Monday, October 15, 2012

[EQ] Closing the health equity gap: evidence-based strategies for primary health care organizations

Closing the health equity gap:
evidence-based strategies for primary health care organizations

Annette J Browne, Colleen M Varcoe, Sabrina T Wong, Victoria L Smye, Josée Lavoie, Doreen Littlejohn, David Tu, Olive Godwin, Murry Krause, Koushambhi B Khan, Alycia Fridkin, Patricia Rodney, John O¿Neil and Scott Lennox

International Journal for Equity in Health - 13 October 2012

Available online PDF [29p.] at:

“…….International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector.

Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss
(a) the key dimensions of equity-oriented services to guide PHC organizations, and
(b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations.


The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included:
a) in-depth interviews with a total of 114 participants (73 patients; 41 staff),
b) over 900 hours of participant observation, and
c) an analysis of key organizational documents, which shed light on the policy and funding environments.



Through our analysis, we identified four key dimensions of equity-oriented PHC services:

inequity-responsive care; trauma-informed care; contextually-tailored care; and culturally competent care.

The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through

improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care.
Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels:
organizational, clinical programming, and at the  level of patient-provider interactions…


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