Promoting health equity in health and other systems

For roughly 15 years, poverty has been an issue of concern for Saskatoon Health Region. In 2006, the Saskatoon Health Region (SHR) released a study that found startling health disparities correlated to neighbourhood income levels in the city. This health-disparity-by-neighbourhood study:

“… compared the health status of residents within Saskatoon’s six low income neighbourhoods to the rest of the city and found substantial disparities in suicide attempts, mental disorders, injuries and poisonings, diabetes, chronic obstructive pulmonary disorder, coronary heart disease, chlamydia, gonorrhoea, hepatitis C, teen births, low birth weights, infant mortality and all cause mortality. Although disparity in health outcomes by socioeconomic status is well known, the magnitude of the disparity in health outcomes is shocking for a city in the western world. For example, the infant mortality rate in Saskatoon’s low income neighbourhoods was 448% higher than the rest of the city; which is worse than developing nations.”¹

The vast differences in health between residents of the city’s poorest and richest neighbourhoods galvanized community attention and put the social determinants of health (SDH) that underpin health inequities and the specific issue of poverty squarely on the agenda of community leaders.

SHR followed in 2008 with the publication of its landmark research summary Saskatoon Health Disparities: Analysis to Intervention, including 46 interventions that evaluation research had shown to be effective at reducing health inequities.

Evidence, action, equity: Making population health information count

Since that time, SHR has used these findings to implement practice and policy changes within the health sector. For example, SHR’s Building Heath Equity Program was launched to meet unique cultural and socioeconomic needs of residents in low-income neighbourhoods in Saskatoon. SHR’s Health Promotion Department has reoriented its focus from promoting healthy lifestyles to the SDH and upstream causes of health issues. Health equity became both a tool to build programs and a means to measure the outcomes, impact and performance of the SHR; such as through the reporting of health equity status as a performance indicator to the SHR’s CEO and Board, using a health equity lens in Medical Health Officer analysis and reports as well as in presentations by care groups to the Quality and Safety Board. In addition, Health Care Equity Audits are regularly conducted to determine if SHR service provision is equitable.

Health equity approach: The way we work

Cristina Ugolini, Manager of SHR’s Public Health Observatory, says about health equity, “[i]t is the way we work… within health. But it’s also the way we work with our partners outside of health. It’s a culture…. Equity is such a big piece of everything we do.” Since 2006, SHR has used its research findings to encourage partnerships with other sectors and organizations to address the SDH that lie outside the health care sector.

Local leaders of the various sectors that affect the SDH have endorsed a process for developing a Community Action Plan to Reduce Poverty. These partners have come together to form the Saskatoon Poverty Reduction Partnership (SPRP). Health equity work now occurs through intersectoral partnerships, such as those between SHR and the education sector to promote student and community health through the Health Promoting Schools Program; partnerships with human service providers to develop Community View Collaboration, a web-based tool aimed at making local data accessible to assist with evidence-based decision-making; and partnerships with members of the Saskatoon Regional Intersectoral Committee to focus on priority areas such as housing, Aboriginal employment, poverty, and early childhood development. Dr. Julie Kryzanowski, SHR Deputy Medical Health Officer, notes that the regional health unit has “…tried to incorporate community voice in terms of consultations, and we’re now moving into more qualitative research as well, to really provide stories of what these disparities look like on the ground.”

Including the ‘lived’ experience

Evaluation is also a key component of these initiatives, so that continuous learning and improvement occurs. The communication of key messages about health equity and poverty reduction has involved tailoring messages to various audiences and using different mediums such as social marketing and films. This work has consistently involved community input, including individuals with lived experience, so that actions are based on community priorities. Decision-makers have also been involved in this work to ensure change. Dr. Jennifer Cushon, Program Manager of Research and Evaluation in SHR’s Public Health Observatory says “… it’s really exciting to be able to work with community and see changes in the community based on what we’re trying to do here.”

The health equity approach of the Saskatoon Health Region did not happen overnight. It’s been built on research and evidence, and on sustained local efforts to understand how health is created and maintained in the community by bringing a wide range of partners together to find solutions.

NT3