A Health Equity Action Plan for the Ontario Public Health Association for to

Transcription

1 A Health Equity Actin Plan fr the Ontari Public Health Assciatin fr t April 2016

2 Table f Cntents Backgrund 3 Visin... 4 Values and Beliefs 5 Gals... 5 Desired Outcmes 6 Guiding Principles Framewrk and Activities 7 Appendices: A: Definitins 12 B. Lgic Mdels ( , ) 14 2

3 Backgrund As an rganizatin cmmitted t imprving health and wellbeing, OPHA has lng recgnized the rle f the determinants f heath and health equity in achieving this gal. OPHA is cgnizant that that varius barriers r inequities can prevent individuals and cmmunities frm accessing the cnditins needed t reach their full ptential. As nted by internatinal experts: Health inequities are differences in health which are nt nly unnecessary and avidable, but in additin are cnsidered unfair and unjust. (Whitehead, 1992). Many f the causes f inequities relate t scial and envirnmental determinants including incme, scial status, gender, educatin, and the physical envirnment, including husing. Eliminating these disparities cannt be accmplished withut seriusly addressing the underlying scial determinants f health, many f which are shaped and perpetuated by bias, injustice and inequality. Recgnizing that the Assciatin f Lcal Public Health Agencies (alpha) shared a similar cmmitment t prmting health equity, the tw rganizatins agreed t pl their effrts t create a jint Health Equity Wrkgrup. The Wrkgrup s fcus is n reducing health inequities in Ontari thrugh strengthening public health and intersectral actins n the scial determinants f health and strategizing n pririty areas fr actin. Specifically, the Wrkgrup gals are t: - Prmte the inclusin f activities that address the scial and ecnmic determinants f health within the mandate f Bards f Health in Ontari. - Participate in plicy activities by advcating fr plicies at all levels f gvernment that wrk t reduce scial inequities in health and t mnitr advcacy effrts and plicy changes at the municipal, prvincial and natinal level that impact inequities in health. - Supprt knwledge exchange related t health equity principles, cmpetencies and prmising practices in public health units, the prvincial gvernment and relevant agencies. The grup develped an evergreen wrkplan and has been undertaking a number f activities t achieve these gals. In late 2014, the wrkgrup brught frward a psitin paper and reslutin n Applying a Health Equity Lens which was endrsed at OPHA s Annual General Meeting. The reslutin cmmits OPHA t undertake the fllwing: 1. Incrprate and apply a health equity lens in its planning, implementatin, and evaluatin f all prgram(s), activities, and plicies. 3

4 2. Embark n a cmprehensive health equity plan t guide its wrk based n the Natinal Cllabrating Centre fr Determinants f Health public health rles t advance health equity. 3. Advcate t the MOHLTC fr the cnsistent use f a health equity lens in the Ministry's public health prgramming, and t cntinue t prmte and supprt the use f a health equity lens in ther parts f the health system. 4. Advcate t the Ontari prvincial gvernment fr a Health in All Plicies (HIAP) framewrk which wuld include the use f a health equity lens in ministries affecting equitable access t the scial determinants f health, such as Finance, Children and Yuth Services, Educatin, Municipal Affairs and Husing, Envirnment and Climate Change, etc. 5. Advcate fr ther health rganizatins t incrprate and apply a health equity lens thrugh the use f health equity fcused tls n planned initiatives r plicy. In 2015, OPHA s Bard f Directrs reaffirmed their cmmitment t health equity being a pririty fr OPHA and directed OPHA management t develp an actin plan t guide its wrk in this area. OPHA s Health Equity Actin Plan The 2014 health equity reslutin called n OPHA t base its actin plan n the fur key public health rles fr advancing health equity prmted by The Natinal Cllabrating Centre fr the Determinants f Health (NCCDH). This dcument utlines a health equity plan fr OPHA using the NCCDH framewrk and dcuments frm ther leading rganizatins. The plan is cmplementary t the wrkplan f alpha-opha `s Jint Health Equity Wrkgrup (see Appendix A) and will draw n the wrkgrup members invlvement as well as supprt frm ther OPHA wrkgrups, Bard and ther OPHA members, staff and partners. Visin: All peple (individuals, grups and cmmunities) have a fair chance t reach their full health ptential and are nt disadvantaged by scial, ecnmic and envirnmental cnditins. 4

