provincial and system priority → embed equity • patient-centred care + QI + equity = customized care to meet differing needs • social determinants disadvantaged populations face greater barriers beyond the hospital and clinic walls • availability/cost of transportation, childcare, poor living conditions, inequitable access to community services, discrimination, being able to afford medication → need more intensive case management, referral planning and postdischarge follow-up for those in more challenging/isolated conditions → effective continuum of care and effective navigation/transitions is especially important for marginalized • role for networks like Solutions? identifying what good linkages and comprehensive community support looks like for marginalized | www.wellesleyinstitute.com 16
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  Use Proven Tools:Equity Standards Canadian Health Equity Standards Working Group 17
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  7. Use AvailableLevers To Embed Equity • key priority for Ministry (therefore LHIN) and great potential to transform system = Health Links • considerable debate about whether starting assumptions of heavy service users, etc., are right • but regardless of Min directions lots of innovative approaches on how to build SDoH in • role for Solutions? explore project on how these and other ideas could be developed into a comprehensive health equity toolkit for your Health Links • e.g. all HL to do community health mapping, identify priority and under-served populations, adapt tools for customized care for marginalized, develop explicit equity indicators, etc. • Solutions mbrs could take lead in promoting these tools and ideas in their HLs | www.wellesleyinstitute.com 18
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  8. Target Accessand Quality Barriers improving equity requires identifying and addressing specific equity barriers • within delivery – language, lack of understanding of different cultures, differential treatment, prejudice and discrimination, accessibility • beyond the clinical – e.g. sent home with follow-up prescriptions, but don’t have a drug plan; can’t come into clinic for follow-up because of family responsibilities • most important barriers will vary → back to importance of data and understanding health needs of community another Solutions’ focus for Health Links? • population health profiles, health equity audits, community engagement → to identify most important local barriers and gaps | www.wellesleyinstitute.com 19
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  9. Barrier =Under-Served Populations Solution = Focused Community Partnerships given often higher care needs and less access to personal, family or community resources facing most marginalized: • effective follow-up and referrals and good continuity of care, navigation and transitions are even more impt for the most vulnerable • requires dense and connected web of community support role for Solutions? fulcrum to strengthen collaboration among community agencies through an equity lens • focused on particular populations or barriers
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  10. Shifting thePolicy Frame: Health = Healthy and Equitable Communities what if hospital leaders said: we’re not the most important drivers of good health and we’re going to work with others to build healthier communities. role for Solutions? policy advocacy for key local issues, adding voice to wider campaigns, system issues February 11, 2014 | www.wellesleyinstitute.com © The Wellesley Institute www.wellesleyinstitute.com 21
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  Pull All This Togetherinto a Strategic Roadmap is there value in Solutions developing an equity plan? • what mbrs will do to promote equity in their home orgs • what network can do to identify most pressing common equity challenges and collaborative opportunities for change can’t be a rigid blueprint, needs to be adapted and implemented flexibly to contexts and circumstances • but thinking of equity roadmap helps to pull various initiatives into a coherent and connected plan