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Health Equity Talk: Understandings of Health Equity among Health Leaders

1 Centre for Addictions Research of BC, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
2 School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada

Special Issues: Health Equity across the Lifespan

Introduction: Reducing health inequities is a stated goal of health systems worldwide. There is widespread commitment to health equity among public health leaders and calls for reorientation of health systems towards health equity. As part of the Equity Lens in Public Health (ELPH) program of research, public health decision makers and researchers in British Columbia collaborated to study the application of a health equity lens in a time of health system renewal. We drew on intersectionality, complexity and critical social justice theories to understand how participants construct health equity and apply a health equity lens as part of public health renewal. Methods: 15 focus groups and 16 individual semi-structured qualitative interviews were conducted with 55 health system leaders. Data were analyzed using constant comparative analysis to explore how health equity was constructed in relation to understandings and actions. Results: Four main themes were identified in terms of how health care leaders construct health equity and actions to reduce health inequities: (1) population health, (2) determinants of health, and (3) accessibility and (4) challenges of health equity talk. The first three aspects of health equity talk reflect different understandings of health equity rooted in vulnerability (individual versus structural), determinants of health (material versus social determinants), and appropriate health system responses (targeted versus universal responses). Participants identified that talking about health equity in the health care system, either inside or outside of public health, is a ‘challenging conversation’ because health equity is understood in diverse ways and there is little guidance available to apply a health equity lens. Conclusions: These findings reflect the importance of creating a shared understanding of health equity within public health systems, and providing guidance and clarity as to the meaning and application of a health equity lens. A health equity lens for public health should capture both the production and distribution of health inequities and link to social justice to inform action.
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References

1. Crombie I, Irvine L, Elliott L, et al. (2005) Closing the health inequalities gap: An international perspective. Copenhagen: World Health Organization.

2. Commission on the Social Determinants of Health (2008) Closing the gap in a generation: achieving health equity through action on the social determinants of health. Geneva: World Health Organization.

3. Whitehead M, Dahlgren G (2006) Levelling up (part 1): A discussion paper on concepts and principles for tackling social inequities in health. Copenhagen: World Health Organization.

4. Baum F, Begin M, Houweling T, et al. (2009) Changes not for the fainthearted: reorienting health care systems toward health equity through action on the social determinants of health. Am J Public Health 99: 1967.    

5. Stankiewicz A, Herel M, DesMeules M (2015) Report summary--Rio political declaration on social determinants of health: a snapshot of Canadian actions 2015. Health Promot Chronic Dis Prev Can: Res Policy Pract 35: 113-114.    

6. National Collaborating Centre for Determinants of Health (2013) Let's talk: health equity. Antigonish, NS National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

7. Sadana R, Blas E (2013) What can public health programs do to improve health equity? Public Health Rep 128: 12-20.    

8. Brassolotto J, Raphael D, Baldeo N (2014) Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: a qualitative inquiry. Crit Public Health 24: 321-336.    

9. Varcoe C, Pauly BM, Laliberte S (2012) Intersectionality, social justice and influencing policy. In: Hankivsky O. Health inequities in Canada: Intersectional frameworks and practices. Vancouver: UBC Press, 331-348.

10. Raphael D (2003) Barriers to addressing the societal determinants of health: Public health units and poverty in Ontario, Canada. Health Promot Int 18: 397-405.    

11. Graham H (2004) Social determinants and their unequal distribution: Clarifying policy understandings. Milbank Q 82: 101-124.    

12. Braveman P (2014) What are health disparities and health equity? We need to be clear. Public Health Rep 129: 5-8.

13. World Health Organization (2017) What are the social determinants of health?

14. Bryant T, Raphael D, Schrecker T, et al. (2011) Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy 101: 44-58.    

15. Canadian Institutes of Health Research (2003) The future of public health in Canada: Developing a public health system for the 21st century. Ottawa: Author.

16. Di Ruggiero E, Frank J, Moloughney B (2004) Strengthen Canada's public health system now. Can J Public Health 95: 5-11.

17. Select Standing Committee on Health (2004) The path to health and wellness: Making British Columbians healthier by 2010. Victoria, BC: British Columbia Legislative Assembly.

18. Bill C (2002) The standing senate committee on social affairs, science and technology. The health of Canadians – the federal role. Ottawa: Government of Canada.

19. Ministry of Health Services Population Health and Wellness (2005) Public health renewal in British Columbia: an overview of core functions in public health. Victoria BC: Ministry of Health Services.

20. Ministry of Health Services Population Health and Wellness (2005) A framework for core functions in public health. Victoria BC: Ministry of Health Services.

