Thursday, August 9, 2012

[EQ] The 10 Promising Practices Fact Sheets

The 10 Promising Practices Fact Sheets

The Sudbury & District Health Unit (SDHU) – August 2012


As part of a Canadian Health Services Research Foundation Fellowship (Executive Training in Research Application – EXTRA), the Sudbury & District Health Unit identified 10 practices that are promising in their potential to reduce social inequities in health in our communities.

These fact sheets are designed to help public health practitioners and our community partners apply each of the 10 Promising Practices to reduce social inequities in health. They have a common format that identifies essential components, key issues, and tools and resources for each Promising Practice.

1.Targeting With Universalism -

Every citizen deserves the opportunity to be healthy and to practise healthy behaviours. Thus, health promotion and protection programs and services endeavour to ensure that everyone has access to programs and services. Services designed for general access—by everyone, in the same way—constitute a universal approach.

However, evidence shows that individuals who benefit most from “universal” health programs and services are often those who have more money, more time, more social support, higher literacy, and better preceding health. In some cases, universal programs may increase health inequities such that the health of those who are socially advantaged improves more than the health of those who are socially disadvantaged. …”

2.Purposeful Reporting -

“….The World Health Organization, among others, identifies the importance of reporting purposefully on the relationship between health and social inequities in all health status reports. The WHO document The Social Determinants of Health: Developing an evidence base for political action highlights the link between sharing knowledge of health inequities and political action.
Similarly, Closing the Gap in a Generation, notes that “ensuring that health inequity is measured . . . is a vital platform for action” (p. 2). Thus, intentional and public presentation of evidence about health inequities can be part of a broad strategy for change…”

3. Social Marketing -


“….Social marketing is “the systematic application of marketing alongside other concepts and techniques, to achieve specific behavioural goals, for a social good”. (p. 451)1  Social marketing involves defining and understanding target audiences so that interventions and health communications can be tailored to audience needs and preferences.

With the objective of reducing health inequities, social marketing interventions for local public health practice can create positive social change and improve the health of vulnerable populations by two approaches:
The first tailors behaviour change interventions to more disadvantaged populations (with the goal of levelling-up).
The second, less conventional approach, uses social marketing to change the understanding and ultimate behaviour of decision makers and the public to take or support action to improve the social determinants of health inequities….”

4. Health Equity Target Setting -


“….As understood by the National Health Service (NHS) in the United Kingdom, “targets are a way of ensuring that resources and effort are directed at tackling health inequalities in an explicit and measurable way”. (p. 9)1 Many countries have incorporated target setting into their intersectoral work on social inequities in health. However, as the World Health Organization highlights, the exact nature of the targets appears to be important, since some targets may be more enabling of progress than others.2

Although target setting is not universally supported in the literature, it appears to hold some promise as part of a strategy for reducing health inequities and may have a role at the local public health level….”

5. Equity-Focused Health Impact Assessment -


“….Health impact assessment (HIA) is a structured method to assess the potential health impacts of proposed policies and practices. HIA enables decision makers to highlight and enhance the positive elements of a proposal, and minimize the aspects that may result in negative health outcomes1. By evaluating a broad range of evidence, HIAs are a useful way to assess the impact of proposals (either policy or specific practice) at the general population level. However, they are also recognized as a promising method to address the underlying social and economic determinants of health and resulting health inequities2.

Equity-focused health impact assessment (EfHIA) specifically includes questions such as “Is this proposal likely to affect those who are already disadvantaged? Is it likely to impose new health burdens on specific groups? Is it likely to change exposure to, and/or distribution of, risk factors or specific determinants of health (for example, living conditions, access to services)?”2 By applying an equity lens to HIAs, it becomes clear that virtually every policy has winners and losers—some groups benefiting more than others….”

6. Competencies/Organizational Standards -


“….Competencies and organizational standards guide our daily practice. The Public Health Agency of Canada1 identifies 36 core competencies for public health encompassing essential knowledge, attitudes, and skills. Most importantly, these competencies were developed for practice within the context of the values of public health and include, for example, equity, social justice, community participation, and determinants of health. The core competencies for public heath offer a solid foundation for local public health staff recruitment and skill development.

As building blocks for effective public health practice, organizational standards provide benchmarks for public health units….”

7. Contribution to the Evidence Base -


“….When public health staff are asked about their capacity to address social inequities in health, a frequent issue that emerges is a lack of “best practices” to guide their interventions. The EXTRA Research Fellowship was carried out, in part, to help address these staff needs. However, it confirmed the existence of a gap in the evidence base with respect to effective local public health practice to reduce social inequities in health.

The evidence that does exist is often produced by practitioners working in a service delivery context in which publishing is not a priority. The evidence produced is often preliminary, small scale and specific to a particular context. Therefore, practice-based evidence might not be accepted for publication in traditional academic outlets….”

8. Early Childhood Development -


“…..Early child experiences establish the foundational building blocks for development across the life stages. Furthermore, with the greatest gains experienced by the most deprived children, investments in early child development have been referred to as powerful equalizers.

Early child experiences influence language, physical, social, emotional and cognitive development, which in turn, and throughout the lifecourse, affect learning, educational, economic, and social success, and health. Early childhood development (ECD), nurturing environments, and quality childhood experiences are important for positive human development and health. Early child experiences contribute to positive developmental outcomes, and subsequently health, through a number of pathways, including psychological, behavioural, and physical….”

9. Community Engagement -


“…..As a strategy to reduce health inequities, community engagement is the process of involving community stakeholders in the development and implementation of policies, programs, and services. In Closing the gap in a generation, the World Health Organization highlights the need to “empower all groups in society through fair representation in decision-making about how society operates, particularly in relation to its effect on health equity, and create and maintain a socially inclusive framework for policy-making.”

Working with community professionals and agency representatives is one approach to engagement. However, building relationships with target populations and service users is also key to identifying community strengths and challenges….”

10. Intersectoral Action -


“…..A comprehensive strategy to promote health includes health care when individuals are ill and addresses the underlying causes of poor health where people live, work, learn, and play. These underlying causes are, in part, the result of social, economic, and political actions from different community sectors and all levels of government and industry.
Safe and affordable housing, access to parks and recreational activities, quality health care, early childhood education, safe streets, public transportation, and opportunities for meaningful employment are just some of the many factors that influence an individual’s opportunities for health and well-being….”



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