5 Values and Beliefs The values and beliefs that underpin this actin plan are drawn frm Dr. Benita Chen s Cnceptual Framewrk f Organizatinal Capacity fr Public Health Equity Actin and include: - Scial Justice: Everyne deserves equal rights t the ecnmic, plitical and scial benefits f ur sciety, including a human right t health and an equal pprtunity fr health; A predminant cncern fr thse wh are scially disadvantaged and thus excluded; - Brad cnceptualizatin f health : Includes multiple dimensins (psychlgical, emtinal, cgnitive, spiritual, scial and physical) and recgnitin f rle played by the determinants f health; - Shared Respnsibility: The creatin f equitable pprtunities fr health is a scietal respnsibility that requires all sectrs -- gvernment, faith grups, business, cmmunity and civil sciety -- t address the systemic and structural cnditins that fster inequity; - Cultural Humility: Invlves persnal reflectin and grwth arund culture in rder t increase awareness and the quality f interactins with thers; - Distributin f Pwer: Prcesses ensure pririty ppulatins cnsistently have a strng vice and recgnized pwer in defining and slving issues; - Integrity: Mdeling health equity within OPHA. Gals: - Champin and be an effective advcate fr plicies that create equitable pprtunities fr health; - Strengthen OPHA s practices; - Prmte a fairer and inclusive sciety; - Call attentin t the impact f scial disadvantage n health and the underlying factrs that impact health; - Facilitate sustainable cntributins and cllabratins frm many sectrs; and - Supprt awareness, educatin, advcacy and plicy develpment at the prvincial level. 5

6 Desired Outcmes: Shrt Term: - Health equity cncepts are embedded in all f OPHA s initiatives. - OPHA s Bard and staff have enhanced knwledge abut health equity and systematically apply these cncepts in their wrk and decisin making. - It is evident t OPHA s members, partners and key stakehlders that health equity is a pririty fr OPHA. Medium Term: - Health equity is adpted as an underlying principle in Ontari s health system and cnsidered in all health planning, delivery and decisin making f gvernment and ther key health stakehlders. - Health equity impact assessment tls are used in health planning. - Interventins and investments acrss gvernment are made where they will have the highest impact n reducing health disparities. - Resurces r prgrams are targeted specifically t addressing disadvantaged ppulatins r remve key access barriers. - A Health-in-all Plicies apprach is used acrss gvernment thrugh legislatin and/ther centrally directed requirements. Lng Term: - All Ontarians have equal pprtunities fr gd health and well-being. - All Ontarians have equitable access t a full range f high-quality health prgrams and services. - The gap in health between the best and wrst ff is narrwed thrugh reducing the scial and ecnmic barriers t health. - Ontarians have the supprts they need t reach their full health ptential. 6

7 Guiding Principles: OPHA s actins are: - Cmplementary t thers and nt duplicative; - Supprtive f, infrmed and guided by the expertise and feedback f the alpha-opha Jint Health Equity Wrkgrup and OPHA s members; - Prmte cllabratin and inclusin; - Guided by evidence; - Transparent and accuntable; - Influenced by the scial determinants f health; - Implemented accrding t available capacity and resurces; - Built n OPHA`s strengths and that f its members; and - Guided by an anti-ppressin framewrk and understanding f intersectinality. OPHA s Framewrk and Activities t Advance Health Equity: Described belw are the prpsed actins OPHA will undertake t achieve the gals and utcmes listed abve. As directed by the wrkgrup`s reslutin, these actins are aligned with the fur rles included in NCCDH s framewrk fr advancing health equity. 1. Assess and reprt n the existence and impact f health inequities; and effective strategies t reduce these inequities. Under this strategy, OPHA`s activities wuld include: - In : Ensure health equity is embedded in all f OPHA s advcacy effrts (e.g. include equity cncepts in OPHA`s advcacy effrts related t the updating f OPHA standards, health refrm and thrugh ther submissins and presentatins t gvernment). Use pprtunities t raise awareness abut health equity within the public health and health care sectr, gvernment and the public: Thrugh OPHA s planning and participatin in events, cnferences (e.g. TOPHC, CPHA) and partnership tables (e.g. OCDPA). 7

