POWER, Data and Driving a Health Equity Agenda

© The Wellesley Institutewww.wellesleyinstitute.com

Bob GardnerPanel on Releasing Power Report:

Access Chapter

March 30, 2010


• goal is to ensure equitable access to high quality healthcare regardless of social position

• can do this through a two pronged strategy:1. building health equity into all health planning and delivery

• doesn’t mean all programs are all about equity

• but all take equity into account in planning their services and outreach

2. targeting some resources or programs specifically to addressing disadvantaged populations or key access barriers

• looking for investments and interventions that will have the highest impact on reducing health disparities or enhancing the opportunities for good health of the most vulnerable

all of which needs good data = POWER

2April 12, 2010


• many speeches outlining health equity frameworks:• to define and show problem to be solved

• to LHINs, agencies and other stakeholders

• conferences, etc. e.g. speech last week to public health professors and other leaders in Berlin

• community planning and other forums

• also to highlight complexity and inter-dependence of SDoH• e.g. food insecurity and chronic conditions data

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Success condition1. addressing health disparities in

service delivery and planning requires a solid understanding of:• key barriers to equitable access to high

quality care• the specific needs of health-

disadvantaged populations

4. which then highlights need for sophisticated analyses of the bases of disparities:• i.e. is the main problem language

barriers, lack of coordination among providers, sheer lack of services in particular neighbourhoods, etc.

• which requires good local research and detailed information as well

POWER provides

2. and that requires solid actionable data

3. e.g. data on how access to care varies by:

• length of time in Canada for immigrants

• language group

4April 12, 2010


1. Toronto Central and other LHINs are implementing

• as key means of encouraging/enabling equity-focused planning of specific programs

• part of template is asking for data and evidence to support planned service

2. POWER provides

• solid actionable data

• by LHIN

• to support devel of best HEIA process

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1. TC LHIN (and others)

• required Hospital Equity Plans

• major theme of our analysis of plans was to identify how to build system where equity is integrated into targets, requirements and incentives of performance mgmt system• e.g. how does hospital

utilization match catchment needs?

• is interpretation available to match languages of communities?

2. POWER provides• baseline data on inequitable

outcomes and access – i.e. the problem to be solved

• can allow realistic targets to be set, and locally relevant indicators to be developed

• POWER will provide data on progress on these indicators

• which can be incorporated into SAAs

• which can drive ongoing monitoring

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identify key barriers

2. can then drill down to see what problem is:• is it language barriers →

inability to communicate with provider and understand treatment

3. and then develop solutions:• TC LHIN project to analyze

how to streamline interpretation

• Sick Kids project to translate key docs into many languages

POWER provides

1. data on inequitable access to care by:• ethno-cultural background

and language

• by income and SES

April 12, 2010 7


Diabetes for Prov and LHINs

1. can’t succeed without understanding where diabetes is concentrated and which populations/communities are most at risk

3. once identified, then need to develop programs that take SDoH/particular social conditions into account

POWER provides

2. data on incidence by SDoH in each LHIN → can identify most vulnerable populations

4. allows development of equity targets and indicators:

• not just overall reduction in incidence

• reducing differences in incidence and impact by neighbourhood

5. then can monitor progress

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Healthy behaviour

1. major provincial and LHIN priority – esp. implications for CDPM

3. up-stream health promotion, empowering people to life well, chronic disease prevention and maintenance are crucial

POWER provides2. differences in healthy

behaviour and risk factors by:• income• ethno-cultural

4. need to customize health promotion programs to take underlying SDoH inequalities into account• universal programs will make

inequities worse unless they take unequal SDoH into account (better off take up health promotion program at a higher rate – benefit more)

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• these speaking notes and further resources on policy directions to enhance health equity, health reform and the social determinants of health are available on our site at http://wellesleyinstitute.com

• my email is [email protected]

• I would be interested in any comments on the ideas in this presentation and any information or analysis on initiatives or experience that address health equity

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http://wellesleyinstitute.com/

mailto:[email protected]

The Wellesley Institute advances urban health through rigorous research,

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© The Wellesley Institutewww.wellesleyinstitute.comApril 12, 2010 11

Health & Medicine

POWER, Data and Driving a Health Equity Agenda