Health Equity: 02/17/12

Friday, February 17, 2012

[EQ] Getting Started with Health in All Policies: A Resource Pack

Getting Started with Health in All Policies: A Resource Pack

Health in All Policies: A Snapshot for Ontario

Scoping Review of the Literature

Prepared by the Centre for Research on Inner City Health (CRICH) in the Keenan Research Centre of the Li Ka Shing
Knowledge Institute of St. Michael's Hospital

Lead Authors: Shankardass K, Solar O, Murphy K, Freiler A, Bobbili S, Bayoumi A, O'Campo P.

Research Team: O'Campo P, Laupacis A, Dhalla I, Kirst M, Lofters A, Murphy K, Perrier L, Shankardass K.

2011 - Report to the Ministry of Health and Long-Term Care (Ontario) Canada

Available online PDF [88p.] at: http://bit.ly/wnt2hN
Methodology appendix PDF

"Health in All Policies" refers to formal, sustained, "whole‐of‐government" (read: cross‐sectoral and coordinated) policy initiatives aimed to improve population health. In some cases, health inequities are targeted specifically in "Health in All Policies" initiatives.

A scoping review identified literature describing international examples of health equity‐focused "Health in All Policies". A total of 4833 scholarly articles and 501 sources of grey literature were gathered based on a keyword search.

Following screening and sorting, 163 articles were retained, and intersectoral health activities were described in 43 countries. Further screening identified 16 jurisdictions that have implemented a "Health in All Policies" approach, specifically.

Scoping Review of "Health in All Policies" Literature: Findings

Whole‐of‐government, "Health in All Policies" approaches focused on health equity have been implemented in 16 countries or sub‐national areas worldwide: Australia, Brazil, Cuba, England, Finland, Iran, Malaysia, New Zealand, Northern Ireland, Norway, Quebec, Scotland, Sri Lanka, Sweden, Thailand, and Wales.

In every case, a formal, whole‐of‐government "Health in All Policies" approach was preceded by intersectoral initiatives that were less formal and broad‐reaching.

Government‐wide Health Impact Assessment (HIA) or a variant thereof to measure health outcomes/health needs was instituted in almost all jurisdictions.

"Health in All Policies" strategies were usually aimed to improve working/living conditions, or to target individual behavior change. Improving access to health care was also stressed. Fewer than a third of cases involved wealth redistribution to address health inequities.

By definition, "Health in All Policies" approaches have a broader focus than vulnerable populations only. Most jurisdictions combined attention to vulnerable populations and universal policy initiatives. The preponderance of policy activity related to vulnerable groups.

"Health in all Policies" involved a high degree of interaction and interdependence across sectors, and limited individual sectors' autonomy. "Health in All Policies" was not supported through simple information‐sharing.

Mechanisms for supporting "Health in All Policies" included formal intersectoral committees (e.g. cabinet committees, interdepartmental committees), joint budgets, and evaluation and monitoring tools. In most jurisdictions a mix of horizontal and vertical integration management strategies was used to manage policy implementation. ………."

Table of Contents

Executive Summary

1. Introduction

2. Background

2.1 Reducing Health Inequities in Ontario

2.2 What is a Realist Scoping Review

2.3 Defining "Health in All Policies

2.4 Five Stage Scoping Review and the Identification of "Health in All Policies" Cases

3. Scoping Review Results

3.1 "Health in All Policies" Jurisdictions Around the World

3.2 Information Collected and Compiled About "Health in All Policies" Approaches

3.3 Case Summaries

4. Getting Started with "Health in All Policies": Conceptual Framework and Core Concepts

5. Understanding "Health in All Policies"
Initiation and Implementation: A Descriptive Comparison of Empirical Cases, Using the Conceptual Framework

5.1 Understanding the Context of Initiation: Relevance of Welfare State Profile, Timing, and International Influences

5.2 Understanding Implementation Mechanisms: Patterns of Interaction between Health Care and Other Sectors, Tools, and Government Structures Influencing Interactions, and Health Impact and Health Equity Impact Assessment Tools

5.3 Understanding Intervention Design: Entry Points, Equity Lens and Management and Control of Interventions

6. Relevance to Ministry of Health and Long Term Care and Options for Further Study

6.1 Getting Started with "Health in All Policies: Resources Produced and How they Can be Used

6.2 Further Investigation of "Health in All Policies" that may be Relevant to the Ministry of Health and Long‐Term Care

6.3 Conclusion

Works Cited

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[EQ] Fair Enough? Inviting Inequities in State Health Benefits

Fair Enough? Inviting Inequities in State Health Benefits

Jennifer Prah Ruger

Yale School of Public Health, the Yale School of Medicine, the Yale University Graduate School of Arts and Sciences, and Yale Law School

New England Journal of Medicine, February 8, 2012; DOI 10.1056/NEJMp1200751.

Available online at: http://bit.ly/znBMdI

“……Those who object to the uniform-standards solution will counter that it idealistically and naively seeks, as measures of fairness, the same health outcomes and the same amounts of care for everyone. In fact, however, it is based on the principle of proportionality — the notion that similar cases should be treated similarly and different cases differently, in proportion to their differences. Medical cases in which the health needs are the same are deemed alike; those in which the health needs are different are considered unalike.

… The principle of equal access … would call for differential provision of health care resources to achieve the same desired outcome for both patients — giving each what he or she needs to reach a medically determined level of functional health.

… There is no perfect health care system. But setting a goal of equal access to high-quality, evidence-based care would be a step in the right direction. Unceasing effort to standardize comprehensive health coverage and reach a gold standard of care is essential to attaining this goal….”