8 Build mre links n OPHA s website t educatinal materials, tls and resurces n health equity, HEIAP and SDOH and use OPHA s scial media channels t prmte them. - In : Supprt the effrts f thse advcating fr enhancements t gvernment research related t health equity; Partner with academics and researchers n studies that advance knwledge abut health equity. - In : Use data n inequities when assessing the design f gvernment plicies and prgrams. Prmte the cmmunicatin effrts f thers (e.g. Sudbury Health Unit s scial marketing campaign n the SDOH). Indicatrs: - % f OPHA submissins and presentatins that include health equity. - % f reprts that reference health status and include disaggregatin f data by scial determinants f health (SDOH). - % increase in materials n health equity and traffic t OPHA s website and ther scial media. - % f OPHA activities that prmte health equity. 2. Mdify and rient interventins and services t reduce inequities, with an understanding f the unique need f ppulatins that experience marginalizatin. Under this strategy, OPHA s activities wuld include: - In : Build knwledge, understanding and capacity within OPHA s staff team (e.g. finalizing a literature review fr the Cllabrative Leadership in Practice prject being undertaken with Health Nexus). Develp and deliver prfessinal develpment activities and/r cllabrating with thers n capacity building, knwledge exchange and training events. 8

9 Enhance OPHA s internal capacity (e.g. assign a student t maintain inventry f key rganizatins, their equity activities and develpments, learn frm the experiences f thers). Adpt health equity as the theme fr OPHA s 2016 fall frum. - In : Build equity int OPHA s strategic and business planning. Develp a webinar series n health equity (e.g. implicatins f Truth and Recnciliatin Cmmissin fr health prfessinals in cllabratin with the Health Equity Wrkgrup). Supprt and/r prmte activities that build knwledge, skills and understanding in the public health wrkfrce n effective ways t address health inequities and integrating it int OPHA s training and events (e.g. Lean Sigma, Leadership Develpment Prgram). Explre training pprtunities (e.g. Hst a Cllabrative Leadership Fall Training Institute with Health Nexus), hst a training wrkshp n Cultural Humility in cnjunctin with the Fall Frum). Hld bard and staff training t increase knwledge and understanding f equity cncepts (e.g. racism, anti-ppressin) and the implicatins fr OPHA`s activities. Develp r sign n t an existing Healthy Equity Charter that builds n OPHA s reslutin and clearly defines and cmmits OPHA t health equity principles. - In : Use equity-fcused rganizatinal planning, management and evaluatin tls and data n inequities t design and evaluate plicies, prgrams, services. Indicatrs: - % increase in number f OPHA events/activities that address health equity. - Mechanisms exit t ensure that planning includes a health equity assessment f prgrams and services. 9

10 - Existence f a strategic plan that describes hw equity issues will be addressed. - Increase in number f changes t prgrams and services resulting frm the use f health equity assessment. 3. Partner with ther gvernment and cmmunity rganizatins t identify ways t imprve health utcmes fr ppulatins that experience marginalizatin. Under this activity, OPHA s activities wuld include: - In : Identify pprtunities t bring an equity fcus t existing partnerships (e.g. Ontari Chrnic Disease Preventin Alliance, EcHealth Ontari, and Prvincial Alchl Steering Cmmittee). - In : Identify pprtunities t build new partnerships (e.g. Basic Incme Canada Netwrk) and renew lder nes (e.g. Campaign 2000). Cllabrate with the scial determinants f health public health nurses netwrk t prmte innvatins and lessns learned. - In : Strengthen partnerships with existing grups (e.g. AOHC, alpha, OMA, CCO, and NCCDH) and develp new nes (e.g. OHA, Wellesley Institute, AFHTO, and Fdshare). Cllabrate with ministries (e.g. MECC, EDU, MOHLTC, MTO, MHMA, and MCSS). Indicatrs: - % increase in equity fcus t existing partnerships and number f new partnerships frmed. 10