21. British Columbia Ministry of Health (2013) Promote, protect, prevent: Our health begins here. B.C's Guiding Framework for Public Health. In: Population Health and Wellness BCMoHS. Ministry of Health. Victoria, BC.

22. Braveman P (2006) Health disparities and health equity: concepts and measurement. Annu Rev Public Health 27: 167.    

23. Smith MJ (2015) Health equity in public health: clarifying our commitment. Public Health Ethics 8: 173.    

24. Brassolotto J, Raphael D, Baldeo N (2013) Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: A qualitative inquiry. Crit Public Health 24: 321-338.

25. Pauly BM, MacDonald M, Hancock T, et al. (2013) Reducing health inequities: The contribution of core public health services in BC. BMC Public Health 13: 550.    

26. Walby S (2007) Complexity theory, systems theory, and multiple intersecting social inequalities. Philos Soc Sci 37: 449-470.    

27. Walby S, Armstrong J, Strid S (2012) Intersectionality: Multiple inequalities in social theory. Socioogy 46: 224-240.

28. Walby S (2009) Theorizing Multiple Social Systems. Globalization and Inequalities: Complexity and Contested Modernities. London: Sage.

29. Hankivsky O, Cormier R (2009) Intersectionality: Moving women's health research and policy forward. Vancouver: Women's Health Research Network.

30. Hankivsky O, Reid C, Cormier R, et al. (2010) Exploring the promises of intersectionality for advancing women's health research. Int J Inequity Health 9: 5.    

31. McCall L (2005) The complexity of intersectionality. J Women Cultur Soc 30: 1771-1800.    

32. McGibbon E, MacPherson C (2011) Applying intersectionality and complexity theory to address the social determinants of women's health. Women's Health Urban Life 10: 59-86.

33. Ostlin P, Schrecker T, Sadana R (2010) Priorities for research on equity and health: Implications for global and national priority setting and the role of WHO to take the health equity research agenda forward. Final report.

34. Boeije H (2002) A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 36: 391-409.    

35. Fram SM (2013) The constant comparative analysis method outside of grounded theory. Qual Rep 18: 1.

36. Marent B, Forest R, Nowalk P (2012) Theorizing participation in health promotion: A literature review. Soc Theory Health 10: 188-207.    

37. MacDonald M, Mullett J (2008) Dilemmas in health promotion evaluation: Participation and empowerment. In: Potvin L, McQueen DV, Health promotion evaluation practices in the Americas. New York: Springer, 149-178.

38. Young IM (1990) Justice and the politics of difference. Princeton, N.J.: Princeton University Press.

39. Fraser N (2007) Re-framing justice in a globalizing world. In: Lovel T. (Mis)recognition, social inequality and social justice: Nancy Fraser and Pierre Bourdieu. New York: Routledge.

40. Carey G, Crammond B, De Leeuw E (2015) Towards health equity: a framework for the application of proportionate universalism. Int J Equity Health 14: 8.    

41. Quesada J, Hart L, Bourgois P (2011) Structural vulnerabilty and health: Latino Migrant Laboreres in the United States. Med Anthropol Q 30: 339-362.    

42. Bauer GR (2014) Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc Sci Med 110: 10-17.    

43. Priest N, Paradies Y, Trenerry B, et al. (2013) A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people. Soc Sci Med 95: 115-127.    

44. Paradies Y, Jehonathan B, Denson N, et al. (2015) Racism as a determinant of health: A systematic review and meta-analysis. PLOS One 10: 85.

45. Benoit C, Shumka L (2009) Gendering the population health perspective: Fundamental determinants of women's health. Vancouver, BC.: Women's Health Research Network.

46. Powers M, Faden R (2006) Social justice: the moral foundations of public health and health policy: Oxford University Press, USA.

47. Hankivsky O (2012) Women's health, men's health, and gender and health: implications of intersectionality. Soc Sci Med 74: 1712-1720.    

48. Socías ME, Koehoorn M, Shoveller J (2016) Gender inequalities in access to health care among adults living in British Columbia, Canada. Women's Health Issues 26: 74-79.    

49. Marmot M, Allen JJ (2014) Social determinants of health equity. Slov J Public Health 51: 1-4.

50. Jackson SF, Birn AE, Fawcett SB, et al. (2013) Synergy for health equity: integrating health promotion and social determinants of health approaches in and beyond the Americas. Rev Panam Salud Publica 34: 473-480.

51. Solar O, Irwin A (2010) A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva: World Health Organization.

52. Shareck M, Frohlich KL, Poland B (2013) Reducing inequities in health through settings related interventions - a conceptual framework. Glob Health Promot 20: 39-52.

Copyright Info: © 2017, Bernadette M. Pauly, et al., licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

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