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“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Call for innovative health technologies and eHealth solutions for low-resource settings

Call for innovative health technologies and eHealth solutions for low-resource settings

WHO World Health Organization - GOe - Global Observatory for eHealth

Website: http://bit.ly/zPYjNS

PDF file: http://bit.ly/zjOOfX

Submission of Application Deadlines:
- Dateline for Innovative health technologies - 29 February 2012
- Dateline for eHealth solutions – 30 April 2012

“…….Medical devices and eHealth solutions have the potential to improve lives. However, too many people worldwide suffer because they don’t have access to the appropriate health technologies. This call highlights the importance of these innovative technologies towards improved health outcomes and the quality of life.

WHO aims to raise awareness of the pressing need for appropriate design solutions. The Compendium series was initiated to encourage a dialogue between stakeholders and stimulate further development and technology dissemination.

The annual publication serves as a neutral platform to introduce health technologies and eHealth solutions that have the potential to improve health outcomes or to offer a solution to an unmet medical need. The Compendium series specifically focuses on showcasing innovative technologies that are not yet widely available in under-resourced regions.

It is designed to help developing countries becoming aware of appropriate health technologies and eHealth solutions in support of their environment….”

“….Entries must demonstrate the technology’s suitability for use in low-resource settings. Technologies are then selected for inclusion in the Compendium if they fulfill at least one of the criteria below:

- The technology or the practice is better suited to address a health problem or to improve current health systems and services than existing solutions available. Examples of improvements over existing technologies may include superior effectiveness; enhanced ease of use and maintenance; reduced training requirements; labor saving; improved safety level for user, patient, and/or environment; increased social and cultural acceptability; technical superiority; improved accessibility, better cost-effectiveness and affordability; reduced energy requirements.

- The technology provides an appropriate solution to a health problem not yet addressed by any other technology…”

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[EQ] The Public Health Observatory Handbook of Health Inequalities Measurement

Electronic Version:

Health Inequalities Intervention Toolkit

Website: http://bit.ly/wyoX1t

"…. It is designed to assist evidence-based local service planning and commissioning, including Joint Strategic Needs Assessments. The Toolkit does this by providing information on the diseases, which are causing low life expectancy in individual areas, enabling good local priority setting. …."

The Public Health Observatory Handbook of Health Inequalities Measurement

Roy Carr-Hill and Paul Chalmers-Dixon Centre for Health Economics - York University

Edited by Jennifer Lin

South East Public Health Observatory - SEPHO

Available online at: http://bit.ly/yw8bV6

"…..it provides a comprehensive collection of material for those concerned to document and understand health inequalities…."

"…….a welcome contribution to the resources available to people working to reduce inequalities in health in their communities. I commend it to anyone involved in addressing health inequalities. The measurement of inequalities is a complicated and convoluted science, but this book brings together much of that science in a rigorous but accessible way. It is a rich source of information and will contribute to advancing our knowledge and practice, with the ultimate aim to reduce inequalities and to make this country a more equitable society. …." Sir Donald Acheson

Table of Contents

Preface

Foreword

SECTION 1 Introduction

SECTION 2 Measuring Inequality by Social Categories

2.1 Introduction

2.2 The Proposed Categories

2.3 Features of the Social Environment that Might Lead to Inequalities

SECTION 3 Measuring Inequality by Health and Disease Categories (Using Data from Administrative Sources)

3.1 Mortality Data

3.2 Morbidity Data from Health Service Activity Statistics, Disease Registers and Similar Ofﬁcial Sources

3.3 General Practice/Primary Care Data

3.4 Acute Sector Data

3.5 Community Health Sector Data

SECTION 4 Measuring Inequality by Health and Disease Categories (Using Data from Surveys)

4.1 Health and Lifestyle Surveys

4.2 Regular Health and Lifestyle Surveys

4.3 Health Status and Symptom Report Questionnaires

SECTION 5 An Introduction to the Use of Indexes to Measure Deprivation

5.1 Background

5.2 Selecting an Index of Deprivation

5.3 The Properties of Deprivation Indexes

5.4 Sources of Further Information – Reviews of Indexes and Their Properties

5.5 Conclusion and Summary of Key Issues Concerning Indexes of Deprivation

SECTION 6 A Selection of Indexes of Multiple Deprivation

6.1 Indexes from Census or Administrative Data?

6.2 Census-Based Indexes

6.3 Indexes with a Majority of Non-Census Components

6.4 Geo-Classiﬁcation and Other Area Classiﬁcation Systems

SECTION 7 Indexes: Properties and Problems

7.1 Introduction

7.2 Measuring Disability and Limiting Illness with Indicators and Indexes

7.3 Key Aspects of the Construction and Structure of Indexes

7.4 Testing an Index

7.5 The Purpose of Testing

7.6 Matching the Index to the Application – Example of an Index for Policy Use

7.7 Pitfalls and Problems of Using Indexes

SECTION 8 Data Sources: Availablity and Problems

8.1 Introduction

8.2 The Area Base

8.3 Major National Archives and Sources

8.4 Data Sources on Speciﬁc Topics

SECTION 9 Designing Surveys to Measure Inequality

9.1 Introduction

9.2 Surveys and Their Limitations

9.3 Assuming You Have Decided on a Survey

9.4 Different Types of Survey

SECTION 10 Inequalities and Methods of Measurement

10.1 Introduction

10.2 Context

10.3 Properties of Indexes and Measurements

10.4 Approaches to Summarising Inequality

10.5 Measuring Inequalities in Health Over Time

10.6 Summary and Conclusions: Choosing between the Measures

SECTION 11 Context, History and Theory

11.1 Introduction

11.2 Context

11.3 The Principal Theoretical Frameworks for Approaching Inequalities

11.4 Summary and Conclusions

References

Appendix to Section

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