11 4. Lead, supprt, and participate with ther rganizatins in plicy analysis and develpment, and in advcacy fr imprvement in health determinants and inequities Under this activity, OPHA s activities wuld include: - In : Supprt implementatin f alpha-opha wrkgrup s wrkplan (nging pririty). - In : Advcate fr a strengthened health equity mandate fr public health (e.g. as part f the review f the OPHS). Advcate t MOHLTC fr cnsistent use f health equity lens, targets and evaluatin in its prgramming and adptin f a health in all plicies framewrk and legislatin (e.g. thrugh building relatinships with MOHLTC s Health Equity Office). Advcate fr HIAP and use f health equity in nn-health ministries and actins t address the scial/structural determinants f health thrugh the Ontari Gvernment s varius initiatives, in cllabratin with ther sectrs: - In : (e.g. Climate Change, Pverty Reductin Plan, Pensin Refrm, healthy Kids, Affrdable Husing, dental health, child care, emplyment prgrams, increases in minimum wage, changes t scial assistance, Basic Incme Guarantee, mental health strategy). Engage in advcacy with r n behalf f equity seeking ppulatins. Advcate t ther health rganizatins t use a health equity lens. Indicatrs: - Strengthened health equity mandate in updated OPHS. - % increase in references t health impact in new gvernment initiatives. 11

12 Cnclusin The American Public Health Assciatin has nted that: Making a purpseful shift tward achieving health equity frces us t cnsistently view health status within the larger cntext f sciety and histry and will ultimately bring public health farther upstream than it s ever been befre. OPHA recgnizes that achieving health equity is a challenging jurney. We cmmit t imprving ur wn practices. We welcme the pprtunity cllabrate with ther sectrs and equity seeking grups n this jurney t remve barriers t health equity, create the cnditins needed t prmte health and wellbeing and achieve health fr all. 12

13 Appendix A: Definitins Intersectinality: Tthe study f verlapping r intersecting scial identities and related systems f ppressin, dminatin r discriminatin. The thery suggests that and seeks t examine hw varius bilgical, scial and cultural categries such as gender, race, class, ability, sexual rientatin, religin, caste, age and ther axes f identity interact n multiple and ften simultaneus levels. This helps with understanding hw systemic injustice and scial inequality ccurs and its multiple dimensins. (Frm Etwa s Mdified Map f Health Equity- Attitudes, Behavirs & Understandings that fster a supprtive envirnment fr Health Equity) Health Equity: The absence f systematic disparities in health (r its scial determinants) between mre and less advantaged scial grups. Scial advantage means wealth, pwer, and/r prestige the attributes defining hw peple are gruped in scial hierarchies. Health inequities put disadvantaged grups at further disadvantage with respect t health, diminishing pprtunities t be healthy. Health equity, an ethical cncept based n the principle f distributive justice, is als linked t human rights. (Frm the Jurnal f Epidemilgy and Cmmunity Health) Health Inequities: Differences in health that are avidable, unfair, and unjust. Health inequities are affected by scial, ecnmic, and envirnmental cnditins. (Frm Health Equity Institute Health Disparities: Differences in health utcmes amng grups f peple (Frm Health Equity Institute Link t Human Rights: All human beings are brn free and equal in dignity and rights. They are endwed with reasn and cnscience and shuld act twards ne anther in a spirit f brtherhd. Article 1, United Natins Declaratin f Human Rights. 13

