Moving from Meaning to Action on Health Equity

1. Moving from Meaning to Action on Health Equity Bernie Pauly, Marjorie MacDonald, Anita Kothari,Heather Manson, Nancy Peroff Johnson, Kathy Easton, Ingrid Tyler, Brian Hyndman, Victoria Lee (RePHS) CPHA, May, 2014

2. Overview of RePHS Renewal of Public Health Systems/Services Principal Investigators: Marjorie MacDonald, Trevor Hancock, Bernie Pauly, Ruta Valaitis BC Decision-maker Lead: Warren O’Briain ON Academic Lead: Ruta Valaitis ON Decision-maker Lead: Heather Manson Funder: CIHR - IHSPR Time Frame: January 2009 – January 2014 Extended to March, 2015

3. PURPOSE • To examine the implementation and impact of public health renewal policy interventions in BC and ON (the core functions framework in BC and the public health standards in ON) • Using two public health programs as exemplar cases - chronic disease prevention/healthy living and sexually transmitted infection prevention

4. Overarching Research Questions Question 1: What factors/contexts influence or affect the implementation of these policy interventions? Question 2: What have been the impacts/effects of these policy interventions on: staff, the organization, the populations served, other organizations, and communities?

5. Cross-cutting Themes/Questions a) equity – how is an equity lens applied in the core programs/standards? b) public health human resources – what are the implications of these policy interventions for PHHR? c) primary care/public health collaboration – how do these sectors collaborate? What influences the success of these collaborations?

6. Data Collection and Analysis • Indepth Qualitative semi-structured interviews and focus groups • 75 public health directors, managers and practitioners in BC and Ontario • Interviews audiotapes and transcribed • Entered into NVIVO • Inductive analysis with progressive levels of abstraction.

7. Neo-materialism Material economic Theories Political Economy Critical Social Justice (eg. Feminst Ethics) Social Position Cultural Capital Structural Violence Critical and Feminist Perspectives Social Organization/Networks Ecological Intersectionality Diffusion of Innovations Social Capital Life course Syndemics Fundamental Causes Equity Lens in PH (ELPH) Theoretical Perspectives Initial Mapping Ecosocial Social Epi Personal Characteristic Epigenetics Mathematical Artifact

8. What is health equity? • Well, I am not sure…. • We don’t have a language • “Its hard to explain.” We need to ‘change the script’ for talking to public and others. • Its an idea and way of thinking. • “We understand health equity differently.”

9. Understandings of Health equity • Well, It’s not about Equality • It’s about the Social Determinants of Health • It’s about Access to Health Services • Equal Access to Services • Reaching at Risk and Marginalized Populations. • It’s about Closing the Gap

10. Reflections on Theoretical Perspectives • Broad Range of Understandings and lack of shared understandings. • Most understandings focus on broader social conditions rather than individual behaviors. • Understandings of health equity related to SDOH are consistent with materialist theories of health equity but do not engage with forms of stigma/discrimination (e.g. racism).

11. Understandings of HE related to access engage with critical and social epi perspectives but less with the material conditions or social organization that produce HE. • Going forward, complexity theory may provide an overarching perspective for practice that brings together multiple perspectives to inform HE interventions.

12. Implications • Need for shared understandings of health equity and common language. • Need for leaders to be knowledgeable re understandings and mechanisms of the production of health inequities and HE. • Importance of theoretical perspectives that can inform multi-level and multi-sector health equity interventions.