Equity in public health standards: a qualitative document analysis of policies from two Canadian provinces

International Journal for Equity in Health

Amy Cox⁴  Amanda Parks¹  Joanne Thanos⁶  Bernadette Pauly³  Heather Manson⁵  Andrew D Pinto² 

[1] Interior Health Authority, 220-1815 Kirschner Road, Kelowna, British Columbia, Canada, V1Y 4N7;Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, 3rd floor, Toronto, Canada, M5B 1T8;Centre For Addictions Research of British Columbia, 273-2300 McKenzie Avenue, Victoria, British Columbia, Canada, V8P 5C2;School of Nursing, University of Victoria, Box 1700 STN CSC, Victoria, British Columbia, Canada, V8W 2Y2;Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, Canada, M5G 1V2;Public Health Division, Ministry of Health and Long-Term Care, 393 University Avenue, 21st Floor, Toronto, Ontario, Canada, M7A 2S1

关键词: Standards;    Health planning;    Health equity;    Social justice;    Public health;   

Others  :  829084
DOI  :  10.1186/1475-9276-11-28

 received in 2012-01-04, accepted in 2012-04-10,  发布年份 2012

【 摘 要 】

Introduction

Promoting health equity is a key goal of many public health systems. However, little is known about how equity is conceptualized in such systems, particularly as standards of public health practice are established. As part of a larger study examining the renewal of public health in two Canadian provinces, Ontario and British Columbia (BC), we undertook an analysis of relevant public health documents related to equity. The aim of this paper is to discuss how equity is considered within documents that outline standards for public health.

Methods

A research team consisting of policymakers and academics identified key documents related to the public health renewal process in each province. The documents were analyzed using constant comparative analysis to identify key themes related to the conceptualization and integration of health equity as part of public health renewal in Ontario and BC. Documents were coded inductively with higher levels of abstraction achieved through multiple readings. Sets of questions were developed to guide the analysis throughout the process.

Results

In both sets of provincial documents health inequities were defined in a similar fashion, as the consequence of unfair or unjust structural conditions. Reducing health inequities was an explicit goal of the public health renewal process. In Ontario, addressing “priority populations” was used as a proxy term for health equity and the focus was on existing programs. In BC, the incorporation of an equity lens enhanced the identification of health inequities, with a particular emphasis on the social determinants of health. In both, priority was given to reducing barriers to public health services and to forming partnerships with other sectors to reduce health inequities. Limits to the accountability of public health to reduce health inequities were identified in both provinces.

Conclusion

This study contributes to understanding how health equity is conceptualized and incorporated into standards for local public health. As reflected in their policies, both provinces have embraced the importance of reducing health inequities. Both concepualized this process as rooted in structural injustices and the social determinants of health. Differences in the conceptualization of health equity likely reflect contextual influences on the public health renewal processes in each jurisdiction.