14 LOGIC MODEL - OPHA s Health Equity Actin Plan fr Prgram Gal: Establish Health Equity as an essential cncept t be applied in all health planning, decisin making, investments and prgrams acrss Ontari Inputs Activities Outputs Indicatrs Outcmes Shrt Medium Lng Assess & Reprt n health inequities; and Develp Strategies t reduce inequities Orient services t address needs f marginalized ppulatins Partnerships with Gvernment, Cmmunity rganizatins, Academics and researchers Lead, supprt & participate with ther rganizatins in plicy develpment and advcacy Values and Beliefs -Embed Health Equity (HE) in all OPHA advcacy effrts -Raise awareness within public health, gv t and public -Add mre tls & resurces (HEIAP & SDOH) n Website -Partner with academics t advance knwledge n HE -Adpt HE as theme fr OPHA s 2016 Fall Frum -Enhance OPHA s internal capacity & build knwledge -Hst webinar series n health equity -Cllabrative Leadership Fall Training Institute with Health Nexus -Build equity int OPHA s strategic & business planning -Bring equity fcus t existing partnerships (OCDPA, EcHealth Ontari) -Build new partnerships (Basic Incme Canada Netwrk) & renew lder nes (Campaign 2000) -Cllabrate with SDOH PHNs -Supprt HEWG s wrkplan -Advcate fr strengthened health equity mandate (OPHS review prcess) -Advcate use f health equity lens t MOHLTC -Advcate fr HIAP & use f health equity in nn-health ministries/ther sectrs -OPHS updating, ther submissins t Gv t -Participatin in events (TOPHC, CPHA) & partner tables (OCDPA) -Increased traffic t OPHA s website -Increase in OPHA events that address health equity -Planning with health equity assessment f prgrams & services -Strategic plan t address equity issues -Increase in equity fcus t existing partnerships and new partnerships. -Strengthened health equity mandate in updated OPHS Scial Justice, Brad cnceptualizatin f health, Shared Respnsibility, Cultural Humility, Distributin f Pwer, Integrity Health equity cncepts embedded in all initiatives f OPHA and its wrkgrups Increased knwledge abut health equity amng OPHA s bard, staff and wrkgrups Health equity established as pririty fr OPHA. Health equity applied in all health planning, delivery, & decisin making f gvernment & key stakehlders Health equity impact assessment tls used in health planning Interventins & investments acrss gvernment t reduce health disparities Prgrams targeted t address disadvantaged ppulatins Health-in-all Plicies apprached used acrss gvernment All Ontarians have equal pprtunities and supprts they need t reach their full health ptential and have equitable access t highquality health prgrams & services External Factrs OPHS revisin, Changes prpsed under Patients First Discussin Paper, New MOHLTC ffice fr Health Equity, Ministry plicy changes, varius rganizatins adpting health equity (e.g. sme LHINs, AOHC) 14

15 Prgram Gal: Establish Health Equity as an essential cncept t be applied in all health planning, decisin making, investments and prgrams acrss Ontari Inputs Activities Outputs Indicatrs Outcmes Shrt Medium Lng Assess & Reprt n health inequities; and Develp Strategies t reduce inequities Orient services t address needs f marginalized ppulatins Partnerships with Gvernment, Cmmunity rganizatins, Academics and researchers Lead, supprt & participate with ther rganizatins in plicy develpment and advcacy -Assess gvernment plicies & prgrams using data n inequities -Prmte cmmunicatin effrts f thers (Sudbury s scial marketing campaign n the SDOH) -Use equity-fcused rganizatinal planning, management & evaluatin tls -Design and evaluate plicies, prgrams, services using data n inequities -Strengthen partnerships with existing grups (AOHC, alpha, OMA, CCO, and NCCDH) -Develp new partnerships (OHA, Wellesley Institute, FTHA, and Fdshare) -Cllabrate with ministries (MECC, MOHLTC, and MCSS) -Supprt HEWG s wrkplan -Engage in advcacy with/n behalf f equity seeking ppulatins -Advcate use f health equity lens t ther health rganizatins. -% f OPHA activities that prmte health equity -Increase in number f changes t prgrams & services thrugh use f health equity assessment -% increase in equity fcus t existing partnerships & number f new partnerships frmed -% increase in references t health impact in new gvernment initiatives Health equity cncepts embedded in all initiatives f OPHA and its wrkgrups Increased knwledge abut health equity amng OPHA s bard, staff and wrkgrups Health equity established as pririty fr OPHA. Health equity applied in all health planning, delivery, & decisin making f gvernment & key stakehlders Health equity impact assessment tls used in health planning Interventins & investments acrss gvernment t reduce health disparities Prgrams targeted t address disadvantaged ppulatins Health-in-all Plicies apprached used acrss gvernment All Ontarians have equal pprtunities and supprts they need t reach their full health ptential and have equitable access t highquality health prgrams & services Values and Beliefs Scial Justice, Brad cnceptualizatin f health, Shared Respnsibility, Cultural Humility, Distributin f Pwer, Integrity External Factrs OPHS revisin, Changes prpsed under Patients First Discussin Paper, New MOHLTC ffice fr Health Equity, Ministry plicy changes, varius rganizatins 15 adpting health equity (e.g. sme LHINs, AOHC)