【 授权许可】

   
2012 Pinto et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Fierlbeck K: Public health and collaborative governance. Can Public Admin 2010, 53(1):1-19.
• [2]Butler-Jones D: Chief Public Health Officer’s Report on the State of Public Health in Canada. Public Health Agency of Canada, Ottawa; 2008.
• [3]Naylor CD: Learning from SARS: Renewal of public health in Canada. Health Canada, Ottawa; 2003.
• [4]O'Connor DR: Report of the Walkerton Inquiry: The events of May 2000 and related issues. Ontario Ministry of the Attorney General, Toronto; 2002.
• [5]Whitehead M: The concepts and principles of equity and health. Int J Health Serv 1992, 22(3):429-445.
• [6]Schaefer M, Abrantes A: Standards for local public health services: where stand the states? Am J Public Health 1985, 75(6):649-650.
• [7]Weir E, d'Entremont N, Stalker S, Kurji K, Robinson V: Applying the balanced scorecard to local public health performance measurement: deliberations and decisions. BMC Public Health 2009, 9:127. BioMed Central Full Text
• [8]Halverson PK: Performance measurement and performance standards: old wine in new bottles. J Public Health Manag Pract 2000, 6(5):vi-x.
• [9]Corso LC, Landrum LB, Lenaway D, Brooks R, Halverson PK: Building a bridge to accreditation–the role of the National Public Health Performance Standards Program. J Public Health Manag Pract 2007, 13(4):374-377.
• [10]Browning P, von Cube A, Leibrand H: Minimum public health standards as a basis for secure public health funding. J Public Health Manag Pract 2004, 10(1):19-22.
• [11]Corso LC, Lenaway D, Beitsch LM, Landrum LB, Deutsch H: The national public health performance standards: driving quality improvement in public health systems. J Public Health Manag Pract 2010, 16(1):19-23.
• [12]Commission on the Social Determinants of Health: Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. World Health Organization. Geneva 2008.
• [13]Graham H: Social determinants and their unequal distribution: clarifying policy understandings. Milbank Q 2004, 82(1):101-124.
• [14]Signal L, Martin J, Reid R, Carroll C, Howden-Chapman P, Ormsby VK, Richards R, Robson B, Wall T: Tackling health inequalities: moving theory to action. Int J Equity Health 2007, 6:12. BioMed Central Full Text
• [15]Deber RB, Millan K, Shapiro H, McDougall CW: A Cautionary Tale of Downloading Public Health in Ontario: What Does It Say about the Need for National Standards for More Than Doctors and Hospitals? Healthc Policy 2006, 2(2):60-75.
• [16]Ontario Public Health Standards [ https://www.publichealthontario.ca/portal/server.pt?open=512&objID=1191&PageID=0&parentname=CommunityEditor&parentid=12&cached=true&mode=2 webcite]
• [17]Ministry of Health and Long-Term Care: Ontario Public Health Standards. Toronto 2008.
• [18]Ontario Public Health Standards - OPHS presentation template [ http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/pdfs/ophs_presentation_template.ppt webcite]
• [19]Population Health and Wellness: A framework for core functions in public health: A resource document. 2005.
• [20]Population Health and Wellness: Public Health Renewal in British Columbia: An overview of core functions in public health. 2005.
• [21]Glaser B, Strauss A: The discovery of grounded theory: strategies for qualitative research. Aldine, Chicago; 1967.
• [22]Glossary of terms used - Health Impact Assessment (HIA) [ http://www.who.int/hia/about/glos/en/ webcite]
• [23]Whitehead M, Dahlgren G: Levelling up (part 1): A discussion paper on concepts and principles for tackling social inequities in health. World Health Organization, Copenhagen; 2006.
• [24]Powers M, Faden R: Social justice: The moral foundations of public health and health policy. Oxford University Press, Oxford; 2006.
• [25]Model Core Program Paper: Healthy Infant and Child Development [ http://www.phabc.org/pdfcore/Healthy_Infant_and_Child_Development-Model_Core_Program_Paper.pdf webcite]
• [26]Model Core Program Paper: Healthy Living [ http://www.phabc.org/pdfcore/Healthy_Living-Model_Core_Program_Paper.pdf webcite]
• [27]Model Core Program Paper: Healthy Living [ http://www.phabc.org/pdfcore/Healthy_Communities-Model_Core_Program_Paper.pdf webcite]
• [28]Model Core Program Paper: Healthy Emergency Management [ http://www.phabc.org/pdfcore/Health_Emergency_Management_Model_Core_Program_Paper.pdf webcite]
• [29]Model Core Program Paper: Food Security [ http://www.phabc.org/pdfcore/Food_Security_Model_Core_Program_Paper.pdf webcite]
• [30]Model Core Program Paper: Dental Public Health [ http://www.phabc.org/pdfcore/Dental_Health_Model_Core_Program_Paper.pdf webcite]
• [31]Model Core Program Paper: Prevention of Unintentional Injuries [ http://www.phabc.org/pdfcore/Unintentional_Injury_Prevention-Model_Core_Program_Paper.pdf webcite]
• [32]First Steps to Equity: Ideas and Strategies for Health Equity in Ontario 2008-2010 [ http://www.healthnexus.ca/policy/firststeps_healthyequity.pdf webcite]
• [33]Health Disparities Task Group of the Federal, Provincial and Territorial Advisory Committee on Population Health and Health Security: Reducing Health Disparities – Roles of the Health Sector: Recommended Policy Directions and Activities. Health Canada. Ottawa, 2005.
• [34]Bambra C, Fox D, Scott-Samuel A: Towards a politics of health. Health Promot Int 2005, 20(2):187-193.
• [35]Manzano AT, Raphael D: CPHA and the social determinants of health: an analysis of policy documents and statements and recommendations for future action. Can J Public Health 2010, 101(5):399-404.
• [36]Kirkpatrick SI, McIntyre L: The Chief Public Health Officer's report on health inequalities: what are the implications for public health practitioners and researchers? CJPH 2009, 100(2):93-95.
• [37]Birn AE: Making it politic(al): closing the gap in a generation: health equity through action on the social determinants of health. Soc Med 2009, 4(3):166-182.
• [38]Navarro V: What we mean by social determinants of health. Int J Health Serv 2009, 39(3):423-441.
• [39]Kass NE: An ethics framework for public health. Am J Public Health 2001, 91:1776-1782.